Psychotherapy may help with gaming addiction
German study takes a new approach to dealing with a modern disease. Paul Biegler reports.
A European study has found a type of psychotherapy developed for people with substance abuse is remarkably effective in men with internet and gaming addiction.
Led by Klaus Wölfling of the University Medical Centre of the Johannes Gutenberg-University Mainz, Germany, it is the first ever randomised multi-centre trial of internet addiction, recruiting 143 men from towns in Germany as well as the Austrian capital Vienna.
In May, the World Health Organisation recognised gaming disorder as a modern disease, voting to add it to the latest version of the International Classification of Diseases.
The bible of psychiatric diagnoses, the DSM-5, also describes gaming disorder in its most recent 2013 edition, but the evidence at that time fell short for calling it a unique disorder.
In the latest study, the researchers drew on both sources to set benchmarks for the illness, which include a preoccupation with gaming, withdrawal symptoms such as anxiety when it is taken away, a need to spend more time gaming to satisfy the urge, losing interest in other activities, and risking the loss of a job or relationship.
The criteria also include broader measures of internet addiction, such as frequent use of social media and pornography.
The study enrolled men aged 17 to 55 who met those criteria, randomising them to either join a waiting list or take a course of cognitive behavioural therapy (CBT) comprising 15 group and eight individual sessions.
The therapy takes its cue from a version of CBT used in people with substance abuse. It drills down on the type of internet use and the problems caused, then teaches ways to deal with triggers and cravings based on the person’s thoughts, feelings and behaviours as well as insights into their personality and the social environment.
Taking a leaf from the addiction management playbook delivered some very good medicine.
Of the 72 men who got CBT, 50 achieved remission over a six-month follow-up. Of the 71 men who didn’t get CBT (but who were on a wait list to get it after the trial finished) only 17 remitted. That difference was significant, translating to a more than 10-fold higher odds of remission from internet addiction for people getting the therapy.
“It was a little bit surprising for us as this was so high,” says Wölfling in a related podcast.
“This indicates a strong treatment effect for subjects suffering from internet addiction or gaming disorder.”
The study was not, however, without casualties. Several participants became depressed during the course of the trial, with some needing admission to hospital. That result reflects the surprising fact that even psychotherapy can have side effects.
“Generally, addiction serves as a mechanism which dysfunctionally covers problems of the patient,” says Wölfling.
“The therapeutic process of psycho-education elaborates on this mechanism and maybe underlying problems. This causes a reflection in the patient about these problems. And some problems, I think, were so severe that destabilisation was a consequence.”
Wölfling says 15% of their internet addiction patients were, in fact, female. Those low numbers, he says, contributed to their decision to only study males. It is a finding that does not, however, reflect the broader literature on sex differences in internet addiction.
“Empirical studies report equal proportions of men and women regarding the prevalence of internet addiction,” says Wölfling.
“We know there is a little bit of difference between the form of internet usage so that male patients are more gamers and women are more social network users,” he adds.
Wölfling has funds to study those gender differences and says future trials should include women. The key lesson, however, would seem to apply irrespective of gender.
“It may be more important for the patient to learn about their own history, to learn about their own life, development, and to learn more about their so-called pathological behaviour... therefore, I think, relapse prevention is better,” he says
The study is published in the journal JAMA Psychiatry.