Can we prevent Internet addiction in high school?
An intervention based on cognitive-behavioral therapy (CBT) has found moderate success in preventing gambling and internet addiction among at-risk young people, according to German researchers.
Compared to a control group, adolescents who participated in the PROTECT intervention experienced a significantly greater reduction in symptoms related to gambling disorder and disordered internet use not otherwise specified over 12 months (reduction of 27 .7% versus 39.8%, effect size d = 0.67), Katajun Lindenberg, PhD, of Goethe University Frankfurt in Germany, and colleagues reported.
“Excessive use of video games and internet applications has increased (particularly during the ongoing COVID-19 pandemic), underscoring the need for prevention and early intervention,” the group wrote. Lindenberg in Open JAMA Network.
Participants in the intervention took part in four 90-minute group sessions in their schools with two trained psychologists and were assessed at baseline, 1 month, 4 months, and 12 months. Those in the control group only received the ratings.
The PROTECT intervention also resulted in a significantly greater reduction in procrastination, according to Lindenberg and colleagues. Previous studies had shown that gambling addiction and procrastination were closely linked, they noted.
Meta-analyses conducted before COVID estimated the prevalence of internet gaming disorder in adolescents at 4.6% and that of internet addiction at 6.0%.
Since the pandemic, more children have turned to games and the internet to fill their newfound extra time thanks to online instruction and the cancellation of extracurricular activities. However, “unlike other pandemic-related activities, such as gardening and bread-making among adults, internet use and gambling behaviors among young people have addictive qualities that could amplify risk. term,” Evelyn Stewart, MD, of the University of British Columbia. in Vancouver, wrote in a corresponding editorial.
“With their work, Lindenberg [and colleagues] issued a reminder to proactively address subclinical behaviors that are potentially addictive in adolescents,” Stewart wrote. “A glimmer of hope for reducing mental illness in this population may lie in prevention rather than clinical interventions after illness onset. Game on!”
Interestingly, the trial showed that symptom severity at 1 month increased in the intervention group but decreased in the control group. The researchers said they observed a similar pattern in their PROTECT+ study, which was based on the same concepts as this study.
“This paradoxical reaction could be explained by an increased awareness of problematic Internet behavior, which was induced by the PROTECT intervention,” they suggested.
Six students each in the intervention and control groups developed Internet use disorder not otherwise specified. A further 40 participants were diagnosed with subthreshold gaming or internet use disorder, with the two groups sharing similar incident rates.
Yet what these conditions actually describe is unclear, according to Linda Kaye, PhD, of Edge Hill University in England, which was not affiliated with the study.
“The conceptual basis of ‘internet addiction’ and ‘gambling disorder’ is quite flimsy,” she said. MedPage today. They described in many terms, such as “gambling addiction, gaming disorder, internet gaming disorder” and lack insight into “what is specifically ‘addictive'”.
The act or process of gambling itself is unlikely to be addictive, “but rather specifics of the type of gambling and how that interacts with an individual player’s context,” Kaye said. “Research often tends to take a large measure of ‘gambling disorder’ or ‘gambling addiction’ and so on, but not really monitoring or measuring the types of games people play and how that can vary depending on the measurements taken.
Gaming disorder made its debut in the recently implemented ICD-11. Internet use disorder not otherwise specified, on the other hand, is always classified with other addiction-related disorders.
The present study examined over 5,500 high school students from schools in the Rhine-Neckar metropolitan area of Germany using the German version of the Compulsive Internet Use Scale. Of these, 422 students deemed at risk for gambling or Internet addiction were randomized to the PROTECT intervention arm (n=167) or control arm (n=255).
The average age of the students was 15 years old and 54.3% were women. Race and ethnicity data were not collected.
Teens in the intervention group attended group sessions with no more than 11 participants. The average number of sessions attended was 3.7 out of 4 sessions in total.
Lindenberg and colleagues said their trial is the first to examine the long-term impacts of a school-based and CBT-based prevention intervention for gambling disorder and internet use disorder not otherwise specified. compared to a control group.
Nevertheless, they acknowledged that only one in five eligible students participated in their study, which may limit the generalizability of the results. They also noted that their sample size left the incidence analysis underpowered.
Lindenberg reported grants from the German Federal Ministry of Education and Research (BMBF) and the Ministerium für Soziales und Integration Baden-Württemberg.
Stewart said he was a member of the clinical and scientific advisory board of the International OCD Foundation.