Treatment Of Internet Gaming Disorder Research Articles

Brain functional connectivity during and after imagery of gaming and alternative leisure activities in patients with internet gaming disorder

BackgroundThe effect of gaming cue exposure on brain activity in patients with internet gaming disorder (IGD) has been investigated a lot, but the effect on brain connectivity has not. This study aimed to investigate the effects of imageries of gaming and alternative leisure activities on functional connectivity during the during-task and post-task states in patients with IGD. MethodsTwenty-nine patients and 20 healthy controls were scanned in the 6-min states before, during, and after the imagery tasks for gaming and alternative leisure behaviors using fMRI. Seed-based functional connectivity during and after the tasks were analyzed. The seeds were the nucleus accumbens (NAcc), ventral tegmental area (VTA), caudate, putamen, anterior cingulate cortex (ACC), and posterior cingulate cortex. ResultsThe group-by-state interaction effects for the during-tasks were found in caudate-, putamen-, and ACC-based connectivity, whereas those for the post-tasks were shown only in NAcc-based connectivity. In particular, patients showed that caudate-right parahippocampal gyrus connectivity and putamen-right orbitofrontal cortex connectivity increased during gaming and decreased during alternative, whereas NAcc-right precuneus connectivity decreased at baseline, increased in post-gaming, and were not different in post-alternative. ConclusionDifferences in during-task connectivity of the habit/motor and salience networks and post-task resting-state connectivity of the reward and limbic networks between the two imagery tasks may differ between the groups. In the treatment of IGD, when these network connections are reactive to alternative leisure activity, just as to gaming activity, they seem to be freed from gaming addiction.

Biochemical Correlates of Video Game Use: From Physiology to Pathology. A Narrative Review

In the last few decades, video game playing progressively became a widespread activity for many people, in childhood as well in adulthood. An increasing amount of literature has focused on pathological and non-pathological correlates of video game playing, with specific attention towards Internet Gaming Disorder (IGD). While many neurobiological studies in this field were based on neuroimaging, highlighting structural and functional brain changes among video game users, only a limited number of studies investigated the presence of biochemical correlates of video gaming. The present work aims to summarize and review the available literature about biochemical changes linked to video game use in IGD patients as well as non-pathological users, and the differences in between. Results may shed light on risks and benefits of video games, providing directions for further research on IGD treatment and, on other hand, on the potential role of video games in therapeutic or preventive protocols for specific conditions.

Multidimensional family therapy reduces problematic gaming in adolescents: A randomised controlled trial.

Background and aimsSocial variables including parental and family factors may serve as risk factors for Internet Gaming Disorder (IGD) in adolescents. An IGD treatment programme should address these factors. We assessed two family therapies – multidimensional family therapy (MDFT) and family therapy as usual (FTAU) – on their impact on the prevalence of IGD and IGD symptoms.MethodsEligible for this randomised controlled trial comparing MDFT (N = 12) with FTAU (N = 30) were adolescents of 12–19 years old meeting at least 5 of the 9 DSM-5 IGD criteria and with at least one parent willing to participate in the study. The youths were recruited from the Centre Phénix-Mail, which offers outpatient adolescent addiction care in Geneva. Assessments occurred at baseline and 6 and 12 months.ResultsBoth family therapies decreased the prevalence of IGD across the one-year period. Both therapies also lowered the number of IGD criteria met, with MDFT outperforming FTAU. There was no effect on the amount of time spent on gaming. At baseline, parents judged their child’s gaming problems to be important whereas the adolescents thought these problems were minimal. This discrepancy in judgment diminished across the study period as parents became milder in rating problem severity. MDFT better retained families in treatment than FTAU.Discussion and ConclusionsFamily therapy, especially MDFT, was effective in treating adolescent IGD. Improvements in family relationships may contribute to the treatment success. Our findings are promising but need to be replicated in larger study.Trial registration numberISRCTN 11142726.

Impaired regulation of both addiction-related and primary rewards in individuals with internet gaming disorder

Poor executive function (EF) has been implicated in addictions. Among “hot” EFs (i.e., those involving motivations and emotions), poor regulation of craving has been proposed to underlie addiction development in substance-use disorders (SUDs), making such regulation a potential treatment target. However, regulation of craving remains poorly understood in internet gaming disorder (IGD). Additionally, prior studies of cold EFs (e.g., inhibition and cognitive flexibility under neutral conditions) in IGD have provided mixed results and mostly included only male subjects. We addressed these issues by instructing 54 participants (26 with IGD including males and females, and 28 control subjects) to perform a regulation-of-craving (ROC) task and a Stroop color-word-interference task. Compared to control subjects, individuals with IGD revealed deficits in regulation for both gaming- and food-related craving, but no differences in Stroop performance. The current study provides initial empirical support suggesting regulation impairments for both addiction-related and primary rewards among individuals with IGD. The findings are consistent with studies in SUDs, suggesting that impaired regulation of craving may be a relevant transdiagnostic construct across SUDs and behavioral addictions. The findings suggest targeting regulation of “hot” processes should be considered in IGD treatment development.

Assessment and Treatment of Internet Gaming Disorder

Among both youth and adults, video gaming is a rapidly growing recreational activity. The American Psychiatric Association and the World Health Organization have identified problematic video gaming behavior as a clinical concern in need of further research and have conceptualized this condition as a behavioral addiction. Empirically validated assessment tools may aid in case conceptualization, and cognitive-behavioral techniques have accrued some evidence supporting their efficacy when targeting internet gaming disorder. Clinicians should consider employing goal setting, behavior tracking, and functional analyses, and should consider increasing alternative pleasurable activities, incentivizing specific behavior changes, and integrating caregivers into treatment when working with adolescents.

Efficacy of cognitive behavioural therapy for internet gaming disorder.

Cognitive behavioural therapy (CBT) is considered to be an effective treatment for internet gaming disorder (IGD). This study examined the effectiveness of CBT in treating impulsivity, anxiety, avoidance, and family and environmental problems in patients. A total of 101 patients completed the CBT programme, and 104 completed the supportive therapy. The CBT programme consisted of fourteen 90-min sessions with one therapist and four to five patients, once or twice a week. The supportive therapy group visited a psychiatric outpatient department once or twice a week until they completed 14 visits. Outcomes were measured in terms of improvement in IGD, psychological symptoms, and social interaction. The CBT group (improvement: 67 [66.3%] versus non-improvement: 34 [33.7%]) showed more improvement in IGD compared with the supportive therapy group. The CBT group also showed a greater decrease in internet addiction, anxiety, impulsivity, and social avoidance. In the CBT group, among patients who improved, the greatest improvements were in internet addiction, attention, depression, anxiety, impulsivity, social avoidance, and family cohesion. Our CBT programme may be more effective than supportive therapy with regard to improvement in IGD symptoms by controlling anxiety, impulsivity, and social avoidance. In addition, CBT-related improvements in patients with IGD could be enhanced by controlling anxiety, social avoidance, and family cohesion.

Effect of physical exercise intervention on mood and frontal alpha asymmetry in internet gaming disorder

PurposeWe aimed to evaluate the effect and neurophysiological mechanism of physical exercise intervention combined with cognitive behavioral therapy on mood and frontal alpha asymmetry in the treatment of Internet gaming disorder. MethodsFifty male adolescents with Internet gaming disorder were randomly assigned to one of two groups. In the cognitive behavioral therapy + physical exercise group (CBT + PE group, n = 25), participants underwent eight sessions of cognitive behavioral therapy and six sessions of exercise intervention; in the cognitive behavioral therapy-only group (CBT-only group, n = 25), participants underwent eight sessions of cognitive behavioral therapy and six sessions of supportive counseling. A resting quantitative electroencephalogram, Young Internet Addiction Scale, the Korean Attention Deficit Hyperactivity Disorder Rating Scale, Beck Depression Inventory, and Beck Anxiety Inventory were evaluated before and after the intervention. ResultsAlthough both the CBT + PE and CBT-only groups showed a significant reduction in Beck Depression Inventory and Young Internet Addiction Scale scores, indexing a decrease in depression, this effect was more pronounced in the CBT + PE group than in the CBT-only group. An increase in the F4–F3 and F8–F7 frontal alpha asymmetry values was more pronounced in the CBT + PE group than in the CBT-only group. ConclusionPhysical exercise intervention in combination with cognitive behavioral therapy for individuals with Internet gaming disorder seems to improve the severity of internet use and depressive mood and enhance left prefrontal activation.

Telemedicine: A New Perspective in the Treatment of Internet Gaming Disorder Among Adolescents

Telemedicine: A New Perspective in the Treatment of Internet Gaming Disorder Among Adolescents

Why and how to include parents in the treatment of adolescents presenting Internet gaming disorder?

Background and aimsClinicians and researchers are increasingly interested in investigating excessive use of video gaming recently named Internet gaming disorder (IGD). As is the case with extensively researched adolescent problem behaviors such as substance use disorder, several studies associate IGD with the young person’s family environment and the parent–adolescent relationship in particular. Evidence-based treatments for a range of adolescent clinical problems including behavioral addictions demonstrate efficacy, the capacity for transdiagnostic adaptation, and lasting impact. However, less attention has been paid to developing and testing science-based interventions for IGD, and at present most tested interventions for IGD have been individual treatments (cognitive behavioral therapy).MethodsThis article presents the rationale for a systemic conceptualization of IGD and a therapeutic approach that targets multiple units or subsystems. The IGD treatment program is based on the science-supported multidimensional family therapy approach (MDFT). Following treatment development work, the MDFT approach has been adapted for IGD.ResultsThe article discusses recurring individual and family-based clinical themes and therapeutic responses in the MDFT-IGD clinical model, which tailors interventions for individuals and subsystems within the young person’s family.Discussion and conclusionsBasic science developmental research can inform conceptualization of IGD and a systemic logic model of intervention and change. This paper aims to expand treatment theorizing and intervention approaches for practitioners working with frequently life-altering behaviors of excessive Internet gaming. We operationalize this aim by addressing the question of why and how parents should be involved in youth IGD treatment.

Sex difference in the effect of Internet gaming disorder on the brain functions: Evidence from resting-state fMRI

ObjectiveStudies have shown that males are more prevalence than females in Internet gaming disorder (IGD). This study was set to explore the sex difference on the effect of IGD in resting states of the brain. MethodsResting-state fMRI data were collected from 58 recreational Internet game users (RGU, male = 29) and 46 IGD subjects (male = 23). Regional homogeneity (ReHo) was used to calculate group difference between the subjects. A two-way ANOVA was used to explore the IGD-by-sex interactions. Correlations between addiction severity and the ReHo values were also calculated. ResultsSignificant sex-by-group interactions were found associated with the brain features in the right posterior cingulate (rPCC), left middle occipital gyrus (lMOG), right middle temporal gyrus (rMTG), and right postcentral gyrus (rPG). Post-hoc analysis revealed that comparing with same-sex RGUs, male IGD showed decreased ReHo in the rPCC, and the ReHo in the rPCC was also negatively associated with Internet addiction test (IAT) scores for male subjects. Moreover, male IGDs showed increased ReHo, but female ones showed decreased ReHo, in both lMOG and rMTG, when comparing with same-sex RGUs. ConclusionsSex differences were observed in brain regions that are responsible for executive control, visual and auditory perception. These sex differences should be taken into consideration in future studies and the treatment of IGD.

A cohort study of patients seeking Internet gaming disorder treatment

Background and aimsAlthough Internet gaming disorder (IGD) is included as a condition in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders, little is known about its nature or treatment response. This study is a follow-up of 755 patients who received professional treatment for IGD over a 5-year period.MethodsThe initial recommended treatment course lasted for 8 weeks, with additional care provided as needed. Treatment completion rates in the complete sample, as well as baseline predictors of treatment completion and long-term recovery among the 367 patients who completed the follow-up, are reported.ResultsNearly two thirds of patients who initiated treatment for IGD completed the 8-week psychotherapy. Of these, about two thirds who had not recovered completely by the end were offered additional care. Independent predictors of extended treatment were higher baseline scores on the Young Internet Addiction Scale, Beck Depression Inventory (BDI), and Korean-Attention Deficit Hyperactivity Disorder-Rating Scale (K-ADHD-RS). Between 1 and 5 years later, 33.5% of the complete sample was considered as recovered from IGD. Significant predictors of recovery from IGD were older age, earlier admission to the clinic, lower baseline scores on the BDI and K-ADHD-RS, and no offer of extended treatment.Discussion and conclusionsThe majority of the patients seeking treatment for IGD continued experiencing difficulties and randomized controlled trials of interventions, which are needed to be conducted to improve outcomes. Age, family, social factors, and psychological symptoms should be considered, while designing and evaluating interventions, because they impact initial and sustained response to treatment for IGD.

Resting-State Activity of Prefrontal-Striatal Circuits in Internet Gaming Disorder: Changes With Cognitive Behavior Therapy and Predictors of Treatment Response.

Cognitive behavior therapy (CBT) is effective for the treatment of Internet gaming disorder (IGD). However, the mechanisms by which CBT improves IGD-related clinical symptoms remain unknown. This study aimed to discover the therapeutic mechanism of CBT in IGD subjects using resting-state functional magnetic resonance imaging (rsfMRI). Twenty-six IGD subjects and 30 matched healthy controls (HCs) received rsfMRI scan and clinical assessments; 20 IGD subjects completed CBT and then were scanned again. The amplitude of low-frequency (ALFF) values and the functional connectivity (FC) between the IGD group and the HC group were compared at baseline, as well as the ALFF values and FC before and after the CBT in the IGD group. Prior to treatment, the IGD group exhibited significantly increased ALFF values in the bilateral putamen, the right medial orbitofrontal cortex (OFC), the bilateral supplementary motor area (SMA), the left postcentral gyrus, and the left anterior cingulate (ACC) compared with the HC group. The HC group showed significantly increased FC values between the left medial OFC and the putamen compared with the IGD group, the FC values of IGD group were negatively associated with the BIS-11 scores before treatment. After the CBT, the weekly gaming time was significantly shorter, and the CIAS and BIS-II scores were significantly lower. The ALFF values in the IGD subjects significantly decreased in the left superior OFC and the left putamen, and the FC between them significantly increased after the CBT. The degree of the FC changes (ΔFC/Pre−FC) was positively correlated with the scale of the CIAS scores changes (ΔCIAS/Pre−CIAS) in the IGD subjects. CBT could regulate the abnormal low-frequency fluctuations in prefrontal-striatal regions in IGD subjects and could improve IGD-related symptoms. Resting-state alternations in prefrontal-striatal regions may reveal the therapeutic mechanism of CBT in IGD subjects.

Internet Gaming Disorder: the interplay between physical activity and user–avatar relationship

ABSTRACTUnderstanding both the risk and protective factors associated with Internet Gaming Disorder (IGD) has been viewed by many in the gaming studies field as an area of research priority. The present study focused on the potential risk and protective effects of user–avatar (game figure) relationship and physical activity (PA), respectively. To address these aims, a cross-sectional and a longitudinal mixed-methods design were combined (comprising both psychological and physiological assessments). A sample of 121 emerging adult gamers (18–29 years) residing in Australia, who played massively multiplayer online games, were assessed in relation to their IGD behaviours using the nine-item Internet Gaming Disorder Scale – Short Form. Additionally, the Proto-Self-Presence (PSP) scale was used to evaluate the extent to which gamers identified with the body of their avatar. Finally, a PA monitor (Fitbit Flex) measured levels of energy consumed during real-world daily activities (active minutes). A number of linear regressions and moderation analyses were conducted. Findings confirmed that PSP functioned as an IGD risk factor and that PA acted protectively, weakening the association between PSP and IGD behaviours. Implications of these findings are discussed in relation to IGD treatment and gaming development aspects.

Development of an effective virtual environment in eliciting craving in adolescents and young adults with internet gaming disorder.

Internet gaming disorder (IGD) is a new disorder that warrants further investigation, as recently noted in the research criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Offering controlled environments that increase cue-induced craving, virtual reality cue-exposure therapy has been shown to be effective for some addiction disorders. To assess the feasibility of virtual reality for patients with IGD, this study aimed to develop virtual environments that represent risk situations for inducing craving, and assess the effect of virtual reality in cue reactivity. A total of 64 male adolescents and young adults (34 with IGD and 30 without) were recruited for participation. We developed a virtual internet café environment and the participants were exposed to four different tasks. As the primary feasibility outcome, cravings were measured with a visual analogue scale measuring current urge to play a game after exposure to each task. The virtual internet café induced significantly greater cravings in patients with IGD compared to controls. Additionally, patients exhibited a significantly higher acceptance rate of an avatar’s invitation to play a game together than that of controls. In IGD, craving response to the tasks was positively associated with the symptom severity score as measured by Young's Internet Addiction Test. These findings reveal that virtual reality laden with complex game-related cues could evoke game craving in patients with IGD and could be used in the treatment of IGD as a cue-exposure therapy tool for eliciting craving.

When addiction symptoms and life problems diverge: a latent class analysis of problematic gaming in a representative multinational sample of European adolescents.

The proposed diagnosis of Internet gaming disorder (IGD) in DSM-5 has been criticized for "borrowing" criteria related to substance addiction, as this might result in misclassifying highly involved gamers as having a disorder. In this paper, we took a person-centered statistical approach to group adolescent gamers by levels of addiction-related symptoms and gaming-related problems, compared these groups to traditional scale scores for IGD, and checked how groups were related to psychosocial well-being using a preregistered analysis plan. We performed latent class analysis and regression with items from IGD and psychosocial well-being scales in a representative sample of 7865 adolescent European gamers. Symptoms and problems matched in only two groups: an IGD class (2.2%) having a high level of symptoms and problems and a Normative class (63.5%) having low levels of symptoms and problems. We also identified two classes comprising 30.9% of our sample that would be misclassified based on their report of gaming-related problems: an Engaged class (7.3%) that seemed to correspond to the engaged gamers described in previous literature, and a Concerned class (23.6%) reporting few symptoms but moderate to high levels of problems. Our findings suggest that a reformulation of IGD is needed. Treating Engaged gamers as having IGD when their poor well-being might not be gaming related may delay appropriate treatment, while Concerned gamers may need help to reduce gaming but would not be identified as such. Additional work to describe the phenomenology of these two groups would help refine diagnosis, prevention and treatment for IGD.

Detection of Craving for Gaming in Adolescents with Internet Gaming Disorder Using Multimodal Biosignals.

The increase in the number of adolescents with internet gaming disorder (IGD), a type of behavioral addiction is becoming an issue of public concern. Teaching adolescents to suppress their craving for gaming in daily life situations is one of the core strategies for treating IGD. Recent studies have demonstrated that computer-aided treatment methods, such as neurofeedback therapy, are effective in relieving the symptoms of a variety of addictions. When a computer-aided treatment strategy is applied to the treatment of IGD, detecting whether an individual is currently experiencing a craving for gaming is important. We aroused a craving for gaming in 57 adolescents with mild to severe IGD using numerous short video clips showing gameplay videos of three addictive games. At the same time, a variety of biosignals were recorded including photoplethysmogram, galvanic skin response, and electrooculogram measurements. After observing the changes in these biosignals during the craving state, we classified each individual participant’s craving/non-craving states using a support vector machine. When video clips edited to arouse a craving for gaming were played, significant decreases in the standard deviation of the heart rate, the number of eye blinks, and saccadic eye movements were observed, along with a significant increase in the mean respiratory rate. Based on these results, we were able to classify whether an individual participant felt a craving for gaming with an average accuracy of 87.04%. This is the first study that has attempted to detect a craving for gaming in an individual with IGD using multimodal biosignal measurements. Moreover, this is the first that showed that an electrooculogram could provide useful biosignal markers for detecting a craving for gaming.

A Tripartite Neurocognitive Model of Internet Gaming Disorder.

Playing Internet games has emerged as a growing in prevalence leisure activity. In some cases, excess gaming can lead to addiction-like symptoms and aversive outcomes that may be seen by some as manifestations of a behavioral addiction. Even though agreement regarding the pathologizing of excessive video gaming is not yet achieved and perhaps because the field requires more research, many works have examined the antecedents and outcomes of what is termed internet gaming disorder (IGD). In this article, we aim at summarizing perspectives and findings related to the neurocognitive processes that may underlie IGD and map such findings onto the triadic-system that governs behavior and decision-making, the deficits in which have been shown to be associated with many addictive disorders. This tripartite system model includes the following three brain systems: (1) the impulsive system, which often mediates fast, automatic, unconscious, and habitual behaviors; (2) the reflective system, which mediates deliberating, planning, predicting future outcomes of selected behaviors, and exerting inhibitory control; and (3) the interoceptive awareness system, which generates a state of craving through the translation of somatic signals into a subjective state of drive. We suggest that IGD formation and maintenance can be associated with (1) a hyperactive “impulsive” system; (2) a hypoactive “reflective” system, as exacerbated by (3) an interoceptive awareness system that potentiates the activity of the impulsive system, and/or hijacks the goal-driven cognitive resources needed for the normal operation of the reflective system. Based on this review, we propose ways to improve the therapy and treatment of IGD and reduce the risk of relapse among recovering IGD populations.

Internet Gaming Disorder Treatment: A Case Study Evaluation of Four Different Types of Adolescent Problematic Gamers

Research examining Internet Gaming Disorder (IGD) has grown markedly in recent years. However, research on its psychological treatment is still scarce, especially with respect to efficacy of specific programs. The PIPATIC (Programa Individualizado Psicoterapéutico para la Adicción a las Tecnologías de la Información y la Comunicación) program is a 22-session specialized treatment for adolescents with IGD. The present paper briefly outlines the cases of four treatment-seeking male adolescents aged between 13 and 18 years with different clinical IGD profiles undergoing the treatment. A case study using an A-B-A’ withdrawal design was conducted. After completing the PIPATIC program, all participants showed clinical improvement in the amount of time spent using video games and in the symptoms of IGD. Results also demonstrated they received lower scores on clinical tests related to comorbid disorders. In an area with so few studies relating to IGD treatment, the present study is of existential value and contributes clinical information concerning the treatment of IGD in treatment-seeking adolescent patients.

43.4 The Big Disconnect: A Case Study in the Treatment of Internet Gaming Disorder

The goal of this session is to discuss the assessment and treatment of technology addiction in clinical practice, using a specific case example from the author's own clinical experience in order to highlight common themes, challenges, comorbidities, and complexities common to such cases.

A Family Systems Approach to the Understanding and Treatment of Internet Gaming Disorder

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition, proposed criteria for Internet gaming disorder (IGD) share similar symptomology with substance use disorders (SUDs), so counselors have adopted individual, cognitive–behavioral models from SUD research to apply to IGD. Studies of these cognitive–behavioral treatments reveal that symptoms return as clients leave treatment. Systemic interventions lower rates of relapse in SUD. Thus, it shall be proposed that Steinglass’s systemic-motivational therapy, designed initially for treatment of SUD, could have similar effects on relapse rates when applied to an analogous issue of IGD.