July 10, 2019

expert reaction to study on CBT for gaming and internet addiction

An RCT, published in JAMA Psychiatry, reports that Cognitive Behavioural Therapy (CBT) was able to help some sufferers of internet addiction return to normal-internet use.

Prof Naomi Fineberg, Consultant Psychiatrist, Hertfordshire Partnership University NHS Foundation Trust, Professor, University of Hertfordshire and Chair of the COST Action group into Problematic Internet Usage, said:

“The stated goal of the work was to improve upon the methodology of previously published studies exploring the efficacy of different forms of cognitive behavioural psychotherapy (CBT) for internet and computer game addiction. This is a very important emerging field of clinical study. As yet there are no firmly established ‘evidence-based’ treatments to offer patients presenting with the various known forms of problematic usage of the Internet (gaming, pornography viewing, streaming etc), and so a randomised controlled trial in this area is welcome.

“The authors investigated the effects of a manualised cognitive behaviour therapy package developed for participants with ‘Internet and Computer Game Addiction’. There were, however, several important limitations in the design of this study, as described in the limitations and conclusions sections within the paper, that could have had the effect of inflating the apparent efficacy of the active intervention and that therefore significantly impact on the interpretation of the study results, to the extent that robust conclusions about the efficacy of CBT in this clinical group may not be drawn with confidence.

“One of the main methodological limitations was the choice of a waiting list control (placebo) intervention, as opposed to a neutral psychological comparator intervention, against which to compare the active treatment. Being on a waiting list does not adequately control for the non-specific positive effects associated with receiving at least some form of regular therapy and could therefore be expected to have inflated the apparent effect of CBT.”

Dr Bob Patton, Lecturer in Clinical Psychology, University of Surrey, said:

“This study builds on the evidence that suggests Cognitive Behavioural Therapy (CBT) is an effective treatment for internet addiction. It addressed some of the problems identified with earlier research by randomly allocating participants to either the intervention or putting them on a waiting list (random allocation is a pretty good way to eliminate bias from the results), and they also made sure that the intervention itself was administered consistently by using a manual. In this case the CBT is quite intensive, with both individual and group sessions (lasting up to an hour and a half) delivered on a weekly basis over about three months. There were enough people in the study to make sure that any effects observed were not due to chance. Everyone in the study started off with a level of internet use that indicated addiction – in terms of time spent online, content accessed and associated consequences.  Internet addiction was measured at four and six months from the start of the study, and the researchers found that those whose internet use was now classified as normal were ten times more likely to have received the CBT. Even after taking into account the participants differing levels of internet use at the start, age and whether or not they were also diagnosed with depression, levels of internet addiction in the CBT group were significantly lower six months after they received the therapy, compared to those on the waiting list. The study was not without its issues however, and a number of participants experienced adverse events following the therapy – given that internet addiction may be associated with other psychological issues, such as depression, taking away that particular crutch can leave individuals exposed to other problems.

“From the results presented, this sort of therapy does look like it can help reduce problematic internet use (in men), at least in the short term. It’s impact in the longer term (and on women) is less certain, but the results are promising. While the overall costs of delivering this intensive but seemingly effective therapy are not discussed, it nevertheless represents a useful addition to therapists as a potential tool in treating problematic internet use’

‘Efficacy of Short-term Treatment of Internet and Computer Game Addiction’ by Klaus Wölfling et al. was published in JAMA Psychiatry at 16:00 UK time on Wednesday 10th July. 

DOI:10.1001/jamapsychiatry.2019.1676

Declared interests

Prof Naomi Fineberg:

In the past 12 months I have participated in the following

• paid employment or self-employment – I work as a consultant psychiatrist in a specialist NHS obsessive compulsive disorders treatment service, that provides medication and CBT for OCD. I received honoraria from Taylor and Francis and Elsevier for editorial duties.
• grant funding – I have held research or networking grants from the European College of Neuropsychopharmacology, UK NIHR, EU Horizon2020, and accepted travel and hospitality expenses from the  British Association   for Psychopharmacology, European College of Neuropsychopharmacology, International College of Neuropsychopharmacology, International forum of Mood and Anxiety Disorders. I chair a EU-funded COST Action (CA16207) devoted to advancing the research of problematic usage of the Internet.
• voluntary appointments – I hold Board membership for various registered charities linked to OCD.
• internet memberships – I am a member of the Royal College of Psychiatrists, European College of Neuropsychopharmacology, British Association   for Psychopharmacology, International College of Neuropsychopharmacology, International College of Obsessive Compulsive Spectrum disorders
• decision-making positions – I provide the MHRA with advice on psychopharmacology issues. I publish scientific papers in the field of compulsivity, and problematic internet usage.

Dr Bob Patton: No conflict of interest to declare.