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Treatment outcomes of a CBT-based group intervention for adolescents with internet use disorders
(2021)
Background and aims: Instances of Internet use disorders (IUD) including Internet gaming disorder (IGD) and non-gaming pathological Internet use (ng-PIU) have the extent that they are now a growing mental health issue. Individuals suffering from IUD show a large range of symptoms, high comorbidities and impairments in different areas of life. To date there is a lack of efficient and evidence-based treatment programs for such adolescents. The present registered single-arm trial (ClinicalTrials.gov: NCT03582839) aimed to investigate the long-term effects of a brief manualized cognitive behavioral therapy (CBT) program for adolescents with IUD. Methods: N = 54 patients (16.7% female), aged 9–19 years (M = 13.48, SD = 1.72) received the CBT group program PROTECT+. IUD symptom severity (primary outcome variable) as well as comorbid symptoms, risk-related variables and potentially protective skills (secondary outcome variables) were assessed at pretest, posttest, as well as 4 and 12 months after admission. Results: Patients showed a significant reduction in IUD symptom severity at the 12-month follow-up. Effect sizes were medium to large depending on the measure. Beyond the statistical significance, the clinical significance was confirmed using the reliable change index. Secondary outcome variables showed a significant reduction in self-reported depression, social anxiety, performance anxiety and school anxiety as well as in parental-reported general psychopathology. Discussion and conclusions: The present study shows long-term effects of a manual-based CBT treatment for adolescents suffering from IUD. The results indicate that even a 4-session brief intervention can achieve a medium to large effect over 12 months. Future work is needed to confirm the efficacy within a randomized controlled trial (RCT).
Fragestellung: Es existiert eine Vielzahl von Begriffen für Verhaltenssüchte, die Mängel in Operationalisierung, Bezug zum Verhalten, Kompatibilität mit internationalen Klassifikationen sowie nicht stigmatisierender Nutzung aufweisen. Daher werden einheitliche Begriffe für Verhaltenssüchte benötigt. Methode: Im Rahmen einer Leitlinie zur Diagnostik und Behandlung Internetbezogener Störungen wurden Lösungen in Form eines Expertenkonsens entwickelt. Ergebnisse: Als Grundlage wurde die Einteilung von Verhaltenssüchten in der 11. Revision der International Classification of Diseases (ICD-11) genutzt. Es wurden die Begriffe Computerspielstörung (CSS) und Glücksspielstörung (GSS) für die beiden in ICD-11 enthaltenen Verhaltenssüchte gewählt sowie drei weitere spezifizierte Verhaltenssüchte vorgeschlagen: Soziale-Netzwerke-Nutzungsstörung (SNS), Shoppingstörung (ShS) und Pornografie-Nutzungsstörung (PNS). Für CSS, GSS und ShS wird weiterhin zwischen vorwiegend online oder vorwiegend offline unterschieden. Als Oberbegriff wird Störungen aufgrund von Verhaltenssüchten vorgeschlagen. Für Störungen aufgrund von Verhaltenssüchten, die sich vorwiegend auf online ausgeübte Verhaltensweisen beziehen, kann alternativ der Oberbegriff Internetnutzungsstörungen verwendet werden. Schlussfolgerung: Die vorgeschlagenen Termini weisen Verbesserungen im Vergleich zu uneindeutigen oder aus anderen Gründen ungünstigen Begriffen dar. Gleichzeitig konnte eine Kompatibilität mit der ICD-11 ermöglicht werden.
Internet Gaming Disorder (IGD) has been included in the DSM-5 as a diagnosis for further study, and Gaming Disorder as a new diagnosis in the ICD-11. Nonetheless, little is known about the clinical prevalence of IGD in children and adolescents. Additionally, it is unclear if patients with IGD are already identified in routine psychotherapy, using the ICD-10 diagnosis F 63.8 (recommended classification of IGD in ICD-10). This study investigated N = 358 children and adolescents (self and parental rating) of an outpatient psychotherapy centre in Germany using the Video Game Dependency Scale. According to self-report 4.0% of the 11- to 17-year-old patients met criteria for a tentative IGD diagnosis and 14.0% according to the parental report. Of the 5- to 10-year-old patients, 4.1% were diagnosed with tentative IGD according to parental report. Patients meeting IGD criteria were most frequently diagnosed with hyperkinetic disorders, followed by anxiety disorders, F 63.8, conduct disorders, mood disorders and obsessive-compulsive disorders (descending order) as primary clinical diagnoses. Consequently, this study indicates that a significant amount of the clinical population presents IGD. Meaning, appropriate diagnostics should be included in routine psychological diagnostics in order to avoid “hidden” cases of IGD in the future.
Objective: The problematic use of computer games was included in the DSM-5 and in the ICD-11. Initial research revealed associa- tions between problematic gaming (PG) and quality of life (QoL). However, clarification is needed concerning which dimensions of the multidi- mensional construct QoL are particularly relevant for PG. Method: To answer this question empirically, we asked 503 parents (mean age: 47.63 years) to rate their 503 children (average age: 14.60 years) regarding QoL and PG, using validated questionnaires on parental assessments of adolescent PG and health-related QoL to collect the data. Correlation analyses were calculated to determine bivariate relations, and a multiple linear regression was used to conduct a multivariable analysis. Results: In the bivariate analyses, a higher severity of PG was associated with a lower health-related QoL in all five surveyed dimensions. In the multivariable model (corrected R2 = 0.35), we observed statistically significant associations between higher severity of PG and male sex and lower age of the adolescent as well as lower QoL in the dimensions of physical well-being and school environment. Conclusions: According to the findings of the present study, physical well-being and school environment should be especially focused on in preventive approaches against the development of PG in youth.
Trajectories of internalizing disorders and behavioral addictions are still largely unknown. Research shows that both disorders are highly comorbid. Previous longitudinal studies have focused on associations between internalizing disorders and behavioral addictions using screening instruments. Our aim was to develop and examine a theory-based model of trajectories, according to which internalizing disorders foster symptoms of Internet use disorders, mediated by a reward deprivation and maladaptive emotion regulation. We applied clinically relevant measures for depression and social anxiety in a prospective longitudinal study with a 12-month follow-up investigation. On the basis of an at-risk population of 476 students (mean age = 14.99 years, SD = 1.99), we investigated the predictive influence of clinically relevant depression and social anxiety at baseline (t1) on Internet use disorder symptoms at 12-month follow-up (t2) using multiple linear regression analyses. Our results showed that both clinically relevant depression and social anxiety significantly predicted symptom severity of Internet use disorders one year later after controlling for baseline symptoms of Internet use disorders, gender and age. These results remained robust after including both depression and social anxiety simultaneously in the model, indicating an independent influence of both predictors on Internet use disorder symptoms. The present study enhances knowledge going beyond a mere association between internalizing disorders and Internet use disorders. To our knowledge, this is the first study investigating clinically relevant depression and social anxiety to predict future Internet use disorder symptoms at 12-month follow-up. In line with our model of trajectories, a significant temporal relationship between clinically relevant internalizing disorders and Internet use disorder symptoms at 12-month follow-up was confirmed. Further studies should investigate the mediating role of reward deprivation and maladaptive emotion regulation, as postulated in our model. One implication of these findings is that clinicians should pay particular attention to the increased risk of developing behavioral addictions for adolescents with depression and social anxiety.
Hintergrund: Das Kindesalter wurde bei der Entwicklung von wirksamen Präventions- und Interventionsprogrammen bei Computerspiel- und Internetabhängigkeit bisher kaum berücksichtigt. PROTECTdissonanz wurde daher als 1-stündiges dissonanzbasiertes universelles Primärpräventionsprogramm für die Klassenstufe 5 konzipiert. Die vorliegende Pilotstudie überprüft die unmittelbaren Effekte der Dissonanzinduktion auf die Einstellung zum Gaming. Methodik: In einem einarmigen A+B-Design mit drei Messzeitpunkten (T0, T1, T2) wurde die Einstellung zum Gaming anhand des Gaming Attitude Test (GAT) erfasst. In die Baselinesequenz (Sequenz A, T0 bis T1, Teilstichprobe) wurden N = 83 Schüler_innen eingeschlossen (Alter: M = 10.27; SD = 0.48) und in die Interventionssequenz (Sequenz B, T1 bis T2, Gesamtstichprobe) N = 200 Schüler_innen (Alter: M = 10.24; SD = 0.47). Akzeptanz und Zufriedenheit wurden nach der Intervention erfasst. Ergebnisse: Hierarchisch lineare Wachstumsmodelle zeigten eine signifikante Reduktion der GAT-Symptome durch die Intervention, sowohl im Gesamtwert des GAT als auch auf der Subskala „Bagatellisierung negativer Konsequenzen“. Im natürlichen Verlauf (Baselinesequenz A) zeigten sich keine Veränderungen. Die Schüler_innen bewerteten PROTECTdissonanz zudem mit einer hohen Zufriedenheit. Schlussfolgerungen: Eine kurze, gezielte übung zur Dissonanzinduktion zeigt unmittelbare Effekte auf ein Einstellungsmaß zum Gaming. Zur Weiterverfolgung dieses vielversprechenden Ansatzes sollte in künftigen Studien untersucht werden, ob sich eine verringerte Bagatellisierung negativer Konsequenzen von Gaming im Sinne der kognitiven Dissonanztheorie auch tatsächlich in einer Verhaltensänderung widerspiegelt.