Cognitive behavioral treatment for disordered gaming and problem gambling in adolescents: a pilot feasibility study

  • Frida André Faculty of Medicine, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden https://orcid.org/0000-0003-2909-8470
  • Isak Einarsson Outpatient Department, Child and Adolescent Psychiatry Clinic, Region Skåne, Sweden
  • Elisabeth Dahlström Outpatient Department, Child and Adolescent Psychiatry Clinic, Region Skåne, Sweden
  • Katalin Niklasson Outpatient Department, Child and Adolescent Psychiatry Clinic, Region Skåne, Sweden
  • Anders Håkansson Psychiatry, Faculty of Medicine, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden; and Region Skåne, Malmö Addiction Centre, Gambling Disorder Unit, Malmö, Sweden https://orcid.org/0000-0002-5800-8975
  • Emma Claesdotter-Knutsson Psychiatry, Faculty of Medicine, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden; and Region Skåne, Child and Adolescent Psychiatry, Regional Outpatient Care, Lund University Hospital, Lund, Sweden https://orcid.org/0000-0002-6832-2482
Keywords: Gaming, gambling, CBT, relapse prevention

Abstract

Background: Disordered gaming and problem gambling (DG/PG) are associated with a range of functional impairments as well as psychiatric comorbidity. With the proliferation of digital gaming apps aimed at children and adolescents, which involve in-game purchases, there is increasing evidence that DG/PG are on the rise in this age range. The behavior can be detected in youth presenting at school-based health clinics and community psychiatric clinics. Cognitive behavioral therapy (CBT) is one of several recommended treatments for adults, but little evidence is available for the efficacy of this approach in adolescents with DG/PG.

Aim: To evaluate the acceptability and feasibility of a CBT-based intervention developed for adolescents with DG/PG, which can be delivered in routine psychiatric care facilities.

Methods: Adolescents who were patients at a child and adolescent psychiatry service were screened for DG/PG. Those aged 12–17 years with pronounced symptoms were invited to participate in a 7-week CBT program called Relapse Prevention. Nine adolescents agreed to participate and five consented to repeated assessments of outcome (pre-, post-treatment, and 6-month follow-up). In addition to acceptability and satisfaction with treatment, symptoms of DG were assessed with standardized interview and self-report measures.

Results: There were no dropouts from the treatment. Participants who completed treatment and all outcome assessments reported satisfaction with the treatment. The participants showed fewer symptoms of DG after treatment, and the proportion who met criteria for computer game addiction decreased from 56 to 0%. There was no reduction in the number of participants who met criteria for PG.

Conclusion: This study provides preliminary evidence for the acceptability and feasibility of a CBT-based intervention for DG/PG in adolescents. Preliminary data suggest that the treatment may be effective for DG but not PG. Further studies are needed to evaluate the efficacy of this approach for both conditions.

Downloads

Download data is not yet available.

References


1.
Petry NM, Rehbein F, Gentile DA, Lemmens JS, Rumpf HJ, Mößle T, et al. An international consensus for assessing internet gaming disorder using the new DSM-5 approach. Addiction. 2014;109:1399–406. doi: 10.1111/add.12457


2.
Fam JY. Prevalence of internet gaming disorder in adolescents: a meta-analysis across three decades. Scand J Psychol. 2018;59:524–31. doi: 10.1111/sjop.12459


3.
Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Arlington, VA: American Psychiatric Association; 2013.


4.
SFS 2021:1254, Spellag. Available from: Lag om ändring i spellagen (2018:1138) | Svensk författningssamling (svenskforfattningssamling.se) [cited 28 December 2021].


5.
Folkhälsomyndigheten. Statistik över spelproblem i Sverige [updated 25 October 2021]. Available from: https://www.folkhalsomyndigheten.se/spelprevention/statistik/spelproblem/ [cited 30 December 2021].


6.
Rangmar J, Thomée S. När datorspelandet blir problematiskt – en kunskapsöversikt om gaming disorder hos barn och unga. Report No.: 2019:31. Västra Götaland: Länsstyrelsen; 2019.


7.
Paulus FW, Ohmann S, von Gontard A, Popow C. Internet gaming disorder in children and adolescents: a systematic review. Dev Med Child Neurol. 2018;60:645–59. doi: 10.1111/dmcn.13754


8.
Müller KW, Janikian M, Dreier M, Wölfling K, Beutel ME, Tzavara C, et al. Regular gaming behavior and internet gaming disorder in European adolescents: results from a cross-national representative survey of prevalence, predictors, and psychopathological correlates. Eur Child Adolesc Psychiatry. 2015;24:565–74. doi: 10.1007/s00787-014-0611-2


9.
King DL, Chamberlain SR, Carragher N, Billieux J, Stein D, Mueller K, et al. Screening and assessment tools for gaming disorder: a comprehensive systematic review. Clin Psychol Rev. 2020;77:101831. doi: 10.1016/j.cpr.2020.101831


10.
Stevens MW, Dorstyn D, Delfabbro PH, King DL. Global prevalence of gaming disorder: a systematic review and meta-analysis. Aust N Z J Psychiatry. 2020;55:553–68. doi: 10.1177/0004867420962851


11.
Freeman A, Felgoise S, Nezu C, Nezu A, Reinecke M. Encyclopedia of cognitive behavior therapy. New York, NY: Springer; 2005.


12.
Brunborg GS, Hanss D, Mentzoni RA, Pallesen S. Core and peripheral criteria of video game addiction in the game addiction scale for adolescents. Cyberpsychol Behav Soc Netw. 2015;18:280–5. doi: 10.1089/cyber.2014.0509


13.
Brunborg GS, Mentzoni RA, Melkevik OR, Torsheim T, Samdal O, Hetland J, et al. Gaming addiction, gaming engagement, and psychological health complaints among norwegian adolescents. Media Psychol. 2013;16:115–28. doi: 10.1080/15213269.2012.756374


14.
Lemmens JS, Valkenburg PM, Peter J. Development and validation of a game addiction scale for adolescents. Media Psychol. 2009;12:77–95. doi: 10.1080/15213260802669458


15.
Charlton JP, Danforth IDW. Distinguishing addiction and high engagement in the context of online game playing. Comput Hum Behav. 2007;23:1531–48. doi: 10.1016/j.chb.2005.07.002


16.
Ferguson CJ, Coulson M, Barnett J. A meta-analysis of pathological gaming prevalence and comorbidity with mental health, academic and social problems. J Psychiatr Res. 2011;45:1573–8. doi: 10.1016/j.jpsychires.2011.09.005


17.
Greenfield DN. Treatment considerations in internet and video game addiction: a qualitative discussion. Child Adolesc Psychiatr Clin N Am. 2018;27:327–44. doi: 10.1016/j.chc.2017.11.007


18.
Stevens MWR, King DL, Dorstyn D, Delfabbro PH. Cognitive-behavioral therapy for Internet gaming disorder: a systematic review and meta-analysis. Clin Psychol Psychother. 2019;26:191–203. doi: 10.1002/cpp.2341


19.
Gentile DA, Bailey K, Bavelier D, Brockmyer JF, Cash H, Coyne SM, et al. Internet gaming disorder in children and adolescents. Pediatrics. 2017;140(Suppl 2):S81–5. doi: 10.1542/peds.2016-1758H


20.
Witkiewitz K, Marlatt GA. Relapse Prevention for Alcohol and Drug Problems: That Was Zen, This Is Tao. American Psychologist. 2005;59:224–235. doi: 10.1037/0003-066X.59.4.224


21.
Socialstyrelsen. Återfallsprevention [updated 2 December 2018]. Available from: https://www.socialstyrelsen.se/utveckla-verksamhet/evidensbaserad-praktik/metodguiden/aterfallsprevention/ [cited 30 December 2021].


22.
André F, Munck I, Håkansson A, Claesdotter-Knutsson E. Game addiction scale for adolescents – psychometric analyses of gaming behavior, gender differences and ADHD. Front Psychiatry. 2022;13. doi: 10.3389/fpsyt.2022.791254


23.
Toce-Gerstein M, Gerstein DR, Volberg RA. The NODS-CLiP: a rapid screen for adult pathological and problem gambling. J Gambl Stud. 2009;25:541–55. doi: 10.1007/s10899-009-9135-y


24.
Lehenbauer-Baum M, Klaps A, Kovacovsky Z, Witzmann K, Zahlbruckner R, Stetina BU. Addiction and engagement: an explorative study toward classification criteria for internet gaming disorder. Cyberpsychol Behav Soc Netw. 2015;18:343–9. doi: 10.1089/cyber.2015.0063


25.
Snodgrass JG, Zhao W, Lacy MG, Zhang S, Tate R. Distinguishing core from peripheral psychiatric symptoms: addictive and problematic internet gaming in North America, Europe, and China. Cult Med Psychiatry. 2019;43:181–210. doi: 10.1007/s11013-018-9608-5


26.
Andre F, Broman N, Hakansson A, Claesdotter-Knutsson E. Gaming addiction, problematic gaming and engaged gaming – prevalence and associated characteristics. Addict Behav Rep. 2020;12:100324. doi: 10.1016/j.abrep.2020.100324


27.
Gerstein D, Murphy S, Toce M, Volberg R, Harwood H, Tucker A, et al. Gambling impact and behavior study: report to the National Gambling Impact Study Commission. Chicago: National Opinion Research Center at the University of Chicago; 1999.


28.
Volberg RA, Munck IM, Petry NM. A quick and simple screening method for pathological and problem gamblers in addiction programs and practices. Am J Addict. 2011;20:220–7. doi: 10.1111/j.1521-0391.2011.00118.x


29.
Zajac K, Ginley MK, Chang R. Treatments of internet gaming disorder: a systematic review of the evidence. Expert Rev Neurother. 2020;20: 85–93. doi: 10.1080/14737175.2020.1671824


30.
Zajac K, Ginley MK, Chang R, Petry NM. Treatments for Internet gaming disorder and Internet addiction: a systematic review. Psychol Addict Behav. 2017;31:979–94. doi: 10.1037/adb0000315


31.
Zendle D, Cairns P. Loot boxes are again linked to problem gambling: results of a replication study. PLoS One. 2019;14:e0213194. doi: 10.1371/journal.pone.0213194


32.
Chen KH, Oliffe JL, Kelly MT. Internet gaming disorder: an emergent health issue for men. Am J Mens Health. 2018;12:1151–9. doi: 10.1177/1557988318766950
Published
2022-08-08
How to Cite
André F., Einarsson I., Dahlström E., Niklasson K., Håkansson A., & Claesdotter-Knutsson E. (2022). Cognitive behavioral treatment for disordered gaming and problem gambling in adolescents: a pilot feasibility study. Upsala Journal of Medical Sciences, 127(1). https://doi.org/10.48101/ujms.v127.8693
Section
Original Articles