Effectiveness of an integrated motivational cognitive-behavioral group intervention for adolescents with gaming disorder: a randomized controlled trial

Aims, Design and SettingThe aim of this study was to test the efficacy of the integrated cognitive-behavioral therapy with a strength-based motivational approach [internet-delivered cognitive-behavioral therapy (ICBT)] intervention to change gaming disorder (GD) symptoms and other outcomes and to study the therapeutic mechanism. A two-arm parallel randomized waiting-list controlled trial with 3- and 6-month follow-ups were conducted in a secondary vocational school in mainland China. ParticipantsParticipants comprised 77 Chinese adolescents with GD symptoms with a mean age of 16.36 years [standard deviation (SD) = 0.93]; 88.3% were male InterventionsParticipants were randomized into an ICBT group (n = 38) and a waiting-list control (WLC, n = 39) group. ICBT intervention comprised eight weekly sessions to encourage participants to identify their interests and strengths and set goals for developing personally meaningful real-life activities. Measurements and FindingsThe outcomes were measured at pre-treatment (t(0)), post-treatment (t(1)), 3-month (t(2)) and 6-month (t(3)) follow-ups. The primary outcome was GD symptoms at t3. Secondary outcomes included GD symptoms at t(1) and t(2), and gaming motivation, maladaptive gaming cognition, depression and anxiety symptoms at t(1), t(2) and t(3). With the intention-to-treat principle, the GD scores at t(3) were significantly different between the CBT and WLC groups [mean difference 62.08 (SD = 10.48) versus 73.64 (SD = 11.70); Hedges' g = 1.15, 95% confidence interval = 0.67-1.62]. Linear mixed-effects modeling showed significant group x time interaction for the secondary outcomes (P < 0.01), with a moderate to strong between-group effect size in the reduction in depression symptoms (g = 0.67-0.84) and anxiety symptoms (g = 0.6-0.64). Path analysis shows ICBT leads to GD reduction through reducing gaming motivation and maladaptive gaming cognition. ConclusionsAn integrated cognitive-behavioral therapy with strength-based motivational approach intervention reduced gaming disorder symptoms and time spent gaming over a 6-month period by decreasing maladaptive gaming motivation and cognition.