Behavioral Addictions _ _______________________________________________________________________
Motivational Enhancement Therapy/CBT CBT is combined with motivational enhancement therapy (MET/CBT) to move patients from ambivalence to engage- ment concerning behavioral change. MET/CBT is structured by stages: • Contemplation stage: Rapport building during the initial sessions includes a detailed interview and case formulation. • Preparation stage: The therapist creates an empathetic environment to deliver psychoeducation, including instruction on managing physiologic and emotional arousal through relaxation techniques and a cost-benefit analysis of gaming addiction. • Contract stage: With the patient and parents (if appro- priate), the therapist addresses behavior modification of gaming, reducing time spent online and promoting healthy activities. MET/CBT has led to decreased symptoms and improved school performance in Internet gaming disorder [204; 228]. Craving Behavioral Intervention Based on cognitive neuroscience and behavioral addiction research, craving behavioral intervention was developed for patients with Internet gaming disorder to reduce cravings and enhance coping skills, which may improve therapeutic outcomes and prevent relapse. Craving behavioral interven- tion is conducted weekly in a group format with eight to nine participants. Topics for each weekly session include [63]: • Perceiving subjective craving • Recognizing and testing irrational beliefs regarding craving • Detecting craving and relieving craving-related negative emotions • Coping with cravings and altering participant fulfill- ment of psychological needs • Learning time management and skills training for cop- ing with cravings • Reviewing, practicing, and implementing skills • Mindfulness training Short-Term Treatment of Internet and Computer Game Addiction Short-term treatment of Internet and computer game addic- tion (STICA) is a disorder-specific, CBT-based, individual and group treatment lasting three months. The STICA treatment protocol and focus of treatment sessions is organized into three phases [229]. In the early phase, the focus is on patient educa- tion on the mechanisms and effects of Internet gaming dis- order (e.g., learning theories, development and consequences of Internet gaming disorder, the vicious cycle of addiction).
The ICD-11 formally includes as diagnostic entities gaming disorder (predominately online) and gaming disorder (pre- dominately offline) [109]. A comprehensive understanding of patient motivation is neces- sary for optimal treatment selection. The Motives for Online Gaming Questionnaire (MOGQ) was developed to assist in this assessment. The MOGQ consists of 27 statements, such as “I play online games because gaming helps me to forget about daily hassles,” which are rated from 1 (almost never/never) to 5 (almost always/always). Motivational factors identified by the MOGQ include social, escape, competition, coping, skill development, fantasy, and recreation [12; 224].
TREATMENT Psychological Interventions
In the published research to date, psychological treatment is the dominant modality for Internet gaming disorder, with CBTs the most-studied. Cognitive-Behavioral Therapies As discussed, maladaptive cognitions are a core feature of Internet gaming disorder and include self-regulation deficits, preference for a virtual life, cognitive bias, impaired cognitive control abilities, cognitive deficits, poor cognitive error process- ing, and decision-making deficits [204]. CBT addresses these cognitions and is the most widely used psychological treatment for Internet gaming disorder. The first stage of CBT treatment for Internet gaming disorder deals with the behavioral aspects of addicted gaming, and subsequent stages gradually shift the focus toward the development of positive cognitive assump- tions. During therapy, addicted gamers identify false beliefs and learn how to modify them into more adaptive ones. CBT also trains patients to monitor their thoughts and to identify affective and situational triggers associated with their addictive gaming behavior [204]. In the treatment of Internet gaming disorder, CBT typically involves 8 to 28 sessions that address psychoeducation, prob- lem identification, healthy communication, Internet aware- ness, and cessation techniques. Treatment of Internet gaming disorder may also include short-term therapy, group therapy, and systemic therapy with parents/teachers/peer support and multilevel interventions that incorporate motivational interviewing [204]. Although CBT has some efficacy in Internet gaming disorder, the results do not appear to differ from other non-specialized psychological treatments for Internet gaming disorder [225]. One study found that combinations of CBT and medications showed an advantage over monotherapies [226]. To improve patient response and clinical outcomes with standard psycho- logical approaches, therapy modalities have been developed that target the cognitive pathologies and underlying neural substrates specific to Internet gaming disorder [227].
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