Indian Journal of Clinical Psychology Copyright, 2023 Indian Association of

Vol. 50, No. 2, 78-86 Review Article Clinical Psychologists (ISSN 0303-2582)

Psycho-Therapeutic Management of Internet Gaming Disorder: A Systematic Review

Divya Chauhan1 and Kritika Rastogi2
ABSTRACT
The Diagnostic and Statistical Manual of Mental Disorders (DSM 5) has now included Internet
Gaming disorder in section III as the condition that warrants more clinical research. Internet or
Online gaming has become one of the most popular sources of entertainment among children and
adolescents. It represents the fastest growing segment leading to hazards as well. In this study,
existing literature on Internet Gaming Addiction and, intervention-based studies were reviewed in
an attempt to systematically analyze existing psychological management. A total of 14 full-text
papers were strategically chosen for review using PRISMA, adhering to the inclusion and
exclusion criteria. It was observed that the majority of studies included prevention-based, CBT-
based intervention, mindfulness, and targeted family-focused treatments as well. Furthermore, the
majority of the studies shed light on the wise utilization of gaming rather than abstinence from the
act.
Keywords: Internet gaming disorder, systematic review, psychological management, psychotherapy,
Intervention.
INTRODUCTION According to this paradigm, treatment begins by
concentrating on the patient’s behavior before
The problematic gaming was introduced in the late
progressively altering the focus to the formation of
1980s with the successful treatment through the
positive cognitive assumptions (Przepiorka et al.,
promotion of self-control and interpersonal skills by
2014). The CBT approach also advises patients to keep
"endorsing compulsive video games" (Kuczmierczyk,
a close eye on their thoughts to spot affective and
Walley, & Calhoun, 1987). Online gaming is becoming
environmental triggers linked to their addictive online
the most popular pastime for children and adolescents
behaviour (Khazaal et al., 2014).
worldwide. Clinicians and empirical research suggest
that some adolescents play a substantial amount of METHOD
online gaming, which leads to functional impairments
A systematic review of intervention and repulsion for
in daily life (Gentile, 2009; King, Delfabbro, Doh, et
Internet gaming disorder (IGD) was performed to
al., 2018; Kuss & Griffiths, 2012). In 2013, the
identify what methods of treatment exist for this
Diagnostic and Statistical Manual of Mental Disorders
behavioral addiction. The Preferred Reporting Items for
(American Psychiatric Association, 2013) included
Systematic Reviews (PRISMA; Liberati et al. 2009)
Internet Gaming Disorder (IGD) under Section III, and
reporting checklist was followed when conducting the
the same was added to the 11th World Health
current systematic review. A thorough literature search
Organization’s classification as Gaming Disorder
was conducted for this investigation to find intervention
(WHO, 2018).
studies. For systematic review papers, all articles
Problematic gaming has been included in the cognitive- published in behavioural addiction journals up until
behavioural model's application (Haagsma, Caplan, et April 2023 were specifically searched. A protocol was
al., 2013), which initially attempted to explain pre-developed to document analytical methods and
pathological Internet use (Caplan, 2010). It makes the inclusion criteria. We utilized Scopus, which also
case that problematic gaming is caused by a strong included journals from Springer, PubMed, Elsevier,
propensity for online interaction, a reliance on video BioMed Central Ltd, Wiley, Mosby, Sage Publications,
games to control moods, and a lack of self-regulation, Blackwell Publishing, Emerald, Frontiers Media SA,
which includes a high preoccupation with gaming and Routledge, the American Psychological Association,
obsessive use of video games. Multiple psycho-social Oxford University Press, Cambridge University Press,
factors thus play a vital role in its prognosis. Taylor and Francis, and in some cases, it searched the
journal's website for articles published in the selected
The increased acknowledgment of this clinical
journal that contained that term. (Internet gam*) OR
condition shifts the focus to prevention and
(Behavioural Addict*) OR (Gaming Psychopathology*)
intervention. Nonetheless, one of the most popular
OR (Gaming Psychopathology) OR (Online gam*
models for psychological treatments for internet
addict*) OR (Internet gam* disorder*) OR (Gaming
addiction is cognitive behavioural therapy (CBT). The
Addiction*) OR (Problematic Internet Gaming) OR
mentioned model has been successfully used to treat
(Video gam* addict*) OR(Problematic Gaming) OR
internet addiction in various trials (Young, 2013).
(Problematic Online Gaming) OR (Internet Gaming
1
Research scholar, PhD. in Psychology, Christ (Deemed to be University), Delhi NCR, India
2
Assistant Professor, Christ (Deemed to be University), Delhi NCR, India
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Addict*) OR (Online gaming addict*) OR (Excessive titles, abstracts, keywords, author names and
Internet Gaming) AND (Intervention*) OR affiliations, journal names, and publications were
(Psychotherapy*) OR (Therapy*) OR (Therapeutic exported to an MS Excel spreadsheet. Papers that were
Module*) OR (Therapy* Model*) OR (Eclectic not related to intervention and prevention, were
Treatment*) OR (Management*) OR (Treatment*) OR discarded. All review articles that at least partially
(Psychological Management*) OR (Prevention*) OR highlighted psychotherapy or preventative strategies
(Psychological Prevention*) OR (Psychological were included. For data management, data elements
Intervention*) OR (Behavioural Intervention*) OR have been added to the MS Excel spreadsheet. The data
(Behavioural Addiction* Intervention*) OR (Therapy management spreadsheet also includes the
Program*) OR (Clinical Intervention*)in their titles, bibliographic data for the studies, the required PRISMA
abstracts, and/or keywords. The last search was run on checklist items with some additions, and a section for
April 30, 2023. From 10 years of identified records, reporting the PRISMA flowchart.
Figure 1: The PRISMA flow diagram for the systematic review detailing the database searches, the number of abstracts screened, and the full
texts retrieve

The present study reviewed 14 papers. The study selection process has been summarized in figure 1. While the
literature search using databases and search engines produced 849 items, 787 of them were disregarded because they
did not focus on interventions. 48 papers were eliminated after rigorously screening the full texts of the remaining
reviews because they did not match the eligibility criteria. Thus a composite of 14 full-text papers was further
reviewed to understand the types of psycho-therapeutic interventions being covered and analysed.

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RESULT
Table 1: Details of the reviewed research papers

Note: It reports the journal’s author, publisher, source title keywords,

and title of the publication of included reviews.
Table 2: Treatment outcome of the research

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DISCUSSION
The young minds were born and made their way to
adolescents in a world of IT devices, to the extent that
they became natives of this era (Teo, 2013). But this
rapidly evolving era is creating room for dysfunction
and pathologies with the addition of co-morbidities.
The need of the hour demands evidence-based
treatment, and multiple pieces of research support the
importance of psychotherapeutic treatments.
The upward graph of cases due to excessive use of the
internet and online games has researchers' and
clinicians' eyes on it. The rapid growth of cases of IGD
worldwide automatically fuels the need for various
treatment services to deal with this, and Young’s Model
is one of the oldest and most widely used treatment
procedures in this genre. Young in 2009 proposed
strategies for the treatment of online addiction
(including video gaming). Several reports show the
effectiveness of group CBT as a treatment for internet
addiction (Du et al., 2010; Young, 2011). Hence, it
concluded the efficacy and effectiveness of CBT as a
treatment for online gaming addiction. Though it has
been argued by a few researchers that abstinence from
the internet shouldn’t be the ultimate goal of the
intervention, it should focus on abstinence from
problematic online uses and regulate the users’ internet
activity (Cash et al., 2012; Khazaal et al., 2014).
Details of existing treatment studies
Existing research suggests that individuals who endorse
the internet at a relatively young age are at higher risk
for common internet addictions and are susceptible to
the disorder once they enter adolescence. For the
current research, five existing papers have mentioned
psycho-therapeutic treatment for adolescents, whereas
eight papers have young adults as their participants.
Most studies have indicated that males are more
vulnerable and prone to developing internet addiction
(IA) than females. A meta-analysis quantified the
gender-relation equation wherein a random-effects
model provided evidence that supports the gender-
specific distinctions in IGD, where males are more
prone to Internet gaming disorder than females (g =
0.479) (Su et al., 2020). An intervention study by Chau
et al. (2019) included 248 primary school students from
four different schools, and 56% of the participants were
boys. Similarly, other studies that included both
genders indicated the same. As per a recent Indian
population-based intervention, the participants
Note: The current report is on the sample (i.e., number of participants, comprised 39 (95.89%) males and 1 (2.34%) females,
mean age, diagnostic criteria), treatment type, number of sessions, indicating that males made up the majority of the
and duration of treatment and outcomes. The outcome has indicated
that conducting intervention systematically is growing over time. study's participants. (Sharma, et. al., 2022).
highlights forteen treatment studies; one is individual session based
whereas the rest are group-based interventions. one study is primarily
The DSM-5 and ICD-11 both included and defined IGD
family-based and another in combination. as being presented as a repetitive pattern of persistent

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gaming behavior. Clinicians and professionals both use Similarly, by improving students' knowledge, skills,
the manuals for diagnosis. In existing studies, ten of and attitudes and equipping them with self-help
them have used DSM-5 and one has used DSM-4, strategies to monitor and regulate their gaming
another has used DSM and ICD-11 revised, and the last behaviour with the goal of preventing gaming disorder,
has used a self-report questionnaire of the Korean Students were the target audience for an e-Health
Internet Addiction Proneness Scale for the diagnosis. intervention designed to aid in the early detection and
prevention of gaming disorder. The intervention was
As per a meta-analysis using a random-effect model, it
designed to last for around an hour. There were four
was indicated that the population has a 3.05%
modules in all which sought to alter abnormal cognitive
prevalence rate of gaming disorder worldwide (Stevens
processes and addictive reward processing. The
et al., 2021). The rate of IGD and co-morbid
symptoms of unidentified internet use problems and
psychological pathologies is quite high; 92% of pieces
gaming disorders were successfully alleviated by the
of research work suggested that there’s a significant
treatments over the course of a year. (Balhara et al.
correlation between anxiety, depression (89%),
2023)
attention deficit hyperactivity disorder (87%), social
phobia (75%), and obsessive-compulsive symptoms For adolescents with IGD and co-morbid disorders,
(Gonzalez et al., 2018). The research by Sakuma et al. CBT is effective as a treatment procedure, and multiple
in 2016 showed that six participants had psychiatric pieces of research support the same. Rodriguez et. al.,
comorbidities that did not interfere with the SDLC (2018) designed a treatment plan (PIPATIC) for
program they were in. Six participants had ADHD, adolescents with IGD and co-morbid disorders. The
which triggered them to concentrate on stimulating plan was for 6 months with 22 sessions, 45 minutes
phenomena, and those cases required a special amount each, which comprised six modules to evaluate the
of time for treatment (Sakuma, et. al., 2016). The changes in IGD symptoms and “psychopathology, co-
research by Han, et. al. (2020), on IGD, focused on morbid symptoms, emotional intelligence, self-esteem,
assessing IQ, attention deficit hyperactivity disorder, social skills, family environment, therapeutic alliances,
major depressive disorder, anxiety, and impulsivity and change in perception”. The result indicated that the
before kick-starting the treatment procedure. For PIPATIC group reported a reduction in co-morbid
measuring the IQ, the Korean Wechsler Adult symptoms compared to the control group, and there was
Intelligence Scale was used, and after giving supportive an improvement in ‘’identity diffusion, self-
therapy (CBT), the symptoms of IGD and co-morbid devaluation, emotional intelligence, social abilities, and
symptoms such as attention deficit hyperactivity reduced familial conflict’’. A similar multimodal
disorder, major depressive disorder, anxiety, and psychotherapy program makes an effort to concentrate
impulsivity were measured again. In Korean on six major therapeutic intervention domains. This
adolescents with problematic Internet use MDD was the multimodal treatment approach was developed using a
most prevalent co-morbid psychiatric disorder (Kim et number of elements from evidence-based
al., 2012). In another study using the Beck Depression psychotherapy intervention programmes for IGD,
Inventory and the Beck Anxiety Inventory (BAI), both including motivational enhancement therapy, cognitive
clinical conditions of depression and anxiety were behaviour therapy, and family therapy. (Sharma et al.
measured. The IGD group showed significantly lower 2022)
scores after the intervention compared to the baseline
Another study by Han et al. (2020) focused on the CBT
(Yao et al., 2017). Anxiety is a major disorder
approach for the treatment of ‘’stress management,
highlighted in research by Maden et. al. (2022),
anxiety control, impulse control, and environmental
assessed using the BAI. A reduction in anxiety levels
control, including family’’, where non-use of
was found after training.
medication predicted a good prognosis and was
METHOD OF TREATMENT regarded as having “no comorbidity,” and people with
comorbidities took the required medication. Hans’s
Various researchers applied treatment plans that best
CBT program was focused on anxiety control, which
suited their samples under certain conditions. In a very
could help highly anxious and introverted IGD patients
recent work by Chau et al. (2019), they designed a
improve their Internet gaming disorder symptoms. The
universal prevention program called Wise IT-use,
CBT program mainly made the patients face their
aimed to alleviate the symptoms of internet gaming
emotions, especially loneliness so that they could
disorder and risky internet behaviour in children. This
realise that loneliness may be one of the factors fueling
was based on a psycho-educational program that
the development of problematic internet gaming. The
encouraged the young participants to tackle societal
program also focused on developing interpersonal
problems and, co-morbid symptoms (e.g., depression),
relationships, and better control over internet usage,
which developed from various problematic IT uses.
which can eventually lead to life satisfaction and better

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impulse control. Han’s research indicated that CBT is behavioural intervention based on the WDEP model of
comparatively more effective than supportive therapy, reality therapy helped the participants with IGD
as the revised CBT program highlighted the symptoms control their impulsivity and decrease
improvement in YIAS, BAI, BIS/BAS, and SADS anxiety and severe depressive symptoms. and
scores. Kim et al., (2012) conducted a study focused on behavioural therapy combining reality therapy and
CBT as the treatment plan for problematic online game mindfulness is even more effective in IGD severity, and
play in adolescents with major depressive disorder this research work also highlighted the cognitive
(MDD). An experiment was conducted on two groups, enhancement intervention as an effective treatment for
one with medicines and one with a combination of IGD (Yao et al., 2017).
medicine and CBT, the result indicated that the Med-
The biopsychosocial theory of addiction is incorporated
CBT group had an improvement in the level of anxiety
into the IGD intervention. In a nonclinical population,
of the Med group participants.
the study outlined the effects of a unique group
Research conducted by Sakuma et al. (2016) indicated intervention for fostering mindful gaming behaviour.
that a self-discovery camp consisting of 14 sessions of Measurements of gaming time, gaming-related issues,
CBT with clinical psychologists and professionals was time spent on other popular leisure activities, and
an effective treatment plan for IGD. The camp involved subjective well-being were used to evaluate the
outdoor activities such as trekking, woodworking, intervention's impact. Measurements were made at
cooking, and rally walking to foster a well-regulated three different time points: baseline, right after the
healthy life where participants could enhance intervention, and six months afterward. The severity of
communication without the presence of the internet and IGD symptoms among the study participants
digital mediums. This treatment plan led to the significantly decreased (Männikkö et al., 2022).
improvement of addictive behaviors and beneficial Parental and family characteristics as well as other
effects that lasted for a long time. The SDiC was a non- social variables have been linked to problem gaming in
pharmacotherapeutic treatment with an activity adolescents (Paulus et al., 2018; Richard et al., 2020;
program that improved the motivation of participants Sugaya et al., 2019). In order to determine whether
and improved IGD symptoms by strengthening their multidimensional family therapy (MDFT) reduces
self-awareness and providing confidence to deal with problem gaming, Nielsen et al. (2023) conducted a
conflicts and solve them (Sakuma et al., 2016). study as a randomised controlled trial contrasting
MDFT with Family Therapy as Usual (FTAU). In
Apart from CBT, other intervention techniques are
MDFT, the therapeutic process is meticulously planned
proven to be effective in treating IGD symptoms,
out in terms of protective and risk factors, treatment
Mindfulness therapy is one of them. Li et al. (2017), in
objectives, and processes for each youth and family. A
their experimental research with IGD adults, applied
proactive posture was adopted by the therapists. The
mindfulness intervention (MORE), and the results
therapists at FTAU are more responsive, adjusting to
indicated that within 8 weeks of post-treatment, the
the family's pace, and reacting to situations as they
signs of IGD symptoms got reduced
arise. FTAU treatment frequently focuses on forming
visibly. Mindfulness intervention was effective with
alliances and enhancing relationships and
the maladaptive cognition and cravings related to
communication within the family. Sessions are held
internet gaming, including depressive thoughts and
with the adolescent alone, the parents alone, and the
loneliness. In an attempt to determine if improvements
entire family, like those in MDFT. Additionally, they
in maladaptive cognitions and positive reappraisal
concentrated on two benefits of in-session gaming:
influenced the clinical effects of mindfulness-based
improving treatment motivation and addressing issues
intervention, the researchers conducted another study in
with family functioning. Because it enables the
2018 using the same data on mindfulness intervention
therapist to enter the young person's world, show
(MORE) as a treatment for IGD symptoms. Previously,
interest and curiosity, and explore the reasons for
mindfulness intervention was effective in reducing the
gaming without passing judgment, in-session gaming
maladaptive cognitive process and acted as a craving
may present a powerful opportunity to engage the
reductive treatment by enhancing awareness but the
young person in treatment. The game demonstration
new mediation effect in the mindfulness intervention
technique gives pertinent topical issues immediacy.
(MORE) suggested more effectiveness in decreasing
Instead of focusing on past disputes there and then, this
addictive tendencies toward video game playing by
approach puts more emphasis on the present and makes
targeting maladaptive cognitive processes (Li et al.,
it easier to examine and change faulty assumptions and
2018). Mindful meditation, including body relaxation
attributions as well as family interactions.
and mindful training with soothing music, encouraged
participants to concentrate on their emotional awareness Krossbakken et al. (2018) did research on children
and adjust their mind and body in sync. The group endorsing internet gaming and developed a parental

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guide with clinical and professional guidance focused data were gathered using a traditional mail response
on “how to regulate video game behaviour in form, which makes it undependable.
children”. Self-acceptance can be viewed as one of the
Lastly, in all of the research, the samples were drawn
key factors influencing frustration tolerance, with a
from a single setting, and the findings may not be
significant impact on performance and emotion (Tyagi,
generalizable to other geographical regions. The
et. al., 2022). The main aim of this study was to
intervention was in English and might have deterred
examine the effectiveness of parenting roles in reducing
students who were more conversant in the local
gaming activity in a random sampling of children ages
language. (Balhara et al. 2023)
8 to 12 years old. The limitation of this study was the
lack of pre-tests, which precluded further investigation CONCLUSION
to determine the difference in the condition of the
The Internet, or online gaming, has become one of the
child’s gaming activity. (Krossbakken, et. al., 2018).
most popular sources of entertainment among children
In a study by Maden et al. (2022), the researchers and adolescents. It represents the fastest-growing
explored the therapeutic benefits of virtual reality segment, leading to hazards as well. This study
training and aerobics training treatments on physical reviewed existing literature on internet gaming
activity, physical fitness, and anxiety among gamers addiction and intervention-based studies to
and the differences between the treatment group and the systematically analyze existing psychological
control group. Exercise and physical activity are proven management. A total of 62 full-text papers were chosen
to improve psychological well-being by relieving for review, adhering to the inclusion and exclusion
tension and reducing anxiety. In this study, the amount criteria. Lastly, forteen intervention-based studies were
of anxiety and gaming disorder was reduced by VRT reviewed, and it was observed that the majority of
training and by AT programme, which uses a studies included prevention-based, CBT-based
routine exercise strategy. The VRT programme was intervention, mindfulness, and targeted family-focused
also found to enhance physical fitness. treatments as well. However, the existing limitations
bring about an enormous and vast scope for more need-
Limitations
based and focused psychological interventions.
Multiple pieces of work indicated the effectiveness of
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