Park Jennifer J, King Daniel L, Wilkinson-Meyers Laura, Rodda Simone N
School of Population Health, The University of Auckland, Auckland, New Zealand.
College of Education, Psychology & Social Work, Flinders University, Adelaide, Australia.
JMIR Ment Health. 2022 Sep 9;9(9):e36662. doi: 10.2196/36662.
Very few people seek in-person treatment for online behavioral addictions including gaming and gambling or problems associated with shopping, pornography use, or social media use. Web-based treatments have the potential to address low rates of help seeking due to their convenience, accessibility, and capacity to address barriers to health care access (eg, shame, stigma, cost, and access to expert care). However, web-based treatments for online behavioral addictions have not been systematically evaluated.
This review aimed to systematically describe the content of web-based treatments for online behavioral addictions and describe their therapeutic effectiveness on symptom severity and consumption behavior.
A database search of MEDLINE, Embase, PsycInfo, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar was conducted in June 2022. Studies were eligible if the study design was a randomized controlled trial or a pre-post study with at least 1 web-based intervention arm for an online behavioral addiction and if the study included the use of a validated measure of problem severity, frequency, or duration of online behavior. Data on change techniques were collected to analyze intervention content, using the Gambling Intervention System of CharacTerization. Quality assessment was conducted using the Effective Public Health Practice Project Quality Assessment Tool.
The review included 12 studies with 15 intervention arms, comprising 7 randomized controlled trials and 5 pre-post studies. The primary focus of interventions was gaming (n=4), followed by internet use inclusive of screen time and smartphone use (n=3), gambling (n=3), and pornography (n=2). A range of different technologies were used to deliver content, including websites (n=6), email (n=2), computer software (n=2), social media messaging (n=1), smartphone app (n=1), virtual reality (n=1), and videoconferencing (n=1). Interventions contained 15 different change techniques with an average of 4 per study. The techniques most frequently administered (>30% of intervention arms) were cognitive restructuring, relapse prevention, motivational enhancement, goal setting, and social support. Assessment of study quality indicated that 7 studies met the criteria for moderate or strong global ratings, but only 8 out of 12 studies evaluated change immediately following the treatment. Across included studies, two-thirds of participants completed after-treatment evaluation, and one-quarter completed follow-up evaluation. After-intervention evaluation indicated reduced severity (5/9, 56%), frequency (2/3, 67%), and duration (3/7, 43%). Follow-up evaluation indicated that 3 pre-post studies for gaming, gambling, and internet use demonstrated reduced severity, frequency, and duration of consumption. At 3-month evaluation, just 1 pre-post study indicated significant change to mental health symptoms.
Web-based treatments for online behavioral addictions use an array of mechanisms to deliver cognitive and behavioral change techniques. Web-based treatments demonstrate promise for short-term reduction in symptoms, duration, or frequency of online addictive behaviors. However, there is limited evidence on the effectiveness of web-based treatments over the longer term due to the absence of controlled trials.
很少有人会寻求针对网络行为成瘾（包括游戏和赌博）或与购物、使用色情内容或使用社交媒体相关问题的面对面治疗。基于网络的治疗因其便利性、可及性以及解决医疗保健获取障碍（如羞耻感、污名化、成本和获得专家护理的机会）的能力，有可能解决求助率低的问题。然而，针对网络行为成瘾的基于网络的治疗尚未得到系统评估。
本综述旨在系统描述针对网络行为成瘾的基于网络的治疗内容，并描述其对症状严重程度和消费行为的治疗效果。
2022年6月对MEDLINE、Embase、PsycInfo、科学网、Cochrane对照试验中心注册库和谷歌学术进行了数据库搜索。如果研究设计为随机对照试验或前后对照研究，且至少有一个针对网络行为成瘾的基于网络的干预组，并且研究包括使用经过验证的问题严重程度、频率或网络行为持续时间的测量方法，则该研究符合纳入标准。使用赌博干预特征系统收集关于改变技术的数据，以分析干预内容。使用有效公共卫生实践项目质量评估工具进行质量评估。
该综述纳入了12项研究，共15个干预组，包括7项随机对照试验和5项前后对照研究。干预的主要重点是游戏（n = 4），其次是包括屏幕时间和智能手机使用在内的互联网使用（n = 3）、赌博（n = 3）和色情内容（n = 2）。使用了一系列不同的技术来提供内容，包括网站（n = 6）、电子邮件（n = 2）、计算机软件（n = 2）、社交媒体消息（n = 1）、智能手机应用程序（n = 1）、虚拟现实（n = 1）和视频会议（n = 1）。干预包含15种不同的改变技术，每项研究平均有4种。最常使用的技术（超过30%的干预组）是认知重构、预防复发、动机增强、目标设定和社会支持。研究质量评估表明，7项研究符合中度或高度全球评级标准，但12项研究中只有8项在治疗后立即评估了变化。在纳入的研究中，三分之二的参与者完成了治疗后评估，四分之一的参与者完成了随访评估。干预后评估表明严重程度降低（5/9，56%）、频率降低（2/3，67%）和持续时间降低（3/7，43%）。随访评估表明，3项关于游戏、赌博和互联网使用的前后对照研究显示消费的严重程度、频率和持续时间降低。在3个月的评估中，只有1项前后对照研究表明心理健康症状有显著变化。
针对网络行为成瘾的基于网络的治疗使用一系列机制来提供认知和行为改变技术。基于网络的治疗显示出有望在短期内减少网络成瘾行为的症状、持续时间或频率。然而，由于缺乏对照试验，关于基于网络的治疗长期有效性的证据有限。
