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. 2023 May 8;12(9):3345. doi: 10.3390/jcm12093345

Table 1.

Summary of Included Randomized Controlled Trials in Systematic Review.

Number Title Author,
Year of Publication
Type of Trial		 Sample Size Age of Participants
Range, Mean		 Primary Outcome Measure Intervention Description Key Findings
1 Effectiveness of Cognitive Behavioral Therapy–Based Intervention in Preventing Gaming Disorder and Unspecified Internet Use Disorder in Adolescents A Cluster Randomized Clinical Trial [47] Lindenberg,
2022
RCT		 Active group: 167
Control group: 255		 Age Range 12–18
Mean Age 15.11 (SD = 2.01)

  1. Symptom severity and incident rate symptom severity of gaming disorder unspecified internet use disorder

  2. Secondary outcomes were comorbid psychopathology and problem behaviors.

 Professional
Use of Technical Media(PROTECT), which is a theory-driven, school-based, manualized, cognitive behavioral therapy (CBT)–based
indicated preventive group intervention. It consists of four 90-min sessions and is delivered by 2
trained psychologists per group		 The PROTECT intervention group showed a significantly greater reduction in symptom severity of gaming disorder or unspecified internet use disorder compared to the control group (39.8% vs. 27.7% reduction of symptoms).
The effect size of the reduction in symptom severity was Cohen d = 0.67.
Differences in incidence rates did not reach statistical significance.
The PROTECT group showed a significantly greater decrease in procrastination over 12 months.
No significant differences were found for other secondary outcomes.
2 Combined cognitive behavioral therapy and bupropion for the treatment of problematic on-line game play in adolescents with major depressive disorder [43] Kim,
2012
RCT		 Active group (CBT + MED): 32
Control group MED: 33		 Age Range 13–18
Mean Age:
Active group (CBT + MED):
16.2 (SD = 1.4)
Control group MED:
15.9 (SD = 1.6)

  1. Total on-line game playing time (h/week)

  2. Young Internet Addiction Scale Score

  3. Beck Depressive Inventory

  4. Beck Anxiety Inventory

  5. Life satisfaction scale score

  6. School problematic behavior scale

 This study created two groups of subjects with problematic online game play and major depressive disorder after screenings All participants were prescribed bupropion with
a fixed schedule of 150 mg/day for 1 week followed by 300 mg/day
for 7 weeks.
Participants in the Med group had weekly,
10 min interviews with a psychiatrist. Participants in the CBT-Med group also received an eight-session CBT provided by a multidisciplinary treatment team including
a psychiatrist, nurse, psychologist, and social worker.

  1. CBT combined with bupropion was effective for treating online game addiction in adolescents with co-morbid major depressive disorder, improving internet addiction scores, anxiety, and life satisfaction.

  2. CBT for substance abuse can be modified for the successful treatment of on-line game play.

  3. Treatment for only eight sessions, as in prior studies, has a significant clinical benefit.

  4. Consideration of psychiatric comorbidity is essential for optimizing treatment outcomes in adolescents with problematic on-line game play.

  5. Bupropion seems helpful in the treatment of behavioral addiction in addition to substance dependence.
3 Longer Term Effect of Randomized, Controlled Group Cognitive Behavioral Therapy for Internet Addiction in Adolescent Students in Shanghai [48] Du,
2010
RCT		 Active group: 32
Control group: 24		 Age Range
12–17
Mean Age: Active group: years old 15.39 (SD = 1.69)
Control group: years old 16.63 (SD = 1.23)

  1. Beard’s Diagnostic Questionnaire for Internet addiction

  2. Internet Overuse Self-Rating Scale

  3. Time Management Disposition Scale

  4. Strength and Difficulties Questionnaire (Chinese edition)

  5. Screen for Child Anxiety Related Emotional Disorders (SCARED)

 This study utilizes a Multimodal school-based intervention with three components
1—8 sessions of Group CBT delivered to 6–10 adolescent students by two child and adolescent psychiatrists. Each session lasted 1.5–2 h, and discussed a unique topic.
2—Group cognitive behavioral parent training.
3—Psychoeducation provided to teachers about identification and treatment of Internet addiction.		 Multimodal school-based group CBT is effective for adolescents with Internet addiction, particularly in improving emotional state and regulation ability. It also leads to improvement in behavioral style and self-management style.
4 Evaluation of a School-Based Program for Internet Addiction of Adolescents in Turkey [49] Uysal,
2018
RCT		 Active group: 41
Control group: 43		 Age Range:
11–16
Mean Age:
Active group: years old 13.1
Control group: 13.05 years old		 Internet Addiction Scale (IAS) Healthy Internet Use Program.
This program involves 8 sessions (each 40–80 min long) over a 3-month period. The sessions covered topics regarding internet use and its impact. Parents were interviewed before the start, and in the last week of the program. Also, weekly phone calls were made to parents to track internet use.		 The findings suggest that use of the
Healthy Internet Use Program decreases the rate of internet addiction among adolescents.
5 Electro-acupuncture treatment for internet addiction: Evidence of normalization of impulse control disorder in adolescents [46] Yang,
2017
RCT		 Active group:
EA (electro-acupuncture): 16
PI (Psychological Intervention): 16
Control group: 16		 Age Range:
18–30
Mean Age:
Active group:
EA (electro-acupuncture): 21.13 (SD = 1.3)
PI (Psychological Intervention): 21.65 (SD = 2.36)
Control group: 21.50 (SD = 1.41)

  1. Young’s Internet Addiction Test (IAT)

  2. Barratt Impulsiveness Scale (BIS-11)

  3. Ratio of brain N-acetyl aspartate (NAA) to creatinine (NAA/Cr) and Choline (Cho) to creatinine (Cho/Cr)

 Electro-acupuncture was administered on 10 acupoints using 0.3 mm × 40 mm needles for LI 4, PC 6, LR 3, and SP 6, and 0.3 mm × 25 mm needles for GV 20 and EX-HN 1. Electric stimulation with 2 Hz dilatational and 100 Hz condensation waves was applied, adjusting intensity according to patient tolerance. Needles remained for 30 min per session, given every other day for a total of 20 sessions across 45 days, comprising two treatment courses.

  1. Both EA and PI had significantly positive effects on internet addiction adolescents, especially in the aspects of psychological experiences and behavioral expressions.

  2. EA might have an advantage over PI in terms of impulsivity control and brain neuron protection.

  3. The mechanism underlying this advantage might be related to the increased NAA and Cho levels in prefrontal and anterior cingulate cortices.
6 Effect of solution-focused approach on problematic internet use, health behaviors in schoolchildren [50] Akgül-Gündoğdu,
2023
RCT		 Active group: 64
Control group: 64		 Age Range:
10–15
Mean Age:
Active group: 12.66 years old
Control group: 12.89 years old

  1. Young’s Internet Addiction Test

  2. Nutrition–Exercise Behavior Scale

  3. Nutrition–Exercise Attitude Scale

  4. Perceived academic success

 In the study, four groups of 16 students discussed their internet usage and participated in Solution-Focused Approach (SFA) techniques to address problematic internet use. Techniques included Magic Sphere, Letter Writing, Miracle Question, Exceptional Situation Question, Cheerleading Effect/Compliment, Grading, and Homework. Students attended six sessions, held every two weeks, lasting 30–45 min each. The intervention group attended six solution-focused approach (SFA) group meetings. SFA may prevent students’ uncontrolled internet use, help them gain positive health behaviors, and increase perceived academic success.
7 Effectiveness of atomoxetine and methylphenidate for
problematic online gaming in adolescents with attention deficit
hyperactivity disorder [51]		 Park,
2016
Single Blinded RCT		 Active group:
MPH: 44
ATM: 42
No Control Groups.		 Age Range:
13–18
Mean Age:
Active group:
MPH: 16.9 years old (SD = 1.6)
ATM: 17.1 years old (SD = 1)
No Control Groups.

  1. Young Internet Addiction Scale

  2. Beck Depression Inventory

  3. ADHD Rating Scale

  4. Behavioral Inhibition and Activation Scales

 Participants were randomly assigned to either the MPH group or the ATM group at a 1:1 ratio. The MPH group participants started on MPH 10 mg/day and increased to 40 mg/day during the first 2 weeks as per individual symptoms. The ATM group participants were started on ATM 10 mg/day and increased to 60 mg/day during the first 2 weeks as per individual symptoms.

  1. Both methylphenidate (MPH) and atomoxetine (ATM) reduced the severity of Internet gaming disorder symptoms.

  2. This reduction was correlated with impulsivity reduction, which also resulted from both attention deficit hyperactivity disorder (ADHD) medications.
8 Effect of Social-Psychological Intervention on Self-Efficacy, Social Adaptability, and Quality of Life of Internet-Addicted Teenagers [52] Zhao,
2022
RCT		 Active group: 50
Control group: 50		 Age Range:
12–19
Mean Age:
Active group: years old 15.25 (SD = 2.12)
Control group: 15.16 years old (SD = 2.18)

  1. Internet Addiction

  2. Self Efficacy

  3. Internet Addiction Strategy Change

  4. Social Adaptability

  5. Quality of Life

 Participants were divided into five groups of 10, based on common traits, and met weekly for 1-h sessions over three months. They fostered relationships and identified healthy internet use by watching addiction-related sitcoms, sharing feedback, feelings, and suggestions to improve their online behaviors. Finally, they signed a behavior contract and publicly committed to rectifying their ‘bad’ online habits. Social psychological intervention can effectively improve the self-efficacy of internet-addicted teenagers, correct.
Their bad surfing habits and improve their social adaptability and quality of life.
9 Efficacy of a Mobile App-Based Coaching Program for Addiction
Prevention among Apprentices: A Cluster-Randomized
Controlled Trial [53]		 Haug,
2022
Cluster- RCT		 Active group: 688
Control group: 663		 Age Range:
16–19
Mean Age:
Active group: years old 17.3 (SD =2.7)
Control group: years old 17.4 (SD = 3.2)

  1. At risk-drinking in the preceding 30 days

  2. 30 days point prevalence for tobacco/e-cigarette smoking

  3. Number of tobacco cigarettes smoked in the previous 30 days

  4. Cannabis use days in the preceding 30 days

  5. Problematic Internet use (Short Compulsive Internet Use Scale)

  6. Short Scale for Measuring General Self Efficacy Beliefs

 participants used a mobile app-based program ready4life, which provides individualized coaching by a conversational agent based on information provided by participants. Participant can then choose 2 out of 6 modules and chose to receive coaching for each topic
for a total of 8 weeks		 The mobile app-based coaching was effective in reducing risk behaviors such as at-risk drinking and problematic Internet use in a group of adolescents who have an especially high risk of engaging in addictive activities.
10 Effects of a brief school-based media literacy intervention on digital media use in adolescents: Cluster randomized controlled trial. [54] Walther,
2014
cluster-RCT		 Active group: 804
Control group: 1039		 Age Rage: 10–14
Mean Age:
Active group: 11.8 years old (SD = 0.80)
Control group: 12.1 years old (SD = 0.83)

  1. Adolescents’ computer gaming and Internet use: days per month, hours per day, and addictive use patterns

  2. Parental media monitoring and rules at home

 Participants engaged in a media literacy program Vernetzte www.Welten (“Connected www.Worlds”) which was implemented by trained teachers during class time. The control group attended regular class.

  1. Significant intervention effect in terms of a lower increase in self-reported gaming frequency, gaming time, and proportion of excessive gamers in the intervention group.

  2. Significant group–time interactions for the addictive gaming scale and the Internet Addiction Scale.

  3. No effect was found for days and hours of Internet use or parental media behavior.