The term Internet use disorders (IUD) covers addictive behaviors related to the use of Internet applications and contents such as online computer games, social networks, online pornography and shopping platforms. Research findings have demonstrated that IUD lead to significant psychological, societal and social impairments. Based on scientific evidence and clinical requirements, Internet Gaming Disorder (IGD) has been included in the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11). The formal recognition of IGD as a disorder due to behavioral addiction has been highlighted as an achievement regarding the nosological classification and the development of treatment approaches. In addition to IGD, other IUD appear to be of comparable clinical relevance considering their addictive potential and the aversive consequences. Scientific research on interventions for IUD is still at an early stage and further studies are required. Although, systematic reviews and meta-analyses suggest that Cognitive Behavioral Therapy (CBT) may be an effective treatment approach for IUD. Even though the availability of specific interventions for the treatment of IUD is steadily increasing, access barriers and a low utilization of outpatient services lead to shortages of sufficient health care. Digital interventions have the potential to facilitate access to healthcare services and to address treatment barriers.
Based on the current state of research, digital interventions for IUD were investigated in the cumulative dissertation. The research project was embedded in the online short-term therapy of the randomized controlled trial Stepped Care Approach for Problematic Internet use Treatment (SCAPIT; German: Stepped Care Ansatz zur Versorgung Internetbezogener Störungen, SCAVIS). The first study synthesized the systematic evidence for treatment interventions for IUD in order to critically appraise the quality of reporting according to the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guidelines. The evaluation of systematic reviews and meta-analyses of interventions for IUD revealed considerable heterogeneity in terms of classification of addictive Internet behaviors and treatment approaches. In addition, a lack of studies on IUD manifestations other than IGD was highlighted. The assessment of the quality of reporting indicated deviations from the PRISMA guidelines in terms of missing information on the methodological and scientific approach. The second study was conducted as part of the scientific monitoring of the pilot phase of the online short-term therapy. Baseline data collected from the pilot sample were analyzed to provide preliminary information on clinical characteristics of treatment recipients. A descriptive analysis of sociodemographic data, psychopathological and individual variables was performed and correlations with symptoms of IUD were analyzed. Results of the study revealed that comorbid psychopathologies were associated with INS. The majority of participants reported at least one comorbid mental disorder at the time of inclusion in the online short-term therapy, while affective disorders were most prevalent. In the third study effects of psychopathological symptoms and impairments of functioning on symptom severity of IUD and the duration of Internet use was examined in the sample of patients. Based on a dichotomous classification of the symptom severity of IUD, differences among participants presenting moderate compared to severe addictive Internet behavior were analyzed. Besides psychosocial impairments, depressive, social phobic and somatoform symptoms were assessed. Results of the regression analyses confirmed that psychopathological symptoms and impairments of functioning had a significant effect on symptoms of IUD. Participants with severe addictive Internet behavior exhibited significantly higher psychopathological strains compared to patients with moderate addictive Internet behavior.
In summary, findings of the three studies contribute to the scientific evidence base of digital interventions for IUD. Results of the first study highlight that the current evidence on treatment interventions for IUD is limited by considerable heterogeneity and shortcomings in reporting. Further studies are urgently required to investigate digital treatment approaches. Findings of the second study underline the relevance of studies on certain manifestations of IUD and confirm that those affected commonly exhibit additional psychopathologies in clinical setting. Further, results of the third study imply opportunities for the expansion of the health care system by considering digital interventions as a promising way to minimize access barriers, and to provide evidence-based treatments for those affected. Additional research studies with high methodological quality should be conducted to confirm the findings and to promote the evidence base for digital interventions for the treatment of IUD.
