Evaluating an Integrated Motivational and Cognitive-Behaviour Therapy Model for Chinese Adolescents with Gaming Disorder Symptoms: A Three-Arm Study

Background

Gaming disorder (GD) is a serious concern affecting adolescents globally and in China. As a relatively newly endorsed mental disorder, current intervention studies on GD are beset with conceptual and methodological problems. Conceptually, an empirically based framework for understanding the GD phenomenon is lacking. Although motivational factors are a significant predictor of GD, they have not been meaningfully integrated into any intervention model for working with adolescents with GD. Current studies have been heavily criticized for significant methodological flaws, such as non-random assignment, a lack of appropriate control groups and small sample sizes, which prevent any meaningful conclusion about their treatment efficacy.

Objectives

This study is a three-year outcome study with a mixed design. The first part is a quantitative outcome evaluation of two GD interventions, and the second part involves qualitative feedback from participants of the interventions. This study has four aims: (1) to refine an Integrated Motivational and Cognitive Behaviour Therapy (IMCBT) programme for Chinese adolescents with GD; (2) to examine the efficacy of IMCBT and Cognitive-Behaviour Therapy (CBT) for alleviating GD symptoms among Chinese students with GD, (3) to examine the potential mechanisms leading to change in the outcomes in the two approaches. It will examine both the immediate and longer-term effects of the two interventions and the potential mechanisms underlying the changes in the participants and (4) to collect feedback from IMCBT and CBT participants about their experiences in the group processes.

Method

For the outcome evaluation, a cluster randomized control design with baseline, postintervention and 3-month and 6-month follow-ups will be employed. One hundred and fifty high school students aged between 14-18 in four cities will be randomly assigned into IMCBT, CBT and support groups as a control condition. Each group will include eight students rated to be above the threshold of internet gaming symptoms assessed by the Chen Internet Addiction Scale. They will be provided with eight sessions of interventions facilitated by school counsellors, who will receive ongoing training and supervision for one year provided by CBT experts in mainland China and Hong Kong. We hypothesize that participants in the IMCBT and CBT programmes will exhibit significantly greater improvement in outcomes postintervention and at follow-ups than participants in the support groups and that the outcomes for participants in the IMCBT groups will be significantly better in all measured variables than those in the CBT groups. For the qualitative feedback, this study will draw on semistructured individual interviews incorporating open-ended questions to collect feedback from participants receiving the IMCBT and CBT interventions about (1) the changes, if any, in their gaming behaviours, gaming motivation and gaming cognitions; (2) factors contributing to these changes/no changes; and (3) various group characteristics related to the changes or a lack of change. Thematic analysis will be used to identify the themes and subthemes that pertain to firsthand personal opinions relating to the three objectives of this study.

Significance

This is one of the first few conceptually driven and rigorously designed studies attempting to address the rising mental health concerns about adolescents with GD in a Chinese society. If found to be efficacious, the intervention models can be adopted for use with Chinese adolescents in different parts of the world.