Requirements of a Group Intervention for Adolescents with Internet Gaming Disorder in a Clinical Setting: A Qualitative Interview Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. IGD Group Therapy Program
- “Program start and motivation of participants”.
- “Development of a disturbance model”.
- “Role of own feelings and individual goal setting”.
- “Development of control behavior and compensation mechanisms”.
- “Importance and development of relationships”.
- “Interim review of achievements”.
- “Relapse prevention and dealing with social pressure”.
- “Conclusion and farewell”.
2.2. Participants and Procedure
2.3. Interview Conduction
2.4. Analysis of the Data Material
3. Results
3.1. Interviews with Patients
3.1.1. Patients’ Characteristics
- Escape;
- Neglect;
- Loss of control.
3.1.2. Functional Aspects of Gaming
3.1.3. General Setting of the Group Therapy
- Requirements for a functional group setting
- Respectful interaction between group members;
- Mutual support of group members;
- Stable group constellations;
- Difficulty with unstable group constellation;
- No difficulty with unstable group constellation;
- Positive group atmosphere;
- Working on tasks;
- Presentation of contents.
3.1.4. Effective Treatment Factors
- Problem identification and discussion;
- Structure of everyday life;
- Group cohesion.
3.1.5. Experiences with Group Therapy Contents
- Level of knowledge about psychoeducative contents;
- Helpful group content;
- Psychoeducation;
- Addressing individual problematic behavior;
- Fun;
- Competent group leaders;
- Interesting group content;
- Mechanisms of IGD and regaining control over gaming;
- Conception and mechanisms of games;
- Less helpful group content;
- Contents without personal reference;
- Content without gaming reference;
- Redundant content (with regard to other attended therapy groups);
- Challenging group content.
3.1.6. Increase and Maintenance Motivation for Group Therapy
- Feedback on individual progress;
- Motivation through meaningful others;
- Positive reinforcement;
- Structuring of group therapy sessions.
3.1.7. Therapeutic Diary and Homework
- Motivational aspects for regular filling in of the therapeutic diary;
- Self-responsibility;
- Professional support;
- Diary structure;
- Volume of homework;
- Optional homework.
3.1.8. Suggestions for Modifications of the IGD Group Therapy
- General conditions;
- Conduction of group therapy;
- Guidance by the group leader;
- Content details;
- Creation of tension.
3.2. Interviews with Experts
3.2.1. Patient Requirements
- Indication;
- Individual group ability.
3.2.2. Therapist Requirements
3.2.3. General Conditions
- Requirements of a functional group setting;
- Group structure;
- Group composition;
- Task setting;
- Therapy motivation;
- Transparency;
- Social competence;
- Feedback and positive reinforcement;
- Long-term consequences;
- Presentation of contents.
3.2.4. Reflection of the Therapy Contents
- Important/effective contents;
- Psychoeducation;
- Therapeutic diary;
- Social competence training;
- Emotion management;
- Control mechanisms;
- Building up alternative activities;
- Reflection on the group participation and saying goodbye;
- Challenging content;
- Individual disorder model;
- Situational control;
- Scope for structuring the sessions.
3.2.5. Homework
- Relevance;
- Motivation;
- Therapeutic diaries.
3.2.6. The Role of Parents in Therapy
4. Discussion
4.1. Patients’ Characteristics
4.2. Group Content
4.3. Group Setting
- Physical and psychological safety;
- Appropriate structure;
- Supportive relationships;
- Opportunities for belonging;
- Positive social norms;
- Support for efficacy and mattering;
- Opportunities for skill building.
4.4. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Question | |
---|---|
Current state of knowledge of psychoeducation and individual gaming behavior | |
1. | At this point in your treatment, how informed do you feel about your use of the Internet and online games? 1.1 What could be discussed more intensively? 1.2 What is too much? |
2. | What do you think is your biggest problem in terms of online gaming? |
Group therapy contents | |
3. | What brings you the most out of your treatment? |
4. | When has the group been helpful for you? With what feeling do you leave a helpful session? |
5. | What content of the IGD group do you consider most interesting? |
6. | What is less helpful/challenging for you in the IGD group? |
Suggested changes/additions to the current therapy | |
7. | Imagine you are a therapist, and you are leading the IGD group: what would you do in a different way? 7.1 What content would you add? |
8. | How did you achieve a lasting change in your behavior and reduce your gaming? |
General therapy setting | |
9. | How can the motivation for the IGD group be maintained? |
10. | What is particularly important for you regarding the group setting? |
11. | How do you feel about the fact that new participants keep joining the IGD group? 11.1 Can you think of anything that might make it easier to be more open in front of other patients? |
12. | How do you prefer to work on the tasks in the IGD group (alone, in groups of two, group discussion)? |
13. | What is the best way for you to present the group’s content (flipchart/whiteboard)? Can you think of any improvements in this regard? |
Dealing with homework | |
14. | What can increase the motivation to keep the diary continuously? |
15. | Let’s assume that the diary would become more extensive, for example, by including information on the daily structure. How realistic is it that it will still be kept regularly? |
16. | Is there anything else important you want to talk about that I haven’t asked yet? |
Appendix B
Question | |
---|---|
Requirements for participants | |
1. | How is a good selection of participants made? (Indication, group ability) |
2. | How can the age difference between patients be handled in the group therapy setting? |
3. | What can maintain motivation to participate in group therapy? |
Requirements for group leaders | |
4. | What are the requirements for the group leader? |
General therapy settings | |
5. | What is important to consider regarding the group setting? |
Group therapy contents | |
6. | What content should be included in a group program? |
7. | What is effective for participants in group therapy? How is this noticeable? |
8. | What is challenging for participants in group therapy? How does this become noticeable? |
Presentation of the contents | |
9. | What form of presentation of the content addresses the patients well? (Reference: age differences of the participants) 9.1 What improvements can you think of for the presentation? 9.2 How can the content be integrated into everyday life in a more lasting way? |
10. | What aspects should be included in an Internet-diary to best encourage reflection on Internet use? |
11. | What is your experience with homework? Which form is best for it? |
12. | Is there anything else important you want to talk about that I haven’t asked yet? |
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Age at the Time of Treatment | Gender | Treatment Duration at the Time of the Interview | Treatment Type | Comorbid Diagnoses | |
---|---|---|---|---|---|
P1 | 17 years | male | 8 weeks | day clinic | F32.1, F93.8 |
P2 | 12 years | male | 4 weeks | day clinic | F32.1, F90.0, F91.3, F93.8 |
P3 | 16 years | male | 10 weeks (discharged) | inpatient | F81.0, F90.0, F93.8 |
P4 | 17 years | male | 14 weeks (discharged) | inpatient | F10.2, F12.1, F32.2 |
P5 | 16 years | female | 4 weeks | inpatient | F93.8 |
P6 | 18 years (16 years) | male | 4 weeks/2. stay (1. day clinic treatment in 2019 [12 weeks]) | day clinic | F12.1, F33.2, F90.0, F93.8 |
P7 | 15 years | male | 4 weeks | inpatient | F12.2, F15.1, F17.2, F32.2, F50.4, F90.0 |
Question | |
---|---|
Group therapy contents | |
1. | What brings you the most out of your treatment? |
2. | When has the group been helpful for you? With what feeling do you leave a helpful session? |
3. | What is less helpful/what is especially challenging for you in the group? |
Suggested alterations of the current group program | |
4. | Imagine you are a therapist, and you are leading the IGD group: what would you do differently? |
General group therapy setting | |
5. | How can the motivation for the group be maintained? |
6. | What is particularly important for you regarding the group setting? |
7. | How do you feel about the fact that new participants are joining the group? |
Dealing with homework | |
8. | What can increase the motivation to keep the diary continuously? |
Main and Subcategories | Selected Anchor Examples * | Reference |
---|---|---|
1. Patients’ characteristics | ||
1.1 Escape | Escape from stress and problems at school or in the family: | |
“[I played digital games] because I just had a bunch of problems at home, at school and in my personal life.” | I. 06, l. 1276 | |
“[I’ve had] permanent trouble at home. And I just backed off because of that, [...] [I played] to just take my mind off of it.” | I. 05, l. 1026 | |
Escape from worries and difficult emotions: | ||
“[..] I’m just gaming [...] because I have so many worries [...] because I’m depressed.” | I. 03, l. 491 | |
Escape from interpersonal problems: “I play games because I used to get bullied at school.” | I. 05, l. 1024 | |
1.2 Neglect | Neglecting school and family responsibilities or leisure activities: “During school time I definitely neglected school. I didn’t go there at all […]. I’ve never done homework either way.” | I. 08, l. 1551 |
“The biggest problem with that is that I pretty much neglect my family [...]. I also no longer engage in [other] recreational activities [than gaming].” | I. 03, l. 571–573 | |
1.3 Loss of control | “[…] when I am gaming, I can’t stop that well.” | I. 09, l. 1715 |
2. Functional aspects of gaming | Being someone else: “I [could] be someone completely different [...] with a completely different story. And I could then open myself up and […] | I. 06, l. 1276 |
lose myself in this world.” “[I game] because I can be a different person [there than I am in real life].” | I. 03, l. 493 | |
3. General setting of the group therapy | ||
3.1 Requirements for a functional group setting | ||
3.1.1 Respectful interaction between group members | “I think it’s important that you get along with the people [...] and that you get along with each other and don’t trouble each other.” | I. 05, l. 1148 |
“The […] [group members] don’t have to be best friends, but everyone has to get on well with each other. [It is important] that you […] follow the group rules. That is how it should be in a group.” | I. 06, l. 1350 | |
3.1.2 Mutual support of group members | Support of restrained co-patients: “If you have a more open character yourself, you just try to include [the others] [...] in the group. And you always try to build up a little bond so that they are more familiar with the group itself and then some of them dare to say something in front of the group.” | I. 01, l. 136–138 |
Of new group members: “I think you also have to be attentive to others, especially to the new […] [group members].” | I. 03, l. 661 | |
In the form of mutual encouragement: “When people [...] have accomplished something, what concerns the computer [use patterns], I also have the feeling that I have the motivation to achieve this. I am also happy for the person [for his success].” | I. 08, l. 1603 | |
3.1.3 Stable group constellation | ||
3.1.3.1 Difficulty with unstable group constellation | Difficulty opening up in front of others: “I have so much social anxiety anyway and I don’t like to say anything in front of strangers. [...] Especially when talking about problems.” | I. 09, l. 1815–1817 |
Composition of the therapy group of day clinic and ward: “[…] it’s actually quite difficult, because I was on the ward [...] and most of the […] other […] [group members] were from the day clinic. It is really difficult to get to know them personally.” | I. 06, l. 1354–1356 | |
3.1.3.2 No difficulty with unstable group constellation | “I had no problems with adjusting to the new fellow patients in any way.” | I. 01, l. 134 |
“[…] opening up to people, [...] I have no problem with that.” | I. 08, l. 1609 | |
3.1.3.3 Positive group atmosphere | Getting to know new patients: “I think you have to get to know them first to really see “Yeah ok what’s he like? How should I behave?” | I. 03, l. 657 |
Fun in the group: “If you can laugh with other people, you feel much more comfortable with them.” | I. 07, l. 1484 | |
3.2 Working on tasks | Optimal way of task solving depends on the task: “It always varies. If it’s a task where you really have to work on it for yourself, then it’s good if you do it alone. If there’s a task where it’s about collecting a bunch of things, [...] then it’s cool if you do it in a group and one of you writes in front. Then there are also tasks where it’s good to work with a partner.” | I. 06, l. 1360 |
Group work improves social competence: “[…] that you do more in the group. Because it also increases social competence, for example, which I would say from my own experience is usually less present in other gaming patients [...] That’s why I think that group work is best.” | I. 01, l. 148–150 | |
Working in groups of two: “I prefer to work in pairs.” | I. 09, l. 1825 | |
Form of the task working is unimportant: “I actually found it didn’t matter […]” | I. 05, l. 1176 | |
3.3 Presentation of contents | Visual presentation of the content: “I am quite a [...] visual learner [...] the visualization of content is very important for me.” | I. 08, l. 1635–1637 |
“I am rather a visual learner.” | I. 06, l. 1364 | |
Form of presentation of the content is unimportant: “[it plays] not a big role.” | I. 01, l. 158 | |
4. Effective treatment factors | ||
4.1 Problem identification and discussion | “I think what was most helpful were the one-on-one sessions with the psychologists and psychiatrists. There we did not directly talk about my addiction, but also about the problems behind it […] why my gaming use became problematic.” | I. 06, l. 1294 |
4.2 Structure of everyday life | “That I create a daily plan, [...] so when my mom asks me to clean out the dishwasher, then I just do it […]. It no longer comes to conflicts because my mom thinks that I’m on the computer the whole time.” | I. 07, l. 1420 |
“The most important thing for me is that this therapy has finally helped me to pursue my goals [...] all the things that I wanted to do all along, I have now started to do.” | I. 01, l. 58–60 | |
4.3 Group cohesion | Exchange with other patients: “[…] to know that there are others…that you’re not the only one [...]. […] It’s also good to make progress with other people.” | I. 08, l. 1559–1561 |
5. Experiences with group therapy contents | ||
5.1 Level of knowledge regarding psychoeducation | Knowledge of IGD before the treatment: “I know what the risks are, what […] [gaming addiction] can do to you […]. But I already knew all that before.” | I. 07, l. 1388 |
“I knew the risks of gaming before I went into treatment.” | I. 08, l. 1531 | |
Satisfaction with explanation about the disorder in group therapy: “In general, I felt very informed.” | I. 06, l. 1252 | |
5.2 Helpful group content | ||
5.2.1 Psychoeducation | Understanding causes of pathological gaming: “[…] for example, [...] to learn about the triggers that tempt me to play.” | I. 01, l. 80 |
Risk of developing addiction: “[to learn about] how quickly one can become addicted [to gaming].” | I. 05, l. 1126 | |
Negative effects: “What I just said at the beginning with the [negative] effects.” | I. 05, l. 1124 | |
Learning to deal with GD: “[to learn] how to deal with […] [gaming disorder] and what alternatives you have [...] that would be useful.” | I. 01, l. 80 | |
5.2.2 Addressing individual problematic behavior | “To find another point of view or a new point of view or generally a point of view on one’s own addiction.” | I. 08, l. 1567 |
“To find an alternative for it [gaming] so that you don’t fall back into this old pattern.” | I. 01, l. 74 | |
5.2.3 Fun | “In this group you also have fun.” | I. 03, l. 597 |
5.2.4 Competent group leaders | “I found that it helped that Ms. X [anonymized] was always so nice to you and no matter what you said, she didn’t say “that’s wrong”, but also listened to everything and talked to you about it.” | I. 05, l. 1064 |
5.3 Interesting group content | ||
5.3.1 Origin of IGD and regaining control over gaming | “It was very interesting to talk about how much everyone played, what did they play, with […] [which device] did they play, with whom did they play [...]. And from that you could somehow also identify the reasons [for gaming addiction].” | I. 05, l. 1084–1086 |
“This kind of self-control. [...] That you really pay attention “ok, I have this period now, I have a game and that’s it.” | I. 06, l. 1306–1308 | |
5.3.2 Conception and mechanisms of games | “I think that’s the most interesting thing. [...] Seeing [what methods] game developers use to influence gamers’ brains to keep them engaged in the game.” | I. 08, l. 1577 |
5.4 Less helpful group content | ||
5.4.1 Contents without personal reference | “This often does not apply to me.” | I. 09, l. 1745 |
5.4.2 Content without gaming reference | “There were just [...] these non-gaming related modules, [...] which could have been done quite well in a skill group.” | I. 01, l. 88 |
5.4.3 Redundant content (with regard to other attended therapy groups) | “[Topics] that have already been discussed in another group. [...] were less useful.” | I. 01, l. 90 |
5.5 Challenging group content | First sessions in group therapy: “It was especially challenging that you should accept your own problematic behavior so quickly.” | I. 05, l. 1090 |
“If you must be open in the group, then it’s quite a lot [...] but only at the beginning. At some point it was okay.” | I. 05, l. 1110–1114 | |
6. Increase and maintenance of group therapy motivation | ||
6.1 Feedback of individual progress | “I think it’s always good when you see progress in yourself, because that’s when you realize “yeah ok, it’s getting better.” And then you have more motivation to stay on track.” | I. 06, l. 1342 |
6.2 Motivation through meaningful others | “I [came] to a new class. [...] And there was just a girl who I thought was cool. And at some point, I fell in love with her [...] And that was, among other things, a crucial point for me to really change and make something out of myself.” | I. 05, l. 1134 |
6.3 Positive reinforcement | “This Can-stop group [notes from the authors: a therapy group on substance use disorders], there you get a certificate when you [...] have achieved something. [...] To build in a reward system. [...] [that] could help quite a bit, I think.” | I. 08, l. 1593–1595 |
“You have to see that the children [...] want to participate. And then say, for example, “Yes, okay, this week we’ll pay attention [and if] you are all doing well […] we can play something [notes from the authors: this suggestion refers to group games not digital games].” | I. 03, l. 623–625 | |
6.4 Structuring of group therapy sessions | “ I would be motivated by more physical exercise during the group sessions.” | I. 01, l. 110 |
“That you arouse the interest of the participants by providing more tasks, involving them more and simply bringing more fun into the group.” | I. 07, l. 1468 | |
7. Therapeutic diary and homework | ||
7.1 Motivational aspects for diaries | ||
7.1.1 Self-responsibility | “I think that is a matter of the patient, how he motivates himself to fill in the diary.” | I. 01, l. 180 |
7.1.2 Professional support | “You just have to work more with the counselors I think, who then remind you every day to fill in the diary.” | I. 08, l. 1677 |
7.1.3 Diary structure | “The diary should be more easy to understand [...] then it would be easier and faster to enter the data.” | I. 03, l. 693–697 |
7.2 Volume of homework | “As it is now, it makes sense, but I wouldn’t add anything, because then at some point no one really wants to do it anymore.” “[If there would be more homework] I think it will be filled out even less, [...] so I would lack the motivation [to do the homework].” | I. 07, l. 1508 I. 09, l. 1845 |
7.3 Optional homework | “Especially at the beginning [...], I think it was extremely boring [...]. If you get one or two tasks that you should do until the next time, I don’t think it’s bad. [...] It doesn’t even have to be much, but just little things, if you’re really bored.” | I. 05, l. 1182–1186 |
8. Suggestions for modifications of the IGD group therapy | ||
8.1 General conditions | “[…] a little more time for the individual therapies.” | I. 01, l. 20 |
“I think the group in itself was partly very similar to other groups that were done [...] with all the fellow patients.” | I. 01, l. 66 | |
“If everyone was from the ward for addictive disorders, then everything would be good. So, then it would be easier for me to open up in front of the others.” | I. 09, l. 1819 | |
8.2 Conduction of group therapy | ||
8.2.1 Guidance by the group leader | “[…] that a better group climate is ensured and that the group leaders can be a bit more assertive [...] perhaps first of all make the group rules clear.” | I. 07, l. 1478–1480 |
“Plan the group more and don’t just let the participants sit around bored.” | I. 07, l. 1478 | |
“The focus was a bit too much on one person [...] if the psychotherapist had paid a bit more attention to the group [...] it is often the case that somehow only two or three people in the group talk.” | I. 01, l. 28–44 | |
8.2.2 Content details | “I found that some topics were not addressed enough. [...] It would be nice to discuss the topics in more detail.” | I. 05, l. 1118–1120 |
“[…] the therapist should say “ok, we are now collecting topics that are very important to you”. [...] In this way you personalize it a bit more.” | I. 06, l. 1326 | |
8.2.3 Creation of tension | “Maybe let the adolescents do more. [...] For example, give them more tasks[...] [or] let them do some handcrafts or whatever. Just do something that is also fun.” | I. 07, l. 1460–1462 |
“Less paperwork, more discussion.” | I. 09, l. 1765 | |
“Maybe we should play a game every now and then [...] also with regard to the modules.” | I. 01, Z. 164 |
Main and Subcategories | Selected Anchor Examples * | Reference |
---|---|---|
1. Patient requirements | ||
1.1 Indication | “At first it is important to clarify whether the patient meets the diagnosis of internet gaming disorder. [...] This can be determined by means of self-assessment and external assessment questionnaires, which we give to the adolescents concerned and their parents. Self-assessment and external assessment are often very different, [which means that the affected adolescents often assess their usage behavior quite differently than their parents].” | I. 04, l. 724 |
“Then it’s important to check if any exclusion criteria apply for participation in the group. For example, you must consider beforehand whether someone with Asperger’s autism can fit in and feel comfortable in the group. Sometimes there are also comorbid conditions that show up in problematic gaming and need special treatment.” | I. 04, l. 734 | |
1.2 Individual group ability | Check for motivation to participate: “Before we accept a patient for the group, we have to check if there is enough motivation to participate in the group program. If not, we would have to do a lot of motivational work in the group and that would be difficult [as it would stop the rest of the group from progressing in the program].” | I. 04, l. 726 |
“I would not offer the group program to a patient who absolutely resists it and sees no benefit in it.” | I. 02, l. 318 | |
Introduce group rules and make sure they are followed: “It is very important to present the group rules [to the patients] so that they know what to expect and what they have to stick to. This includes, for example, being on time and doing homework.” | I. 04, l. 730–732 | |
2. Therapist requirements | Being experienced in working with groups: “You should always keep in mind that it’s not always about one individual, but that the group dynamic is also important […] that the group coherence is encouraged.” | I. 02, l. 330 |
“You should know the comorbid disorders of all participants. [...] So that you don’t over- or under-challenge them.” | I. 04, l. 774 | |
Gaming and disorder-specific knowledge: “In addition to knowledge about gaming addiction, being a group therapist also requires you to keep up to date with computer games. You should definitely know from what age a game is allowed, what addictive factors it includes (e.g., the reward system) and what nicknames the patients have in the game. It is also advisable to simply try out certain games yourself.” | I. 04, l. 766–774 | |
3. General conditions | ||
3.1 Requirements of a functional group setting | ||
3.1.1 Group structure | “Patients with internet gaming disorder often have no daily structure. Therefore, it is very important that a structured approach is taken in the group program.” | I. 02, l. 388 |
“The beginning of each group session should always be similar. For example, the therapeutic diary should always be discussed at the beginning. Then there should be a main part in which knowledge is shared and self-reflection is encouraged. At the end, there should always be a final group discussion. This sequence gives patients a simple structure and they know what to expect in the group sessions.” | I. 04, l. 786–788 | |
3.1.2 Group composition | Group size: “I accept a maximum of 8 patients in the group. This encourages patients to share experiences and create memories together.” | I. 02, l. 344 |
Age differences: “I do not attach any importance to the age of the patients.” | I. 02, l. 348 | |
“It’s an advantage to have different age groups represented.” | I. 04, l. 790 | |
“I assign more responsibilities to the older adolescents in the group program.” | I. 04, l. 742 | |
“We have also noticed in our work again and again that it is difficult when you have, for example, 11-, 12-year-olds [...] and 16-, 17-year-olds [in one group]. And that’s why I think the group rules are very important.” | I. 04, l. 738–740 | |
3.1.3 Task setting | “The same tasks are given to each patient. [...] [but to someone] with a severe ADHD, who is not medicated, I explain things differently [...] than to someone who is super shy. [...] That doesn’t just have to do with age. It also has to do with the individuality of the patient clientele.” | I. 02, l. 372–384 |
“I would always do different worksheets. [...] The younger patients are often really overloaded with some tasks. Therefore, I make sure that the worksheets are easier to understand and the design is also a bit more appealing to them.” | I. 04, l. 744–746 | |
3.2 Therapy motivation | ||
3.2.1 Transparency | “It is important to discuss the program goals and therapy content in detail at the beginning. Patients are often very grateful for this.” | I. 02, Z. 330 |
3.2.2 Social competence | “Then it is very important to get the patients to motivate each other. That’s why I also introduced this final round at the end of each group session, in which the patients assure each other that they will attending the next session. [...] Because then, of course, it is a social promise.” | I. 02, l. 338–340 |
3.2.3 Feedback and positive reinforcement | “Patients should always be encouraged to reflect on what has changed positively for them during the program. […] What has changed in family life? Are there perhaps fewer fights? What has changed in school?” | I. 04, l. 754–756 |
“I also try to motivate patients with rewards.” | I. 04, l. 762 | |
3.2.4 Long-term consequences | “I do not only [point out] the short-term negative consequences of internet gaming disorder, but also the long-term consequences. The patients usually don’t know about these.” | I. 04, l. 760 |
“I always write a pro and con list of IGD to motivate patients to change. In doing so, I also consider short- and long-term consequences of gaming. [...]What is the argument for me to continue playing as usual? What is the argument against it, why should I stop excessive gaming?” | I. 04, l. 812 | |
3.3 Presentation of contents | “I only use a flipchart. [...] I deliberately do it that way because in my group therapy and in my understanding of what is effective, it’s about getting in touch. [...] They are sitting in front of the screens all the time.” | I, 02, l. 392–396 |
“I think it is enough [...] if you make a flipchart and try to visualize the contents nicely.” | I. 04, l. 880 | |
4. Reflection of the therapy contents | ||
4.1 Important/effective contents | ||
4.1.1 Psychoeducation | “Of particular interest is the psychoeducational part of the program, in which the patients had to think for themselves whether the criteria of internet gaming disorder applied to them or not. [...] The self-knowledge that one is addicted is of course something completely different for the patient than when teachers or parents tell him that he is an addict. If it is possible to create a trusting, honest atmosphere in therapy and a patient recognizes for himself: “yes, I am on the verge of fulfilling such a diagnosis” [...], then an important requirement for successful treatment is met.” | I. 02, l. 234–238 |
Psychoeducation content: “I would always do the addiction cycle, to explain how IGD develops in the first place. I think that’s important. The patients start to ask themselves “what is gaming actually doing to me? How did I actually start to become addictive?” | I. 04, l. 808 | |
“I have noticed that it is important to show the patients the long-term consequences of internet gaming disorder. They should think for themselves what it would be like if they didn’t graduate from school because of excessive gaming, if they were constantly dependent on the state, on their parents...that they couldn’t lead an independent life. They often don’t want that to happen.” | I. 04, l. 836–842 | |
“I also think it’s important to explain the game mechanisms to the patients. [...] They should know the addictive characteristics of games and how game developers deliberately use them to achieve high user retention. Patients should also understand the reward system used in digital games. Most of them are not aware of it at all.” | I. 04, l. 810 | |
4.1.2 Therapeutic diary | “In the therapeutic diary, patients can record how much they played at the beginning of therapy and how that changed after therapy.” | I. 04, l. 816 |
4.1.3 Social competence training | “The social competence training [...] is very important to encourage patients to think about whether they behave toward others the way they want to.” | I. 02, l. 238–240 |
4.1.4 Emotion management | “I always discuss with patients how to deal with stress and negative emotions [...]. “How can I deal with anger? How can I deal with grief?” I find these are the most difficult emotions for adolescents. They often have to learn new strategies for dealing with these emotions. For example, they don’t know what to do when they’re angry, and in the past, they’ve then often turned on the computer.” | I. 04, l. 828–830 |
4.1.5 Control mechanisms | “You should consider with the patient what technical settings and rules are necessary to keep gaming under control. The patient could, for example, set certain gaming times or agree not to play until homework has been completed.” | I. 04, l. 822–826 |
4.1.6 Building up alternative activities | “The patients have to find new alternative activities and hobbies they like, because when the patients reduce their gaming time, they should have alternative activities they would like to engage in [...]” | I. 04, l. 814 |
4.1.7 Reflection on the group participation and farewell | Retrospective: “At the end of therapy, a proper farewell ritual is very important. Patients should realize that they have now spent eight weeks or eight sessions together. Social cohesion is an important aspect of the group program. The patients should also look back at the beginning of therapy. It is often the case that at the beginning none of the participants wanted to take part in the group and now they have managed to do so [...].” | I. 02, l. 248 |
Farewell: “The last session is very important. [...] To understand what it means to say goodbye. Because that is something that is rarely the case in computer games. [...] Somehow goodbye never happens because you just go off or change the game. And in everyday life, in everyday social life, it’s also rarely about saying goodbye to each other properly.” | I. 02, l. 242–246 | |
Relapse prevention: “Relapse prevention should be addressed at the end of the course. [...] The early warning signs of relapse and risk situations should be written down [...]. An emergency kit should be packed. Patients should determine who to contact if they relapse.” | I. 04, l. 830–832 | |
4.2 Challenging content | ||
4.2.1 Individual disorder model | “Patients should work out an individual disorder model for themselves [...]. In this way, they become aware of the personal and external factors that have led them to excessive gaming. The challenging part is that the patients have to admit their weaknesses. It is often stressful for them to realize what they are actually trying to suppress by gaming.” | I. 04, l. 866–872 |
“Family stressors should also be worked out. It should be talked about whether the parents have separated, or whether there was a lot of arguing, or whether there was violence at home.” | I. 04, l. 874 | |
4.2.2 Situational control | “I think the module where it’s about exercising situational control is very difficult. Because you often realize that a lot of patients have never reflected on their high usage times and what comes with it.” | I. 02, l. 270–282 |
4.3 Scope for structuring the sessions | “The modules leave room for flexibility. [...] You can choose modules based on what’s relevant to patients at that moment.” | I. 02, l. 286–292 |
“To stick strictly to the module is not possible with this topic anyway. [...] It requires a therapist who is also experienced enough to respond flexibly to the needs [of the patients] at that moment.” | I. 02, l. 306 | |
5. Homework | ||
5.1 Relevance | “I believe that the homework is very important [...]. At the beginning of the session, the homework of the last week should be discussed. I also ask the participants to briefly recall the contents of the last session.” | I. 04, l. 898–900 |
5.2 Motivation | “I think that for adolescents who have a rather negative attitude towards homework, they do it very well. [...] So, I think it’s going quite well.” | I. 02, l. 414–416 |
“Homework is always a difficult topic. I think it’s important to remind the patients to do it regularly.” | I. 04, l. 940 | |
5.3 Therapeutic diary | “It’s important to explain to patients why keeping a therapeutic diary is important. The advantage they gain from self-observation must be made clear to them. They should realize what effect self-observation has on their own behavior.” | I. 02, l. 428 |
“The therapeutic diary makes patients aware of everything they have done on the Internet and how long they have been doing it. This includes not only the time spent on the computer, but also the time spent on the smartphone. They can also enter in the diary when they went to bed and how long they slept. They can also note what alternative activities they did and what their mood was while doing them.” | I. 04, l. 924–936 | |
6. The role of parents in therapy | “If you could include the parents, it would be nice. [...] But yes, that is difficult, because the parents are usually only involved in the individual setting or in family sessions.” | I. 04, l. 904–906 |
“I would like it if the parents were in a “parent training” at the same time, because then I think the patients see that the parents are also doing something [...]. For the parents it is simply important to know how they can support their children at home. [...] A parent group program would be more intensive than if they now only go to a family session every three weeks.” | I. 04, l. 912–916 | |
“When half of the sessions are completed, it is important to ask the parents if anything has changed at home. Their feedback on the course of therapy is very important.” | I. 04, l. 920 |
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Wendt, L.M.; Austermann, M.I.; Rumpf, H.-J.; Thomasius, R.; Paschke, K. Requirements of a Group Intervention for Adolescents with Internet Gaming Disorder in a Clinical Setting: A Qualitative Interview Study. Int. J. Environ. Res. Public Health 2021, 18, 7813. https://doi.org/10.3390/ijerph18157813
Wendt LM, Austermann MI, Rumpf H-J, Thomasius R, Paschke K. Requirements of a Group Intervention for Adolescents with Internet Gaming Disorder in a Clinical Setting: A Qualitative Interview Study. International Journal of Environmental Research and Public Health. 2021; 18(15):7813. https://doi.org/10.3390/ijerph18157813
Chicago/Turabian StyleWendt, Lisa Marie, Maria Isabella Austermann, Hans-Jürgen Rumpf, Rainer Thomasius, and Kerstin Paschke. 2021. "Requirements of a Group Intervention for Adolescents with Internet Gaming Disorder in a Clinical Setting: A Qualitative Interview Study" International Journal of Environmental Research and Public Health 18, no. 15: 7813. https://doi.org/10.3390/ijerph18157813
APA StyleWendt, L. M., Austermann, M. I., Rumpf, H. -J., Thomasius, R., & Paschke, K. (2021). Requirements of a Group Intervention for Adolescents with Internet Gaming Disorder in a Clinical Setting: A Qualitative Interview Study. International Journal of Environmental Research and Public Health, 18(15), 7813. https://doi.org/10.3390/ijerph18157813