Effectiveness of Therapeutic Interventions in the Treatment of Internet Gaming Disorder: A Systematic Review

Abstract

Internet Gaming Disorder (IGD) has been recognized by the World Health Organization (WHO) in the International Classification of Diseases (ICD-11) and as an emerging condition in the DSM-5. IGD is increasingly prevalent, with various negative effects on individuals’ development and adaptation. To address this issue, different therapeutic interventions, like CBT, virtual reality, mindfulness, or family therapy, have been explored. This systematic review aimed to answer the following research question: What is the effectiveness of therapeutic interventions in reducing IGD symptoms in adolescents and young adults diagnosed with this disorder? Following PRISMA guidelines, 22 studies published between 2014 and 2025 were included. Results show that cognitive behavioral therapy (CBT) is the most effective intervention, significantly reducing IGD severity, anxiety, and depression. Combining CBT with physical exercise or mindfulness further enhanced outcomes. Other promising approaches include virtual reality (VR), transcranial direct current stimulation (tDCS), and family-based interventions. Additionally, treatments involving mindfulness and animal-assisted therapy showed potential in improving emotional regulation and interpersonal relationships. However, further research is needed to evaluate long-term efficacy and explore emerging therapies.

1. Introduction

Internet Gaming Disorder (IGD) has been recognized as a significant public health concern due to its impact on psychological, social, and functional well-being. The World Health Organization (WHO) included IGD in the International Classification of Diseases (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classified it as an emerging condition requiring further study (Castro-Calvo et al., 2021; Yen et al., 2022). IGD is characterized by impaired control over gaming, prioritization of gaming over other activities, and significant negative consequences in daily life, including academic, occupational, and social impairments (Auerbach et al., 2018; Jo et al., 2019).

The technological revolution and widespread access to online gaming have contributed to an increase in IGD cases, particularly among adolescents and young adults (Feng et al., 2017; Paulus et al., 2018). Several risk factors have been associated with IGD, including low self-esteem, difficulties in interpersonal relationships, high levels of stress, anxiety, and depression. In addition, lack of parental supervision, academic difficulties, and a history of other addictive behaviors increase the vulnerability to developing this disorder (Balhara et al., 2021; Fumero et al., 2020; Nielsen et al., 2020; Teng et al., 2020).

The most frequently reported symptoms of IGD include mood disturbances(depression, anhedonia, and anxiety). increased stress levels, low life satisfaction, and impulsivity (Bargeron & Hormes, 2017; De Pasquale et al., 2020; A. M. S. Wu et al., 2018). Given the growing prevalence of IGD and its negative impact, research has focused on (1) understanding its underlying mechanisms and risk factors and (2) evaluating the effectiveness of various therapeutic interventions (Lee et al., 2021; Pearcy et al., 2017).

Among these interventions, cognitive behavioral therapy (CBT) has been widely recognized as the first-line treatment for IGD, given its effectiveness in modifying addictive behaviors and maladaptive thought patterns (Dong et al., 2024; X. Han et al., 2018). However, recent studies have explored alternative and complementary interventions, such as mindfulness-based therapies, virtual reality (VR), transcranial direct current stimulation (tDCS), and family-based interventions (Li et al., 2017; Moghaddas et al., 2023; Park et al., 2016). These emerging approaches aim to enhance emotional regulation, improve impulse control, and strengthen social and family relationships.

Aim and Research Question

This systematic review aims to evaluate the effectiveness of IGD treatments of different therapeutic interventions in reducing IGD symptoms among adolescents and young adults. Specifically, this review seeks to answer the following research question: What is the effectiveness of therapeutic interventions in reducing IGD symptoms in adolescents and young adults diagnosed with this disorder? This study was conducted following PRISMA guidelines, ensuring a rigorous methodology for selecting and analyzing the relevant literature.

A systematic search was performed in Web of Science, ScienceDirect, PubMed, and Scopus, using Medical Subject Headings (MeSH) and Boolean operators to optimize the selection of studies published between 2014 and 2025. Inclusion criteria focused on experimental and quasi-experimental studies that assessed the effectiveness of interventions specifically targeting IGD. Studies with low methodological quality, case reports, and research focusing on populations with comorbidities unrelated to IGD were excluded.

By synthesizing current evidence on IGD treatments, this review aims to provide a comprehensive evaluation of their efficacy, highlight their strengths and limitations, and suggest future directions for research and clinical practice.

2. Materials and Methods

Following the guidelines established by the PRISMA Declaration and in accordance with the defined research protocol, a systematic review of the scientific literature was conducted from 3 to 9 January 2025. To achieve this, the electronic versions of the Web of Science, ScienceDirect, PubMed, and Scopus databases were consulted.

The search was based on a clinically answerable research question using the PIO format (

Table 1. PIO format.

Population	Adolescents and Young Adults (10–30 Years Old) Diagnosed with Gaming Disorder
Intervention	Treatment strategies, therapeutic interventions
Outcomes	Reduction in IGD symptoms
Research Question	What is the effectiveness of therapeutic interventions in reducing IGD symptoms in adolescents and young adults diagnosed with this disorder?

):

Subsequently, search strategies were designed and adapted for each database (

Table 2. Search strategies.

Database	Search Strategy
Pubmed	(“Gaming Disorder” OR “Video Game Addiction” OR “Internet Gaming Disorder” OR “Problematic Gaming” OR “Gaming Dependency” OR “Video Game Overuse” OR “Excessive Gaming”) AND (“adolescents” OR “young adults” OR “children” OR “teenagers” OR “youth”) AND (“therapy” OR “treatment” OR “psychological intervention” OR “cognitive therapy” OR “behavioral therapy” OR “mental health therapy” OR “CBT” OR “cognitive behavioral therapy”) AND (“outcomes” OR “symptoms” OR “improvement” OR “reduction” OR “health improvement” OR “clinical improvement”)
Web of Science	TS = (“Gaming Disorder” OR “IGD” OE “Video Game Addiction” OR “Internet Gaming Disorder” OR “Problematic Gaming” OR “Gaming Dependency” OR “Video Game Overuse” OR “Excessive Gaming”) AND TS = (“therapy” OR “treatment” OR “psychological intervention” OR “cognitive therapy” OR “behavioral therapy” OR “CBT” OR “cognitive behavioral therapy” OR “mental health therapy”) AND TS = (“symptoms” OR “outcomes” OR “improvement” OR “reduction” OR “health improvement” OR “clinical improvement”)
Scopus	TITLE-ABS-KEY(“Gaming Disorder” OR “Video Game Addiction” OR “Internet Gaming Disorder” OR “Problematic Video Gaming” OR “Gaming Dependency” OR “Excessive Gaming”) AND TITLE-ABS-KEY(“adolescents” OR “young adults” OR “children” OR “teenagers” OR “youth”) AND TITLE-ABS-KEY(“therapy” OR “treatment” OR “intervention” OR “psychological therapy” OR “behavioral therapy” OR “CBT”) AND TITLE-ABS-KEY(“symptoms” OR “outcomes” OR “improvement” OR “reduction”)
Science Direct	(“Gaming Disorder” OR “IGD” OR “Internet Gaming Disorder” OR “Video Game Addiction”) (“therapy” OR “treatment” OR “psychological intervention”) (“adolescents” OR “young adults” OR “youth”) (“symptoms” OR “outcomes” OR “clinical improvement”)

). During the search process, the corresponding Medical Subject Headings (MeSH) were used, along with Boolean operators and free-text search terms, some of which were truncated to include all possible variations and word endings.

The systematic review included original research studies that met the following criteria: experimental or quasi-experimental design, publication in English or Spanish, publication date from 2014 onwards, availability of at least an abstract, and evaluation of the effectiveness of the intervention in IGD as part of the results. The selection of 2014 as the starting year is due to the fact that this was when the scientific community began to develop specific treatments for Internet Gaming Disorder following its inclusion in the DSM-5 as an emerging condition.

Case reports, scientific letters, low-quality records, and studies that did not answer the research question, were unrelated to the objective of the review, or focused on specific population subgroups under 10 years old or over 30 years old were excluded.

Additionally, although ADHD and MDD are major comorbidities of IGD, the objective of this review is to determine the effectiveness of different treatments in patients with IGD. Therefore, the selection of studies was limited to patients with IGD without comorbid disorders.

The selection of studies and the evaluation of their methodological quality were carried out in pairs, independently, and in a blinded manner. Any discrepancies between reviewers were resolved by consensus, and in cases of persistent disagreement, a third reviewer was consulted.

To ensure uniformity in data collection, a standardized data extraction form was designed, including the following aspects for each article: title and main author, country and year of publication, study type and objective, sample size and characteristics, variables and instruments used, a summary of the main findings and conclusions, as well as the results of methodological quality assessment using the critical appraisal tools of the Joanna Briggs Institute at the University of Adelaide (Australia), adapted to the design of each study [insert annexes with questions].

To include studies in the systematic review, a minimum threshold was established: 6 out of 9 points for quasi-experimental studies and 9 out of 13 points for experimental studies.

Prior to the final analysis, a pilot test was conducted in which each reviewer evaluated three articles, and the concordance between their assessments was subsequently compared.

3. Results

Initially, 1288 studies were identified through the search strategies. After a full-text critical review, 24 studies were selected for inclusion in the systematic review (Figure 1).

With the selected studies, the previously mentioned data collection protocol was completed. The characteristics of the studies included in the systematic review can be found in Appendix A.

3.1. Description of the Characteristics of the Studies

A total of 24 studies were included in the systematic review, evaluating the effectiveness of different interventions for the treatment of Internet Gaming Disorder (IGD). Regarding study design, 11 studies were randomized clinical trials (RCTs), while 13 were quasi-experimental. The studies were conducted in Asia (n = 12, 50%), Europe (n = 6, 25%), North America (n = 4, 17%), and Oceania (n = 2, 8%), reflecting a global interest in IGD research.

The sample size ranged between 10 and 205 participants, focusing on adolescents and young adults aged 12 to 30 years. In more than half of the studies, participants were exclusively male (n = 12), while other studies included mixed samples (n = 9) with lower female representation, and one study did not specify the sex of the sample.

The instruments used assessed the severity of IGD with validated scales such as the Chen Internet Addiction Scale—CIAS (n = 4), Internet Addiction Test—IAT (n = 4), Internet Gaming Disorder Scale in both its long and short version (n = 5), Young Internet Addiction Scale (n = 3), DSM-5 diagnostic criteria (n = 3), Game Addiction Screening Assessment—GASA (n = 1), Game Addiction Screening Test (n = 1), or hours of gaming per day/week (n = 3). In addition, game craving was measured in nine of the selected studies, with instruments such as the Visual Analog Scale (n = 4), Signal Reactivity Task (fMRI) (n = 2), adaptation of the Tiffani questionnaire (n = 1), adaptation of the QSU-Brief smoking urgency questionnaire (n = 1), and the Online Game Signal Exposure Craving Questionnaire (n = 1).

To measure anxious symptoms (n = 12), the BAI scale was mostly used (n = 7), followed by the DASS-21 (n = 2) and the PSS-10 (n = 1). Depressive symptoms were measured in 11 studies, with the BDI as the most commonly used instrument (n = 8), together with the CDI (n = 1) and the DASS-21 (n = 2). Impulsivity was tested in six studies, mainly with the BIS-11 (three times) and the BIS/BAS (one time), while impulsivity in decision-making was assessed in five studies using the DDT (two times), the BART (two times) and the STT (one time). Brain activity and physiological responses were measured in nine studies, with fMRI (five times), EEG (two times), ECG (one time), and SCR (one time).

In addition, other variables such as personal and personality factors, quality of life and life satisfaction, interpersonal skills, physical activity and functional capacity, cognitive and general functioning, attachment, and family relationships were measured.

Of the 11 randomized controlled trials (RCTs) included in the review, five used a passive control group, meaning participants were placed on a waiting list or received no intervention (Hong et al., 2020; J. Han et al., 2020; Park et al., 2016; Maden et al., 2022; Zhao et al., 2022). In these studies, active treatments (such as cognitive behavioral therapy [CBT] or mindfulness-based therapy) showed significant improvements in reducing IGD severity, anxiety, and depression compared to no intervention. On the other hand, six studies included an active control group, where the experimental intervention was compared to an alternative therapeutic strategy, such as physical training, virtual reality, or transcranial direct current stimulation (tDCS) (Ni et al., 2024; Yao et al., 2017; Nielsen et al., 2021; Shin et al., 2021; Zheng et al., 2022; Kochuchakkalackal Kuriala & Reyes, 2023). Studies with an active control group provide greater incremental validity, allowing researchers to assess whether the benefits of a specific intervention exceed those of other available alternatives. In this regard, combined interventions, such as CBT plus physical exercise or mindfulness, demonstrated the most robust and sustained effects over time compared to isolated treatments.

Differentiation Between Clinical and Subclinical Samples

The studies included in this review varied in terms of sample characteristics, specifically whether participants met the full diagnostic criteria for Internet Gaming Disorder (IGD) or exhibited subthreshold symptoms. Of the 24 studies analyzed, 15 explicitly recruited participants diagnosed with IGD according to standardized criteria such as the DSM-5 or ICD-11 (J. Han et al., 2020; Hong et al., 2020; Nielsen et al., 2021; Park et al., 2016; Shin et al., 2021; Torres-Rodríguez et al., 2018; L. Wu et al., 2021; Zhang et al., 2016; Zhao et al., 2022; Zheng et al., 2022; André et al., 2023; Pornnoppadol et al., 2020; Kang et al., 2018; Marcelle et al., 2019; Sakuma et al., 2017). These studies primarily assessed the effectiveness of treatments in individuals with a confirmed clinical condition.

The remaining nine studies included participants with problematic gaming behaviors who did not necessarily meet the full diagnostic threshold for IGD but exhibited significant symptoms such as excessive gaming time, loss of control, and negative consequences in daily life (Igarashi et al., 2024; Kochuchakkalackal Kuriala & Reyes, 2023; Li et al., 2018; Maden et al., 2022; Nielsen et al., 2021; Ni et al., 2024; Zhang et al., 2018; L. Wu et al., 2021; Yao et al., 2017). Differentiating between clinical and subclinical samples is essential, as treatment effectiveness may vary depending on the severity of the disorder. It was observed that interventions such as cognitive behavioral therapy (CBT) and mindfulness-based therapy were effective in both groups; however, studies with clinical samples reported greater symptom reductions and more sustained effects over time.

As for statistical analyses, most used univariate tests to compare means before and after the intervention and multivariate tests to analyze different variables simultaneously.

When analyzing methodological quality and risk of bias, most studies achieved high scores, consistently exceeding the established threshold. The results can be seen in

Table 3. Results of the quality assessment of randomized trials.

Study	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	Q9	Q10	Q11	Q12	Q13
(Ni et al., 2024)	+	+	+	-	-	-	+	+	+	+	+	+	+
(Hong et al., 2020)	+	+	+	-	-	-	+	+	+	+	+	+	+
(Park et al., 2016)	+	+	+	-	-	+	+	+	+	+	+	+	+
(Maden et al., 2022)
(Zheng et al., 2022)	+	-	+	-	+	-	+	-	+	+	+	+	+
(Kochuchakkalackal Kuriala & Reyes, 2023)	+	-	+	+	-	-	+	+	+	+	+	+	+
(L. Wu et al., 2021)	+	+	+	+	+	+	+	-	-	+	+	+	+
(Nielsen et al., 2021)	+	+	+	-	-	+	+	+	+	+	+	+	+
(Zhao et al., 2022)	+	+	+	+	-	+	+	+	+	+	+	+	+

and

Table 4. Results of the quality assessment of quasi-experimental studies.

Study	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	Q9
(Shin et al., 2021)	+	+	+	+	+	-	+	+	+
(André et al., 2023)	+	+	+	+	+	+	+	+	+
(Torres-Rodríguez et al., 2018)	+	+	+	+	+	+	+	+	+
(Igarashi et al., 2024)	+	+	-	+	+	+	+	+	+
(Marcelle et al., 2019)	+	+	-	+	+	+	+	+	+
(Zhang et al., 2016)	+	+	-	+	+	+	+	+	+
(Pornnoppadol et al., 2020)	+	+	+	+	+	+	+	+	+
(Zhang et al., 2018)	+	+	-	+	+	+	+	+	+
(Kang et al., 2018)
(J. Han et al., 2020)	+	+	+	+	+	+	+	+	+
(Li et al., 2018)	+	+	+	+	+	+	+	+	+
(Sakuma et al., 2017)	+	+	+	-	+	+	+	+	+
(Yao et al., 2017)	+	+	+	+	+	-	+	+	+

.

3.2. Description of the Results

3.2.1. Internet Gambling Disorder

All the studies included in this review (n = 22) reported a significant reduction in IGD severity following intervention (André et al., 2023; J. Han et al., 2020; Hong et al., 2020; Igarashi et al., 2024; Kang et al., 2018; Kochuchakkalackal Kuriala & Reyes, 2023; Li et al., 2018; Maden et al., 2022; Marcelle et al., 2019; Ni et al., 2024; Nielsen et al., 2021; Park et al., 2016; Pornnoppadol et al., 2020; Sakuma et al., 2017; Shin et al., 2021; Torres-Rodríguez et al., 2018; L. Wu et al., 2021; Yao et al., 2017; Zhang et al., 2016, 2018; Zhao et al., 2022; Zheng et al., 2022). Within these, cognitive behavioral therapy stood out as the strategy with the most empirical support, significantly improving IGD symptomatology and in some cases reducing the severity of the disorder by up to 66.3% (André et al., 2023; J. Han et al., 2020; Hong et al., 2020; Kochuchakkalackal Kuriala & Reyes, 2023; Torres-Rodríguez et al., 2018; Zhang et al., 2016, 2018; Zheng et al., 2022).

In addition to CBT, other approaches have been studied with positive results. Three studies evaluated mindfulness-based therapy. This strategy showed a significant reduction in IGD symptoms, especially in emotional regulation and impulse control (Li et al., 2018; Ni et al., 2024; Yao et al., 2017). On the other hand, three studies investigated the efficacy of virtual reality (VR) therapy, reducing gaming time, and significantly improving control over gaming impulses after the intervention. Thus, research is beginning to suggest that immersion in controlled VR environments may facilitate awareness of the negative effects of gambling. (Maden et al., 2022; Park et al., 2016; Shin et al., 2021).

The most effective results have been found when several interventions are combined (Hong et al., 2020; Pornnoppadol et al., 2020; Yao et al., 2017; Zheng et al., 2022). For example, the combination of CBT with physical exercise was highlighted as having the most pronounced decrease in symptoms compared to isolated interventions (Hong et al., 2020). Also, the addition of CBT with meditation and relaxation techniques significantly decreased impulsivity and weekly play time (Yao et al., 2017).

Other interventions such as the use of transcranial direct current stimulation (tDCS) (L. Wu et al., 2021) and Multidimensional Family Therapy (MDFT) (Nielsen et al., 2021) have been explored and have shown promising results. One study indicated that tDCS applied to the dorsolateral prefrontal cortex significantly reduced gambling craving and improved self-control in individuals with IGD (L. Wu et al., 2021). In the case of MDFT, it substantially reduced IGD symptomatology and improved family cohesion (Nielsen et al., 2021).

3.2.2. Treatment Effectiveness in Reducing Anxious and Depressive Symptoms

The efficacy of interventions on anxiety and depressive symptoms were studied in 11 of the selected studies (J. Han et al., 2020; Hong et al., 2020; Kang et al., 2018; Maden et al., 2022; Marcelle et al., 2019; Park et al., 2016; Yao et al., 2017; Zhang et al., 2016, 2018; Zhao et al., 2022; Zheng et al., 2022). In relation to anxiety, seven studies using the BAI to assess the evolution of symptoms concluded a significant reduction in anxiety (J. Han et al., 2020; Hong et al., 2020; Maden et al., 2022; Park et al., 2016; Zhang et al., 2016, 2018; Zhao et al., 2022). In particular, interventions involving CBT and mindfulness techniques were found to be more effective, improving emotional regulation and helping to decrease levels of physiological arousal associated with impulsivity and gambling cravings (Yao et al., 2017).

Regarding depression, seven studies used the BDI and also showed significant improvements in the reduction in depressive symptoms associated with IGD (J. Han et al., 2020; Hong et al., 2020; Park et al., 2016; Yao et al., 2017; Zhang et al., 2016, 2018; Zhao et al., 2022). The best evaluated technique was individual and/or group CBT, which helped patients to change negative thoughts related to feelings of lack of control and self-image. In addition, equine-assisted therapy also reported significant results on anxious–depressive symptomatology (Kang et al., 2018).

Again, combined interventions have shown better results. The combination of CBT with physical exercise achieved the greatest reduction in anxiety and depression levels compared to the isolated use of the technique (Hong et al., 2020). On the other hand, CBT combined with mindfulness has also resulted in a more marked decrease in anxious–depressive symptomatology (Yao et al., 2017).

On the other hand, VR approaches found a reduction in gambling anxiety, just as tDCS was effective in reducing depressive symptoms (Igarashi et al., 2024; Maden et al., 2022; Shin et al., 2021).

Finally, five studies looked at impulsiveness in decision-making, finding that the combined intervention of reality therapy together with mindfulness significantly reduced intertemporal impulsivity. Other studies showed that training inhibitory control and reward sensitivity significantly reduced this condition (Park et al., 2016; Sakuma et al., 2017; Yao et al., 2017; Zhang et al., 2016; Zheng et al., 2022).

3.2.3. Effectiveness of Treatment in Improving Interpersonal Relationships and Family Functioning

Four studies of the 22 included in the review provided results on the effectiveness of their interventions on the family functioning and interpersonal skills of affected individuals (J. Han et al., 2020; Nielsen et al., 2021; Sakuma et al., 2017; Torres-Rodríguez et al., 2018). Interventions include structured family therapy, specialized social skills training programs, and VR.

In this context, Multidimensional Family Therapy (MDFT) proved to be the most effective strategy in improving the family environment (Nielsen et al., 2021). Moreover, participants improved their quality of life, their family relationships and decreased the severity of IGD more than those who received regular family therapy.

On the other hand, PIPATIC demonstrated positive effects on the improvement of interpersonal relationships. This program combines CBT with social skills training, and significantly increased family cohesion as well as the quality of personal interactions. In addition, the program also improved communication skills, emotional regulation and conflict resolution skills (Torres-Rodríguez et al., 2018).

In addition to interventions involving family members, other individual interventions with affected individuals also improved interpersonal relationships. For example, VR interventions reduced parents’ perceived conflict intensity and increased control of emotional responses to family stressful situations after training in a controlled digital environment on problem-solving practices for IGD-triggered family conflicts (Nielsen et al., 2021; Shin et al., 2021).

On the other hand, an intervention based on a stay in a residential therapeutic camp showed that being in a structured, technology-free social environment facilitated participants’ development of social skills and increased the perception of social support among them (Sakuma et al., 2017).

3.2.4. Changes in Brain Connectivity and Neurophysiology

A total of seven studies in studies included in the review examined the effects of interventions on brain activity, using measurement tools such as fMRI, EGG, and ECG (Hong et al., 2020; Kang et al., 2018; Ni et al., 2024; Park et al., 2016; Zhang et al., 2016, 2018; Zhao et al., 2022).

Therapeutic strategies evaluated included mindfulness-based interventions and CBT, which were effective in modifying brain connectivity (Ni et al., 2024). Studies indicated a significant increase in functional connectivity in the ventral striatum, medial frontal gyrus, and insula following the application of these therapies, regions responsible for reward processing, emotional regulation, and self-control (Hong et al., 2020; Kang et al., 2018; Ni et al., 2024; Park et al., 2016; Zhang et al., 2016, 2018; Zhao et al., 2022).

In addition, physical exercise increased frontal alpha asymmetry, a neural biomarker related to emotional balance and stress reduction (Hong et al., 2020)). Furthermore, tDCS on the dorsolateral prefrontal cortex significantly reduced the activation of circuits associated with reactivity to gambling cues, which improves inhibitory control and reduces impulsivity (L. Wu et al., 2021).

Additionally, animal-assisted therapy produced greater activation in the medial prefrontal cortex and the limbic system, which are responsible for emotional regulation and the processing of interpersonal relationships (Kang et al., 2018).

3.2.5. Differential Outcomes Based in Follow-Up

Analysis of follow-up data revealed differential outcomes based on the type of intervention and the duration of post-treatment assessment. Studies utilizing CBT and mindfulness-based therapies reported the most stable long-term results, with symptom reductions maintained up to 6–12 months post-intervention (André et al., 2023; Hong et al., 2020; Yao et al., 2017). In contrast, interventions based on neuromodulation (tDCS) and VR tended to show short-term improvements, with a gradual decline in effectiveness observed after 3–6 months, particularly in the absence of reinforcement strategies (Park et al., 2016; Shin et al., 2021). Additionally, studies that incorporated family-based interventions or structured relapse prevention plans showed greater treatment adherence and lower relapse rates, reinforcing the importance of multimodal approaches that integrate psychological, neurophysiological, and social support strategies.

To summarize and better understand each study reviewed, please refer to Appendix A, where the main characteristics of the studies and their key findings are included.

4. Discussion

The aim of this review was to analyze the existing literature on the effectiveness of treatments for IGD. During the review, it has been possible to analyze how different interventions influence the severity of the disorder, the most frequent comorbid symptomatology, such as anxiety and depression, change in family and interpersonal relationships, and the neurophysiological alterations associated with IGD. The findings reinforce the importance of structured, evidence-based treatments, particularly cognitive behavioral therapy (CBT), while also highlighting the potential benefits of alternative and combined interventions.

In terms of sex distribution, IGD predominantly affects males, as observed in most of the analyzed studies, which included predominantly male samples (Hong et al., 2020; Kang et al., 2018; Maden et al., 2022; Park et al., 2016; Sakuma et al., 2017; Shin et al., 2021; Torres-Rodríguez et al., 2018; L. Wu et al., 2021; Zhang et al., 2016, 2018; Zheng et al., 2022). Even in mixed-gender studies, male participants significantly outnumbered females (André et al., 2023; Igarashi et al., 2024; Kochuchakkalackal Kuriala & Reyes, 2023; Li et al., 2018; Marcelle et al., 2019; Ni et al., 2024; Nielsen et al., 2021; Pornnoppadol et al., 2020; Zhao et al., 2022).

Psychological interventions, particularly CBT, have been identified as the most effective treatment for IGD, significantly reducing disorder severity and associated symptoms (André et al., 2023; J. Han et al., 2020; Hong et al., 2020; Kochuchakkalackal Kuriala & Reyes, 2023; Torres-Rodríguez et al., 2018; Zhang et al., 2016, 2018; Zheng et al., 2022). CBT helps individuals develop self-regulation skills, restructure maladaptive thoughts, and implement behavioral changes aimed at reducing gaming dependence. However, findings suggest that combined interventions may enhance long-term treatment outcomes, particularly those integrating CBT with physical activity or mindfulness-based therapy (Hong et al., 2020; Pornnoppadol et al., 2020; Yao et al., 2017; Zheng et al., 2022).

Alternative interventions such as virtual reality therapy (VR), transcranial direct current stimulation (tDCS), and animal-assisted therapy have also demonstrated effectiveness in reducing IGD symptoms. VR-based interventions appear to enhance self-awareness and impulse control, while tDCS may improve cognitive flexibility and reduce compulsive gaming urges. Moreover, recent studies indicate that neurofeedback training and serious gaming interventions may be promising complementary strategies, helping individuals develop greater impulse control by providing real-time feedback on brain activity and reinforcing positive behavioral changes. However, the limited number of supporting studies, small sample sizes, and lack of long-term follow-up data restrict conclusions about their sustained effectiveness (Kang et al., 2018; Maden et al., 2022; Nielsen et al., 2021; Park et al., 2016; Shin et al., 2021; L. Wu et al., 2021). Future research should include larger trials with extended follow-up periods to evaluate their sustained impact and compare their efficacy to more established interventions. IGD is frequently associated with anxious and depressive symptomatology, reinforcing the need for treatments that address both gaming behavior and underlying psychological distress (Bargeron & Hormes, 2017; De Pasquale et al., 2020; Maden et al., 2022; Marcelle et al., 2019). In this regard, the studies reviewed suggest that integrative approaches combining CBT with mindfulness and physical exercise show the most promising results (Hong et al., 2020; Maden et al., 2022). These results emphasize CBT as the most empirically supported treatment, increasing its efficacy if combined with physical activity, since it has been shown to improve executive function and promote the release of neurotransmitters related to emotional well-being, which potentiates the effects of CBT, as well as with mindfulness, probably due to the strengthening of emotional self-regulation and the reduction in ruminative thinking (Li et al., 2018; Magill et al., 2019; Pascoe et al., 2020; Smith & Merwin, 2021; Yao et al., 2017; Zheng et al., 2024). Additionally, research suggests that individuals with IGD often present cognitive distortions related to gaming as a coping mechanism for emotional distress, which may explain the strong association between IGD and depression. These distortions include overestimation of gaming skills, avoidance of real-life responsibilities, and reliance on gaming for emotional regulation. Addressing these factors through cognitive restructuring techniques within CBT could further enhance treatment outcomes. Given the strong correlation between IGD and depression, these findings underscore the importance of screening for depressive symptoms in IGD patients and incorporating interventions that target both conditions simultaneously.

On the other hand, this disorder affects all spheres of life, also having a negative impact on interpersonal relationships and family functioning. People with IGD often have impaired communication with their families and friends, increased family conflicts and difficulties in establishing social relationships outside the digital environment (Fumero et al., 2020; Teng et al., 2020). The studies included in the review highlight the value of family involvement in the recovery process, particularly in adolescent populations. Family-based interventions such as Multidimensional Family Therapy (MDFT) and the PIPATIC program have demonstrated significant improvements in family dynamics, communication, and the establishment of healthy gaming limits, which are key factors in preventing relapse and fostering long-term recovery (Nielsen et al., 2021; Torres-Rodríguez et al., 2018). In addition, VR-based and social skills training interventions have shown effectiveness in reducing family conflict and improving interpersonal cohesion (Shin et al., 2021).

Beyond structured family-based interventions, studies have indicated that parents’ digital literacy and gaming-related attitudes play a crucial role in the success of IGD interventions. Parents who actively engage in digital education programs and set consistent gaming-related boundaries tend to have adolescents with better treatment adherence and lower relapse rates. Therefore, integrating parental education components into IGD interventions could further enhance long-term treatment effectiveness.

Finally, the literature supports that IGD is associated with alterations in brain activity, in particular in regions related to impulse control and emotional regulation. Neuroimaging studies indicate that IGD is associated with altered neural activity in regions responsible for impulse control, reward processing, and emotional regulation. For its part, interventions for IGD may therefore induce changes in neural connectivity and physiology in patients (Hong et al., 2020; Kang et al., 2018; Ni et al., 2024; Park et al., 2016; Zhang et al., 2016, 2018; Zhao et al., 2022). The reviewed studies show that combined interventions of CBT with physical exercise or mindfulness, as well as animal therapy and tDCS, strengthen the activity of the ventral striatum, prefrontal cortex and insula, reducing gambling craving, and increasing self-control and emotional regulation (Kang et al., 2018; L. Wu et al., 2021; Yao et al., 2017; Zheng et al., 2022).

Additionally, emerging research suggests that abnormalities in dopamine regulation and prefrontal cortex function may contribute to the compulsive nature of IGD. Studies using functional MRI have shown that individuals with IGD exhibit increased activity in reward-processing regions (such as the striatum) and reduced activity in areas associated with cognitive control (such as the dorsolateral prefrontal cortex) (Kang et al., 2018; L. Wu et al., 2021; Yao et al., 2017; Zheng et al., 2022). These findings suggest that targeting neurobiological mechanisms through pharmacological or neuromodulation approaches may enhance treatment outcomes, particularly for individuals with severe IGD who do not respond to conventional psychotherapy.

Limitations and Future Research Directions

This review provides information that will guide future research and facilitate the development of programs to reduce IGD and/or alleviate symptoms derived from the disorder. Knowledge of IGD continues to advance in terms of understanding it and how to intervene with this new problem that is advancing not only in terms of severity, but also in terms of the population it affects. On the one hand, the adolescent population that has grown up with the unlimited use of screens is growing, and with it, the age group suffering from this disorder is increasing. The new generations have an increasingly uncontrolled use of technology from a very early age, making them a population at risk from childhood.

For future research, these results should be interpreted taking into account the limitations of the review, such as small sample sizes and limited follow-up periods. This reduces the possibility of inferring long-term therapeutic effects. Future lines of research should explore the impact of IGD on academic performance and its potential relationship with school dropout rates, as this could provide valuable insights into the broader effects of the disorder on adolescent development. On the other hand, more studies directly comparing the efficacy of different therapeutic approaches would be interesting, as well as studies with emerging interventions that can be compared with CBT. In addition, due to the correlation seen in this review of the disorder with depression, future research and/or reviews could focus on this.

5. Conclusions

The results of this review suggest that IGD is a multidimensional disorder that requires comprehensive therapies addressing various areas of the individual. CBT is the most empirically supported intervention due to its effectiveness and also due to the long list of research that has been carried out on this technique. Moreover, its effectiveness can be enhanced by combining it with techniques such as physical exercise, mindfulness, or VR.

On the other hand, the integration of family and social relationships in the therapeutic process is important to improve the functionality of patients, as well as to improve their quality of life.

In future research, it is interesting to conduct studies with prolonged follow-ups to evaluate long-term interventions, as well as to combine therapeutic approaches and the use of emerging intervention tools.