Why is this important?
It is estimated that between 0.1% and 5.8% of adults have a gaming addiction. CBT can help those affected to better identify risky situations and to expose themselves less to them by developing new coping strategies. Literature data suggests that they help reduce the severity of addiction. Several systematic reviews and meta-analyses have been conducted on the subject, but have only focused on certain endpoints. The objective of this work was to conduct an umbrella review, which compiles all pre-existing meta-analyses in order to have the highest possible level of evidence, capable of promoting changes in practices or recommendations.
This study included meta-analyses conducted to evaluate the effectiveness of CBT on gambling-related behavioral problems in adult subjects, and published until May 2023. All types of CBT were considered. The AMSTAR-2 scale (Assessing the Methodological Quality of Systematic Reviews 2) was used to rate the methodological quality of each review. Only those of medium to high quality were taken into account. The GRADE system (Grading of Recommendations Assessment, Development, and Evaluation) was also used to assess the quality of evidence for each endpoint. Finally, the effect size was calculated for each parameter using Hedges’ g (changes were considered minor, medium or large when the numerical value of g was greater than 0.20, 0.50 and 0.80 respectively).
In total, 5 meta-analyses could be included in this work, 3 of which looked at the effect of CBT compared to conventional treatment (advice, referral to patient associations) or compared to a group without treatment (waiting list, evaluation only), another compared them to active treatment (motivational interviewing) and a last one was not controlled (before-after evaluation). Two of these were judged to be of insufficient quality and were not included in the meta-analysis.
The meta-analysis carried out from the three previous analyzes ultimately compiled 31 studies and 4,023 participants. After treatment, the severity of the disorders, the frequency and intensity of gaming were significantly improved in patients who received CBT compared to control subjects: the size of the effect on the severity of the problem Addiction was high (g -0.91, [-1,33 à -0,49]high heterogeneity), that on the frequency of use of post-treatment games was average (g -0.52, [-0,77 à -0,27]high heterogeneity) and that on the intensity of post-treatment game practice was minor (g -0.32[-0,48 à -0,16]low heterogeneity.
The level of evidence and its quality regarding the functioning and maintenance of the benefit of CBT after treatment was not high enough to conclude.