Trial document

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Trial Description

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Self perception and self knowledge retrieval in online role-players before and after psychotherapy

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Trial Acronym


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URL of the Trial


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Brief Summary in Lay Language

In spite of the increasing number of people suffering from computer and online gaming addiction, the therapeutic possibilities are limited due to a lack of research in the field. The highest risk for developing an addictive behaviour derives from playing Massive Multiplayer Online Role-Playing Games (MMORPGs). The few existing studies of this behavioural addiction indicate similarities to substance dependent disorders in reward processing. Furthermore, there is also a particular constellation of personality traits and deficits in social skills in addictive MMORPG players that may suggest an impairment of their self-concept. This leads to the hypothesis that taking action in an online role game via one’s own avatar may compensate for deficits in self-concept. Apart from one investigation, no neurobiological studies in addicted MMORPG players have been conducted so far assessing reward processing and self-concept in addicted players. Thus, the first aim of the proposed study is to assess psychological and neurobiological correlates of self-concept and reward processing in addicted MMORPG players. This investigation will be conducted as a part of a multicentre study, assessing the effects of a Short-term treatment of Internet and Computer game Addiction (STICA), funded by the Deutsche Forschungsgemeinschaft (DFG). STICA includes the following psychotherapeutic key elements: (1) psychoeducation, (2) functional analyses to identify and modify triggers for the addictive behaviour, (3) skills and social competence training as well as (4) relapse prevention by transferring the learned skills to everyday life. This intervention aims at achieving emotional detachment from the avatar, building up self-worth and coping strategies to deal with craving. 60 treatment seeking addicted MMORPG players will be recruited for the present study; 30 will receive STICA from the beginning (therapy group) and 30 will receive STICA after a delay of four months (waiting list group). A second control group consists in 30 non addicted MMORPG players not receiving psychotherapy. Consistent with the objectives of this therapeutic approach, the second aim of the proposed study will be to assess intervention effects in terms of neurobiological alterations in self-concept and reward processing following psychotherapy.

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Brief Summary in Scientific Language

Several study findings as well as our own pilot data indicate strong deficits in self-concept in addicted MMORPG players and these impairments may lead to social interaction problems in real life. Therefore it can be hypothesized that players may compensate these deficits in self-concept by means of vicarious action of their own avatar that may be regarded as an interactive filter in a more controllable virtual life environment compared to real life. Indeed, psychological and neurobiological data have revealed stronger identification with their own avatar in addicted and regular WOW players (Ganesh et al., 2011; Smahel et al, 2008). Furthermore, neurobiological studies indicate similar underlying mechanisms in reward processing related to alterations in the mesocorticolimbic dopaminergic reward system with substance related disorders. Thus, an additional possible reason for the addictive potential of MMORPG is that by repeatedly engaging in these games, this might 'hijack' the brain reward system in the same way as drug associated stimuli do in patients with substance disorders. Taken together, previous findings on self-concept and reward processing lead to the assumption that playing MMORPGs might be more risky to develop addictive behaviour in players for whom the avatar serves to compensate for self-concept deficits.
Apart from one fMRI based study assessing self-concept and avatar identification in non-addictive WOW players and one cue reactivity investigation involving the presentation of unspecific WOW associated stimuli in addictive MMORPG players, no studies to our knowledge have been published to date investigating the neurobiological mechanisms of self-concept and specific avatar associated cue reactivity in addictive MMORPG players. As described above, fMRI is an excellent tool to study brain systems that mediate cue reactivity and two specific domains of self-concept, such as physical self-concept (visual self perception) and self attribution processing (self knowledge retrieval). Thus, one general aim of the study is to investigate psychological and neurobiological mechanisms of the self-concept and cue reactivity in addictive MMORPG players.
While some studies indicate neurobiological changes following psychotherapeutic interventions in other disorders no study has evaluated standardized psychotherapy for addictive computer game players and its neurobiological correlates. The randomized controlled trial (RCT) STICA is a promising approach for implementing an adequate psychotherapeutic intervention for computer game addiction. In close association to STICA, the second aim of the present study is to investigate neurobiological psychotherapeutic effects of the self-concept and cue reactivity in abstinent addictive MMORPG players. The study findings may contribute to the development of integrative explanation models for MMORPG addiction and may have important implications for clinical classification as well as for pharmacological and psychotherapeutic treatment. For the investigation of addiction specific neurobiological mechanisms, two groups are included in the study design: one group will include n=60 dependent MMORG players (containing n=30 players in the treatment group and n=30 in the waiting list group). The other group will include n=30 non addicted gamers. In order to investigate neurobiological effects of the therapy we will compare neurobiological alterations from pre- to post treatment between treatment group (n=30) and waiting list group (n=30).

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Organizational Data

  •   DRKS00003423
  •   2012/04/23
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  •   yes
  •   Approved
  •   2010-207N-MA, Medizinische Ethik-Kommission II Medizinische Fakultät Mannheim der Universität Heidelberg
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Secondary IDs

  • [---]*
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Health Condition or Problem studied

  •   Online role-playing addiction
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Interventions/Observational Groups

  •   N=30 Addicted online role-players directly receiving STICA, the 4 month treatment program combining fiveteen 90-minute group interventions and eight 50-minute individual interventions based on cognitive behavioural therapy (therapy group)
  •   N=30 Non addicted online role-players without psychotherapy (control group)
  •   N=30 Addicted online role-players, receiving psychotherapy after a delay of 4 months (waiting list group)
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  •   Interventional
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  •   Non-randomized controlled trial
  •   Open (masking not used)
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  •   No treatment, Other
  •   Treatment
  •   Parallel
  •   N/A
  •   N/A
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Primary Outcome

Self perception and self knowledge retrieval in online role-players before and after psychotherapy are assessed by self-rating questionnaires (e.g. Fragebogen zum Körperbild zur Erfassung der körperlichen Attraktivität FKB-20; Clement & Löwe, 1996, Emotionale-Kompetenz Fragebogen EKF; Rindermann, 2009, Avatar Identification Scale; Klein, 2011, Skala zur Erfassung des Selbstwerts: Rosenberg Skala; Rosenberg, 1965) and the two fMRI paradigms (Self Perception Task and Self Knowledge Retrieval Task). The total investigation includes three appointments (two before and one after psychotherapy or after 4 months for the waiting-list group). The first visit involves written informed consent, screen for fMRI eligibility, SKID I and II, Ko criteria, photoshooting and screenshot of the own avatar. At the second visit patients will perform the questionnaires and will be scanned with fMRI. In order to assess psychotherapy effects the third visit will include only the assessment (questionnaires and fMRI scanning) of addicted groups.

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Secondary Outcome

Cue reactivity assessed by the Self Perception Paradigm during fMRI, where pictures of WOW associated stimuli are presented (second and third visit).

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Countries of Recruitment

  •   Germany
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Locations of Recruitment

  • Medical Center 
  • University Medical Center 
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  •   Actual
  •   2012/04/01
  •   90
  •   Multicenter trial
  •   National
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Inclusion Criteria

  •   Male
  •   18   Years
  •   45   Years
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Additional Inclusion Criteria

- Men between 18 and 45 years of age
- Right handedness
- Diagnosis of online role-game playing addiction according to AICA and Ko et al. (2008) for the groups of addicted online role-players
- Individuals who don't fulfil the diagnostic criteria for online role-game addiction according to AICA and Ko et al. (2008) will be included in the non-addicted group
- No psychotropic medication within the last four weeks prior to neuroimaging assessments
- Ability to provide fully informed consent and to use self-rating questionnaires
- Written Informed Consent

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Exclusion Criteria

- Any current substance dependence other than nicotine and caffeine within the last year
- Any current psychiatric disorder diagnosis that requires pharmacological treatment
- Lifetime history of organic psychiatric disorders
- History of severe head trauma or other severe central neurological disorder
- Participants who require concomitant therapy with any medications that affects the central nervous system
- Insufficient German language skills
- Limited legal capacity or incapacity to provide written informed consent
- Deafness and blindness
- MRI contraindications (i.e. pacemakers, metal in the body)
- Positive rapid drug test (urine)

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  • start of 1:1-Block address primary-sponsor
    • Zentralinstitut für Seelische Gesundheit Klinik für Abhängiges Verhalten und Suchtmedizin
    • Mr.  Prof. Dr. med.  Karl  Mann 
    • J5
    • 68159  Mannheim
    • Germany
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    • Zentralinstitut für Seelische Gesundheit Klinik für Abhängiges Verhalten und Suchtmedizin
    • Ms.  Dr. Dipl. Psych.  Tagrid  Leménager 
    • J5
    • 68159  Mannheim
    • Germany
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    • Zentralinstitut für Seelische Gesundheit Klinik für Abhängiges Verhalten und Suchtmedizin
    • Ms.  Dr. Dipl. Psych.  Tagrid  Leménager 
    • J5
    • 68159  Mannheim
    • Germany
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Sources of Monetary or Material Support

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    • Deutsche Forschungsgemeinschaft
    • Kennedyallee 40
    • 53175  Bonn
    • Germany
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  •   Recruiting ongoing
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Trial Publications, Results and other Documents

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* This entry means the parameter is not applicable or has not been set.