Collective Motivational Interviewing (CMI) for Adolescents With Internet Gaming Disorder

Study Overview
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Brief Summary
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The present study examines the efficacy of CMI in reducing adolescent IGD symptoms and enhancing social support given by CSOs among adolescents with high risk of IGD (probable IGD cases screened positive by validated tools). It is hypothesized that the intervention group (with CMI plus IGD education materials for both the clients and his/her selected CSO) would show more improvements in reduction in the severity of IGD, motivation to change maladaptive gaming behaviour, craving on gaming, and social support obtained from CSOs than to the control group (only educational materials for both the client and the CSOs).

Detailed Description
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This study adopts a randomized controlled efficacy study with an open-label parallel-group design. The trial will be registered by the WHO's International Clinical Trials Registry Platform once the project is approved. Research participants will be recruited from the primary and secondary schools, and youth social services. After completing the screening process, research participants who are confirmed to fit the inclusion criteria will be randomly assigned to the intervention group with CMI intervention plus IGD education materials to both adolescents with IGD and their CSO or the control group with IGD education materials alone. The present study sets four-time points to track the change in the between-group difference of the primary and secondary outcomes from the baseline (T0) to post-intervention (T1), 3-month follow-up (T2), and 6-month follow-up (T3).

Official Title
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A Randomized Controlled Study of Collective Motivational Interviewing (CMI) for Adolescents With Internet Gaming Disorder

Conditions
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Internet Gaming Disorder

Intervention / Treatment
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* Behavioral: Collective Motivational Interviewing plus Education Materials
* Other: Control group (Education Materials)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria for Adolescents: Aged between 10-16 Probable IGD condition screened by the Internet Gaming Disorder Scale-Short-Form (IGDS9-SF) reaching the cut-off value at 21, those at high risk of having IGD but no IGD cases with clinical diagnosis, although the symptoms measured by IGDS9-SF are equivalent to DSM-5 IGD criteria) Hong Kong ID card holder Chinese speaking Student identity Possessing an electronic mobile device or computer Willingness to participate in the intervention/control group and complete four surveys (baseline, post-intervention, 3-month follow-up, and 6-month follow-up) Can nominate a CSO (e.g., parents) [client's autonomy is a critical factor to facilitate motivation posited by the self-determination theory (Ryan & Deci, 2020) (9) to obtain informed consent and parental consent Inclusion Criteria for CSO: Aged greater than 18 years Having a close relationship with the adolescent with probable IGD (as rated by participants being generally supportive of the participants) Being willing to participate in the present study and provide informed consent Exclusion Criteria for Adolescents: Participants who have psychiatric problems such as psychosis, significant cognitive impairment and/or receiving active and structured psychotherapy about IGD elsewhere will be excluded (Nielsen et al., 2021). Exclusion Criteria for CSO: Participants who have psychosis, aggressive or suicidal behavior Having life-threatening medical conditions

Ages Eligible for Study
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Minimum Age: 10 Years
Maximum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: The present study adopted a two-armed RCT to examine the efficacy of CMI in improving IGD among adolescents with IGD. The research participants will be randomly assigned to either the intervention group (four-session CMI intervention plus IGD educational materials) or the control group (IGD education materials alone). Block randomization will be executed, of which the block size is 4. Computer-generated randomization allocation codes will be produced and sealed in opaque envelopes by a research associate with no involvement in recruitment. One envelope will be drawn and opened by the project officer.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Control group (Education Materials)<br>After completing the baseline screening, survey and randomization, the participants in the control group will receive educational materials regarding topics including: (1) what IGD is and its consequences, (2) how to communicate with parents about the gaming time, and (3) how to develop a healthy lifestyle, etc. | Other: Control group (Education Materials)<br>* The participants in the control group will receive IGD educational materials.<br>|
| Experimental: Intervention group (Collective Motivational Interviewing plus Education Materials)<br>Participants in the intervention group will be given the same Internet Gaming Disorder (IGD) education materials as those in the control group, thus, they will further participate in four counseling sessions with Collective Motivational Interviewing (CMI) (each session 60 mins). In the first session, adolescents with Internet Gaming Disorder will be implemented a standard MI session to elicit and strengthen the client's motivation to change. In the second session, a nominated CSO of the client will participate in a standard MI session to elicit their motivation to help the client toward change and prepare positive attitudes of CSO for the conjoint session. Afterward, the third and fourth sessions (75 mins) will be conjoint sessions. The Collective Motivational Interviewing practitioners will create a safe platform for both parties to share their perspectives with openness and trustfulness, in turn, to reach an agreed goal (e.g., develop a change plan on internet gaming behaviors). | Behavioral: Collective Motivational Interviewing plus Education Materials<br>* The participants in the intervention group will receive IGD educational materials as well as four counseling sessions of CMI intervention.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Severity of IGD | The nine-item Internet Gaming Disorder Scale-Short-Form (IGDS9-SF) are used to detect the change in the severity of IGD. It is the first brief standardized psychometric tool of IGD based on the nine DSM-5 IGD criteria. This instrument has been translated into 15 languages and is widely used in research and clinical settings. In addition, a validated Chinese version with satisfactory psychometric properties is available (Qin et al., 2020). The items were rated by using a 5-point Likert scale (1 = Never to 5 = Very often). | Change from Baseline (T0) Severity of IGD at posttest (T1: After intervention) | 
| Severity of IGD | The nine-item Internet Gaming Disorder Scale-Short-Form (IGDS9-SF) are used to detect the change in the severity of IGD. It is the first brief standardized psychometric tool of IGD based on the nine DSM-5 IGD criteria. This instrument has been translated into 15 languages and is widely used in research and clinical settings. In addition, a validated Chinese version with satisfactory psychometric properties is available (Qin et al., 2020). The items were rated by using a 5-point Likert scale (1 = Never to 5 = Very often). | Change from Baseline (T0) Severity of IGD at 3-month follow-up (T2) | 
| Severity of IGD | The nine-item Internet Gaming Disorder Scale-Short-Form (IGDS9-SF) are used to detect the change in the severity of IGD. It is the first brief standardized psychometric tool of IGD based on the nine DSM-5 IGD criteria. This instrument has been translated into 15 languages and is widely used in research and clinical settings. In addition, a validated Chinese version with satisfactory psychometric properties is available (Qin et al., 2020). The items were rated by using a 5-point Likert scale (1 = Never to 5 = Very often). | Change from Baseline (T0) Severity of IGD at 6-month follow-up (T3) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Motivation to change maladaptive gaming behaviour | Contemplation Ladder for Internet Gaming (CL-LG), which is derived from the Contemplation Ladder measure the motivation to quit smoking (Biener & Abrams, 1991), are employed. Contemplation Ladder for drug use problems is commonly used in clinical settings and research in Hong Kong (Siu et al., 2018). The instrument measures the motivation to abstain from maladaptive gaming behaviors based on a single brief option of 11 rungs and five types of statements. The instrument is rated on a scale from 0 to 10, with each point representing a specific statement showing a corresponding stage of change. The ladder has been used in smoking cessation studies, which displayed strong reliability and validity with strong intercorrelations (Pearson's r = .82 - .98) (Rustin & Tate, 1993). | Change from Baseline (T0) Motivation to change maladaptive gaming behaviour at posttest (T1: After intervention) | 
| Motivation to change maladaptive gaming behaviour | Contemplation Ladder for Internet Gaming (CL-LG), which is derived from the Contemplation Ladder measure the motivation to quit smoking (Biener & Abrams, 1991), are employed. Contemplation Ladder for drug use problems is commonly used in clinical settings and research in Hong Kong (Siu et al., 2018). The instrument measures the motivation to abstain from maladaptive gaming behaviors based on a single brief option of 11 rungs and five types of statements. The instrument is rated on a scale from 0 to 10, with each point representing a specific statement showing a corresponding stage of change. The ladder has been used in smoking cessation studies, which displayed strong reliability and validity with strong intercorrelations (Pearson's r = .82 - .98) (Rustin & Tate, 1993). | Change from Baseline (T0) Motivation to change maladaptive gaming behaviour at 3-month follow-up (T2) | 
| Motivation to change maladaptive gaming behaviour | Contemplation Ladder for Internet Gaming (CL-LG), which is derived from the Contemplation Ladder measure the motivation to quit smoking (Biener & Abrams, 1991), are employed. Contemplation Ladder for drug use problems is commonly used in clinical settings and research in Hong Kong (Siu et al., 2018). The instrument measures the motivation to abstain from maladaptive gaming behaviors based on a single brief option of 11 rungs and five types of statements. The instrument is rated on a scale from 0 to 10, with each point representing a specific statement showing a corresponding stage of change. The ladder has been used in smoking cessation studies, which displayed strong reliability and validity with strong intercorrelations (Pearson's r = .82 - .98) (Rustin & Tate, 1993). | Change from Baseline (T0) Motivation to change maladaptive gaming behaviour at 6-month follow-up (T3) | 
| Craving for Internet Gaming | Craving for Internet Gaming Scale (CIGS) is used to measure respondents' intensity, frequency, duration of their craving, and capability to resist acting on their craving for a particular period of time. It comprises five-item, scoring from 0 to 6 for each item. Respondents with higher scores tend to have higher levels of gaming craving (Cronbach's alpha was .88-.91) (Savci & Griffiths, 2019). | Change from Baseline (T0) Craving for Internet Gaming at posttest (T1: After intervention) | 
| Craving for Internet Gaming | Craving for Internet Gaming Scale (CIGS) is used to measure respondents' intensity, frequency, duration of their craving, and capability to resist acting on their craving for a particular period of time. It comprises five-item, scoring from 0 to 6 for each item. Respondents with higher scores tend to have higher levels of gaming craving (Cronbach's alpha was .88-.91) (Savci & Griffiths, 2019). | Change from Baseline (T0) Craving for Internet Gaming at 3-month follow-up (T2) | 
| Craving for Internet Gaming | Craving for Internet Gaming Scale (CIGS) is used to measure respondents' intensity, frequency, duration of their craving, and capability to resist acting on their craving for a particular period of time. It comprises five-item, scoring from 0 to 6 for each item. Respondents with higher scores tend to have higher levels of gaming craving (Cronbach's alpha was .88-.91) (Savci & Griffiths, 2019). | Change from Baseline (T0) Craving for Internet Gaming at 6-month follow-up (T3) | 
| Social support from CSO | The 4-item significant other subscales of the Multidimensional Scale of Perceived Social Support (MSPSS) will be used. It is a self-reporting instrument designed for assessing the level of perceived social support from significant others. The items are scored on a 7-point Likert scale ranging from 1 (very strongly disagree) to 7 (very strongly agree). The Cantonese version has demonstrated a high internal consistency coefficient with a Cronbach's alpha of .89 (Chou, 2000). | Change from Baseline (T0) Social support from CSO at posttest (T1: After intervention) | 
| Social support from CSO | The 4-item significant other subscales of the Multidimensional Scale of Perceived Social Support (MSPSS) will be used. It is a self-reporting instrument designed for assessing the level of perceived social support from significant others. The items are scored on a 7-point Likert scale ranging from 1 (very strongly disagree) to 7 (very strongly agree). The Cantonese version has demonstrated a high internal consistency coefficient with a Cronbach's alpha of .89 (Chou, 2000). | Change from Baseline (T0) Social support from CSO at 3-month follow-up (T2) | 
| Social support from CSO | The 4-item significant other subscales of the Multidimensional Scale of Perceived Social Support (MSPSS) will be used. It is a self-reporting instrument designed for assessing the level of perceived social support from significant others. The items are scored on a 7-point Likert scale ranging from 1 (very strongly disagree) to 7 (very strongly agree). The Cantonese version has demonstrated a high internal consistency coefficient with a Cronbach's alpha of .89 (Chou, 2000). | Change from Baseline (T0) Social support from CSO at 6-month follow-up (T3) | 
| Child-Parent Relationship | The Child-Parent Relationship Scale (C-PRS). The items are scored on a 5-point Likert scale ranging from 1 (very strongly disagree) to 5 (very strongly agree). | Change from Baseline (T0) Child-Parent Relationship at posttest (T1: After intervention) | 
| Child-Parent Relationship | The Child-Parent Relationship Scale (C-PRS). The items are scored on a 5-point Likert scale ranging from 1 (very strongly disagree) to 5 (very strongly agree). | Change from Baseline (T0) Child-Parent Relationship at 3-month follow-up (T2) | 
| Child-Parent Relationship | The Child-Parent Relationship Scale (C-PRS). The items are scored on a 5-point Likert scale ranging from 1 (very strongly disagree) to 5 (very strongly agree). | Change from Baseline (T0) Child-Parent Relationship at 6-month follow-up (T3) | 
| Parental Stress | The 17-items Parental Stress Scale (PSS). The items are scored on a 6-point Likert scale ranging from 1 (very strongly disagree) to 6 (very strongly agree). | Change from Baseline (T0) Parental Stress at posttest (T1: After intervention) | 
| Parental Stress | The 17-items Parental Stress Scale (PSS). The items are scored on a 6-point Likert scale ranging from 1 (very strongly disagree) to 6 (very strongly agree). | Change from Baseline (T0) Parental Stress at 3-month follow-up (T2) | 
| Parental Stress | The 17-items Parental Stress Scale (PSS). The items are scored on a 6-point Likert scale ranging from 1 (very strongly disagree) to 6 (very strongly agree). | Change from Baseline (T0) Parental Stress at 6-month follow-up (T3) | 
| Motivation for treatment | The 8-item Motivation for Youth's Treatment Scale (MYTS). The items are scored on a 5-point Likert scale ranging from 1 (very strongly disagree) to 5 (very strongly agree). | Change from Baseline (T0) Motivation for treatment at posttest (T1: After intervention) | 
| Motivation for treatment | The 8-item Motivation for Youth's Treatment Scale (MYTS). The items are scored on a 5-point Likert scale ranging from 1 (very strongly disagree) to 5 (very strongly agree). | Change from Baseline (T0) Motivation for treatment at 3-month follow-up (T2) | 
| Motivation for treatment | The 8-item Motivation for Youth's Treatment Scale (MYTS). The items are scored on a 5-point Likert scale ranging from 1 (very strongly disagree) to 5 (very strongly agree). | Change from Baseline (T0) Motivation for treatment at 6-month follow-up (T3) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Motivational interviewing, Family counselling, Effective treatment, Randomized controlled trial