There is growing recognition that some individuals engage in problematic and potentially addictive behaviors across a wide range of online activities, including gaming, gambling, shopping, social media use, and pornography use [1-3]. The International Classification of Diseases 11th Revision (ICD-11) includes 2 behavioral addictions associated with gaming and gambling [4,5]. Gambling disorder was the first recognized behavioral addiction and is characterized by gambling to escape negative mood, tolerance, repeated unsuccessful attempts to change, and gambling despite negative consequences. Gambling disorder encompasses both land-based activities as well as online casino gambling and web-based betting on sports and racing, which have increased for adults and adolescents over recent years [6,7]. Gaming disorder has characteristics that are consistent with gambling disorder, but there is less focus on money, chasing losses, and financial impacts of gambling on other people. The ICD-11 describes gaming disorder as a condition involving impaired control (eg, over the onset, duration, frequency, and context of play), increasing prioritization of gaming over other activities and life interests, and continued involvement despite negative consequences (eg, impairment in social, educational, and occupational functioning). Some online behavioral addictions are not yet identified under any diagnostic classification of the ICD-11 (eg, pornography and social media use), and some excessive behaviors may be encapsulated by existing categories (eg, online shopping within compulsive buying disorder). Although the literature on different classes of behavioral addictions is still developing, it is often argued that there is a need for evidence-based interventions and other countermeasures to prevent and reduce problematic use.

The literature on interventions for online behavioral addictions has generally been focused on in-person treatment which is intensive and typically involves 6 or more weekly sessions [8,9]. A recent review of treatment for gaming disorder reported it was predominantly psychotherapeutic, face-to-face, and targeted to those with more severe problems [10]. At the same time, reviews have tended to focus on in-person treatment studies and excluded web-based options as evidenced by a recent Cochrane review on psychological therapies for gambling [9]. The lack of scholarly attention on web-based interventions may be overlooking an important modality that is accessed by many affected by behavioral addictions. Online behavioral addictions reportedly affects between 1% and 3% of the population [11,12], but help-seeking rates are quite low [13,14]. These findings suggest that either few people want or require help to resolve their problem or that available clinical options are not meeting the needs of the population. Help seeking may be impeded by structural issues such as the homogeneity of available treatments, prohibitive cost and accessibility, or individual barriers like depression, introversion, or a preference for self-management [15-20].

Web-based treatment appears to be a viable alternative to in-person treatment and has demonstrated effectiveness in reducing symptom severity and consumption patterns of addictive behaviors [21]. Web-based treatment has the potential to reach a wider group of help seekers, such as those seeking anonymity, to reduce perceived shame and stigma [20]. Web-based options may also be attractive for their relatively lower cost compared to individual sessions or retreats [10] and for their convenience and flexibility [20,22,23]. Furthermore, these options may be optimally positioned in the online environment (ie, at the site where users are experiencing psychological difficulties) despite concerns around the appropriateness of web-based delivery for online problems [24]. Online delivery may occur via email, websites, social media, apps, online calls, instant messaging, and virtual reality and may involve smartphones, laptops, and computers, among other online devices. Currently, it is unknown how each of these diverse options might be leveraged effectively to deliver mental health services or other public health measures to address the problematic use of online activities and applications.

Reviews on treatment for online addictive behaviors have not yet explicitly focused on the mode of intervention delivery. Past treatment reviews have also tended to be narrow in focus and overlooked the wide variability in the scope of online activities. For example, reviews of online behaviors have examined interventions for problems related to gaming [8,10,25-29], cybersex [30], both internet use and gaming [31-33], internet use and smartphone use [34], and general internet addiction or problematic internet use [2,35-38]. Reviews focused on gambling problems have examined the effectiveness of web-based treatment for prevention [39] and treatment [23,40], but these were not restricted to samples of online gamblers. Only 1 previous review has examined web-based treatments specifically for problematic internet use, reporting on 3 studies and without examining the effectiveness of treatment [36]. This review included the search terms “online intervention,” “eIntervention,” “eTherapy,” and “eHealth,” which meant other forms of web-based treatments such as online psychotherapy, psychoeducation, and self-help were overlooked. Given these limitations and that considerable time (ie, 5 years) had passed since the previous review, it was timely to evaluate the content and effectiveness of web-based treatments for online behavioral addictions.

This systematic review aimed to summarize and critique the available literature on web-based treatments for online behavioral addictions. Specifically, this review aimed to do the following: describe the content of web-based treatments inclusive of any intervention type for online gaming, gambling, shopping, pornography use, social media use, smartphone use, or nonspecified online use; and describe the effectiveness of web-based treatments on severity, duration, or frequency of consumption. Although only gaming and gambling are currently recognized as addictive disorders in the ICD-11, the scope of this review was expanded to include other online activities (social media, pornography, and shopping) that have been proposed to share similarities to these disorders and which have been studied using addiction-based approaches [1]. It is acknowledged that, over time, there may be important changes to the classification of these behaviors as disorders, including their status of inclusion in The Diagnostic and Statistical Manual of Mental Disorders and ICD nomenclatural systems.

This systematic review was registered and published on PROSPERO (International Prospective Register of Systematic Reviews; registration code CRD42021224595) and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines [41].

This systematic review aimed to summarize and critique the available literature on web-based treatments for online behavioral addictions. The review described and evaluated 12 studies that administered web-based treatments for problems related to online gaming, gambling, pornography, and internet or smartphone use. Treatment was delivered via a range of different technologies inclusive of websites, email, computer software, social media messaging, smartphone apps, virtual reality, and videoconferencing. Treatment delivered an average of 4 different change techniques and, like previous studies involving in-person treatment [10,26,35,42], the most-employed change techniques were cognitive restructuring, relapse prevention, motivational enhancement, goal setting, and social support. The least-used techniques have demonstrated effectiveness for other addictive behaviors or in-person delivery, including exposure therapy, social comparison, feedback on assessment, self-monitoring, and mindfulness. These findings suggest an opportunity to enhance or develop new intervention types that incorporate these techniques.

This review described the effectiveness of web-based treatments on severity, duration, or frequency of consumption. Immediately following treatment, participant evaluation indicated that 5 out of 9 studies that evaluated problem severity reported significant improvements for gaming, pornography, and internet or smartphone use. Out of 7 studies that conducted after-treatment evaluation of duration, 3 reported reduced gaming and internet use. Out of 3 studies that conducted after-treatment evaluation of frequency, 2 reported reduced pornography use. Just 5 of 12 studies conducted follow-up evaluation, and this was most frequently 3 months with one 12-month evaluation. Follow-up indicated that treatment was effective at improving symptoms, duration, or frequency. However, 4 out of 5 studies that conducted follow-up evaluation included completers only, with just 1 RCT for gambling [55] using intent-to-treat analysis which indicated no effect of the intervention. Taken together, this evidence suggests findings should be treated with caution given studies retained just 1 in 4 participants. Easy access is related to high attrition rates because people can easily step away from treatment without interacting with another person [57,58]. One pre-post study on gaming [48] reported a retention rate of 70%, and this study had addressed the risk of attrition by including a coach for advice and support during engagement with the intervention. Future studies should investigate methods such as support or other mechanisms like incentives for increasing retention in web-based treatment for online addictions.

Participants in the included studies were predominantly male and aged around 25 years old. Research indicates that being male and more frequently engaged in addictive online activities is associated with an increased risk of online addictions (gaming disorder, gambling disorder, compulsive buying disorder, and issues related to pornography use and social media) [59], which suggests that most online interventions had appropriate target groups. Participants reported various online intervention components (not content) that were important or helpful, such as privacy and convenience when accessing the intervention, staying engaged with the intervention instead of being overwhelmed or bored, and staying connected to professional support systems through online messaging [48,60,61]. This aligns with research reporting that help seekers have preferences for web-based treatments due to their convenience, accessibility, time efficiency, and ability to connect with professional support in a nontraditional manner (ie, not face-to-face) [20].

The majority of included studies recruited participants from Europe, North America, and Oceania. Only 4 studies recruited from Asian countries despite a significant amount of in-person intervention research for online addictions being conducted in East Asia [62,63]. It bears noting, however, that East Asian studies may often be published in non–English language journals. In South Korea and China, there have been parallel developments in structural and technological restrictions, including content filters, shutdown features, and time limits [64-67]. However, research shows that people experiencing problems with their online addictive behaviors (specifically gaming, in this case) report disapproval with modifications to the structure of activities. Instead, they report stronger support for education, free online screening, self-monitoring tools, and warning labels [11] that are online in nature or can be adapted to be delivered online.

Several limitations of the review should be considered. First, a meta-analysis could not be conducted due to the limited quality of studies, limited data available, and varying study designs. Second, just 7 RCTs were included, but only 3 conducted short- or medium-term follow-up evaluation. In addition, the findings from the included studies were limited due to high rates of attrition at follow-up evaluation, with 4 out of 5 studies reporting on completer analysis only. To determine the effectiveness of web-based treatment, there needs to be a greater focus on RCT study design as well as participant retention and long-term follow-up evaluation. Third, we did not include non–English language literature, which might have excluded a large body of research conducted in East Asia. A strength of our study was the inclusion of studies that were focused on treatment rather than on prevention or early intervention; however, due to the heterogenous study focus and design, we were unable to determine who would likely benefit from web-based treatment. Future studies might consider examining the effectiveness of web-based treatment, level of problem severity, and type of addictive behavior. Just 1 included study compared in-person and web-based treatment and reported significant improvements in symptom severity after 8 sessions with no difference between groups. If future research finds web-based outcomes are similar to in-person treatment, then there is a strong case for expansion of web-based options.

There were also several limitations in relation to describing the content of interventions. We used the GIST-1 [42] to categorize change techniques instead of the 93-item behavior change technique (BCT) taxonomy [43] because of the absence of associated protocols or study registration. Just 2 studies referenced a published or manualized protocol or trial registration, which may reflect the exploratory nature of the research at this time. The lack of detailed reporting is common in behavioral addictions and was a reason for the development of the GIST-1 classification system which enables researchers to reliably code brief treatment descriptions [42]. Future studies may consider obtaining treatment manuals or working with a study developer to map the content of effective treatments onto the 93-item BCT taxonomy [43]. The current study was also limited to describing the content of interventions because of the limited sample. Future studies should consider examining the relationship between change techniques and participant outcomes. Studies should also consider examining the theoretical underpinnings or mechanisms of interventions and whether these also have an impact on severity, duration, or frequency of use.

This systematic review identified 12 studies assessing web-based treatments for online behavioral addictions. These findings highlight the potential of emerging web-based treatments, but the current evidence base varied greatly in study quality. This review also highlights the importance of having treatment protocols registered or published alongside an article and reporting components as aligned with BCTs or change techniques to be able to replicate studies with the exact components. Enhanced research designs are needed to develop a stronger evidence base to inform health care guidelines. Future research should also consider the relative appropriateness and cost-effectiveness of web-based treatments to guide the provision and allocation of funding across health systems. The review should be updated as more evidence on intervention effectiveness across online behavior types becomes available.