Group-based IMPROVE Therapy for Problematic Internet Use in University Students

Problematic internet use (PIU) has emerged as a prevalent and clinically significant behavioral health problem among university students, characterized by impaired control over online behaviors and associated psychological distress, functional impairment, and academic difficulties. It is increasingly conceptualized as a spectrum of heterogeneous behaviors (e.g., gaming, social media use, short-form video consumption) rather than a single homogeneous entity.

Although a growing body of research has examined interventions for PIU, the current evidence base remains limited by several methodological shortcomings, including small sample sizes , short intervention durations, insufficient follow-up, insufficient consideration of the heterogeneity of PIU, and a lack of theory-driven investigation into psychological mechanisms of change. Moreover, many existing interventions focus on single components (e.g., cognitive-behavioral techniques alone), while neglecting the multidimensional nature of PIU, which involves complex interactions between cognitive biases, emotion dysregulation, and anhedonia.

To address these gaps, this prospective, single-blind, parallel-group randomized controlled trial evaluates the efficacy, durability, and potential mechanisms of action of a manualized, group-based intervention-IMPROVE therapy-for treatment-seeking university students with PIU. IMPROVE therapy is designed as an integrative program that combines cognitive-behavioral strategies with motivational elements, mindfulness training, and socially interactive exercise, targeting core psychological processes implicated in the development and maintenance of PIU.

Eligible participants will be randomized in a 1:1 ratio to the IMPROVE intervention group or the enhanced waitlist control group using a centralized computer-generated allocation sequence. Participants in the IMPROVE group receive an 8-week structured group therapy consisting of one 120-minute session per week . Outcome assessments are conducted at baseline (T0), mid-intervention (Week 4, T1), post-intervention (Week 8, T2), and at follow-up time points of 1 month (T3), 3 months (T4), 6 months (T5), and 12 months (T6) after completion of the intervention.

The primary objective of the trial is to determine whether IMPROVE therapy leads to a greater reduction in PIU severity compared with the enhanced waitlist control at the end of the intervention. Accordingly, the primary outcome is PIU severity measured by the Internet Addiction Test (IAT), operationalized as the between-group difference in change in IAT total score from baseline (T0) to the post-intervention endpoint (T2).

The secondary objectives are to evaluate (1) the maintenance and durability of treatment effects across short-, medium-, and long-term follow-up periods, and (2) additional clinically relevant outcomes related to PIU. Secondary outcomes therefore include IAT scores at follow-up time points (T3-T6), rates of clinical remission defined by a prespecified IAT threshold, changes in associated psychological symptoms and functional impairment, and indicators of feasibility, adherence, and acceptability of the group-based intervention.

A core objective of this trial is to elucidate how the intervention exerts its effects. Guided by the I-PACE model, candidate psychological mediators will be assessed at baseline (T0), mid-intervention (T1), post-intervention (T2), and the 3-month follow-up (T4). Longitudinal mediation analyses will examine whether changes in maladaptive internet-related cognitions, emotion regulation difficulties, self-efficacy, anhedonia, perceived stress, mind wandering, and resilience statistically account for subsequent changes in PIU severity. Among participants reporting recent gaming, gaming-related maladaptive cognitions assessed using the C-RIGCS will also be examined.

A subset of participants of the IMPROVE intervention group will voluntarily undergo neuroimaging (fMRI) and blood sampling at T0 and T2 to explore the neurobiological correlates of therapeutic change.

Outcome assessors and data analysts will be blinded to treatment allocation to minimize assessment and analytic bias.

• Long-term Change in PIU Severity (IAT) [Time frame: Month 1 (T3), Month 3 (T4), Month 6 (T5), and Month 12 (T6) Follow-up]
• Participant Satisfaction and Acceptability [Time frame: Post-intervention at Week 8 (T2)]
• Smartphone Addiction Risk (SAS-SV) [Time frame: Baseline (T0), Post-intervention at Week 8 (T2), Month 3 (T4), and Month 12 (T6) Follow-up]
• Internet-use Disorder severity based on ICD-11 criteria (ACSID-11) [Time frame: Baseline (T0), Post-intervention at Week 8 (T2), Month 3 (T4), and Month 12 (T6) Follow-up]
• Internet Usage Duration [Time frame: Baseline (T0), Week 4 (T1), Week 8 (T2), Month 1 (T3), Month 3 (T4), Month 6 (T5), and Month 12 (T6) Follow-up.]
• Craving Intensity (QSU-Brief) [Time frame: Baseline (T0), Week 4 (T1), Week 8 (T2), Month 1 (T3), Month 3 (T4), Month 6 (T5), and Month 12 (T6) Follow-up]
• Functional Impairment (BNCS Score) [Time frame: Baseline (T0), Post-intervention at Week 8 (T2), Month 3 (T4), and Month 12 (T6) Follow-up]
• Depressive Symptoms (PHQ-9 Score) [Time frame: Baseline (T0), Post-intervention at Week 8 (T2), Month 3 (T4), and Month 12 (T6) Follow-up]
• Anxiety Symptoms (GAD-7 Score) [Time frame: Baseline (T0), Post-intervention at Week 8 (T2), Month 3 (T4), and Month 12 (T6) Follow-up]
• Insomnia Severity (ISI Score) [Time frame: Baseline (T0), Post-intervention at Week 8 (T2), Month 3 (T4), and Month 12 (T6) Follow-up]
• ADHD Symptoms (ASRS-v1.1 Score) [Time frame: Baseline (T0), Post-intervention at Week 8 (T2), Month 3 (T4), and Month 12 (T6) Follow-up]
• Mental Well-being (WHO-5 Index) [Time frame: Baseline (T0), Post-intervention at Week 8 (T2), Month 3 (T4), and Month 12 (T6) Follow-up]