International tertiary students face many challenges and stressors when studying abroad. Past research reports that Asian international students experience acculturative stress due to language barriers, lack of social connections with locals, and discrimination, which may contribute to poor mental health. The aim of this study was to gather firsthand personal experiences of Chinese international tertiary students studying abroad in Australia. Using open-ended survey questions, this study explored Chinese international students’ acculturation challenges in Australia and the strategies employed to navigate these challenges. Chinese international students studying at universities across Australia were recruited. Qualitative data from 129 Chinese international students (M = 23.2, SD = 2.5) were analyzed using thematic analysis. Five main themes were identified with regard to acculturation challenges and coping strategies: ‘language barriers’, ‘social engagement’, ‘dietary changes’, ‘sports and fitness in acculturation’, and ‘mental health support’. The results suggested that Chinese international students may benefit from interventions that promote social connections, local language competency and mental health literacy to ensure a smoother transition in Australia. Participants also highlighted the need for mental health services to be culturally safe and inviting and clearly promoted as free and accessible. Future research should integrate learnings from Chinese students’ detailed accounts with longitudinal surveys to gain a more comprehensive picture of the conditions that promote positive academic and mental health outcomes.

Australia's social media age restriction policy for those aged under 16 years presents substantial evaluation challenges regarding effectiveness. This viewpoint extends the critical discourse on whether the age restrictions are appropriate and/or feasible and examines practical approaches to assess consequences of the policy. Comprehensive evaluation should examine second- and third-order effects, such as changes in young people's academic performance, digital literacy, mental and physical health indicators, and participation in alternative activities. Recognizing the challenges arising from similar policies in Asian regions, this viewpoint argues that age restrictions alone may achieve limited success without accompanying platform regulations based on safety-by-design principles. Social media restrictions may be less effective without regulations to enforce algorithmic transparency, duty of care obligations, and restrictions on user profiling. Rather than viewing this policy as an endpoint, Australia should establish rigorous long-term evaluation frameworks and consider regulatory approaches that address the structural incentives underlying harmful platform design.

Despite the increased incidence of disordered eating among adolescents and low help-seeking rates, there is currently a lack of evidence supporting use of screening tools for this population. The present study aimed to address this gap by examining the factor structure, gender invariance, and psychological correlates of the Weight Concerns Scale (WCS) in a large sample of Australian adolescents to evaluate its potential suitability as a screening tool. Participants (n = 1022) aged 12–17 (Mage = 14.73; SD = 1.55) were recruited from five public secondary schools in South Australia between May and August 2023. All participants completed the WCS and psychological measures of life satisfaction, resilience, psychological distress, self-injurious thoughts and behaviours. Confirmatory factor analysis replicated the original one-factor structure: χ²(5) = 44.83, p < .001, RMSEA = 0.09, CFI = 0.99. Measurement non-invariance was found by gender and socio-economic-status, suggesting the scale functions differently across these subgroups. A cut-off score of ≥ 47 on WCS was associated with elevated psychological distress across all groups except for boys from lower socio-economic-status backgrounds. The present study is the first to apply confirmatory factor analysis to the WCS in adolescents. Future research needs to establish validity of the WCS as a screen in adolescents in terms of associations with ED psychopathology and behaviours. In addition, validation against diagnostic interview is crucial to establishing the WCS as a screening tool.

Online gambling regulation has become more permissive in many regions, particularly in Western countries, and stakeholders are concerned about young people (aged ≤ 25) and other vulnerable consumers experiencing harm. Some regions continue to maintain an online gambling ban, whilst others have adopted regulatory policies with a focus on consumer protection and harm minimization. Following a systematic search strategy, we reviewed empirical evaluations of international gambling policies to better understand their implementation and possible impact. Legalization leads to increased gambling participation and harm and has limited impact on reducing participation in illegal gambling. Bans on online gambling are difficult, if not impossible, to enforce. So-called ‘responsible gambling’ interventions have limited or no impact on behavior, even though they are widely touted by industry interests. Policies specifically impacting youths focus on preventing underage gambling access. However, young people manage to circumvent these restrictions. Insufficiently regulated gambling advertising is shown frequently to children, including through sports sponsorship. We cannot recommend any gambling regulatory approach as being obviously better than its alternatives based on current evidence. Empirical evaluations of the gambling policies of many other countries have either never been conducted or never been reported in English. A policy that works in one country might not work as well in a different cultural context. More research is needed, and governments that have legalized gambling should impose a levy on gambling revenue to fund healthcare and independent scientific investigations to address and hopefully reduce harm.

In this opinion article, we critically evaluate the widespread discussion of proposed phenomena such as AI Psychosis and Brain Rot. These terms lack empirical support but have gained traction in news media and scientific communication. We argue that society bears significant costs when scientific debates and public discourse become dominated by sensationalized terminology which perpetuates pseudo-science and distract from the real harm of technology use. Using such terms in the context of AI phenomena may also contribute to public panic about AI content and technologies, and undermine balanced discussions of the risks and benefits of these innovations.

Importance:Mitigating the harmful effects of digitalization on youth mental health is essential. Objectives:To evaluate the effectiveness of cognitive behavioral therapy (CBT) compared with a media literacy-based intervention for gaming disorder and unspecified internet use disorder and to determine whether universal or indicated prevention yields stronger benefits. Design, Setting, and Participants:PROTECTconfirm was a randomized clinical trial conducted from July 1, 2020, to August 31, 2024, across 44 secondary schools in Baden-Württemberg, Germany, with 1-, 4-, and 12-month follow-up. All students were included in universal prevention analyses, whereas indicated prevention analyses included a subgroup of adolescents at high risk meeting 2 or more Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for gaming disorder or unspecified internet use disorder at baseline. Interventions:Students were individually randomized within 90 classes to PROTECTtraining, a CBT-based program; or PROTECTinfo, a structurally parallel media literacy program. Both consisted of four 90-minute sessions delivered weekly during school hours by trained local prevention professionals under live supervision and adherence protocols. Main Outcomes and Measures:The primary outcome was gaming disorder symptom severity and unspecified internet use disorder symptom severity, assessed at 12 months with a modified version of the Video Game Dependency Scale. Secondary outcomes included internalizing, externalizing, and transdiagnostic symptoms. Primary and secondary outcomes were analyzed according to the intention-to-treat principle. Results:A total of 1793 students were randomized to PROTECTtraining (n = 896; mean [SD] age, 13.1 [1.5] years; 498 male students [56.1%]) or PROTECTinfo (n = 897; mean [SD] age, 13.1 [1.5] years; 484 male students [54.8%]). Participants in the subsample of 205 adolescents at high risk showed significantly lower 12-month severity of gaming disorder and unspecified internet use disorder symptoms with PROTECTtraining than with PROTECTinfo (mean [SD] Modified Video Game Dependency Scale score: 14.7 [9.7] vs 17.7 [10.3]; within-group Cohen d = -0.91 [95% CI, -1.10 to -0.72] vs Cohen d = -0.61 [95% CI, -0.80 to -0.42]; between-group Cohen d = -0.30 [95% CI, -0.55 to -0.05]), but not in the total sample (mean [SD] Modified Video Game Dependency Scale score: PROTECTtraining, 8.8 [8.3] vs PROTECTinfo, 9.4 [8.4]; within-group Cohen d = -0.11 [95% CI, -0.18 to -0.05] vs Cohen d = -0.04 [95% CI, -0.11 to 0.02]; between-group Cohen d = -0.07 [95% CI, -0.16 to 0.01]). Secondary outcomes did not differ significantly between groups. Conclusions and Relevance:In this randomized clinical trial of 1793 adolescents, the CBT-based intervention reduced gaming disorder symptoms and unspecified internet use disorder symptoms more effectively than the media literacy-based intervention among adolescents at high risk. These findings support the use of CBT-based approaches primarily within indicated, rather than universal, prevention. Trial Registration:German Clinical Trials Register (DRKS) trial registration: DRKS00033989.

Importance Mitigating the harmful effects of digitalization on youth mental health is essential. Objectives To evaluate the effectiveness of cognitive behavioral therapy (CBT) compared with a media literacy–based intervention for gaming disorder and unspecified internet use disorder and to determine whether universal or indicated prevention yields stronger benefits. Design, Setting, and Participants PROTECTconfirm was a randomized clinical trial conducted from July 1, 2020, to August 31, 2024, across 44 secondary schools in Baden-Württemberg, Germany, with 1-, 4-, and 12-month follow-up. All students were included in universal prevention analyses, whereas indicated prevention analyses included a subgroup of adolescents at high risk meeting 2 or more Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for gaming disorder or unspecified internet use disorder at baseline. Interventions Students were individually randomized within 90 classes to PROTECTtraining, a CBT-based program; or PROTECTinfo, a structurally parallel media literacy program. Both consisted of four 90-minute sessions delivered weekly during school hours by trained local prevention professionals under live supervision and adherence protocols. Main Outcomes and Measures The primary outcome was gaming disorder symptom severity and unspecified internet use disorder symptom severity, assessed at 12 months with a modified version of the Video Game Dependency Scale. Secondary outcomes included internalizing, externalizing, and transdiagnostic symptoms. Primary and secondary outcomes were analyzed according to the intention-to-treat principle. Results A total of 1793 students were randomized to PROTECTtraining (n = 896; mean [SD] age, 13.1 [1.5] years; 498 male students [56.1%]) or PROTECTinfo (n = 897; mean [SD] age, 13.1 [1.5] years; 484 male students [54.8%]). Participants in the subsample of 205 adolescents at high risk showed significantly lower 12-month severity of gaming disorder and unspecified internet use disorder symptoms with PROTECTtraining than with PROTECTinfo (mean [SD] Modified Video Game Dependency Scale score: 14.7 [9.7] vs 17.7 [10.3]; within-group Cohen d = −0.91 [95% CI, −1.10 to −0.72] vs Cohen d = −0.61 [95% CI, −0.80 to −0.42]; between-group Cohen d = −0.30 [95% CI, −0.55 to −0.05]), but not in the total sample (mean [SD] Modified Video Game Dependency Scale score: PROTECTtraining, 8.8 [8.3] vs PROTECTinfo, 9.4 [8.4]; within-group Cohen d = −0.11 [95% CI, −0.18 to −0.05] vs Cohen d = −0.04 [95% CI, −0.11 to 0.02]; between-group Cohen d = −0.07 [95% CI, −0.16 to 0.01]). Secondary outcomes did not differ significantly between groups. Conclusions and Relevance In this randomized clinical trial of 1793 adolescents, the CBT-based intervention reduced gaming disorder symptoms and unspecified internet use disorder symptoms more effectively than the media literacy–based intervention among adolescents at high risk. These findings support the use of CBT-based approaches primarily within indicated, rather than universal, prevention. Trial Registration German Clinical Trials Register (DRKS) trial registration: DRKS00033989

Background and aims:Recovery from gaming disorder can be difficult because it requires reducing or abstaining from an activity that once fulfilled important psychological needs such as social connection, achievement, and escape. This research examined whether nostalgia for the perceived benefits of gaming-termed addiction-related nostalgia-undermines recovery and whether such nostalgia arises from continued identification as a gamer. Methods:Two pre-registered cross-sectional studies were conducted with individuals in recovery from gaming disorder (Study 1a = 299; Study 1b = 578; total N = 877). Participants completed measures of gamer identification, addiction-related nostalgia, loneliness, depression, anxiety, and intention to remain in recovery. Path analyses tested hypothesised indirect effects using bias-corrected bootstrapping. Results:Gamer identification was positively associated with addiction-related nostalgia, which in turn predicted greater loneliness, depression, and anxiety. Addiction-related nostalgia indirectly undermined intention to remain in recovery through heightened loneliness and depression. Participants who engaged in reduced gaming reported greater nostalgia, depression, anxiety, and lower recovery motivation than abstinent participants. Conclusions:Addiction-related nostalgia represents a significant psychological barrier to recovery from gaming disorder. Continued identification as a gamer may sustain longing for gaming's benefits, exacerbate psychological difficulties, and weaken recovery motivation. Assessing and addressing nostalgia may strengthen recovery-focused interventions.

Dietary restraint is a common weight regulation strategy, yet long-term adherence is frequently disrupted by emotional influences. These disruptions may stem from difficulties in emotion regulation strategy and capability use. The present study utilised a naturalistic seven-day snack diary method to examine the relationships between mood (state and trait), dietary restraint, and emotion regulation on snack choice and consumption. Each day, 155 women recorded their snack intake alongside their mood prior to consuming each snack. Results indicated an interaction between state mood and dietary restraint, with negative (but not positive) mood associated with greater unhealthy snack intake for restrained eaters, compared to unrestrained eaters. Emotion regulation was found to have only a limited moderating role in this relationship, suggesting instead that a restrained eater’s ability to interpret and process their emotional state is more likely to influence their snacking behaviour. Trait affect did not interact with dietary restraint to predict eating behaviour, suggesting that momentary emotional states have a stronger impact on dietary adherence than chronic emotional tendencies. These findings highlight the impact of emotional awareness and real-time mood regulation in influencing snacking behaviour, and inform potential intervention targets to support sustainable weight regulation goals.

Gaming disorder (GD) is an addictive disorder with health and social impacts recognized by the World Health Organization. Although the GD treatment evidence base appear to favor cognitive behavioral therapy (CBT), knowledge of its common practice elements is limited. This systematic review critically evaluates CBT interventions for GD, encompassing individual, group, and mixed approaches, to identify and synthesize common practice elements. Employing a systematic review protocol following PRISMA guidelines and guided by an international expert panel, this review identified CBT studies and then critically reviewed their associated treatment manuals, guidelines, handouts, and related resources. A database search yielding 8479 results identified 28 studies from 12 countries reporting on 22 CBT interventions (n = 7 individual; n = 7 group; n = 8 mixed). Study authors were invited to share intervention materials, which were then independently coded and synthesized. Overall, 14 common practice elements were identified. The most frequent element was emotion regulation skills training (n = 21; 95.5%), followed by psychoeducation (n = 20; 90.9%) and cognitive restructuring (n = 19; 86.4%). Exposure techniques, and strength identification and self-compassion were the least frequent (n = 6; 27.3%). All individual CBT interventions used behavioral activation, psychoeducation, and relapse prevention, whereas emotion regulation skills training was the most frequently used element in group CBT. These findings reveal commonly reported CBT practice elements in the GD evidence base and provide expert summaries of established and less utilized therapeutic techniques. Improving the field's shared understanding of CBT is foundational to advancing GD clinical research and a model of best practice.

Behavioral addictions, including problematic internet use, gaming, and gambling, are emerging as significant public health concerns in Africa, driven by rapid digitalization and socioeconomic shifts. This commentary provides a critical overview of the current state of behavioral addictions in Africa, examining prevalence, cultural influences, and systemic barriers to research and intervention. Despite growing evidence of harm, particularly among youth, the continent faces significant challenges, including limited epidemiological data, cultural biases in assessment tools, and an underdeveloped mental health infrastructure. Drawing on regional studies and global frameworks, the need for culturally sensitive research, evidence-based interventions, and robust policy frameworks is highlighted. The paradoxical coexistence of rising addiction risks and minimal regulatory oversight underscores the urgency of addressing behavioral addictions in African contexts.

This commentary critically considers the case for including non-digital gaming within the scope of gaming disorder. The ICD-11 category for gaming disorder refers to gaming (i.e., 'digital gaming' or 'video-gaming') which may be predominantly 'online' (i.e., over the internet) versus 'offline'. Non-digital forms of gaming (i.e., gaming that does not involve any electronic devices and is not conducted over the internet) are not explicitly recognized. We suggest that gaming in both digital and non-digital formats is an activity of relevance to addiction studies and public health, and that an exclusive focus on digital gaming may overlook potential non-digital game-related risks and harms. We refer to popular collectible card games (e.g., Pokémon, Magic: The Gathering [MtG]) and tabletop games (e.g., Warhammer 40K), as these activities seem to have the most in common with online games, particularly in relation to similarities to digital monetization schemes (e.g., loot boxes). We call for research to investigate the relative costs and benefits of engagement in non-digital gaming activities. If highly involved players of non-digital games tend to not report gaming disorder symptoms or harm, then it may be worthwhile examining how these players differ from digital game players. Finally, investigating non-digital gaming may produce new insights into developing effective interventions and preventive measures for problematic digital gaming.

Online video gaming is a highly popular activity, especially amongst young people (aged ≤25), with entertainment, emotional, and social benefits. However, stakeholders are also concerned about potential risks and harms, including exposure to inappropriate (e.g., violent and sexual) content; excessive use (i.e., ‘addiction’ and ‘gaming disorder’); and overspending, particularly in relation to gambling-like products (e.g., loot boxes). Various regulatory policies have been adopted worldwide in response. We reviewed empirical evaluations of the implementation of these policies. Results showed that age rating systems that provide information on the suitability of a game's content are widely adopted; however, many young people and their parents do not follow the guidance. Restrictions on how long and when young people can play video games in Asia could be easily circumvented and are not obviously beneficial. Regulations governing gambling-like loot boxes and in-game monetary spending in Europe and Asia are poorly complied with and enforced, leaving significant consumer protection concerns unaddressed. Many aspects of the adopted policies remain untested, and the regulatory situation in many countries remains unreported in the English academic literature. Stricter enforcement of pre-existing regulations, which has not occurred, may address many concerns. More research is needed to ensure all adopted policies are regularly monitored and tested: effective policies should be considered for adoption elsewhere, whilst ineffective policies should either be improved or repealed. Governments should fund more research into countermeasures to reduce the unwanted psychosocial effects of video games.

Individuals who struggle to regulate their gaming involvement, particularly those with gaming disorder, often report strong subjective urges to play games. Desire thinking has been proposed to be an active driver of urge, and therefore disrupting desire thinking processes may reduce urges to play. Detached mindfulness, a meta- cognitive therapy technique, is a candidate option for reducing desire thinking, but the available research in relation to gaming is limited. To address this gap, this pre-registered study employed a 3 (Group: mindfulness, relaxation, control) x 3 (Time: baseline, pre-task, post-task) mixed experimental design to evaluate the effectiveness of different techniques to reduce gaming urges. Gamers (N = 337) were recruited via the crowd-sourcing platform Prolific. Participants were administered interactive video-based tasks that induced gaming-related desire thinking and were then randomly delivered one of three techniques. Results showed that the desire thinking exercise significantly increased gaming urge. However, the detached mindfulness technique had no significant effect on urge to play, whereas relaxation significantly reduced urge compared to control. The effect of relaxation on urge was stronger for those with moderate to high impulsivity. These results support the proposed link between desire thinking and gaming urge. Gaming urges may be reliably induced using a brief self- guided protocol, which has applications for interventions involving exposure exercises without the use of physical gaming stimuli. Relaxation techniques may have short-term utility in reducing gaming-related urges. Further research should examine other meta-cognitive therapy-based techniques to support a broader research program on CBT for gaming disorder.

Objective:While gambling is a growing public health concern, research resources are limited, and no guidance is available to prioritise research. This study aimed to identify priorities for gambling research on a global scale using a systematic, transparent, and democratic methodology to inform researchers and other stakeholders. Methods:Leading gambling researchers were invited to list gambling-related research questions that can contribute to strengthening evidence-based policy, prevention, and effective early intervention and treatment of problem gambling. Suggestions were consolidated into research options and evaluated against six criteria (Answerability, Feasibility, Effectiveness, Impact on equity and an additional two based on the category of research options: Novelty and Relevance for description-type, Potential for burden reduction and Deliverability for intervention-related options). Stakeholders (n = 14) assigned relative weights to each criterion, and options were ranked according to their weighted research priority scores. Results:With input from 46.9% of eligible researchers (n = 307) from 35 countries, 1,361 questions were consolidated into 102 options. Evaluations showed strong agreement between experts, and the top 25 priorities were identified. The results highlight the need for further knowledge about the epidemiology, etiology, and consequences of problem gambling. Top-priority topics indicate the importance of focusing on vulnerable and minority groups, youth, significant others, technological innovations, advertisements, the convergence of gaming and gambling, and co-occurring conditions. Evaluating and tailoring existing measures were prioritised more highly than new interventions, and identifying factors underlying treatment seeking, drop-out and relapse was also considered a priority. Conclusions:This initiative successfully involved the global research community in identifying gambling research priorities. The results provide information for researchers and other stakeholders for future projects and funding.

AIMS:The behavioral addictions field lacks clinically useful behavior frequency measures. This study evaluated the psychometric performance of the new 'Red Box, Green Box' method for measuring gaming behavior with a focus on its utility for gaming disorder (GD) screening. DESIGN, SETTING AND PARTICIPANTS:A prospective, cross-sectional survey study was conducted using an online crowdsourcing platform. Participants were 1149 male gamers aged 18-35 years from Australia, Canada, United States, United Kingdom and Asia, reporting ≥12 hours of weekly gaming. MEASUREMENTS:Gaming time was measured using a conventional weekly hours item, Red Box hours (gaming instead of fulfilling responsibilities) and Green Box hours (gaming during free or leisure time). GD was assessed by the Internet Gaming Disorder Test (IGDT-10), with International Classification of Diseases, 11th Revision (ICD-11) and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) scoring approaches. Psychological distress [Depression, Anxiety and Stress Scale - 21 Items (DASS-21)] and impulsivity [Barratt Impulsiveness Scale-short form (BIS-15)] were measured. FINDINGS:Gamers with GD reported higher Red Box hours [mean (M) = 21.1, standard deviation (SD) = 11.3] than those without (M = 8.7, SD = 8.4; P < 0.001), and greater Red Box proportion (41.9% vs. 26.8%; P < 0.001). Red Box hours demonstrated superior diagnostic accuracy for GD [area under the curve (AUC) = 0.86, sensitivity = 0.94, specificity = 0.63] and Internet gaming disorder (IGD) (AUC = 0.76, sensitivity = 0.88, specificity = 0.56), outperforming comparative measures. A Red Box response of ≥ 9.5 hours had a 94% likelihood of indicating ICD-11 GD. CONCLUSIONS:The 'Red Box, Green Box' method appears to effectively identify International Classification of Diseases, 11th Revision, gaming disorder risk among males. Red Box hours demonstrated greater classification validity than the conventional weekly hours approach. This method provides a simple tool for epidemiological research, routine screening (e.g. outpatient consultation) and clinical assessment and treatment planning. Further validation in clinical populations and longitudinal studies is needed.

The mental health status of university students is a global concern. This study investigated the mental health and wellbeing of university students in Australia, with a focus on identifying potential differences between domestic and international tertiary students. It was hypothesized that international students would experience greater mental health challenges compared to domestic students. Building on previous research predominantly centered on domestic students, a diverse sample of 838 university students (Mage = 23.0, SD = 5.4; 69 % female) was recruited. The results indicated a significant prevalence (44.1 % and 93.3 %, respectively) of moderate to severe levels of psychological distress and moderate to high levels of loneliness among the sampled population. It was found that mental health outcomes were comparatively more favorable for Chinese international students than both domestic students and international students from other countries. These findings underscore the need for targeted interventions to address the specific mental health challenges that different student populations face.