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Update on treatment studies for compulsive buying-shopping disorder: A systematic review

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Official websites use. Share sensitive information only on official, secure websites. The reference was corrected to Kukar-Kinney et al. Open Access. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4. Compulsive buying-shopping disorder CBSD is mentioned as an example of other specified impulse control disorders in the ICD coding tool, highlighting its clinical relevance and need for treatment. Original research published between January and December was included. Effect sizes for primary CBSD outcomes were calculated. None of the studies addressed online CBSD. Psychotherapy studies suggest that group cognitive-behavioral therapy is effective in reducing CBSD symptoms. Pharmacological studies with selective serotonin re-uptake inhibitors or topiramate did not indicate superiority over placebo. Predictors of treatment outcome were rarely examined, mechanisms of change were not studied at all. Risk of reporting bias was high in most studies. Poor methodological and low quality of reporting of included studies reduce the reliability of conclusions. There is a lack of studies targeting online CBSD. More high-quality treatment research is needed with more emphasis on the CBSD subtype and mechanisms of change. Phenomenological features of CBSD are time-consuming shopping activities and excessive spending of consumer items that are not needed or not utilized for the intended purposes, which may be offline i. Notwithstanding the numerous adverse consequences, the maladaptive consumer behavior is continued or even escalated. Treatment-seeking individuals with CBSD often suffer from other mental disorders, e. Specific internet features e. While the symptomatic pattern described above applies to both offline and online CBSD, it is not yet clear whether online CBSD should be seen as the virtual equivalent of traditional offline CBSD or, at least in a subgroup of individuals with online CBSD, as a standalone specific internet-use disorder that would not have developed in brick-and-mortar retail Fineberg, Menchon, et al. In addition to specific internet and e-commerce features, individual expectancies and using motives may contribute to the development and maintenance of online CBSD, e. Furthermore, reward and relief mechanisms known form substance use disorders and other behavioral addictions e. Undoubtedly, treatment is necessary for CBSD, as the problem is associated with massive negative consequences for affected persons and their relatives, impairments in important areas of functioning, and chronicity Achtziger et al. In view of the growth of e-commerce and the presumed increase in problematic or even addictive usage of shopping applications Augsburger et al. Previous systematic reviews have not paid attention to whether the CBSD occurred offline or online. This review scope is of relevance for clinicians and researchers because additional information on the treatment of online CBSD will inform about the availability or lack thereof of new or adopted treatment approaches which may optimize clinical practice and initiate future proof-of-concept and treatment studies. When we started this project, the last systematic reviews were published three Goslar et al. Recently, another systematic review was published by Vasiliu that, however, differs from the current work with respect to methodological aspects such as search strategy, included articles, analysis of primary outcomes and discussion. Therefore, the current work is justified and expands on previous reviews. Taking into account past systematic reviews Goslar et al. Due to the expected low number of publications that specifically refer to online CBSD, all available literature on treatments for CBSD was evaluated not only literature considering particularly online CBSD that has been published since then. The present work was performed in accordance with the PRISMA statement, an updated guideline for reporting systematic reviews Page et al. The main methodological adjustments of the preregistered protocol are mentioned below. The review included original research no reviews, no meta-analyses, no case reports published in scholarly peer reviewed journals between and December in the English language. In contrast to the preregistered protocol, the timeframe for the literature search was extended until mid-December The treatment studies had to include patients with diagnosed CBSD. Participants in the case groups should have received some type of treatment to reduce symptoms of CBSD e. Included were case-control between-group comparisons and open within pre-post comparisons studies. Further reasons for exclusion were: no original or empirical research, case study, lack of quantitative data on treatment evaluation i. As an example, Table 1 shows the search string for PubMed see supplementary material S3 for full search strategy of all databases. Studies were selected by using a two-stage procedure. In a second step, the first AM and the last EG author independently examined the full texts of selected articles. In case of disagreements consensus was made regarding the in- or exclusion of studies with the assistance of the whole study team i. Narrative and quantitative analyses of primary outcomes were performed by the first AM and last EG author. Results are provided for controlled psychotherapy and pharmacological studies. As recommended by Dunlap, Cortina, Vaslow, and Burke the effect sizes were calculated for independent variables instead of dependent variables as effect sizes for dependent variables often overestimate the actual size of effect. The risk of bias RoB assessment followed the approach of previous systematic reviews on treatment for behavioral addictions Antons et al. If no evaluation of the item was possible or if the item was not applicable e. The sum score for each study could vary from 0 to 74, with higher scores indicating a higher quality of reporting i. Inconsistencies were discussed between the two authors and resolved if possible. In case of disagreement, the respective items were reassessed jointly by two other authors SSL, MB and consensus was found. Figure 1 presents the flow diagram showing the in- and exclusion process during the systematic literature search. Characteristics and main outcomes of the included 13 studies are detailed in Table 2 open studies and Table 3 controlled studies. Characteristics and main findings of included open studies for compulsive buying-shopping disorder CBSD. Characteristics and main findings of included controlled studies for compulsive buying-shopping disorder CBSD. All identified studies included treatment-seeking patients with the primary diagnosis being CBSD. Most studies Benson et al. Other studies reported that they used a questionnaire only Mitchell et al. The additional search for preregistered ongoing treatment trials did not yield any hits. None of the included studies specifically addressed online CBSD. Most of the 13 identified studies were conducted in the United States Benson et al. Within all studies, mean ages of participants ranged between Three studies included only women Black et al. In terms of treatment, 87 in controlled studies and in open studies persons received psychotherapy, 84 in open studies, 72 in controlled studies received pharmacological treatment, and participants were assigned to a waitlist or placebo-control group. Detailed information on sample characteristics and interventions is provided in Table 2 open studies and Table 3 controlled studies. With respect to psychotherapy, all but one of the studies used group treatment. In the open psychotherapy study by Granero et al. Four psychotherapy studies compared group psychotherapy with waitlist Benson et al. The fourth controlled session group psychotherapy study applied a combination of CBT, dialectical behavior therapy DBT , psychodynamic psychotherapy PD , acceptance and commitment therapy ACT and mindfulness-based interventions Benson et al. In the pharmacological studies different medications were tested: selective serotonin re-uptake inhibitors SSRIs Black et al. With regard to memantine it was presumed that the medication would improve patients' cognitive flexibility and response inhibition by modulating glutamatergic neurotransmission in the cortex, resulting in an improvement of CBSD Grant et al. Topiramate has a complex effect on both the GABAergic and glutamatergic system and may regulate the functioning of the nucleus accumbens in addictive processes Nourredine et al. The most recent study tested the anticonvulsant topiramate over nine to 12 weeks against placebo pills Nicoli de Mattos et al. Table 4 provides an overview of measures that were applied to assess changes in CBSD symptomatology or other treatment outcomes. Measures that were applied to assess changes in CBSD symptomatology and other treatment outcomes across included studies. Furthermore, purchasing recalls Benson et al. Detailed information on risk of bias assessment is given in Table 5. The quality of reporting scores ranged between 11 and Only three studies were registered Grant et al. References are sorted from lowest to highest risk of bias with higher sum scores indicating lower risk of bias. If no evaluation of the item was possible e. The sample size of most studies was small. An a priori sample size determination was reported in the placebo-controlled medication study by Nicoli de Mattos et al. The open psychotherapy study by Granero et al. In some studies, there were even fewer than 10 patients in the psychotherapy Benson et al. Granero et al. Therefore, quantitative synthesis was performed for the three remaining trials Mitchell et al. The results indicate advantage of group CBT over waitlist across the studies and maintenance of treatment effects or even further improvement of CBSD at six-months-follow-ups Mitchell et al. Between group effect sizes, defined as the difference between the end-of-treatment means of the CBT or GSH group and the waitlist group divided by the pooled standard deviation, were reported for CBT vs. The findings of the controlled psychotherapy study by Benson et al. Table 7 lists the results of the quantitative analysis of controlled pharmacological studies. The findings of the three placebo-controlled studies Black et al. Participants receiving the SSRI and those taking placebo pills improved similarly, indicating a high placebo response rate. In the study by Black et al. All based on published intention-to-treat analyses. The findings of the double-blind discontinuation phase reported by Koran et al. The findings of the two open-label studies followed by a double-blind discontinuation phase revealed mixed results. Koran et al. However, the relapse rates were reported and indicated no difference between the escitalopram and the placebo group Being male, high levels of depressive and obsessive-compulsive symptoms, low levels of anxiety symptoms and the personality traits high persistence, high harm avoidance and low self-transcendence measured with the Temperament and Character Inventory-Revised Cloninger, predicted poor therapy adherence in the open CBT study by Granero et al. The aim of the present work was to perform a systematic update on treatment studies for CBSD published since , with a particular focus on online CBSD. Our findings indicate that there is still a paucity of treatment studies for CBSD. Since the systematic reviews published through November Goslar et al. A search on established public trial registers revealed no evidence of currently ongoing preregistered treatment trials. It is necessary to address overlaps and differences between the present systematic review and the recently published work by Vasiliu Differences between the two systematic reviews refer to e. Vasiliu included primary and secondary reports i. In contrast to Vasiliu's work, the present systematic review was preregistered, has a clear focus on original research i. Therefore, the current work is not only an update of the systematic reviews published before , but adds to the literature on treatment for CBSD beyond the work of Vasiliu In the following, we will discuss the advantages and disadvantages of included studies in detail and provide recommendations for further treatment research. None of the studies addressed online CBSD specifically. The preferred shopping environment was reported only in the very first CBT study, which was performed more than 17 years ago Mitchell et al. Below, we first discuss the results of psychotherapy studies and then turn to pharmacological treatment studies for CBSD. Increasing certainty of pre-existing reviews and conclusions Goslar et al. CBT treatments were related to large pre-post and pre-follow-up effect sizes Table 6. Unfortunately, no conclusions can be drawn about other forms of psychotherapy e. Although the findings consistently emphasize the advantage of CBT, poor methodological quality and the high risk of publication bias reduce the reliability of this conclusion. Substantial deficits across all psychotherapy studies were found in the report of the sample size determination, randomization procedure, unintended side effects and trial limitations. In all controlled CBT trials, sample sizes were small and ranged from six Benson et al. The study by Granero et al. Predictors of treatment outcome were examined in two studies Granero et al. Therapists' treatment adherence and therapeutic elements that may have contributed to the treatment outcome were not explored. Therefore, no insight can be derived regarding which specific psychotherapy techniques made the treatment effective for CBSD. Black et al. Moreover, all controlled psychotherapy studies used a group format. It cannot be ruled out that common nonspecific factors of structured group psychotherapy such as e. It should also be noted that three out of the four controlled CBT studies used the same CBT manual and had a high degree of overlap of study teams Mitchell et al. It is questionable whether waiting lists are the appropriate control condition for psychotherapy because common nonspecific therapeutic effects of CBT are not accounted for with waitlist design. Furthermore, potential nocebo effects in the waitlist group may falsely increase the effect size and result in overestimating the efficacy of CBT Fineberg, Pellegrini, et al. The within group effect sizes with broad confidence intervals listed in Table 6 might indicate a comparable benefit from group CBT and GSH and that both approaches were equally superior to waitlist. Unfortunately, the authors failed to report the between-group effect sizes for CBT vs. For all the criticism of the included CBT studies it should be taken into account that at least some of these studies e. They were conducted at a time when very little attention was paid to CBSD. Nevertheless, larger sufficiently powered psychotherapy trials with appropriate control conditions and a focus on mechanisms of change, potential moderators e. Of-course, this requires a better understanding of mechanisms underlying the development and maintenance of CBSD, which would help to develop more tailored psychotherapy interventions. Unfortunately, no conclusion at all can be drawn regarding the psychotherapy of online CBSD. In our assumption, this is questionable given the specific features of the internet and e-commerce e. There is already preliminary evidence for the role of individual expectancies and using motives in online CBSD e. Research on the interaction between environmental factors and individual affective and cognitive mechanisms in online CBSD is still at the beginning Brand, ; Brand et al. More effort is needed to better understand the role of online access to consumer goods with respect to CBSD. In terms of pharmacotherapy, our findings are in line with those of previous reviews that indicated a lack of evidence for drug treatment of CBSD Goslar et al. Only in the study by Koran et al. Given the small number of patients participating in the discontinuation phase, the interpretation of the results is limited. The most recent controlled medication study tested the anticonvulsant topiramate against placebo Nicoli de Mattos et al. The study by Nicoli de Mattos et al. This is in accordance with recent systematic reviews which did not find clear evidence supporting the efficacy of topiramate in the treatment of individuals with high impulsivity Chapron et al. The high placebo rates in the pharmacological studies are striking. They were attributed to the positive effects of maintaining a daily diary to monitor CBSD symptoms Ninan et al. This raises the question to what extent the high numbers of patients meeting responder status by the end of open-label treatments Grant et al. Interestingly, no studies have been conducted with opioid antagonists e. Considering case reports, Grant had already reported about partial or complete remission of urges to shop in two women and one men with CBSD treated with naltrexone. High-dose use of naltrexone may pose a risk of liver damage and requires frequent liver function tests Grant, This might be one reason why no controlled naltrexone studies have been performed for CBSD to date. Taken together, the pharmacological studies included in this review are all preliminary with small samples and a heterogeneity in pharmacological treatment approaches. Insufficient understanding of the neurobiological mechanisms involved in CBSD and the lack of consistency surrounding its recognition as formal diagnosis are obstacles to conducting high quality pharmacological studies. In our opinion, it is also doubtful whether a purely drug-based treatment of CBSD, particularly online CBSD, can be successful in the long term given the assumed complex interactions between environmental, social and individual processes Brand et al. It is important to take a critical look at the measures used to define CBSD and treatment outcomes. The overlap of instruments across studies is a strength because it facilitates comparability of results, but the suitability of both instruments as diagnostic tools or outcome measures is limited. In light of current common theoretical considerations that CBSD is more likely be understood as a disorder due to addictive behaviors Brand et al. At the same time, it remains to be remembered that only few assessments for CBSD were available at the time when most drug trials were conducted. There is a need for quantitative measures to assess symptom severity of CBSD. The requisite for valid assessment tools is the conceptualization of CBSD as formal diagnosis with accepted diagnostic criteria. As with other mental disorders, the clarification of diagnostic criteria of CBSD and the recognition of online CBSD as a form of problematic usage of the internet will encourage the establishment of standard diagnostic assessment tools and help researchers to compare the findings across treatment studies Fineberg, Menchon, et al. The present systematic review has some shortcomings. There is a potential risk of search biases given that studies published before , non-English language manuscripts, grey literature and manuscripts that are not registered with PubMed, Scopus, Web of Science or PsycInfo were not considered. However, wide screening strings were used that were likely be over-inclusive. Additionally, manual search of related articles and reference lists was performed to reduce search biases. While case reports were excluded, open-label trials were included even if only a few patients were treated. The quality of reporting was assessed using the CONSORT criteria for randomized controlled trials, which is not entirely appropriate for the RoB rating of open-label studies. This limited approach was used given the small number of controlled studies. It is also important to note that the RoB assessment refers to the study reports. Hence, missing reports in the publications do not necessary mean that these methods were not used in the respective study. Research on CBSD treatment would profit from more systematic, high-quality methodology. Regarding psychotherapy, it is time to compare CBT with an active treatment based on a priori sample size determination using predefined non-inferiority margins. Much more attention should be paid to the mechanisms of change, treatment adherence, the role of specific and nonspecific therapeutic factors and negative side effects of treatment. Complementary computerized interventions to improve cognitive and affective processes relevant in addictive behaviors e. Drug studies would benefit from further insight into the neurobiology of CBSD. Given the increasing importance of online shopping, research should address the question of whether the treatment of online CBSD differs from the treatment of traditional CBSD and, if so, in what aspects exactly. Specific online CBSD-related interventions could focus on dealing with constant availability of shopping websites, online shopping cues e. Considering the findings indicating that younger consumers tend to engage in problematic online shopping more often than older individuals Augsbuger et al. To date, no treatment studies have been published specifically for online CBSD. The studies included in this systematic review did not differentiate between a predominant offline and a predominant online CBSD subtype. While group CBT was effective in reducing the symptom severity of CBSD, the results should be interpreted with caution given the absence of appropriate control conditions and the lack of investigation of nonspecific compared to specific treatment effects and mechanisms of change. Both, the psychotherapy and medication studies, were limited due to small samples, poor quality of reporting, and other methodological shortcomings. Supervision of literature search: SA, AM. Examination of full texts of selected articles: AM, EG. Quantitative analysis and interpretation of data: AM, EG. All authors had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The authors declare no conflict of interest. As a library, NLM provides access to scientific literature. J Behav Addict. Find articles by Nora M Laskowski. Find articles by Tobias A Thomas. Find articles by Stephanie Antons. Find articles by Nadja Tahmassebi. Find articles by Sabine Steins-Loeber. Find articles by Matthias Brand. Find articles by Ekaterini Georgiadou. E-mail: mueller. Open in a new tab. Quantitative synthesis of controlled psychotherapy studies sorted by risk of bias assessment. Quantitative synthesis of controlled pharmacological studies sorted by risk of bias assessment. RoB Primary endpoint Baseline vs. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Moderate Filomensky and Tavares Brazil. Grant et al. Koran USA. Mitchell et al. Benson et al. Ninan et al. Relapse rate i. Nicoli de Mattos et al. Monahan et al. Valence et al. Kukar-Kinney et al. Weun et al. Number of CBSD episodes, total amount of money spent, total amount of time spent shopping over a certain time period. Patients' adherence in performing inter-sessions tasks e. Missing therapy sessions on three or more occasions without notifying the therapist. Koran

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