Comparative syntheses of psychological treatments for excessive gaming commonly present a treatment hierarchy, yet a high rank does not itself establish that the difference is large enough to matter or sufficiently supported to guide care. This study examined whether distinctions among eight psychological treatment classes remain decision-stable after imposing clinically relevant superiority thresholds and accounting for replication, enrolment, randomization, comparator stringency, and follow-up coverage. Seventeen controlled studies involving 745 participants contributed eight active treatment classes and 28 active-treatment contrasts. Comparator-stratified standardized mean changes and the complete contrast matrix supplied the quantitative record. A threshold-calibrated contrast reliability analysis converted each contrast and its 95% confidence interval into the probability that one treatment exceeded another by \(\delta=0.0\), 0.3, 0.5, or 0.8 standardized units. A tournament simulation drew 200,000 realizations of all 28 contrasts and ranked treatments by the number of threshold-exceeding wins. A five-component evidence-support coefficient and a 50,000-specification weight perturbation experiment examined whether efficacy order and evidential strength converged. Psychological treatment effects were larger against inactive controls (\(g=1.70\), 95% CI 1.27–2.12; \(I^2=69\%\)) than against active controls (\(g=0.88\), 95% CI 0.21–1.56; \(I^2=72\%\)). At \(\delta=0.5\), cognitive behavioural therapy (CBT) plus mindfulness and CBT plus family treatment had probabilities of ranking first of 0.675 and 0.322, respectively. Their direct contrast provided only a 0.372 probability that CBT plus mindfulness exceeded CBT plus family treatment by at least 0.5 units. Mindfulness had a 0.939 probability of exceeding CBT by that amount, whereas CBT had only a 0.143 probability of exceeding behavioural treatment plus mindfulness. Treatment rank and evidence support were weakly associated (Spearman \(\rho=0.119\), \(p=0.779\)). The evidence distinguishes a leading cluster of CBT plus mindfulness, CBT plus family treatment, and mindfulness from several lower-ranked options, but it does not establish a single clinically dominant treatment within that cluster. Treatment selection should therefore reflect patient context and delivery feasibility while confirmatory trials directly compare the leading approaches.
Comparative syntheses of psychological treatments for excessive gaming commonly present a treatment hierarchy, yet a high rank does not itself establish that the difference is large enough to matter or sufficiently supported to guide care. This study examined whether distinctions among eight psychological treatment classes remain decision-stable after imposing clinically relevant superiority thresholds and accounting for replication, enrolment, randomization, comparator stringency, and follow-up coverage. Seventeen controlled studies involving 745 participants contributed eight active treatment classes and 28 active-treatment contrasts. Comparator-stratified standardized mean changes and the complete contrast matrix supplied the quantitative record. A threshold-calibrated contrast reliability analysis converted each contrast and its 95% confidence interval into the probability that one treatment exceeded another by \(\delta=0.0\), 0.3, 0.5, or 0.8 standardized units. A tournament simulation drew 200,000 realizations of all 28 contrasts and ranked treatments by the number of threshold-exceeding wins. A five-component evidence-support coefficient and a 50,000-specification weight perturbation experiment examined whether efficacy order and evidential strength converged. Psychological treatment effects were larger against inactive controls (\(g=1.70\), 95% CI 1.27–2.12; \(I^2=69\%\)) than against active controls (\(g=0.88\), 95% CI 0.21–1.56; \(I^2=72\%\)). At \(\delta=0.5\), cognitive behavioural therapy (CBT) plus mindfulness and CBT plus family treatment had probabilities of ranking first of 0.675 and 0.322, respectively. Their direct contrast provided only a 0.372 probability that CBT plus mindfulness exceeded CBT plus family treatment by at least 0.5 units. Mindfulness had a 0.939 probability of exceeding CBT by that amount, whereas CBT had only a 0.143 probability of exceeding behavioural treatment plus mindfulness. Treatment rank and evidence support were weakly associated (Spearman \(\rho=0.119\), \(p=0.779\)). The evidence distinguishes a leading cluster of CBT plus mindfulness, CBT plus family treatment, and mindfulness from several lower-ranked options, but it does not establish a single clinically dominant treatment within that cluster. Treatment selection should therefore reflect patient context and delivery feasibility while confirmatory trials directly compare the leading approaches.
