online gaming addiction solutions essay

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Internet gaming addiction: current perspectives

Daria j kuss.

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Correspondence: Daria J Kuss, Birmingham City University, City North Campus, Birmingham B42 2SU, UK, Tel +44 78 9111 9490, Email [email protected]

Collection date 2013.

The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/ . Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

In the 2000s, online games became popular, while studies of Internet gaming addiction emerged, outlining the negative consequences of excessive gaming, its prevalence, and associated risk factors. The establishment of specialized treatment centers in South-East Asia, the US, and Europe reflects the growing need for professional help. It is argued that only by understanding the appeal of Internet gaming, its context, and neurobiologic correlates can the phenomenon of Internet gaming addiction be understood comprehensively. The aim of this review is to provide an insight into current perspectives on Internet gaming addiction using a holistic approach, taking into consideration the mass appeal of online games, the context of Internet gaming addiction, and associated neuroimaging findings, as well as the current diagnostic framework adopted by the American Psychiatric Association. The cited research indicates that the individual’s context is a significant factor that marks the dividing line between excessive gaming and gaming addiction, and the game context can gain particular importance for players, depending on their life situation and gaming preferences. Moreover, the cultural context is significant because it embeds the gamer in a community with shared beliefs and practices, endowing their gaming with particular meaning. The cited neuroimaging studies indicate that Internet gaming addiction shares similarities with other addictions, including substance dependence, at the molecular, neurocircuitry, and behavioral levels. The findings provide support for the current perspective of understanding Internet gaming addiction from a disease framework. The benefits of an Internet gaming addiction diagnosis include reliability across research, destigmatization of individuals, development of efficacious treatments, and the creation of an incentive for public health care and insurance providers. The holistic approach adopted here not only highlights empirical research that evidences neurobiologic correlates of Internet gaming addiction and the establishment of a preliminary diagnosis, but also emphasizes the necessity of an indepth understanding of the meaning, context, and practices associated with gaming.

Keywords: Internet gaming, Internet gaming addiction, current perspectives, context, neuroimaging, diagnosis

Introduction: the mass appeal of Internet gaming

Internet gaming is a booming market. In 2012, more than one billion individuals played computer games, which fuelled the 8% growth of the computer gaming industry in the same year. 1 A recent report by the market research company Niko Partners has estimated the People’s Republic of China’s online gaming market at $12 billion in 2013. 2 Massively Multiplayer Online games (MMOs) offer the possibility to play together with many other players and can be differentiated based on game content and player experience. A latent profile analysis of survey data from 4,374 Hungarian online gamers (91% male, mean age 21±6 years) indicated that the most prominent MMOs were role-playing games, first-person shooters, real-time strategy, and other games. 3 First-person MMO shooter games are based on skill because they require good reaction time and attention, and competition is a key aspect of these games. In real-time MMO strategy games, players organize teams, develop their skills, and play for status in the game. 4

Massively Multiplayer Online Role-Playing Games (MMORPGs), on the other hand, appear of particular interest to players because they offer a variety of incentives for play relative to other game genres. Of all online gamers, 46% play MMORPGs, 3 confirming their position as the most popular online games. MMORPGs are game universes inhabited by thousands of players at the same time (massively multiplayer) with no spatial or temporal boundaries because they are played online, and they allow players to adopt various virtual personas vis-à-vis their avatars (role playing). 5 Today’s most popular MMORPG is “World of Warcraft”, the latest game in Blizzard’s Warcraft series, situated in the fantasy world of Azeroth that is populated by members of the opposing factions of the Alliance and the Horde. 6 According to a recent report published by the Entertainment Software Association, 7 World of Warcraft’s extension “Cataclysm” was among the top five selling computer games in 2011. In 2013, eight million players immersed themselves in the world of Azeroth, 8 clearly demonstrating the game’s mass appeal. The game tailors to most age groups, both sexes, and various player interests and preferences, 6 making it an MMORPG success story par excellence.

Online games such as World of Warcraft satisfy various gaming motivations. The analysis by Yee 9 of 3,000 MMORPG players’ gaming motivations revealed that MMORPGs allow players to achieve game goals, be social, and immerse in the game. Each of these factors is composed of a number of subcomponents as particularized by the gamers. First, achievement includes advancing in the game, namely progressing via leveling up, acquiring status and power in the game, the game’s mechanics, including the possibilities for optimizing game play, and competition, including challenging and dominating others. 9 Reputation and admiration from the gaming community for gaming achievements are further key factors motivating players to keep playing. 6 The game mechanics or structural characteristics have been claimed to reinforce the potentially addictive qualities of games because they contribute to initiation, development, and maintenance of gaming. 10

Second, the social factor is composed of socializing, including chatting and making new friends in the game, forming new relationships, and working in a team. 9 Research 11 suggests that the social element in MMORPGs is particularly important for gamers because it is an integral component of the enjoyment of playing. Moreover, it denotes a complex interaction between real and virtual social networks, further blurring the boundaries between these networks, making MMORPGs inherently social spaces. 12

Third, immersion in the game is denoted by discovery, ie, exploring the game and “hidden” game content, role-playing via one’s avatar, customization of one’s online character (such as sex, race, profession, appearance), and escapism, ie, playing in order to avoid real life. 9 Escapism is an aspect of mood modification whereby individuals suffering from addictions induce a subjective shift in their mood by way of engaging in an addictive behavior, making the latter a coping strategy to deal with everyday problems. 13

The variety of gaming motivations satisfied by MMOR-PGs indicates that these types of games are particularly versatile because they can be tailored to individual players with different game preferences. Consequently, one could assume that there are many ways that might lead some individuals to get hooked on MMORPGs. In a sample of 696 MMORPG players (93% male, mean age 26±7.4 years), achievement, socializing, and escapism motivations were found to be predictive of addictive play, together with sex accounting for 19% of variance in the MMORPG addiction score. 14 Similarly, in a sample of 175 primarily Dutch MMORPG players (87% male, mean age 21±6.5 years), escapism and game mechanics predicted excessive gaming over and above the contribution of the time spent gaming, together explaining 46% of the variance in problematic gaming. 5 In a nutshell, the mass appeal of MMORPGs rests on their versatility because they are tailored to gamers young and old, male and female, who have different game preferences. MMORPGs are particularly good at meeting various players’ different needs. This mass appeal may have contributed to findings from research which indicate that online games, and specifically MMORPGs, are more addictive than any other types of both offline and online games 15 because they reward players on partial reinforcement schedules, leading to maintenance of play. 16

Internet gaming addiction

In recent years, research about Internet gaming addiction has increased both in quantity as well as in quality. Research on gaming addiction dates back to 1983, when the first report emerged suggesting that video gaming addiction is a problem for students. 17 Shortly thereafter, the first empirical study on gaming addiction was published by Shotton, 18 based on self-reports of young male players who claimed they were “hooked” on their games. The early studies suffered from a lack of standardized psychometric instruments used for assessing gaming addiction. 19 However, research 20 indicates that self-reports correlate with standardized measures. Following on from that, further studies were carried out in the 1990s, initially assessing gaming addiction based on the criteria for pathologic gambling as stipulated in the third and fourth editions of the Diagnostic and Statistical Manual for Mental Disorders (DSM). 21 Although similar, pathological gambling and excessive gaming do not present with the same clinical picture, and some have argued that using the diagnostic criteria for pathological gambling in order to diagnose pathological gaming only taps into obsessive use and preoccupation rather than actual psychopathology. 22 In the 2000s, online games became popular, while studies of Internet gaming addiction emerged. 23 , 24

The studies on Internet gaming addiction in the new millennium reported prevalence estimates which vary significantly and range from 0.2% in Germany 25 , 26 to 50% of Korean teenagers. 27 This discrepancy in estimates is due to various conceptualizations, diverse measurement instruments, as well as the different cutoff points used. Further, dissimilar constructs (“Internet gaming addiction”, “dependence”, “problematic”, and “excessive play”) are measured in various samples (children, adolescents, gamers) and cultures. In most studies, self-reports have been used, which puts the reliability and validity of the potential diagnosis in question. 28 However, research 20 indicates that self-diagnosis correlates with standardized measures of addiction, suggesting that the individual’s perception of problems can be relatively accurate.

In South-East Asian countries, the negative impacts of Internet gaming addiction have led governments and health care providers to take the problem seriously and to develop a series of initiatives to curb and alleviate the problem. In South Korea, Internet gaming addiction is viewed as a significant concern for public health, 29 and up to 24% of children who have been diagnosed with Internet addiction are hospitalized. 30 In Japan, the government has recognized the problem following a study by the Ministry of Education, which has led to the development of “fasting camps” where individuals suffering from Internet and gaming addiction are helped by being cut off from technology completely. 31 It has been stated that the higher the Internet penetration and social acceptance of gaming, the higher the prevalence of gaming problems, 32 partially explaining the higher prevalence rates reported in South-East Asian countries. In addition to this, there is good reason to think that the lower acceptance of excessive gaming in a culture, the more distress (not less) gamers experience in engaging in the activity, potentially fuelling problem perception. Therefore, a lack of acceptance of excessive gaming and thus stigmatization of the behavior might contribute to higher rates of addiction and problematic play in some way. Following growing concern, specialized treatment centers and programs have been established in Europe (including the outpatient clinic for behavioral addictions in Mainz, Germany, and the Capio Nightingale Hospital in London, UK) and the US (including the inpatient centers RESTART Internet Addiction Recovery Program in Seattle and the recently opened digital detoxification and recovery center in Pennsylvania), reflecting the growing need for professional help.

The concerns appear to be grounded as a growing number of studies indicate that Internet gaming addiction is associated with various negative consequences. 15 The psychological consequences include the following: sacrificing real-life relationships, other pastime activities, sleep, work, education, socializing, and relationships, 33 – 40 obsession with gaming and a lack of real-life relationships, 41 lack of attention, 33 , 42 aggression and hostility, 42 , 43 stress, 33 dysfunctional coping, 33 , 44 , 45 worse academic achievement, 38 , 46 problems with verbal memory, 47 and low well-being and high loneliness. 48 Moreover, psychosomatic consequences have been found in a number of studies. These included problems with sleeping, 41 , 47 seizures, 49 and psychosomatic challenges. 33 This long list indicates that Internet gaming problems must be taken seriously as they can affect the individual negatively in a variety of ways.

Internet gaming addiction is a behavioral problem that has been classified and explained in numerous ways. According to Griffiths, 13 biopsychosocial processes lead to the development of addictions, such as Internet gaming addiction, which include the following components. First, the behavior is salient (the individual is preoccupied with gaming). Second, the individual uses the behavior in order to modify their mood (ie, gaming is used to escape reality or create the feeling of euphoria). Third, tolerance develops (the individual needs increasingly more time to feel the same effect). Fourth, withdrawal symptoms occur upon discontinuation of the behavior (the individual feels anxious, depressed, and irritable if they are prevented from playing). Fifth, interpersonal and intra-personal conflict develops as a consequence of the behavior (the individual has problems with their relationship, job, and hobbies, and lack of success in abstinence). Finally, upon discontinuation of the behavior, the individual experiences relapse (they reinitiate gaming). 13

Although the core criteria appear to be established, the etiology of Internet gaming addiction has yet to be studied in detail. Research 15 indicates that a number of risk factors are associated with Internet gaming addiction. These risk factors include certain personality traits, gaming motivations, and structural game characteristics. The personality traits most commonly associated with Internet addiction include neuroticism, 37 , 50 aggression and hostility, 43 , 50 – 52 and sensation-seeking. 43 , 50 Factors that appear to protect frequent online gamers from developing problems with their gaming were found to be conscientiousness and extraversion, 53 suggesting that for different individuals the same behavior can have different psychological repercussions.

In addition to this, the following gaming motivations were found to be most commonly associated with gaming addiction: coping with daily stressors and escapism, 5 , 16 , 44 , 54 – 57 online relationships, 16 , 51 , 57 – 59 and mastery, control, recognition, completion, excitement, and challenge. 34 , 56 , 60 This indicates that the reasons for game play may be an important indicator of potential risk for Internet gaming addiction. Specifically, in comparison with non-MMORPG players, MMORPG players preferred their online friends over their real-life friends. 16 Similarly, significantly more dependent gamers were found to prefer spending time with their online friends than their offline friends relative to nondependent gamers and felt their social needs were met better online than offline. 44 Moreover, while online games provide nonaddicted players with satisfaction, addicted players play to avoid dissatisfaction, 55 which can be an indication of withdrawal symptoms they want to overcome by engaging in gaming compulsively. The motivational differences to play games between dependent and nondependent as well as MMORPG and other gamers appear to be useful clinical information because these motivations can be specifically targeted in treatment sessions. For instance, elements of exposure therapy may be used for the socially fearful in order to decrease discomfort and reintroduce clients to real-life social environments. Also, alternative pastime activities that are perceived as satisfying can be encouraged specifically in group therapy sessions. Encouraging engagement in group sports might satisfy both the need to engage in competitive and satisfying activities and the need to interact with peers in real life.

Moreover, a number of structural game characteristics have been found to increase the risk for developing Internet gaming addiction, namely online relative to offline gaming, 61 positive reinforcement, 62 the enjoyment of particular game features, such as adult content, finding rare in-game items, and watching game cut scenes, 63 and viewing one’s virtual persona as better than oneself. 64 These characteristics indicate that particular games can be more addictive than others, 15 which appears important for game developers and public prevention campaigns that focus on decreasing risk and raising awareness of potential problems. Prevention campaigns could target school-aged children, teachers, and parents in education settings. They could be based on the principles of providing information and a discussion platform concerning Internet and gaming use and possible negative consequences via psychoeducation, with the ultimate goal of encouraging healthy media use. Success could be determined over the long term using triangulation of data and reports obtained from the targeted populations.

Most reviews to date have primarily focused on specific aspects of Internet gaming addiction, including methods used to assess gaming addiction, 65 , 66 structural characteristics, 60 and treatment. 67 – 69 In light of this, the aim of this review is to provide an insight into current perspectives on Internet gaming addiction using a holistic approach, taking into consideration the mass appeal of online gaming, the context of Internet gaming addiction, and associated neuroimaging findings, as well as the current diagnostic framework adopted by the American Psychiatric Association. 70 It is argued that only by understanding the appeal of Internet gaming, its context, and neurobiologic correlates can the phenomenon of Internet gaming addiction be understood comprehensively. An evaluation of the findings will be presented in the overall discussion.

Gaming addiction: context

Research on gaming addiction has paid little attention to the context of online gaming. However, a few studies have now shed some light on the embedding of Internet gaming addiction in the context of the individual, 71 the game and gaming environment, 6 , 72 and the broader framework of culture. 73 Each of these will be addressed in turn.

Griffiths 71 provided case study evidence of two young men who spent an average of 14 hours a day playing MMORPGs in order to emphasize that the context of the individual’s life is an important factor demarcating gaming excess from gaming addiction. Aged 21 years, unemployed and single, “Dave” reported that gaming had a positive influence on his life because his social life revolved almost exclusively around the game, and playing boosted his self-esteem and gave structure to his everyday life. Dave did not perceive that his excessive gaming impacted upon his life negatively at all. For Dave, his extensive gaming did not lead to significant distress or have a negative impact in his daily life, and therefore his behavior cannot be classified as a condition that would fulfill the requirements of a mental disorder classification as outlined in the DSM-5. 74 Upon starting a new job and entering into a relationship with a woman he met in-game, his excessive gaming decreased significantly.

The second case reported was that of “Jeremy”, a 38-year old financial accountant who was married with two children and experienced detrimental consequences due to his “severe gaming addiction”, namely a relationship breakdown, lack of time for family activities, and loss of his job. Moreover, his playing time, craving for the game, and feelings of low mood and anxiety had increased dramatically. He used gaming to escape from his real-life problems and tried to quit on several occasions, but was unsuccessful in staying abstinent. This led to a number of relapse episodes. 71 The examples of Dave and Jeremy make a compelling case for how the same behavior (namely regular online gaming for excessive periods of time) can have almost diametrically opposed consequences due to different individual contexts, with one experiencing gaming as pleasurable and ultimately beneficial, whereas the other’s entire life was negatively affected by his excessive gaming.

In addition to the individual context, the context of the game appears important in determining the extent to which excessive gaming can truly be an addiction. 6 , 72 Karlsen 72 conducted 12 interviews with online gamers (75% male, mean age 23±2.4 years) who play World of Warcraft and used virtual ethnography 75 in order to assess the consequences of their excessive gaming. The results indicated that some of the players experienced behavioral addiction symptoms as specified by Griffiths, 13 namely salience, mood modification, tolerance, withdrawal, conflict, and relapse, with the latter two demarcating excessive from potentially addictive play. However, rather than advocating current diagnostic frameworks for “pathologizing” gaming, Karlsen 72 advocates to view gaming excess from the vantage point of game structure and gaming context, including the social practice and cultural meaning of games as well as the individual’s connection to the game from the perspective of game and media studies. This understanding entails a move away from the overly simplistic approach of focusing on the psychological rewards that reinforce gaming to include an indepth exploration of gaming motivations, gaming structure and mechanics, as well as the meaning of gaming for the individual. 72

Kuss 6 analyzed online gaming and potential gaming excess by interviewing eleven World of Warcraft players (72% male, mean age 27±7.3 years) and used virtual ethnography 75 as well as ludology principles 76 to understand how playing this particular game mirrors participation in popular media culture. In this context, media culture is understood as a flexible and evolving area of engagement that requires active participation. Potential gaming addiction was found to be associated with escapist motivations and in this context gaming was understood as fulfilling a “narcotic” function. The game context gained particular significance in one participant’s life because of two features of the game. First, he was able to enact heroic tales through his avatar and faction membership. As a member of the Horde, he fought the opposing faction, the Alliance, and was involved in killing their king, an episode “he would not forget until the end of his life”. Second, he was enabled to return to a familiar cultural context by means of his guild which consisted of fellow countrymen, after he had physically migrated to a foreign country. In this way, the provisions of the game (namely participation in the game’s narrative, 77 community, and belonging) 78 were utilized to a problematic extent, leaving the participant feeling “addicted to wow [World of Warcraft]”. Eventually, the analysis revealed that the meaning that is attached to the game can lead to excessive play which may cause a retreat from real life. 6

Snodgrass et al 73 surveyed 252 respondents (78% male, mean age 27±9.0 years) using Yee’s 9 motivational factors achievement, social and immersion to assess problematic MMORPG play in World of Warcraft from the perspective of culture under the supposition that gaming allows for formation of communities and cultures. 12 , 79 , 80 The cultural context situates the individual and his potentially addictive game play (assessed using Young’s Internet Addiction Test) 81 within the framework of commonly shared beliefs and practices. 82 Snodgrass et al 73 used an anthropological approach focusing on meaning, practice, and experience, mirrored in their understanding of gaming motivations and problematic play. They found that achievement motivation may lead to problematic play if players are less successful in real life (ie, less “culturally consonant”) and use game success to compensate, 73 causing stress and negative health outcomes. 83 In terms of social motivation, the extent to which online relationships gain significance over offline relationships was analyzed 73 because research indicates that lack of cultural consonance regarding social networks impacts negatively upon health. 84 Regarding immersion, the amalgamation of online and offline life and identities was assessed, 73 because association of the self with the game and the avatar could lead to dissociation. 85 , 86 The results indicated that game play in World of Warcraft mirrors cultural models of success regarding objectives and responsibilities, indicating that the game world can in some ways substitute the real world. Moreover, the culturally sensitive motivations achievement, social and immersion significantly predicted problematic MMORPG play if they were incongruent with real life, that is, if the game was used to compensate for lack of success and relationships in real life, and to dissociate from real life. 73

Taken together, the individual, game, and cultural contexts appear to have a significant impact upon the extent to which problems occur as a consequence of excessive gaming in terms of how Internet gaming addiction is conceptualized. In this way, the cultural context can be seen as a lens through which individuals and others around them perceive and give meanings to behaviors and their consequences. It is critical to understand gaming problems not only by means of the observable symptoms, but to situate them within the broader context of the game, the individual, and culture.

Gaming addiction: neuroscience

In the last decade, psychiatry has increasingly made use of neuroscientific evidence to understand and conceptualize mental disorders. 87 The major funding body for mental health research, the National Institute of Mental Health, has recently introduced research domain criteria to reclassify mental disorders as based on neuroscience and shared underlying pathophysiology rather than the more subjective approach of phenomenology and clinical presentation that has been utilized previously. 88 The ultimate aim is to improve the reliability and validity of clinical diagnosis and accordingly to deliver optimal treatment. 89 In accordance with this approach, research on Internet gaming addiction is now increasingly making use of neuroimaging techniques to allow for analysis of neurobiological changes due to excessive gaming and neurochemical correlates of addiction. 90

Some studies have shown that changes in brain activity and structure related to addiction are relevant for brain regions involved in reward, motivation, and memory, as well as cognitive control. 91 It has been hypothesized that initially the prefrontal cortex and ventral striatum are involved in the decision to initiate the addictive behavior. Over time, the individual habituates to the behavior and develops a compulsion to engage in it, which is accompanied by alterations of activity in the dorsal striatum as it becomes activated through dopaminergic innervation. There is some evidence for the idea that dopamine is released. 92 The longer the engagement continues, the more permanent the changes in the dopaminergic pathways become. It has been suggested that activity in the anterior cingulate, orbitofrontal cortex, and nucleus accumbens is modified in such a way that natural rewards are experienced as less pleasurable, further reducing control over the behavior. 93 , 94 Research suggests that over time, synaptic activity is reduced, leading to long-term depression and neuroadaptation, 95 as well as behavioral sensitization. The synapses in the ventral tegmental area become stronger, glutamate in the nucleus accumbens is reduced, and activity in the amygdala and hippocampus (related to memory) is increased, which can in turn result in craving 91 , 96 and increased response to the availability and particular context of the addictive behavior. 93 , 97 Some studies have shown that the addictive behavior becomes associated with these cues through activity in the nucleus accumbens, which reinforces the effects of the behavior. 98 With time, tolerance to the addictive behavior develops and natural rewards are depreciated, resulting in a reward system deficiency and activation of the antireward system. 99 The consequent lack of dopamine in mesocortical brain regions can lead to withdrawal symptoms, and in order to overcome these, renewed engagement in the addictive behavior ensues, and may ultimately impact upon the functions of the orbitofrontal cortex and cingulate gyrus. 91 , 100 , 101

Over the last decade, a number of neuroimaging techniques have been applied to Internet gaming research, allowing for an analysis of addiction correlates regarding both brain function as well as brain structure. Electroencephalograms measure brain activity via changes in voltage in the cerebral cortex via electrodes, 102 and were used in six studies of Internet and gaming addiction. 103 – 108 Positron emission tomography measures neuronal metabolism through photons from positron emissions via positively charged electrons. 109 Two studies 110 , 111 made use of positron emission tomography to measure Internet and gaming addiction. Like positron emission tomography, single photon emission computed tomography measures metabolic activity in the brain at the level of individual photons, 112 and was applied in one study of Internet addiction. 113 Eight studies 114 – 121 used functional magnetic resonance imaging to measure changes in blood oxygen levels in order to indicate brain activity in individuals with Internet and gaming addiction. 122 Finally, structural magnetic resonance imaging uses methods such as voxel-based morphometry 123 and diffusion-tensor imaging 124 to image brain morphometry, 125 and was used in two studies 126 , 127 in order to assess Internet addiction.

A systematic review of all Internet and gaming addiction studies using neuroimaging methods until 2012 90 revealed that Internet gaming addiction appears similar to other addictions, including substance-related addictions, at the molecular, neurocircuitry, and behavioral levels. From a molecular perspective, gaming results in the release of striatal dopamine. 111 On the other hand, it has been suggested that, in small samples, Internet and gaming addiction is associated with a reward deficiency whereby dopaminergic transporters in the brain are reduced. 110 , 113 In order to reinstate a biochemical equilibrium, 99 individuals whose reward system is deficient seek substances and activities which result in the release of dopamine. Under normal circumstances, pleasure drives (including eating and reproduction) are natural rewards that are craved, whereas unnatural rewards include psychoactive substances and addictive behaviors. 128 Over time, the individual habituates to the hedonic feelings produced by Internet gaming and develops abstinence symptoms, tolerance, and withdrawal. 129 Internet gaming addiction is initiated and maintained. 90 The decreased dopaminergic transporters in Internet gaming addiction may explain its frequent co-occurrence with depression, 130 bipolar disorder, 131 and borderline personality disorder and dissociative symptoms. 132

With regards to neural circuitry, when gaming, brain areas associated with addictions are frequently utilized and therefore the activity in regions such as the orbitofrontal cortex and cingulate gyrus is high, which over time can lead to significant alterations in neuronal connectivity 114 , 116 , 118 , 119 and brain structure. 115 , 126 , 127 Internet gaming becomes increasingly salient and individuals lose control over their gaming. 90 The individual is immanently motivated to play online games as they have learned the behavior, eventuating in continuous engagement. 133

In terms of behavior, excessive Internet gaming can result in problems with impulse control, behavioral inhibition, executive functioning, attention, and general cognitive functioning. 103 , 104 , 107 , 115 , 126 , 127 However, there are plus sides as well, in that the frequent gamer develops and improves a number of other capabilities, namely the integration of perceptual information into the brain and hand-eye coordination. 118 , 120

Taken together, research on Internet gaming addiction has made use of various neuroimaging techniques in order to shed light upon the neurochemical and neuroanatomic correlates of addiction. Although in most studies the direction of the relationship has not been investigated (ie, it is unclear whether Internet gaming addiction causes changes in brain structure and activity or vice versa), the current evidence suggests a relationship between brain alterations and Internet gaming addiction. Neuroimaging studies of Internet gaming addiction contribute to the current understanding of addiction as based on a disease framework. 128 , 134 This indicates that, similar to cardiovascular diseases, lifestyle (ie, excessive gaming) can result in changes to underlying neurobiology. Moreover, the utilization of sophisticated imaging methods in Internet gaming addiction research is in line with research domain criteria, 88 which makes a significant contribution to our understanding of Internet gaming addiction as a chronic neurobiological disease requiring professional care and adequate treatment. 135

Gaming addiction: clinical diagnosis

Following nearly two decades of research, the American Psychiatric Association has now officially recognized Internet Gaming Disorder as a condition that requires consideration by clinicians and researchers. In June 2013, Internet gaming disorder appeared in the appendix of the updated version of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) for the first time. 70 It stands alongside the only other behavioral addiction, ie, pathological gambling, situating it clearly within the diagnostic category of Substance-Related and Addictive Disorders. Internet gaming disorder has pulled ahead of other behaviors that can become addictive, such as exercise, 136 , 137 work, 138 and shopping. 139

Up until now, researchers have understood Internet addiction or Internet gaming addiction as similar to either impulse control disorders in general or pathological gambling specifically, 140 – 142 substance dependence, 33 , 38 or a combination of the two. 143 , 144 This has led to the development of multiple psychometric instruments, each measuring different aspects associated with Internet gaming problems and addiction. 144 – 153 The multiplicity of conceptualizations used for Internet gaming addiction have led to a diagnostic conundrum leading some researchers to question its existence, 29 and have called for commonly agreed upon criteria which increase reliability across studies and advocate adequate and efficacious treatment. 15

Under the new DSM-5 framework, Internet gaming disorder refers to the “persistent and recurrent use of the Internet to engage in games, often with other players, leading to clinically significant impairment or distress as indicated by five (or more) [criteria] in a 12-month period”. 70 The diagnostic criteria are a preoccupation with gaming, withdrawal symptoms, tolerance (ie, spending more time gaming), lack of control, loss of other interests, use despite negative consequences, deception, mood modification, and losing a relationship, job, and similarly important aspects of life. 70 From a public health perspective, an official diagnosis of Internet gaming addiction is necessary for a number of reasons. First, it will encourage individuals who suffer from associated symptoms to ask for professional help, decreasing morbidity rates, hospitalizations, and potential legal and medical problems. 30 Second, the diagnosis may decrease barriers to care and stigmata with regards to public perception of problematic Internet and gaming use. Third, the diagnosis will support research efforts. 134 Fourth, a diagnostic category will provide the necessary incentive for health care and insurance providers to develop, test, and finance adequate treatment. Ultimately, individuals who require professional care because of substantial distress, suffering, and individual impairment must be helped in an appropriate way. 74 Accordingly, an official diagnosis of Internet gaming addiction is critical for a number of reasons, further emphasizing the need to fully acknowledge and utilize it.

The aim of this review was to provide an insight into current perspectives on Internet gaming addiction using a holistic approach encompassing gaming appeal, context, neuroimaging research, and the diagnostic framework adopted for Internet gaming addiction. It has been shown that Internet gaming has gained increasing popularity since the new millennium, and has led to a substantial growth of the gaming industry and the player fan base. MMORPGs have further been highlighted as offering a wide variety of incentives for players to initiate and maintain playing because they satisfy a variety of needs and tailor to various gaming motives relative to alternative online game genres. Some of these motives, especially escapism, the game’s mechanics, achievement and socializing have been found to be indicative of gaming addiction, 5 suggesting that MMORPGs are more addictive than other offline and online games. 15

This review further shows that until now few studies have investigated the gaming context. Therefore, the context of the individual, the game and gaming environment, and the broader framework of culture are specifically addressed. It has been shown that the individual’s context is a significant factor that marks the dividing line between excessive gaming and gaming addiction. 71 Moreover, it has been emphasized that gaming cannot simply be medicalized if done in excess, but it must be understood from within the context of gaming and the meanings the individual attaches to it. 72 The game context can gain particular importance for players, depending on their life situation and gaming preferences, including the enactment of heroic tales as well as the re-embedding in a (virtual) cultural context that differs from the players’ real-life context. Ultimately, this may lead to a retreat from real life for some individuals. 6 In addition to this, the cultural context is significant because it embeds the gamer in a community with shared beliefs and practices, endowing their gaming with particular meaning. If gaming is used to compensate for lack of success and relationships in real life and to dissociate from real life, Internet gaming addiction can be the consequence. 73 In this context, the “disease” model of addiction can be viewed from the perspective of diseases other than those based on Mendelian genetic mutations or other simple biologically determined pathways. Cardiovascular diseases or adult onset diabetes appear as better models/prototypes for Internet gaming addiction, because these are medical conditions where lifestyles and experiences systematically reshape the body and thus “get under the skin”. That is, the cultural context can become the disease (here addiction) through repeated experiences. Alternatively, cultural norms related to how acceptable game-play is might structure the appeal of the game, which in turn promotes addictive play patterns, which would not be the case in places without such norms.

The cited neuroimaging studies of Internet gaming addiction and associated changes in brain structure and function furthermore correspond with the research domain criteria developed by the National Institute of Mental Health 88 because they emphasize a move away from phenomenology to focus on pathophysiology for clinical diagnosis. Internet gaming addiction was found to share similarities with other addictions, including substance dependence, at the molecular, neurocircuitry, and behavioral levels. These similarities include altered dopaminergic and neuronal activity and brain morphometry, as well as deficient impulse control, behavioral inhibition, and general cognitive functioning. However, there are no known biomarkers of Internet addiction at this point in time. Indeed, there are no known biomarkers of any mental disorder. Ever since Kraepelin, 154 and thus for a century, psychiatrists have been searching to understand mental disorders as underlying physiological diseases, providing an additional incentive to continue research on the neurobiological underpinnings of mental health problems, including Internet gaming addiction.

The findings provide support for the current perspective of understanding Internet gaming addiction from a disease framework. 128 , 134 The dependence classification adopted in previous classification systems 74 , 155 is stigmatizing to patients who require medication because dependence refers to a normal physiological response to the use of a substance (including medication) which, when discontinued, can lead to withdrawal symptoms. 74 The term addiction, on the other hand, denotes a chronic neurobiological disease, 135 which is less stigmatizing because it does not suggest that patients who require medication become “addicted” to their required psychopharmacological treatment. 156 Addiction, unlike dependence, leads to compulsively pursuing rewarding behaviors irrespective of associated biological, psychological, and social problems. 135 Ultimately, the current research base on Internet gaming addiction has led the American Psychiatric Association 70 to include Internet gaming disorder in the appendix of the DSM-5 as the second behavioral addiction alongside pathological gambling, suggesting that the problem is taken seriously. The benefits of such a diagnosis include comparability across research, destigmatization of individuals, development of efficacious treatment, and creation of an incentive for public health care and insurance providers. Once the behavioral problem has an official code, it is worthy of being taken seriously and treated adequately.

However, research concerning the natural course of Internet gaming addiction, the most appropriate interventions, and large-scale epidemiology is scarce, 157 suggesting that more work needs to be done to understand this behavioral problem more fully. King and Delfabbro 158 further question the blurring of the boundaries between Internet addiction and video gaming addiction, as this may “promote further confusion”. Instead, they advocate a conceptualization of Internet addiction which incorporates various subtypes of online behavior, and establishing a diagnostic category of “video gaming disorder” which applies to both online and offline gaming addiction. Ultimately, however, King and Delfabbro 158 concede that the research diagnosis has sparked discussion regarding the nature of behavioral addictions, which testifies to a move away from acknowledging substances only as potentially addictive, and to broaden our understanding of addiction in general.

Moreover, there appear to be problems with regards to the criteria for Internet gaming disorder adopted by the DSM-5 taskforce. Starcevic 29 points out that there exists a debate of whether tolerance is a valid criterion as researchers have validated scales on problematic video game use 159 and compulsive Internet use 160 that do not contain tolerance as a symptom, and some question whether tolerance is a factor involved in gaming. 44 This exemplifies the intricacy of measuring Internet gaming addiction, particularly in light of the reliability of studies as well as the equivalence of findings across studies. Based on these issues, Starcevic 29 recommends the following research approaches: understand when online gaming can be considered a mental disorder; study risk factors and comorbidities, and its position as primary or secondary condition; test a continuum of video gaming problems and video gaming disorder; and revisit its classification as “addiction” rather than an impulse control disorder. 161 Moreover, Pies 134 specifies further that only if the following criteria are satisfied, the condition would qualify to be understood as disease: identify a pattern of genetic transmission; understand its etiology, pathophysiology and/or pathological anatomy; and its course, prognosis, stability, and response to treatment. The current review indicates that research on Internet gaming addiction is on its way to fulfilling these requirements. In terms of understanding the context of Internet gaming addiction, more research is necessary.

Limitations, implications, and suggestions for future research

This review has shown that research on Internet gaming addiction has increased in quality and quantity, particularly over the last decade. Future research is required to overcome the limitations of current research, including closer scrutiny of gaming context (including the individual, game, and culture) and the direction of the relationship between Internet gaming addiction, as well as neuroanatomical and neurochemical changes. Specifically, the following research question requires further exploration: How do individual, game-related, and cultural factors contribute to the etiology, phenomenological experience, and treatment approaches of Internet gaming addiction? Furthermore, the causality of the relationship between neurobiological alterations and neurostructural abnormalities and Internet gaming addiction symptoms should be explored. The further exploration of these issues will enhance our understanding of this potential mental health concern. Moreover, a solid and unequivocal research base will enable the American Psychiatric Association and the World Health Organization to include Internet gaming addiction as an actual diagnosis in their diagnostic systems, which will in turn facilitate future research endeavors as well as clinical parlance.

The context appears crucial to the meaning of the game for the player, and is influenced by individual characteristics, the gaming culture, and the broader society that gamers are situated in. Ultimately, this will allow for developing treatment approaches which can be tailored to different individuals and meet idiosyncratic needs most effectively. The reviewed literature can inform procedures for improving the current treatment of Internet gaming addiction because it puts an emphasis on exploring the life and cultural context of the individual. In terms of neuroimaging studies, the reviewed empirical research has revealed associations between excessive online gaming and alterations in brain structure and function associated with substance addictions. However, understanding the direction of this relationship is crucial because it will provide invaluable insights into the etiology of Internet gaming addiction as well as its status as a primary or secondary disorder. In terms of treatment, establishing the treatment seeker’s most pressing present problem will allow an efficient and efficacious treatment plan to be developed and structuring of treatment sessions. Overall, this literature review suggests that targeting pathogenic neurobiological mechanisms and associated neurological and neurochemical alterations only does not suffice when the clinician’s goal is to alleviate the individual’s idiosyncratic problems. It indicates that Internet gaming addiction must be viewed from a holistic perspective, integrating the neurobiological, individual, game-related, and cultural factors contributing to pathogenesis and symptom experience.

The present review of current perspectives on Internet gaming addiction has shown that research has progressed significantly over the last decade, leading to a larger evidence base which includes important findings from neuroimaging research. Further, it indicates that contextual factors play an important part in our understanding of Internet gaming addiction as a holistic phenomenon. It is suggested that an official diagnosis of Internet gaming addiction must regard embedding of the problematic behavior within the context of the individual, the game, and gaming practices, as well as the broader sociocultural environment as the meaning of the gaming behavior derives from its context. The holistic approach adopted here not only highlights empirical research that confirms neurobiological correlates of Internet gaming addiction and establishment of a preliminary diagnosis, but also emphasizes the need for an indepth understanding of meaning, context, and practices associated with gaming. Ultimately, a holistic understanding will benefit individuals who seek professional help for problematic online gaming as treatment approaches become more targeted and consequently more efficacious.

The author reports no conflicts of interest in this work.

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Essay on Online Games Addiction

Students are often asked to write an essay on Online Games Addiction in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Online Games Addiction

Understanding online games addiction.

Online games addiction means playing games on the internet too much. This happens when someone spends more time playing games than doing other important things. This can cause problems like poor grades in school, less time with friends and family, and even health issues.

Reasons for Addiction

There are many reasons why people get addicted to online games. Some people play to escape from real-world problems. Others find the games exciting and challenging. Some people even play to feel a sense of achievement.

Effects of Addiction

Playing games too much can cause many problems. It can lead to poor performance in school or at work. It can also cause health problems like eye strain and lack of sleep. It can even hurt relationships with friends and family.

Overcoming Addiction

Overcoming online games addiction can be tough, but it’s possible. It’s important to set limits on how much time you spend playing games. It can also help to find other hobbies or activities to do instead of playing games. It might also be helpful to talk to a counselor or therapist.

Online games can be fun, but it’s important not to let them take over your life. If you think you might be addicted, it’s important to seek help. Remember, there’s a lot more to life than just playing games!

Also check:

• Speech on Online Games Addiction

250 Words Essay on Online Games Addiction

What is online games addiction.

Online games addiction is when a person cannot stop playing games on the internet. They spend too much time playing these games and ignore other important things in life. This can harm their studies, health, and relationships.

Why Do People Get Addicted?

People get addicted to online games for many reasons. Some find these games fun and exciting. They enjoy the challenges and rewards that these games offer. Others use these games to escape from stress or problems in real life.

Effects of Online Games Addiction

Online games addiction can have many bad effects. It can cause poor grades in school because students spend too much time playing games instead of studying. It can also lead to health problems like eye strain and lack of sleep. Moreover, it can harm relationships with family and friends because the person is always busy with the games.

How to Overcome Online Games Addiction

Overcoming online games addiction is not easy, but it is possible. One way is to set a limit on how much time you can spend on games each day. Another way is to find other fun activities to do, like playing sports or reading books. It can also help to talk to a trusted adult about the problem.

In conclusion, online games addiction is a serious issue. It can harm a person’s studies, health, and relationships. But with the right help and effort, it can be overcome. It is important to balance online gaming with other activities and responsibilities in life.

500 Words Essay on Online Games Addiction

Online games addiction is when a person spends too much time playing games on the internet and finds it hard to stop. This can lead to problems in other parts of life like school, work, or relationships. It’s a bit like when someone can’t stop eating sweets, even though they know it’s bad for them. They might want to stop, but they find it very hard to do so.

There are many reasons why people get addicted to online games. Some people play games to escape from real-life problems or to feel good about themselves. Games can make people feel like they’re winning or achieving something, which can be very satisfying. Other people might get addicted because the games are so much fun and they lose track of time. Sometimes, people get addicted because they’re trying to be the best at the game and can’t stop until they are.

The Impact of Online Games Addiction

Online games addiction can cause many problems. Firstly, it can lead to poor performance in school or work. This is because people who are addicted to games often spend so much time playing that they don’t have time for anything else. They might also lose sleep because they stay up late to play games.

Secondly, addiction can harm relationships. If a person spends too much time playing games, they might not spend enough time with their friends and family. This can make people feel lonely and isolated.

Lastly, spending too much time playing games can also be bad for health. It can lead to problems like poor posture, eye strain, and lack of physical activity.

How to Prevent and Overcome Online Games Addiction

Preventing online games addiction starts with setting limits. It’s fine to play games, but it’s important to have a balance. This means making time for other activities like studying, playing sports, or spending time with friends and family.

If someone is already addicted to online games, it might be hard for them to stop on their own. In this case, it can be helpful to seek help from a professional, like a counselor or a psychologist. They can provide guidance and support to help the person overcome their addiction.

In conclusion, online games addiction is a serious problem that can affect a person’s school, work, relationships, and health. It’s important to balance time spent on gaming with other activities and seek professional help if needed. Remember, games are meant to be fun, not something that takes over your life.

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Video Game Addiction: Causes, Effects & Treatment Options

• AddictionExperts
• Reviewed By Dr. John Elgin Wilkaitis
• November 20, 2015

How to Recognize & Treat Video Game Addiction

Video Game Addiction Statistics

Researchers and social scientists have been troubled by video game addictions since the phenomenon first presented itself with the advent of video games in the 1970s and 1980s. Today, “gaming” has become a popular term used by people of all ages, not just teens. Ironically, video game addiction isn’t just for kids, either. Adults can have just as much trouble turning away from video games as children do.

Some of the more recent statistics involving video game addiction are pretty startling and are indicators that it’s time to start taking this type of addiction as seriously as other addictions:

• In a survey, 41 percent of respondents said they play video games to escape from real life. These gamers were considered dependent on video games to avoid real-life situations.
• Multiplayer and role-playing games online appear to be the most addictive types of video games, perhaps because of the illusion of community they create.
• Intense ADHD symptoms are linked to video game addiction severity.
• Boys are more likely to become video game addicts than girls. Girls who are addicted tend to prefer games that involve puzzles and other interactive activities rather than violence and aggression.
• Studies have shown that the regions of the brain (the pleasure centers) that are activated in drug addicts and alcohol addicts are also activated in the regions of the brain of video game addicts.
• 13.9 percent of male students in Hong Kong report spending over 21 hours per week playing video games.
• As of 2019, the global prevalence of video game disorder was 3.05 percent.

With information like this, everyone needs to realize that video game addiction is not to be taken lightly.

Risk Factors for Video Game Addiction

Why do some people become video game addicts while others seem to have no problem turning away from the games? The answer might lie in risk factors such as the following:

• The video game addict has been sexually or emotionally abused and is trying to escape the situation.
• The video game addict has been bullied by their peer group and is seeking acceptance in an alternative community.
• The video game addict is socially awkward and uncomfortable interacting with people in a natural environment.
• The video game addict’s parents or siblings are also addicted to playing video games, making it a family pastime.
• The video game addict seeks out gaming to show their aggression toward the world or deal with anger.
• The video game addict has little control in their own life, so they turn to gaming to feel confident.
• The video game addict has lowered self-esteem and constantly uses video games to elevate feelings of self-worth.
• The video game addict is left alone for long periods and turns to gaming — primarily multi-player gaming — as a source of community and comfort.
• The video game addict suffers from untreated depression and uses video games to get a “high” to combat their moods.
• The video game addict is spontaneous and rash by nature and cannot control their impulsivity.
• The video game addict has a history of addiction (i.e., to work, love, drugs, nicotine).

If you notice you have one or more of these risk factors and causes of video game addiction, and you regularly game, you may already be addicted to video games. It’s important not to try to go it alone if you want to overcome this problem. Always seek treatment from a trained expert who can guide you through recovery, including proven solutions to video game addiction.

How to Know If You’re Addicted to Video Games

Are you worried you, or someone you know, is a video game addict? Answer this brief assessment to help you find out:

• Do you play video games for hours and hours, sometimes not eating or sleeping so you can stay in the game?
• Is gaming more important to you than hanging out with people in “real life?”
• When you finish playing a video game, do you feel a sense of pleasure and want to get that “high” again?
• Do you have trouble stepping away from video games or stopping play?
• Can you leave a video game in the middle of play for an emergency?
• Have you ever hidden your gaming because you were embarrassed by how often you play?
• Have people told you that you play too many video games or that you’re addicted to video games?
• Do you become moody or angry when you can’t play video games?
• Have you ever played video games when you should be working?
• Have you ever lost a job because you were playing video games or missed work because of gaming?
• Has gaming hurt your relationships with your loved ones?
• Have you spent money on gaming you should have spent on bills or paying down debt?

The more “yes” answers you have, the greater your chances are that you may be addicted to video games. In that case, you deserve to get help immediately. Call a treatment center or therapist who has experience in video game addiction. You’ll be glad you took the first step toward recovery.

How Parents Can Help Their Kids Avoid Video Game Addiction

Because video game addiction so often happens in childhood, parents need to recognize that they play a huge role in stopping video game addiction in children . Moms and dads should be ready to address this subject, and they can take several proactive steps to help their kids avoid becoming video game addicts.

If you’re a parent of a child who enjoys playing video games or who hasn’t yet started playing video games, the following suggestions may prevent a future issue:

• Talk to your child about the risks of video games . Make sure they understand (at an age-appropriate level) that gaming is meant to be fun, but it should not be all-consuming.
• Know which video games your child is playing . Most video games are rated, but don’t assume the ratings are up to your standards. Check each game thoroughly, and you may even want to play a game with your child.
• Limit the time your child is allowed to play video games . Some parents make video gaming only available on the weekend. This eliminates worries about gaming interfering with schoolwork or grades.
• Make video game playing a seldom-offered reward for a job well done . For instance, if your son comes home with all “A”s on a report card, you may allow him to play a favorite video game for an extra hour or two.
• Monitor all computer and device activity . Children who want to play video games will often sneak around. Make it a practice to check your child’s technology equipment regularly for signs of video game usage.
• Watch for signs of video game addiction violence . If you tell your child to stop playing a game, do they suddenly lash out? When they can’t play, do they withdraw from you? This signals that you need help from a therapist or treatment center.
• Make your child aware of things to do other than video games . Redirect their attention to more positive activities, such as playing outside or helping older neighbors with chores.
• Deal with your own video game addiction and recovery . If you’re addicted to video games, it will be impossible to tell your child not to play.

By being aware of what’s happening with your son or daughter, you’ll be in a much better position to stave off long-term problems associated with video game addiction.

The Effects of Video Game Addiction

Left untreated, video game addiction is unlikely to go away on its own. Like all other addictions, intervention and treatment is the key to ending any cycle of abusive behavior. And make no mistake — video game addiction abuses not only the gamer but also those around them.

The effects of video game addiction have been documented around the world:

• Video game addicts are less likely to succeed in life.
• Video game addicts may suffer from lifelong low self-confidence.
• Video game addicts may never have a fulfilling career or relationships.
• Video game addicts are at risk of depression and potentially suicide.
• Video game addicts are at risk of developing headaches.
• Video game addicts are at risk of insomnia.
• Video game addicts may become obese, leading to other problems, such as diabetes and hypertension.

Learn more about the adverse effects of video game addiction here . Society doesn’t need more video game addicts. It needs more productive people.

How Video Game Addiction is Treated

The treatment plans typically used for video game addicts will vary according to the person being treated. However, there are some steps habitually used by therapists who are focused on working with this type of addiction:

• The behavior is stopped . In some circles, this is called going “cold turkey” and can cause significant withdrawal symptoms. When accompanied by therapy, the withdrawal can be controlled.
• A plan of action is created . This plan includes a listing of the triggers associated with video game addiction. For instance, an addict may find they play video games when they are stressed out. Thus, the next time the person is under severe anxiety, they can recognize this as a trigger and do something different and healthier, such as going for a walk, calling a friend, or journaling.
• Daily schedules and routines are developed . A daily routine can be an asset to video game addicts because their days are mapped out. When they are just beginning treatment, this can be a powerful ally in keeping them focused on getting better and not turning to gaming.
• Ongoing therapy sessions are scheduled . Therapy is essential to overcoming addictions, including video game addictions. Therapy sessions will help restore self-confidence and allow the addict to move past whatever was holding them back.
• Group sessions may be prescribed. These sessions are similar to AA meetings, where each group member expresses support for the others dealing with an addiction.

Other forms of treatment that may be utilized or suggested could be rewards for not playing video games, art therapy, and music therapy. Depending upon the video game addiction level, inpatient treatment centers may be a better fit for the addict, even if the addict is a teenager.

What to Do After a Video Game Addiction Relapse

Relapsing is a commonplace phenomenon in the treatment of video game addiction. A relapse can be considered part of recovery, however, and not an end to it. As soon as the relapse has occurred, the video game addict must return to their treatment center or therapist. The faster a relapse is evaluated, the sooner the addict can continue toward complete recovery.

If you’re the parent of a child or teen who has undergone treatment for video game addiction and suspects a relapse has occurred, do not hesitate to take action . You may feel uncomfortable confronting your child with your suspicions, but it’s better to have an awkward conversation than to enable them to experience a full-blown video game addiction again.

Can a Video Game Addict Ever Play Video Games Again?

There’s an old saying: “Once an addict, always an addict.” If this statement is to be taken conclusively, it means someone diagnosed as a video game addict should avoid video games in the future. Even one video game session could lead to a relapse.

The good news is that, unlike food addicts who need to eat , video game addicts do not have to play video games. Of course, for kids addicted to video games, not gaming may mean not attending social events like parties and other celebrations where gaming will be available. This is similar to the practice of alcoholics not going to functions where alcoholic beverages are likely to be served.

In general, it’s best if the video game addict never returns to gaming. That way, they have a much better chance of beating the addiction completely.

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Reviewed By:

Dr. John Elgin Wilkaitis

Dr. John Elgin Wilkaitis completed medical school at The University of Mississippi Medical Center and residency in general psychiatry in 2003. He completed a fellowship in Child and Adolescent Psychiatry at Cincinnati Children’s Hospital in 2005. Following this, he served as Chief Medical Officer for 10 years of Brentwood Behavioral Healthcare a private health system including a 105-bed hospital, residential treatment, and intensive outpatient services.

Addiction Experts is a group of addiction and behavioral health specialists dedicated to providing helpful, and free, addiction treatment guides. Millions of people have utilized our resources and suggestions for substance use disorders, mental health treatment, and process addiction treatment. Don’t hesitate to reach out to us with any questions you may have! 

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• Published: 28 November 2022

Psychological treatments for excessive gaming: a systematic review and meta-analysis

• Jueun Kim 1 ,
• Sunmin Lee 1 ,
• Dojin Lee 1 ,
• Sungryul Shim 2 ,
• Daniel Balva 3 ,
• Kee-Hong Choi 4 ,
• Jeanyung Chey 5 ,
• Suk-Ho Shin 6 &
• Woo-Young Ahn 5  

Scientific Reports volume  12 , Article number:  20485 ( 2022 ) Cite this article

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Despite widespread public interest in problematic gaming interventions, questions regarding the empirical status of treatment efficacy persist. We conducted pairwise and network meta-analyses based on 17 psychological intervention studies on excessive gaming ( n  = 745 participants). The pairwise meta-analysis showed that psychological interventions reduce excessive gaming more than the inactive control (standardized mean difference [SMD] = 1.70, 95% confidence interval [CI] 1.27 to 2.12) and active control (SMD = 0.88, 95% CI 0.21 to 1.56). The network meta-analysis showed that a combined treatment of Cognitive Behavioral Therapy (CBT) and Mindfulness was the most effective intervention in reducing excessive gaming, followed by a combined CBT and Family intervention, Mindfulness, and then CBT as a standalone treatment. Due to the limited number of included studies and resulting identified methodological concerns, the current results should be interpreted as preliminary to help support future research focused on excessive gaming interventions. Recommendations for improving the methodological rigor are also discussed.

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Introduction.

Excessive gaming refers to an inability to control one’s gaming habits due to a significant immersion in games. Such an immersion may result in experienced difficulties in one’s daily life 1 , including health problems 2 , poor academic or job performance 3 , 4 , and poor social relationships 5 . Although there is debate regarding whether excessive gaming is a mental disorder, the 11th revision of the International Classification of Diseases (ICD-11) included Gaming Disorder as a disorder in 2019 6 . While there is no formal diagnosis for Gaming Disorder listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the DSM-5 included Internet Gaming Disorder (IGD) as a condition for further study 7 . In the time since the DSM-5’s publication, research on excessive gaming has widely continued. Although gaming disorder’s prevalence appears to be considerably heterogeneous by country, results from a systematic review of 53 studies conducted between 2009 and 2019 indicated a global prevalence of excessive gaming of 3.05% 8 . More specifically, a recent study found that Egypt had the highest IGD prevalence rate of 10.9%, followed by Saudi Arabia (8.8%), Indonesia (6.1%), and India (3.8%) among medical students 9 .

While the demand for treatment of excessive gaming has increased in several countries 10 , standard treatment guidelines for problematic gaming are still lacking. For example, a survey in Australia and New Zealand revealed that psychiatrics— particularly child psychiatrists, reported greater frequency of excessive gaming in their practice, yet 43% of the 289 surveyed psychiatrists reported that they were not well informed of treatment modalities for managing excessive gaming 11 . Similarly, 87% of mental health professionals working in addiction-related institutions in Switzerland reported a significant need for professional training in excessive gaming interventions 12 . However, established services for the treatment of gaming remain scarce and disjointed.

Literature has identified a variety of treatments for excessive gaming, but no meta-analysis has yet been conducted on effectiveness of the indicated interventions. The only meta-analysis to date has focused on CBT 13 , and while results demonstrated excellent efficacy in reducing excessive gaming. However, the study did not compare the intervention with other treatment options. Given that gaming behavior is commonly affected by cognitive and behavioral factors as well as social and familial factors 14 , 15 , 16 , it would also be important to examine the effectiveness of treatment approaches that reflect social and familial influences. While two systematic reviews examined diverse therapeutic approaches, they primarily reported methodological concerns of the current literature and did not assess the weight of evidence 17 , 18 . Given that studies in this area are rapidly evolving and studies employing rigorous methodological approaches have since emerged 19 , 20 , a meta-analytic study that analyzes and synthesizes the current stage of methodological limitations while also providing a comprehensive comparison of intervention options is warranted.

In conducting such a study, undertaking a traditional pairwise meta-analysis is vital to assess overall effectiveness of diverse interventions. Particularly, moderator and subgroup analyses in pairwise meta-analysis provide necessary information as to whether effect sizes vary as a function of study characteristics. Furthermore, to obtain a better understanding of the superiority and inferiority of all clinical trials in excessive gaming psychological interventions, it is useful to employ a network meta-analysis, which allows for a ranking and hierarchy of the included interventions. While a traditional pair-wise analysis synthesizes direct evidence of one intervention compared with one control condition, a network meta-analysis incorporates multiple comparisons in one analysis regardless of whether the original studies used them as control groups. It enters all treatment and control arms of each study, and makes estimates of the differences in interventions by using direct evidence (e.g., direct estimates where two interventions were compared) and indirect evidence (e.g., generated comparisons between interventions from evidence loops in a network 21 . Recent meta-analytic studies on treatments for other health concerns and disorders have used this analysis to optimize all available evidence and build treatment hierarchies 22 , 23 , 24 .

In this study, the authors used a traditional pairwise meta-analysis and network meta-analysis to clarify the overall and relative effectiveness of psychological treatments for excessive gaming. The authors also conducted a moderator analysis to examine potential differences in treatment efficacy between Randomized Controlled Trials (RCTs) and non-RCTs, age groups, regions, and research qualities. Finally, the authors examined follow-up treatment efficacy and treatment effectiveness on common comorbid symptoms and characteristics (e.g., depression, anxiety, and impulsivity).

The protocol for this review has been registered in the International Prospective Register of Systematic Review (PROSPERO 2021: CRD 42021231205) and is available for review via the following link: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=231205 . Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) network meta-analysis checklist 25 is included in Supplementary Material 1 .

Identification and selection of studies

The authors searched seven databases, which included ProQuest, PubMed, Scopus, Web of Science, PsycINFO, Research Information Sharing Service (RISS), and DBpia. Given that a substantial number of studies have been published particularly in East Asia and exclusion of literature from the area in languages other than English has been discussed as a major limitation in previous reviews 17 , 18 , the authors gave special attention to gaming treatment studies in English and other languages from that geographical area. Additionally, the authors searched Google Scholar to ensure that no studies were accidentally excluded. The authors conducted extensive searches for studies published in peer-reviewed journals between the first available year (year 2002) and October 31, 2022, using the following search terms: “internet”, or “video”, or “online”, or “computer”, and “game”, or “games”, or “gaming”, and “addiction”, or “addictions”, or “disorder”, “disorders”, or “problem”, or “problems”, or “problematic”, or “disease”, or “diseases”, or “excessive”, or “pathological”, or “addicted”, and “treatment”, or “treatments”, or “intervention”, or “interventions”, or “efficacy”, or “effectiveness”, or “effective”, or “clinical”, or “therapy”, or “therapies”. Search strategies applied to each database is provided in Supplementary Material 2 .

The authors included studies that recruited individuals who were excessively engaging in gaming, according to cutoff scores for different game addiction scales. Since there is not yet an existing consensus on operational definitions for excessive gaming, the authors included studies that recruited individuals who met high-risk cutoff score according to the scales used in each respective study (e.g., Internet Addiction Test [modified in game environments] > 70). The authors also sought studies that provided pretest and posttest scores from the game addiction scales in both the intervention and control groups. Studies meeting the following criteria were excluded: (a) the study targeted excessive Internet use but did not exactly target excessive gaming; (b) the study provided a prevention program rather than an intervention program; (c) the study provided insufficient data to perform an analysis of the effect sizes and follow-up contact to the authors of such studies did not yield the information necessary for inclusion within this paper; and (d) the study conducted undefinable types of intervention with unclear psychological orientations (e.g., art therapy with an undefined psychological intervention, fitness programs, etc.).

Two authors (D.L. and S.L.) independently screened the titles and abstracts of articles identified by the electronic searches and excluded irrelevant studies. A content expert (J.K.) examined the intervention descriptions to determine intervention types that were eligible for this review. All treatments were primarily classified based on the treatment theory, protocol, and descriptions about the procedures presented in each paper. D.L. and S.L.—both of whom have been in clinical training for 2 years categorized treatment type, to which J.K., a licensed psychologist, cross-checked and confirmed the categorization. The authors resolved disagreements through discussion. The specific example of intervention type classification is provided in Supplementary Material 3 .

Risk of bias and data extraction

Three independent authors assessed the following risks of bias among the included studies. The authors used the Risk of Bias 2.0 (RoB 2) tool for RCT studies and the Risk Of Bias In Non-Randomized Studies of Intervention (ROBINS-I) tool for non-RCT studies. The RoB 2 evaluates biases of (a) randomization processes; (b) deviations from intended interventions; (c) missing outcome data; (d) measurement of the outcome; and (e) selection of the reported result, and it categorizes the risk of bias in each dimension into three levels (low risk, moderate risk, and high risk). The ROBINS-I evaluates biases of (a) confounding variables; (b) selection of participants; (c) classification of interventions; (d) deviations from intended interventions; (e) missing data; (f) measurement of outcomes; and (g) selection of the reported result, and it categorizes the risk of bias in each dimension into five levels (low risk, moderate risk, serious risk, critical risk, and no information). After two authors (D.L. and S.L.) assessed each study, another author (J.K.) cross-checked the assessment.

For each study, the authors collected descriptive data, which included the sample size as well as participants’ ages, and regions where the studies were conducted. The authors also collected clinical data, including whether the study design was a RCT, types of treatment and control, treatment duration, and the number of treatment sessions. Finally, the authors collected data on the follow-up periods and the measurement tools used in each study.

Data analysis

The authors employed separate pairwise meta-analyses in active control and inactive control studies using R-package “meta” 26 and employed a random-effects model due to expected heterogeneity among studies. A random-effects model assumes that included studies comprise random samples from the larger population and attempt to generalize findings 27 . The authors categorized inactive control groups including no treatment and wait-list control and categorized active control groups including pseudo training (e.g., a classic stimulus-control compatibility training) and other types of psychological interventions (e.g., Behavioral Therapy, CBT, etc.). The authors also used the bias-corrected standardized mean change score (Hedges’ g ) due to small sample sizes with the corresponding 95% confidence interval 28 . The authors’ primary effectiveness outcome was a mean score change on game addiction scales from pre-treatment to post-treatment. Hedges’ g effect sizes were interpreted as small ( g  = 0.15), medium ( g  = 0.40) and large ( g  = 0.75), as suggested by Cohen 29 . The authors used a conservative estimate of r  = 0.70 for the correlation between pre-and post-treatment measures 30 , and to test heterogeneity, the authors calculated Higgins’ I 2 , which is the percentage of variability in effect estimates due to heterogeneity among studies rather than chance. I 2  > 75% is considered substantial heterogeneity 31 .

The authors conducted moderator analyses as a function of RCT status (RCT versus non-RCT), age group (adolescents versus adults), region (Eastern versus Western), and research quality (high versus low). The authors divided high versus low quality studies using median values of research quality scores (RCT: low [0–2] versus high [3–5], non-RCT: low [0–4] versus high [5]). The authors calculated Cochran’s Q for heterogeneity: A significant Q value indicates a potentially important moderator variable. For the subgroup analyses of follow-up periods and other outcomes, the authors conducted separate pairwise analyses in 1- to 3-month follow-up studies and in 4- to 6-month follow-up studies and separate analyses in depression, anxiety, and impulsivity outcome studies.

The authors sought to further explore relative effectiveness of treatment types and performed a frequentist network meta-analysis using the R-package “netmeta” 4.0.4 version 26 . To examine whether transitivity and consistency assumptions for network meta-analysis were met, the authors assessed global and local inconsistency. To test network heterogeneity, the authors calculated Cochran’s Q to compare the effect of a single study with the pooled effect of the entire study. The authors drew the geometry plot of the network meta-analysis through the netgraph function in “netmeta”, and the thicker lines between the treatments indicated a greater number of studies.

The authors presented the treatment rankings based on estimates using the surface area under the cumulative ranking curve (SUCRA) 32 . The SUCRA ranged from 0 to 100%, with higher scores indicating greater probability of more optimal treatment. The authors also generated a league table to present relative effectiveness between all possible comparisons between treatments. When weighted mean difference for pairwise comparisons is bigger than 0, it favors the column-defining treatment. Finally, funnel plots and Egger’s test were used to examine publication bias.

Included studies and their characteristics

Figure  1 presents the flow diagram of the study selection process. The authors identified 1471 abstracts in electronic searches and identified an additional seven abstracts through secondary/manual searches (total n  = 1478). After excluding duplicates ( n  = 765) and studies that did not meet the inclusion criteria based on the study abstract ( n  = 550), the authors retrieved studies with potential to meet the inclusion criteria for full review ( n  = 163). Of these, 144 studies were excluded due to not meeting inclusion criteria based on full-text articles, leaving 19 remaining studies. Of the 19, two studies did meet this paper’s inclusion criteria but were excluded from this network meta-analysis 33 , 34 because the consistency assumption between direct and indirect estimates was not met at the time of this study's consideration based on previous studies 35 , 36 . Therefore, a total of 17 studies were included in this network meta-analysis, covering a total of 745 participants 36 .

Flow diagram of the study selection process.

Table 1 lists the characteristics of the 17 included studies. CBT ( n  = 4), Behavioral Treatment (BT) + Mindfulness ( n  = 4), and BT only ( n  = 4) were most frequently studied, followed by CBT + Family Intervention ( n  = 1), CBT + Mindfulness ( n  = 1), virtual reality BT ( n  = 1), Mindfulness ( n  = 1), and Motivational Interviewing (MI) + BT ( n  = 1). Seven studies were conducted in Korea and six were conducted in China, followed by Germany and Austria ( n  = 1), Spain ( n  = 1), the United States ( n  = 1), and the Philippines ( n  = 1). Twelve articles were written in English, and five articles were written in a language other than English. Nine studies conducted a follow-up assessment with periods ranging from one to three months, and two studies conducted a follow-up assessment with periods ranging four to six months. In one study 20 , the authors described their 6-month follow-up but did not present their outcome value, and thus only two studies were included in the four- to six-month follow-up analysis. Among the 17 included studies, eight had no treatment control group, five had an active control group (e.g., pseudo training, BT, and CBT), and four had a wait-list control group. Seven of the studies were RCT studies, and 10 were non-RCT studies.

Pairwise meta-analysis

The results of meta-analyses showed a large effect of all psychological treatments when compared to any type of comparison groups ( n  = 17, g  = 1.47, 95% CI [1.07, 1.86]). The treatment effects were separately provided according to active versus inactive comparison groups in Fig.  2 . The effects of psychological treatments were large when compared to the active control ( n  = 5, g  = 0.88, 95% CI [0.21, 1.56]) or inactive control ( n  = 12, g  = 1.70, 95% CI: [1.27, 2.12]). Substantial heterogeneity was evident in studies that were compared to both the active controls (I 2  = 72%, < 0.01) and inactive controls at p -value level of 0.05 (I 2  = 69%, p  < 0.001).

Pairwise Meta-analysis. Psychological treatment effects on excessive gaming by comparison group type (active and inactive controls). SMD standardized mean difference, SD standard deviation,  CI confidence interval, I 2  = Higgins' I 2 .

Moderator analysis

As shown in Table 2 , the moderator analysis suggested that effect sizes were larger in non-RCT studies ( n  = 10, g  = 1.60, 95% CI [1.36, 1.84]) than RCT studies ( n  = 7, g  = 1.26, 95% CI [0.30, 2.23]). However, the results of a Q-test for heterogeneity yielded insignificant results (Q = 0.44, df[Q] = 1, p  = 0.51), indicating that no statistically significant difference in treatment efficacy at p level of 0.05 between RCT and non-RCT studies.

The results of Q-test for heterogeneity did not yield any significant results, indicating no significant differences in treatment efficacy between adults and adolescents (Q = 2.39, df[Q] = 1, p  = 0.12), Western and Eastern regions (Q = 0.40, df[Q] = 1, p  = 0.53), or low and high research qualities among RCT studies (Q = 2.25, df[Q] = 1, p  = 0.13) and non-RCT studies (Q = 3.06, df[Q] = 1, p  = 0.08).

Subgroup analysis

The results demonstrated that the treatment effect was Hedges’ g  = 1.54 (95% CI [0.87, 2.21]) at 1-to-3-month follow-up and Hedges’ g  = 1.23 (95% CI [0.77, 1.68]) 4- to-6-month follow-up. The results also showed that the treatment for excessive gaming was also effective on depression and anxiety. Specifically, treatment on depression was Hedges’ g  = 0.52 (95% CI: [0.22, 0.81], p  < 0.001), and anxiety was Hedges’ g  = 0.60 (95% CI [0.11, 1.08], p  = 0.02), which are medium and significant effects. However, the effect on impulsivity was insignificant, Hedges’ g  = 0.26 (95% CI [− 0.14, 0.67], p  = 0.20).

Network meta-analysis

As shown in Fig.  3 , a network plot represents a connected network of eight intervention types (CBT, BT + Mindfulness, BT, Virtual Reality BT, CBT + Mindfulness, CBT + Family, MI + BT, and Mindfulness) and three control group types (wait-list control, no treatment, treatment as usual). The widest width of nodes was observed when comparing BT + Mindfulness and no treatment, indicating that those two modules were most frequently compared. No evidence of global inconsistency based on a random effects design-by-treatment interaction model was found (Q = 8.5, df[Q] = 7, p  = 0.29). Further, local tests of loop-specific inconsistency did not demonstrate inconsistency, indicating that the results from the direct and indirect estimates were largely in agreement ( p  = 0.12- 0.78).

Network plot for excessive gaming interventions. Width of lines and size of circles are proportional to the number of studies in each comparison. BT behavioral therapy, CBT cognitive behavioral therapy, Family family intervention, MI motivational interviewing, TAU treatment as usual.

As shown in Fig.  4 , according to SUCRA, a combined intervention of CBT and Mindfulness ranked as the most optimal treatment (SUCRA = 97.1%) and demonstrated the largest probability of effectiveness when compared to and averaged over all competing treatments. A combined treatment of CBT and Family intervention ranked second (SUCRA = 90.2%), and Mindfulness intervention ranked third (SUCRA = 82.1%). As shown in Table 3 , according to league table, CBT + Mindfulness intervention showed positive weighted mean difference values in the lower diagonal, indicating greater effectiveness over all other interventions. The CBT + Mindfulness intervention was more effective than CBT + Family or Mindfulness interventions, but their differences were not significant (weighted mean differences = 0.23–1.11, 95% CI [− 1.39 to 2.68]). The top three ranked interventions (e.g., CBT + Mindfulness, CBT + Family intervention, and Mindfulness in a row) were statistically significantly superior to CBT as a standalone treatment as well as the rest of treatments.

Surface under the cumulative ranking curve (SUCRA) rankogram of excessive gaming. BT behavioral therapy, CBT cognitive behavioral therapy, Family family intervention, MI motivational interviewing, TAU treatment as usual.

Risk of bias

Figure  5 displays an overview of the risk of bias across all included studies. Of note was that in the RCT studies, bias due to missing outcome data was least problematic, indicating a low dropout rate (six out of seven studies). In contrast, bias due to deviations from intended interventions was most problematic, indicating that, in some studies, participants and trial personnel were not blinded and/or there was no information provided as to whether treatments adhered to intervention protocols (six out of seven studies). In the non-RCT studies, bias in the selection of participants in the study was least problematic, indicating that researchers did not select participants based on participant characteristics after the start of intervention (10 out of 10 studies). In contrast, bias in the measurement of outcomes was most problematic, indicating that participants and outcome assessors were not blinded and/or studies used self-reported measures without clinical interviews (10 out of 10 studies).

Overview of risk of bias results across all included studies. Cl bias in classification of interventions, Co bias due to confounding, De bias due to deviations from intended interventions, Me bias in measurement of the outcome, Mi bias due to missing outcome data, R bias arising from the randomization process, RoB risk of bias, ROBINS-I risk of bias in non-randomized studies of intervention, Sp bias in selection of participants in the study, Sr bias in selection of the reported result.

Funnel plots and Egger’s test showed no evidence of publication in network meta-analyses. Funnel plots were reasonably symmetric and the result from Egger’s test for sample bias were not significant ( p  = 0.22; see Supplementary Material 4 ).

In this pairwise and network meta-analyses, the authors assessed data from 17 trials and analyzed the overall and relative effectiveness of eight types of psychological treatments for reducing excessive gaming. The pairwise meta-analysis results indicated large overall effectiveness of psychological treatments in reducing excessive gaming. Although the effectiveness was smaller when compared to the active controls than when compared to the inactive controls, both effect sizes were still large. However, this result needs to be interpreted with caution because there are only seven existing RCT studies and several existing low-quality studies. Network meta-analysis results indicated that a combined treatment of CBT and Mindfulness was the most effective, followed by a combined therapy of CBT and Family intervention, Mindfulness, and then CBT as a standalone treatment, however, this finding was based on a limited number of studies. Overall, the findings suggest that psychological treatments for excessive gaming is promising, but replications are warranted, with additional attention being placed on addressing methodological concerns.

The large effect of psychological treatments in reducing excessive gaming seems encouraging but the stability and robustness of the results need to be confirmed. These authors’ moderator analysis indicated that the effect size of non-RCT studies was not significantly different from that of RCT studies. The authors conducted a moderator analysis using the research quality score (high vs low) and found that research quality did not moderate the treatment effect. The authors also examined publication bias using both funnel plots and Egger’s test and found no evidence of publication bias in network meta-analysis. Because most of the studies included in the review were from Asian countries, the authors examined the generalizability of the finding by testing moderator analysis by regions and found no significant difference of treatment effect sizes between Eastern and Western countries. Finally, although limited studies exist, treatment benefits did not greatly diminish after 1–6 months of follow-ups, indicating possible lasting effects.

Network meta-analysis findings provide some preliminary support for the notion that a combined treatment of CBT and Mindfulness and a combined treatment of CBT and Family intervention are most effective in addressing individuals’ gaming behaviors. These combined therapies were significantly more effective than the CBT standalone approach. CBT has been studied and found to be highly effective in addiction treatment—particularly in reducing excessive gaming due to its attention to stimulus control and cognitive restructuring 13 . However, adding Mindfulness and family intervention may have been more effective than CBT alone, given that gaming is affected not only by individual characteristics, but also external stress or family factors.

Mindfulness generally focuses on helping individuals to cope with negative affective states through mindful reappraisal and aims to reduce stress through mindful relaxation training. The effectiveness of Mindfulness has been validated in other substance and behavioral addiction studies such as alcohol 37 , gambling 38 , and Internet 39 addiction treatments. Indulging in excessive gaming is often associated with the motivation to escape from a stressful reality 40 , and mindful exercises are likely to help gamers not depend on gaming as a coping strategy.

Because excessive gaming is often entangled with family environments or parenting-related concerns—particularly with adolescents, addressing appropriate parent–adolescent communication and parenting styles within excessive gaming interventions are likely to increase treatment efficacy 41 , 42 , 43 . Based on a qualitative study focused on interviews with excessive gamers 43 , and per reports from interviewed gamers, parental guidance to support regulatory control and encouragement to participate in other activities are important factors to reduce excessive gaming. However, at the same time, if parents excessively restrict their children’s behavior, children will feel increased stress and may further escape into the online world through gaming 44 as a means of coping with their stress. Our study indicates that appropriate communication among parents and adolescents in addition to parenting styles with respect to game control must be discussed in treatment. However, because only two studies examined the top two ranked combined interventions within this paper, such findings warrant replication.

Limitations and future directions

These authors identified methodological limitations and future directions in the reviewed studies, which include the following. The authors included non-RCTs to capture data on emerging treatments, but a lack of RCT studies contributes to this paper’s identified methodological concerns. Of 17 studies included, seven were RCT studies and 10 were non-RCT studies. The lack of RCT studies has been repeatedly mentioned in previous review studies 17 , 18 . In fact, one of the two identified reviews 17 made the criticism that even CBT (the most widely studied treatment for excessive gaming) was mostly conducted in non-RCT studies, which was commensurate with this paper’s data (only one out of four CBT studies included in this review is a RCT). Including non-RCTs may be likely to increase selection bias by employing easily accessible samples and assigning participants with more willingness (which is an indicator of better treatment outcome) to intervention groups. Selection bias may have increased the effect size of treatments than what is represented in reality and may limit the generalizability of this finding. Thus, more rigorous evaluation through RCTs is necessary in future studies.

While there are concerns surrounding assessment tools, given that all included studies used self-report measures without clinical interviews, this may lead to inaccurate results due to perceived stigma. Additionally, 11 self-reported measurement tools were employed in the included studies—and some of those tools may have poor sensitivity or specificity. A previous narrative review 45 and a recent meta-analytic review 46 suggested that the Game Addiction Scale-7, Assessment of Internet and Computer Addiction Scale-Gaming, Lemmens Internet Gaming Disorder Scale-9, Internet Gaming Disorder Scale 9- Short Form, and Internet Gaming Disorder Test-10 have good internal consistency and test–retest reliability. Thus, there is a need for studies to employ clinical interviews and self-report measures with good psychometric features.

Many studies in this included review did not describe whether participants and experimenters were blinded and there was no information about whether treatments adhered to intervention protocols. Although blinding of participants and personnel may be impossible in most psychotherapy studies, it is crucial to evaluate possible performance biases such as social desirability. Also, a fidelity check by content experts is needed to confirm whether treatments adhered to intervention protocols.

Finally, future studies need to examine treatment efficacy in treating both excessive gaming and its comorbid psychiatric symptoms. Internet/gaming addiction has been reported to have a high comorbidity with attention deficit hyperactivity disorder, depression, anxiety, and other substance abuse 47 , 48 . Our results showed that CBT, BT, and BT + Mindfulness may be effective in reducing depression or anxiety symptoms of excessive gamers. However, other psychological and/or pharmacological treatments such as CBT + Bupropion or Bupropion as a standalone treatment have been also reported as potentially effective treatments for excessive gamers with major depressive disorder 49 , 50 . Thus, it would be worthwile to examine efficacy of treatments on excessive gamers with dual diagnoses.

TO the best of the authors’ knowledge, this is the first pairwise meta-analytic and network meta-analytic study that examined the overall effectiveness of psychological treatments and compared the relative effectiveness of diverse treatment options for excessive gaming. Although the authors intentionally used network meta-analysis because of its usefulness in comparing relative effectiveness of currently existing literature, this finding should be interpreted with caution due to the small number of studies. However, as previously indicated, the global prevalence of excessive gaming highlights the need for greater attention to this topic. Studies focused on the effectiveness of diverse gaming interventions help meet the call for further inquiry and study on this topic placed by the DSM-5 7 , and allow greater advances to be made in treating individuals who may have difficulty controlling excessive gaming habits. As such, this study can provide preliminary support for beneficial treatment interventions for excessive gaming as well as recommendations for more rigorous studies to be directed at helping those who have excessive gaming habits.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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This research was supported by the project investigating scientific evidence for registering gaming disorder on Korean Standard Classification of Disease and Cause of Death funded by the Ministry of Health and Welfare and Korea Creative Content Agency.

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Home — Essay Samples — Entertainment — Video Games — Video Game Addiction: A Growing Threat to Health and Society

Video Game Addiction: a Growing Threat to Health and Society

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The nature of video game addiction, psychological and physical health implications, social and academic consequences, counterarguments and mitigation strategies.

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Online Video Games Addiction Essay

Online video games have already become an essential component of popular culture. A variety of technological products is actively used to train pilots and other safety occupations for better professional skills. Until recently, there was no specific knowledge or empirical evidence with regard to the effect video games may produce on users’ skills. It appears, however, that video games can become a relevant source of better practical knowledge and abilities which young users are to use in the practice. Unfortunately, there is no sufficient information that could unilaterally confirm the positive nature of video games when used by users in practical performance, but the results of recent researches suggest that video games provide unlimited opportunities for the development of better practical skills and avoiding major mistakes (Soukup 43). Video games are often linked to problems including bad grades and violent behavior of people. The idea has been accentuated in the ScienCentral News video reports. The study suggests that might make users do a better job. Confidentiality relates to information sought, obtained, or held by an organization, the disclosure of which might be detrimental to that organization or to the third party that supplied it. In many cases, it is difficult to control e-mail communication between employees and protect information security (Aarseth, 99). The paper will try to answer and research the question “Why people are addicted to online video games? How does it affect their life?”

Online video games create a new reality and can be interested as a “second life” of the user. Bad communications lead to conflict. In this situation, employees cannot find a unified and single solution for the project or program competing with one another during meetings and negotiations. Also, e-mail is not an ideal form to solve current business problems, because it takes time to type an e-mail instead of “simply calling someone if the message is short” (Hartt n.d.). In some cases, employees must accept e-mails inflexibilities, and learn how to interpret the information provided to them and how to make correct deci­sions based on written short messages. On the other hand, electronic mail systems store and then deliver to electronic ‘mail boxes’ which enable the recipient to retrieve the message when convenient.. The main problems that affected e-mail communication include lack of mutual understanding, lack of openness in relations, and damaged relations, chaos situations (Bates, 45). Critics admit that:

Despite this growing concern, children still seem to be spending time playing video games. A recent report released by the Kaiser Family Foundation (1999) reveals that a majority of 2- to 18-year-old children in this country have access to video game technology in their homes. (Smith 54).

As such, whatever is happening in the society in According the theory of the social construction of reality, each person is undeniably a perception and interaction with others. As such, this proves that culture is a vital component that affects the formation of one’s identity. In line with this, the concept of cultural identity was formed. Cultural Identity is often described as an individual’s feeling or perception of his or her belongingness to a certain cultural group. It is also described as the extent to which this feeling affects him or her and influences him/her to act in accordance with the actions, beliefs, traditions, and behavior imposed by the cultural group. A cultural group, on the other hand, refers to a set of individuals, which may be or maybe not be bounded by time and place. However, it is given that members of a cultural group carry the same set of symbolic meanings used in the interpretation of actions and communication. Normally, cultural groups exist in a common cultural space and time also (Berger, 98).

Through the sense of belongingness to a certain online video game, one tries to modify his/her behavior and practices in such a way that they are in accordance with the norms that are accepted by the online video game, to which the individual belongs. Thus, the end product will be that of identity. However, if an individual identifies himself/herself as a member of online video games that have cultural practices that oppose each other, he or she will be exposed to the question of which tradition to follow. Thus, his or her online video game identity will be compromised. In this case, the sense of free will, motivated by which cultural group he/she thinks he/she can more identify with, acts. In the analysis of the cultural identity of the interviewee, the act that he only tries to stay in line with norms of the “majority” while strongly not acting against the norms of his Islam community emphasizes that he identifies himself more as a member of the latter one. However, the fact that the interviewee acknowledges the norms of the “majority” also signifies his appreciation of the culture of this group, and therefore the concept of online video game assimilation exists (Faber, 76).

The changes are far-reaching: the definition of online video game; the nature of the information ‘commons’ for the citizen; the right of privacy in communicated expressions; the regulation of information infrastructures (computer operating systems and networks); the definition of information goods; and the nature of government communication with its citizens. These changes mostly revolve around information ownership and yet no consistent framework has yet to emerge as the question has mostly been approached in a piecemeal way. It is argued in conclusion that a new information dispensation must be built which guarantees information ownership, as this is the foundation on which systems of trading, governance, and research can be built. More interesting, though, was the extent to which users of the Internet as a news source said that as a result, they are using traditional news. It seems that using online video sites may have a more negative effect on news viewing than news reading. This might be because Internet users most often go online for the sort of information featured by television news, especially cable. In the early days, online companies did their very best to replicate the printed or media product (Berners-Lee, 33).

These emergent online video game standards now pose a major problem for competition regulators around the world as they span jurisdictions and the market dominance they create is not easily broken up by their nature. Although in some markets the developers may license the ‘standard’ technology to widen participation (the digital cellular phone standard GSM is one example), in others the standard-setter may aggressively protect its control over the standard as it regards it as an asset. At present most of the dominant information standards have been developed by US companies and they can only be regulated effectively by the US Department of Justice. These technological questions will, however, mark out the information infrastructures of the next century. In the emerging technological and commercial environment defined by the digital encoding of information representations ‘ownership’ is coming to mean different things (Aarseth, 33).

The internet and online video websites have become a new sales channel uncontrolled by the state and free for mass consumers. If any element of the channel can be provided in a more cost-effective way, either by another organization or the application of technology, then the producer will have a strong incentive to change their sales strategy. Mainstream media is limited by censorship and regulations, channels of communication, and geographical scope. In other words, this situation creates a channel conflict for mainstream media. Whenever there are a number of different sales channel elements that can address the same customer base, then there is the potential for conflict. The computer industry is renowned for having multiple channels which often find themselves in direct competition. There have been many instances when the computer manufacture, its distributors and resellers are all fighting for the same business (Smith et al 54).

The online video game is an area occupied by online companies. Some direct marketers have long suspected that the reliance of media advertising on attitudinal factors, instead of behavioral ones, has resulted in “much ado about nothing.” Moreover, they consider the Internet an information media and therefore antithetical to media advertising. When these capabilities are combined to address traditional business situations, it is possible to generate tangible benefits. The American media marketplace is not only larger but far more specialized than any other environment worldwide (Smith et al 54). Also, historically, marketing and advertising, in particular television and electronic media, have had a far more significant role in the United States than elsewhere. These abrupt turns can best be seen through annual changes. In the light of the Internet and its direct potential, these targeting options remained narrow and one-sided. Based on a broadcast model, they made real-time interactivity impossible. Having assessed the degree to which the Internet will affect the organization, the challenge is to manage the adoption of the new technology and the changes it will cause to existing processes. Decisions will be required about the advisability and cost implications of running multiple sales channels and the conflicts that can be created (Aarseth, 66).

Constraints on the geographic, industry, or application areas of trading, available to each channel element, can suddenly disappear. Perhaps the most important thing that can be done is to recognize that a problem will exist and to ensure that the existing channel elements have been informed of how the changes will affect them. If possible, these existing channel partners should be involved in the use of technology and encouraged to accept the changes by sharing part of the planned benefits. There are several reasons why it may be necessary to reduce the level of margin on media products that are being sold via the Internet-related sales channel. It may be sensible to offer a pricing advantage to encourage customers to use the channel. This does not necessarily affect the overall net margin since the cost structure of maintaining the channel may be significantly lower than the traditional alternatives (Berners-Lee 5).

In sum, it was found that people are addicted to online video games because they help users to change their own identity and create the ideal personality they cannot reach in real life. Jones writes that: “As in a video game, in which players acquire new weapons and capabilities within its digital geography and learn more and more about how to play from the collective knowledge of gamers online, both Lost’s characters and its audience are acquiring sequentially the “tools” they need to play. (51). Aarseth states that: “virtual environment has penetrated identity unevenly, thus marketers and advertising use this medium to promote their” (61). These quotes agree that online video games create a new reality for users but do not have a positive and educational impact on their personalities. Lack of regulations and censorship help video websites better position themselves against mainstream media companies. Online video sites succeed in moving economic activity closer to users (viewers) proposing low transaction costs, low barriers to entry, and improved access to information for the consumer. Thus, they have a negative and threatening impact on mainstream media, its audiences, and media messages. (Jones 51). Taking this measure helps the people to engage themselves in doing different kinds of exercises. The same thing can be told about the classic game Asteroids. This game has many important characteristics. One of these characteristics is the ability to rotate the wrist moves of a spaceship. The game is often associated with the waste of time. This is especially true when we are talking about the vast majority of people who are engaged in the research.

Works Cited

Aarseth, E. Cybertext: Perspectives on Ergodic Literature Baltimore and London: Johns Hopkins University Press, 1997.

Bates, B. Game Design: the Art and Business of Creating Games Roseville, CA: Prima Tech (Game Development Series), 2001.

Berger, A.A. Narratives in Popular Culture, Media and Everyday Life Thousand Oaks, CA: Sage, 1997.

Berners-Lee, Tim. Weaving the Web. London: Orion Business Books, 1999.

Faber, L. Re: Play Ultimate Games Graphics London: Laurence King Publishing, 1998.

Jones, S. E. Dickens on Lost: Text, Paratext, Fan-Based Media. Wordsworth Circle , 38 (2007), 51.

Smith, S. L. et al. Popular Video Games: Quantifying the Presentation of Violence and Its Context. Journal of Broadcasting & Electronic Media , 47 (2003), 54.

Soukup, Ch. Mastering the Game: Gender and the Entelechial Motivational System of Video Games. Women’s Studies in Communication , 30 (2007), 43.

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