thesis of video game addiction

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The Association Between Video Gaming and Psychological Functioning

Juliane m. von der heiden.

1 Department of Psychology, Johannes Gutenberg University Mainz, Mainz, Germany

Beate Braun

2 Department of Psychosomatic Medicine, University Medical Center, Mainz, Germany

Kai W. Müller

Boris egloff, associated data.

Video gaming is an extremely popular leisure-time activity with more than two billion users worldwide ( Newzoo, 2017 ). However, the media as well as professionals have underscored the potential dangers of excessive video gaming. With the present research, we aimed to shed light on the relation between video gaming and gamers’ psychological functioning. Questionnaires on personality and psychological health as well as video gaming habits were administered to 2,734 individuals (2,377 male, 357 female, M age = 23.06, SD age = 5.91). Results revealed a medium-sized negative correlation between problematic video gaming and psychological functioning with regard to psychological symptoms, affectivity, coping, and self-esteem. Moreover, gamers’ reasons for playing and their preferred game genres were differentially related to psychological functioning with the most notable findings for distraction-motivated players as well as action game players. Future studies are needed to examine whether these psychological health risks reflect the causes or consequences of video gaming.

Introduction

Video gaming is a very popular leisure activity among adults ( Pew Research Center, 2018 ). The amount of time spent playing video games has increased steadily, from 5.1 h/week in 2011 to 6.5 h/week in 2017 ( The Nielsen Company, 2017 ). Video gaming is known to have some benefits such as improving focus, multitasking, and working memory, but it may also come with costs when it is used heavily. By spending a predominant part of the day gaming, excessive video gamers are at risk of showing lower educational and career attainment, problems with peers, and lower social skills ( Mihara and Higuchi, 2017 ). On the one hand, video game use is widespread, and it may come with certain precursors as well as consequences. On the other hand, little is known about the relations between various video gaming habits and psychological functioning. This study aims to shed light on these important relations using a large sample.

A video game is defined as “a game which we play thanks to an audiovisual apparatus and which can be based on a story” ( Esposito, 2005 ). In the last few years, the amount of scientific research devoted to video game playing has increased (e.g., Ferguson, 2015 ; Calvert et al., 2017 ; Hamari and Keronen, 2017 ). Most scientific studies in this area of research have focused on the extent of video game play and its diverse correlates. While some researchers have emphasized the benefits of game playing and even suggested a therapeutic use of video games ( Primack et al., 2012 ; Granic et al., 2014 ; Colder Carras et al., 2018 ), others have been intrigued by its potential dangers ( Anderson et al., 2010 ; Müller and Wölfling, 2017 ).

Parents and professionals may be worried about their excessively playing children being “addicted.” However, problematic and potentially addictive video game use goes beyond the extent of playing (in hours per week; Skoric et al., 2009 ). It also includes such issues as craving, loss of control, and negative consequences of excessive gaming. While it is still a matter of debate whether problematic video game play should be considered a behavioral addiction , its status as a mental disorder has been clarified since the release of the DSM-5 in 2013. In the DSM-5, the American Psychiatric Association (2013) defined Internet Gaming Disorder with diagnostic criteria closely related to Gambling Disorder. Generally, this decision has been supported by many researchers (e.g., Petry et al., 2014 ) but has also caused controversies. Researchers have criticized the selection of diagnostic criteria and the vague definition of the Internet Gaming Disorder construct, which excludes offline games from being related to addictive use (e.g., Griffiths et al., 2016 ; Bean et al., 2017 ).

Several studies, literature reviews, and meta-analyses have focused on the correlates of problematic video gaming, usually assessed as a continuum with addiction marking the upper end of the scale (e.g., Ferguson et al., 2011 ; Kuss and Griffiths, 2012 ). The degree of addictive video game use has been found to be related to personality traits such as low self-esteem ( Ko et al., 2005 ) and low self-efficacy ( Jeong and Kim, 2011 ), anxiety, and aggression ( Mehroof and Griffiths, 2010 ), and even to clinical symptoms of depression and anxiety disorders ( Wang et al., 2018 ). Potential consequences of video game use have been identified as well, such as a lack of real-life friends ( Kowert et al., 2014a ), stress and maladaptive coping ( Milani et al., 2018 ), lower psychosocial well-being and loneliness ( Lemmens et al., 2011 ), psychosomatic problems ( Müller et al., 2015 ; Milani et al., 2018 ), and decreased academic achievement ( Chiu et al., 2004 ; Gentile, 2009 ). Effect sizes have varied widely across studies ( Ferguson et al., 2011 ). There seem to be sex and age differences with regard to video gaming behavior: potentially problematic video gaming was found to be more likely among males than females (e.g., Greenberg et al., 2010 ; Estévez et al., 2017 ), and among younger gamers ( Rehbein et al., 2016 ).

In addition to looking at problematic video game use and its relation to psychological functioning, it is relevant to also focus on why individuals play video games. Players use video games for very different reasons ( Ryan et al., 2006 ; Yee, 2006 ) such as to distract themselves from daily hassles or because they enjoy the social relationships they have developed in the virtual world. Potentially problematic video gaming has been found to be related to various reasons for playing such as coping and escape ( Hussain and Griffiths, 2009 ; Schneider et al., 2018 ), socialization ( Laconi et al., 2017 ), and personal satisfaction ( Ng and Wiemer-Hastings, 2005 ). Coping ( Laconi et al., 2017 ), social interaction, and competition were among the main reasons for gaming among males but not among females ( Lucas and Sherry, 2004 ). Mixed results emerged concerning age differences ( Greenberg et al., 2010 ), but especially younger gamers seemed to be motivated for video gaming by social interactions ( Hilgard et al., 2013 ). However, so far it remains unclear to what extent people’s various reasons for playing video games are differentially related to their psychological functioning.

Besides investigating the links between potentially problematic video game use and psychological functioning as well as between reasons for playing video games and psychological functioning, it is relevant to also look at which game genres individuals prefer. Correlates of preferences for certain game genres (e.g., simulation, strategy, action, role-playing) are cognitive enhancement ( Dobrowolski et al., 2015 ; Bediou et al., 2018 ), but also the amount of time spent playing ( Lemmens and Hendriks, 2016 ; Rehbein et al., 2016 ) and psychopathological symptoms ( Laconi et al., 2017 ). Males were shown to prefer action and strategy games, whereas females showed a preference for games of skill ( Scharkow et al., 2015 ; Rehbein et al., 2016 ). Younger gamers seemed to prefer action games, older players more so games of skill ( Scharkow et al., 2015 ). However, it is not yet understood to what extent preferences for certain video game genres are differentially related to psychological functioning.

Typically, research has focused merely on violent video games (e.g., Anderson and Bushman, 2001 ; Elson and Ferguson, 2014 ) or one specific game within one specific game genre (frequently World of Warcraft; Graham and Gosling, 2013 ; Visser et al., 2013 ; Herodotou et al., 2014 ), thereby neglecting the variety of possible gaming habits across various game genres.

In the present study, our objective was to examine the relation between video gaming and psychological functioning in a fine-grained manner. For this purpose, we examined psychological functioning by employing various variables such as psychological symptoms, coping strategies, and social support. Likewise, we assessed video gaming in a similarly detailed way, ranging from (a) problematic video game use, (b) the reasons for playing, to (c) the preferred game genres. This strategy prevented us from making potentially invalid generalizations about video gaming in general and allowed us to examine the spectrum of gaming habits and the respective relations between such habits and a diverse set of variables representing psychological functioning.

Playing video games excessively should be appealing to individuals with poor psychological functioning because games allow people to avoid their everyday problems and instead immerse themselves in another environment ( Taquet et al., 2017 ). Moreover, video games offer people a chance to connect with other people socially despite any more or less evident psychological problems they may have ( Kowert et al., 2014b ; Mazurek et al., 2015 ). On the other hand, potentially problematic video game use may also lead to psychological problems because it reduces the amount of time and the number of opportunities gamers have to practice real-life behavior ( Gentile, 2009 ). Thus, we expected to find a negative correlation between problematic video gaming and variables representing psychological functioning such that we expected more potentially problematic video game use to be related to dysfunctional coping strategies ( Wood and Griffith, 2007 ), negative affectivity ( Mathiak et al., 2011 ), and poor school performance ( Mihara and Higuchi, 2017 ). Moreover, we expected to find differential correlates of people’s reasons for playing video games and their psychological functioning: Playing for escape-oriented reasons such as distraction should go along with diverse indices of poor psychological functioning ( Király et al., 2015 ), whereas playing for gain-oriented reasons such as the storyline or the social connections in the game should be related to adequate psychological functioning ( Longman et al., 2009 ). Also, we expected to find people’s preferred game genres (e.g., strategy, action) to be differentially related to their psychological functioning ( Park et al., 2016 ). Finally, we aimed to shed light on the unique contribution of each measure of psychological functioning to the prediction of problematic video game use.

Materials and Methods

Participants 1.

A total of N = 2,891 individuals (2,421 male, 470 female) with a mean age of 23.17 years ( SD = 5.99, Range: 13–65) participated in our study. Of these participants, N = 2,734 (95%) confirmed their use of video games and were thus included in further analyses (2,377 male, 357 female, with a mean age of 23.06 years; SD = 5.91, Range: 13–65). The distribution of participants with regard to sex and age mirrors the findings of past research with males and younger individuals being more likely to play video games (e.g., Griffiths et al., 2004 ). Participants’ place of residence was Germany.

Procedure and Instruments 2

We posted links to our online questionnaire on various online forums as well as on popular online game sites. To achieve heterogeneity of the sample, no exclusion criteria other than having access to the Internet and understanding German were specified. As an incentive to participate in the study, four vouchers of 50€ were raffled.

Video Gaming

Potentially problematic video game use.

The AICA-S, the Scale for the Assessment of Internet and Computer game Addiction ( Wölfling et al., 2016 ), was used to assess participants’ gaming behavior with regard to potential problematic use. Based on the DSM criteria for Internet Gaming Disorder (tolerance, craving, loss of control, emotion regulation, withdrawal, and unsuccessful attempts to cut back), this standardized self-report scale consists of 15 items usually with a five-point scale ranging from 1 ( never ) to 5 ( very often ). The final score (Min = 0, Max = 27 points) is computed using weighted scoring (items with an item-total correlation > 0.55 in the norm sample are weighted double; Wölfling et al., 2011 ). The AICA-S score can be used to differentiate between regular (0–6.5 points) and problematic use of video games (7–13 points: abuse; 13.5–27 points: addiction). In our sample, N = 2,265 (83%) were identified as regular gamers, and N = 469 (17%) as problematic gamers. We used the AICA-S as a continuous variable for all further analyses ( M = 3.98, SD = 3.22, Range: 0–24). The instrument has been validated for different age groups in the general population and in clinical samples ( Müller et al., 2014a , 2019 , but note small sample size; Müller et al., 2014b ). Cronbach’s alpha was α = 0.70. As expected, the AICA-S score was correlated with male sex ( r = 0.17 ∗∗∗ ) and age ( r = –0.15 ∗∗∗ ). On average, participants played video games for M = 4.09 hours per weekday ( SD = 4.44, Range: 0–24), and M = 4.21 h per day at the weekend ( SD = 2.99, Range: 0–24).

Reasons for playing

Gamers indicated how often they played video games for certain reasons. They rated each of 10 reasons separately on Likert scales ranging from 1 ( never ) to 4 ( very often ). The most prevalent reasons were relaxation ( M = 2.96, SD = 0.91), amusement ( M = 2.94, SD = 0.85), and because of the storyline ( M = 2.67, SD = 1.10).

Game genres

Gamers were asked how often they usually played various video game subgenres such as first-person shooter, round-based strategy, massively multiplayer online role-playing games (MMORPGs), life simulations, and others. Ratings were made on Likert scales ranging from 1 ( never ) to 4 ( very often ). Using Apperley’s (2006) classification of game genres, we categorized the subgenres into the main genres action ( M = 2.54, SD = 0.84), strategy ( M = 2.13, SD = 0.80), role-playing ( M = 2.01, SD = 0.73), and simulation ( M = 1.58, SD = 0.44). A cluster for unclassified subgenres ( M = 1.54, SD = 0.39) was added to additionally account for such subgenres as jump’n’runs and games of skill. Descriptive statistics and intercorrelations for all measures (including sex and age) are presented in Supplementary Tables S1–S4 .

Psychological Functioning

Participants provided ratings of their psychological functioning on the following constructs:

General psychopathology

The SCL-K-9 ( Klaghofer and Brähler, 2001 ), a short version of the SCL-90-R ( Derogatis, 1975 ), was administered to assess participants’ subjective impairment regarding psychological symptoms (somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism). The SCL-K-9 score is strongly correlated with the original score of the SCL-90-R ( r = 0.93). The 9 items were answered on 5-point Likert-type scales ranging from 1 ( do not agree at all ) to 5 ( agree completely ). Cronbach’s alpha was satisfactory (α = 0.77).

We assessed 10 coping strategies with the Brief COPE ( Carver, 1997 ; German version by Knoll et al., 2005 ), which is the shorter version of the COPE ( Carver et al., 1989 ): self-distraction, denial, substance use, venting, self-blame, behavioral disengagement, acceptance, active coping, planning, and positive reframing. The two items per subscale were administered on 5-point Likert-type scales ranging from 1 ( never ) to 5 ( very often ). Intercorrelations of the two items per subscale ranged from r = 0.32, p < 0.001 for positive reframing to r = 0.78, p < 0.001 for substance use (with one exception: r = -0.05, p = 0.01 for self-distraction).

We measured general affect as a trait and affect during video gaming as a state using the German version ( Krohne et al., 1996 ) of the Positive and Negative Affect Schedule (PANAS; Watson et al., 1988 ). On a 5-point Likert-type scale ranging from 1 ( not at all ) to 5 ( completely ), participants rated the intensity of 20 adjectives. Cronbach’s alpha was α = 0.78 for general positive affect, α = 0.83 for general negative affect, α = 0.85 for positive affect while playing, and α = 0.83 for negative affect while playing.

The measure for the assessment of shyness in adults ( Asendorpf, 1997 ) consists of 5 items that were answered on a 5-point Likert-type scale ranging from 1 ( not at all ) to 5 ( completely ). Cronbach’s alpha was excellent (α = 0.86).

We administered the German version ( Elbing, 1991 ) of the NYU Loneliness Scale ( Rubenstein and Shaver, 1982 ). The 4 items were answered on 5- to 6-point Likert-type scales. Cronbach’s alpha was satisfactory (α = 0.79).

Preference for solitude

A 10-item measure of preference for solitude ( Nestler et al., 2011 ) was answered on a 6-point Likert-type scale ranging from 1 ( not at all ) to 6 ( completely ). Cronbach’s alpha was excellent (α = 0.86).

Life satisfaction

Participants answered a one-item life satisfaction measure on a 4-point Likert-type scale ranging from 1 ( not at all ) to 4 ( completely ).

Self-esteem

We administered the German version ( von Collani and Herzberg, 2003 ) of the Rosenberg Self-Esteem Scale (RSES; Rosenberg, 1979 ). The 10 items were answered on a 4-point Likert-type scale ranging from 1 ( not at all ) to 4 ( completely ). Cronbach’s alpha was excellent (α = 0.88).

Self-efficacy

We administered a 10-item generalized self-efficacy scale ( Schwarzer and Jerusalem, 1995 ), which was answered on a 4-point Likert-type scale ranging from 1 ( not at all ) to 4 ( completely ). Cronbach’s alpha was excellent (α = 0.86).

Social support and friends

We administered the perceived available social support subscale from the Berlin Social Support Scales (BSSS; Schwarzer and Schulz, 2003 ). The 8 items were answered on a 5-point Likert-type scale ranging from 1 ( not at all ) to 5 ( completely ). Cronbach’s alpha was excellent (α = 0.94). Participants indicated how many offline friends and offline acquaintances they had ( r = 0.44, p < 0.001) as well as how many online friends and online acquaintances they had ( r = 0.33, p < 0.001). Due to left-skewed distributions, we logarithmized the data before aggregation.

Participants reported their grade point average. German grades are assessed on a scale that ranges from 1 ( excellent ) to 6 ( insufficient ). Thus, higher scores indicate worse grades.

Participants further reported their sex and age. Both were used as control variables in further analyses.

In a first step, we computed zero-order correlations between the video gaming variables and the measures of psychological functioning. In a second step, we computed partial correlations in which we controlled for sex and age because past research has repeatedly shown that sex and age are correlated with both video gaming ( Homer et al., 2012 ; Mihara and Higuchi, 2017 ) and psychological functioning ( Kessler et al., 2007 ; Nolen-Hoeksema, 2012 ). Finally, we explored the unique contribution of each measure of psychological functioning to the prediction of potentially problematic video gaming. Therefore, we computed regressions with potentially problematic video gaming as the dependent variable and sex, age, and the measures of psychological functioning as predictors (entered simultaneously into the regression equation). By employing this procedure, we were able to determine the effect that each variable had over and above the other ones. For instance, we could identify whether general psychopathology was predictive of potentially problematic video game use when the influence of all other variables (e.g., shyness, loneliness, and others) was held constant.

Additionally, we included analyses regarding sex and age differences in the link between video gaming and psychological functioning. Since we collected a self-selected sample where different sexes and age groups were not represented equally, our findings are only preliminary, but may stimulate future research.

Potentially Problematic Video Game Use and Psychological Functioning

First, we examined whether potentially problematic video game use was related to various psychological functioning variables. As can be seen in Table 1 , the results for the zero-order correlations were similar to those for the partial correlations in which we controlled for sex and age. A medium-sized positive relation to the potentially problematic use of video games emerged for the presence of psychological symptoms including depression, anxiety, and hostility. Furthermore, several coping strategies were differentially associated with the potentially problematic use of video games: Self-blame and behavioral disengagement showed the strongest positive relations to potentially problematic video game use, followed by denial, acceptance, substance use, self-distraction, and venting. Planning, active coping, and, to a lesser extent, positive reframing were negatively associated with the potentially problematic use of video games. Moreover, the association with potentially problematic video game use was negative for general positive affect and positive and larger in size for general negative affect. However, potentially problematic video game use was clearly positively associated with the experience of both positive and negative affect while playing. Further, a preference for solitude, shyness, and loneliness were positively correlated with the potentially problematic use of video games. Lower self-esteem, lower life satisfaction, and, to a lesser extent, poorer perceived social support and lower self-efficacy went along with potentially problematic video game use. There was an association between fewer offline friends and acquaintances but more online connections with potentially problematic video gaming. Finally, poorer performance in school (i.e., higher grades) was related to the potentially problematic use of video games. These results suggest that potentially problematic video gaming goes along with poor psychological functioning and vice versa.

Associations between potentially problematic video gaming and psychological functioning.

Reasons for Playing Video Games and Psychological Functioning

Second, we investigated whether players’ reasons for playing video games were differentially related to the psychological functioning variables. Table 2 presents the partial correlations, controlling for sex and age. Using video games to distract oneself from stress was clearly connected to a high level of psychological symptoms. Distraction-motivated gamers preferred coping strategies such as self-blame, behavioral disengagement, self-distraction, denial, substance use, venting, and acceptance, but they neglected active coping and planning. They showed less general positive affect and more negative affect both in general and while playing as well as more positive affect while playing. These gamers further reported low self-esteem and low life satisfaction, loneliness, a preference for solitude, shyness, a lack of self-efficacy and social support, and poor achievement in school. A similar but somewhat less extreme picture was revealed for gamers who played video games in order to have something to talk about . However, these gamers reported more online connections. Gamers who played video games to improve their real-life abilities also reported more online connections. In addition, these gamers showed higher levels of general positive affect. The strongest association with online friends and acquaintances emerged, as expected, for gamers who played because of the social relations in the virtual world. Although all reasons for playing video games were related to positive affect while playing, the strongest associations emerged for gamers who played because of the social relations , to stimulate their imagination , and for curiosity . It is interesting that, for gamers who played video games because of the storyline and for relaxation , there was a relation only to positive but not to negative affect while playing. Reasons for playing were only weakly related to sex and age (see Supplementary Table S2 ). In sum, several reasons for playing video games were differentially associated with psychological functioning.

Associations between reasons for playing video games and psychological functioning.

Video Game Genre and Psychological Functioning

Third, we examined whether players’ preferences for different video game genres were differentially associated with the measures of psychological functioning. Table 3 shows the partial correlations in which we controlled for sex and age. There was a weak connection between general psychological symptoms and all of the video game genres we investigated except strategy. A preference for action games had the strongest association with affect while playing. Thus, action games seem to be both rewarding and a source of frustration. A preference for action games went along with poorer school performance. Gamers who preferred role-playing games scored higher on shyness and a preference for solitude and lower on self-esteem; they also reported fewer offline connections. By contrast, preferences for games of the unclassified category on average went along with a larger number of offline friends and more positive affect, both while playing and in general. Two game genres (i.e., role-playing and unclassified games) were related to the coping strategy of self-distraction. Because preferred game genre was related to participants’ sex (see Supplementary Table S3 ), we had a more detailed look at the correlations between preferred game genre and psychological functioning separately for both sexes: For males ( n = 2,377), the strongest correlation between general psychopathology and game genre emerged for action ( r = 0.08, p < 0.001), followed by role playing ( r = 0.07, p < 0.01), and unclassified ( r = 0.07, p < 0.01). For females ( n = 357), the strongest relation between general psychopathology and game genre emerged for simulation ( r = 0.17, p < 0.01). Differences were also found regarding the strength of the relation between number of friends online and the genre action: r = 0.06, p < 0.01 for males, and r = 0.27, p < 0.001 for females. Similarly, preferred game genre was related to participants’ age (see Supplementary Table S3 ). However, there were merely differences with regard to the relation of psychological functioning and game genre, when analyzed separately for different age groups (<19 years, n = 557; 19–30 years, n = 1916; >31 years, n = 261). In sum, our results speak to the idea that individuals with different levels of psychological functioning differ in their choices of game genres and vice versa.

Associations between preferred video game genre and psychological functioning.

Predicting Potentially Problematic Video Game Use by Psychological Functioning Variables

In a final step, we entered all of the investigated psychological functioning variables as well as sex and age as predictors of the potentially problematic use of video games. By employing this procedure, we were able to determine the unique contribution of each psychological functioning variable when the influence of all other variables was held constant. As Table 4 shows, the number of online friends and acquaintances as well as positive affect while playing were most predictive of potentially problematic video game use over and above all other variables. General psychopathology, a lack of offline connections, and poor school performance were weaker but still relevant predictors of potentially problematic video game use.

Prediction of potentially problematic video game use by psychological functioning variables.

With this study, we aimed to shed light on the association of diverse video gaming habits with gamers’ psychological functioning. Drawing on a large sample, our results revealed a medium-sized relation between potentially problematic video game use and poor psychological functioning with regard to general psychological symptoms, maladaptive coping strategies, negative affectivity, low self-esteem, and a preference for solitude as well as poor school performance. These findings are in line with those of prior work (e.g., Kuss and Griffiths, 2012 ; Milani et al., 2018 ). Also, reasons for playing video games were differentially related to psychological functioning with the most pronounced findings for escape-oriented in contrast to gain-oriented motives. Specifically, distraction-motivated gaming went along with higher symptom ratings, lower self-esteem, and more negative affectivity, whereas playing to establish social relationships in the virtual world was related to a larger number of online connections and more positive affect while playing. Furthermore, there were only weak relations between the preferred game genres and psychological functioning. The action games genre was associated with the strongest ratings of affect while playing. These results on reasons and genres may help to explain conflicting findings of former studies, because in our work we examined various reasons for playing, several game genres, and various aspects of psychological functioning simultaneously. Finally, positive affect while playing and a larger number of online friends were the strongest unique predictors of potentially problematic video game use, followed by psychological symptoms, a lack of offline connections, and poor school performance. These findings suggest that, on the one hand, independent of one’s psychological conditions, enjoying oneself during gaming (i.e., experiencing positive affect, connecting with online friends) may go along with potentially problematic use of video games. On the other hand, poor psychological functioning seems to be a unique risk factor for potentially problematic video gaming.

The presented results are generally in line with previous work that has identified a connection between video gaming and psychological health, academic problems, and social problems ( Ferguson et al., 2011 ; Müller et al., 2015 ). However, our study moved beyond prior research by providing in-depth analyses of both video gaming habits (including potentially problematic use, reasons for playing, and preferred game genre) and psychological functioning (including psychological symptoms, coping styles, affectivity, as well as variables that are related to individuals and their social environments). In addition, we identified unique predictors of potentially problematic video game use.

How can the findings on differential relations between video gaming and various indices of psychological functioning – ranging from beneficial results ( Latham et al., 2013 ) to unfavorable results ( Barlett et al., 2009 ; Möller and Krahé, 2009 ; Anderson et al., 2010 ) – be integrated? According to Kanfer and Phillips (1970) , problematic behavior (e.g., excessive video gaming) can be understood as a function of the situation (e.g., being rejected by a peer); the organism (e.g., low self-esteem); the person’s thoughts, physical reactions, and feelings (e.g., sadness, anger); and finally, the short- as well as long-term consequences of the behavior (termed SORKC model). In the short run, according to our results, playing video games may be a way to distract oneself from everyday hassles and may lead to positive affect while playing and a feeling of being connected to like-minded people, all of which are factors that have an immediate reinforcing value. In the long run, however, spending many hours per day in front of a computer screen may prevent a person from (a) developing and practicing functional coping strategies, (b) finding friends and support in the social environment, and (c) showing proper school achievement, factors that are potentially harmful to the person. Thus, differentiating between short- and long-term perspectives may help us understanding the differential correlates of intensive video gaming.

When is it appropriate to speak of video game addiction? More and more researchers have suggested a continuum between engagement ( Charlton and Danforth, 2007 ; Skoric et al., 2009 ) and pathological gaming/addiction, instead of a categorical perspective. In part, this recommendation has also been followed in the DSM-5 ( American Psychiatric Association, 2013 ) where Internet Gaming Disorder is classified with different degrees of severity, ranging from mild to moderate to severe, according to the functional impairment associated with it. The AICA-S also allows for a differential perspective on gaming behavior by providing ways to assess both the time spent playing video games and the main DSM criteria that indicate Internet Gaming Disorder. However, in our study we did not aim at making a diagnosis, but at having a closer look at potentially problematic gaming behavior and its correlates in a non-clinical sample.

In sum, it seems relevant to assess not only the extent of video game use but also the reasons behind this behavior (e.g., distraction) and the concrete rewards that come from playing (e.g., the experience of strong affect while playing action games) to fully understand the relation between video gaming and psychological functioning.

Limitations and Future Directions

With the present study, we aimed to uncover the association between video gaming and psychological functioning. Our approach was cross-sectional and warrants interpretative caution because correlations cannot determine the direction of causation. It remains unclear whether potentially problematic gaming is a factor that contributes to the development of psychological dysfunction or whether psychological dysfunction contributes to potentially problematic gaming. Also, a third factor (e.g., preexisting mental difficulties) may produce both psychological dysfunction and potentially problematic gaming. Thus, longitudinal studies that are designed to identify the causal pathway may provide a promising avenue for future research. Future studies may also answer the question whether the link between video gaming and psychological functioning is moderated by sex, age, the reasons for playing, or the preferred game genre. In addition, it is important not to forget that the present results are based on a self-selected sample in which potentially problematic video gamers were overrepresented (e.g., Festl et al., 2013 , for a representative sample). Thus, future research should replicate our findings in a representative sample. Further, we relied on self-reported data, which is a plausible method for assessing inner affairs such as people’s reasons for their behaviors, but it would be helpful to back up our findings with evidence derived from sources such as peers, caregivers, and health specialists. Our work reflects only a first approach to the topic, and future work may additionally collect in-game behavioral data from the players ( McCreery et al., 2012 ; Billieux et al., 2013 ) to objectively and more specifically investigate diverse patterns of use. Furthermore, one must not forget that the used taxonomy to classify video game genres is only one of various possible options and one should “think of each individual game as belonging to several genres at once” ( Apperley, 2006 , p. 19). Finally, some of the effects reported in our paper were rather modest in size. This is not surprising considering the complexity and multiple determinants of human behavior. In our analyses, we thoroughly controlled for the influence of sex and age and still found evidence that video gaming was differentially related to measures of psychological functioning.

The current study adds to the knowledge on gaming by uncovering the specific relations between video gaming and distinct measures of psychological functioning. Potentially problematic video gaming was found to be associated with positive affect and social relationships while playing but also with psychological symptoms, maladaptive coping strategies, negative affectivity, low self-esteem, a preference for solitude, and poor school performance. Including gamers’ reasons for playing video games and their preferred game genres helped deepen the understanding of the specific and differential associations between video gaming and psychological health. This knowledge might help developing adequate interventions that are applied prior to the occurrence of psychological impairments that may go along with potentially problematic video gaming.

Ethics Statement

In our online survey, participants were given information on voluntary participation, risks, confidentiality/anonymity, and right to withdraw. Whilst participants were not signing a separate consent form, consent was obtained by virtue of completion. We implemented agreed procedures to maintain the confidentiality of participant data.

Author Contributions

BB, BE, JH, and KM conceived and designed the study. BB, JH, and KM collected and prepared the data. JH analyzed the data. BE and JH wrote the manuscript.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

1 The data were gathered as part of a larger project ( Stopfer et al., 2015 ; Braun et al., 2016 ). However, the analyses in the present article do not overlap with analyses from previous work.

2 Other measures were administered, but they were not relevant to the present research questions and are thus not mentioned in this paper. The data set and analysis script supporting the conclusions of this manuscript can be retrieved from https://osf.io/emrpw/?view_only=856491775efe4f99b407e258c2f2fa8d .

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2019.01731/full#supplementary-material

• American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5 , 5th Edn Washington DC: American Psychiatric Association. [ Google Scholar ]
• Anderson C. A., Bushman B. J. (2001). Effects of violent video games on aggressive behavior, aggressive cognition, aggressive affect, physiological arousal, and prosocial behavior: a meta-analytic review of the scientific literature. Psychol. Sci. 12 353–359. 10.1111/1467-9280.00366 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Anderson C. A., Shibuya A., Ihori N., Swing E. L., Bushman B. J., Sakamoto A., et al. (2010). Violent video game effects on aggression, empathy, and prosocial behavior in eastern and western countries: a meta-analytic review. Psychol. Bull. 136 151–173. 10.1037/a0018251 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Apperley T. H. (2006). Genre and game studies: toward a critical approach to video game genres. Simul. Gaming 37 6–23. 10.1177/1046878105282278 [ CrossRef ] [ Google Scholar ]
• Asendorpf J. B. (1997). SGSE-Schüchternheits- und Geselligkeitsskalen für Erwachsene [Scales on shyness and sociality for adults ] . Berlin: Humboldt-Universität. [ Google Scholar ]
• Barlett C. P., Anderson C. A., Swing E. L. (2009). Video game effects—Confirmed, suspected, and speculative: a review of the evidence. Simul. Gaming 40 377–403. 10.1177/1046878108327539 [ CrossRef ] [ Google Scholar ]
• Bean A. M., Nielsen R. K. L., van Rooij A. J., Ferguson C. J. (2017). Video game addiction: the push to pathologize video games. Prof. Psychol. Res. Pr. 48 378–389. 10.1037/pro0000150 [ CrossRef ] [ Google Scholar ]
• Bediou B., Adams D. M., Mayer R. E., Tipton E., Green C. S., Bavelier D. (2018). Meta-analysis of action video game impact on perceptual, attentional, and cognitive skills. Psychol. Bull. 144 77–110. 10.1037/bul0000130 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Billieux J., Van der Linden M., Achab S., Khazaal Y., Paraskevopoulos L., Zullino D., et al. (2013). Why do you play World of Warcraft? An in-depth exploration of self-reported motivations to play online and in-game behaviours in the virtual world of Azeroth. Comput. Hum. Behav. 29 103–109. 10.1016/j.chb.2012.07.021 [ CrossRef ] [ Google Scholar ]
• Braun B., Stopfer J. M., Müller K. W., Beutel M. E., Egloff B. (2016). Personality and video gaming: comparing regular gamers, non-gamers, and gaming addicts and differentiating between game genres. Comput. Hum. Behav. 55 406–412. 10.1016/j.chb.2015.09.041 [ CrossRef ] [ Google Scholar ]
• Calvert S. L., Appelbaum M., Dodge K. A., Graham S., Nagayama Hall G. C., Hamby S., et al. (2017). The american psychological association task force assessment of violent video games: science in the service of public interest. Am. Psychol. 72 126–143. 10.1037/a0040413 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Carver C. S. (1997). You want to measure coping but your protocol’s too long: consider the brief cope. Int. J. Behav. Med. 4 92–100. 10.1207/s15327558ijbm0401_6 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Carver C. S., Scheier M. F., Weintraub J. K. (1989). Assessing coping strategies: a theoretically based approach. J. Personal. Soc. Psychol. 56 267–283. 10.1037/0022-3514.56.2.267 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Charlton J. P., Danforth I. D. (2007). Distinguishing addiction and high engagement in the context of online game playing. Comput. Hum. Behav. 23 1531–1548. 10.1016/j.chb.2005.07.002 [ CrossRef ] [ Google Scholar ]
• Chiu S. I., Lee J. Z., Huang D. H. (2004). Video game addiction in children and teenagers in Taiwan. Cyberpsychol. Behav. 7 571–581. 10.1089/cpb.2004.7.571 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Colder Carras M., Van Rooij A. J., Spruijit-Metz D., Kvedar J., Griffiths M. D., Carabas Y., et al. (2018). Commercial video games as therapy: a new research agenda to unlock the potential of a global pastime. Front. Psychiatry 8 : 300 . 10.3389/fpsyt.2017.00300 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Derogatis L. R. (1975). SCL-90-R: Symptom Checklist-90-R: Administration, Scoring, and Procedures Manual. London: NCS Pearson. [ Google Scholar ]
• Dobrowolski P., Hanusz K., Sobczyk B., Skorko M., Wiatrow A. (2015). Cognitive enhancement in video game players: the role of video game genre. Comput. Hum. Behav. 44 59–63. 10.1016/j.chb.2014.11.051 [ CrossRef ] [ Google Scholar ]
• Elbing E. (1991). Einsamkeit: Psychologische Konzepte, Forschungsbefunde und Treatmentansätze [Loneliness: Psychological Concepts, Research Findings, and Treatments]. Göttingen: Hogrefe. [ Google Scholar ]
• Elson M., Ferguson C. J. (2014). Twenty-five years of research on violence in digital games and aggression: empirical evidence, perspectives, and a debate gone astray. Eur. Psychol. 19 33–46. 10.1027/1016-9040/a000147 [ CrossRef ] [ Google Scholar ]
• Esposito N. (2005). “ A short and simple definition of what a videogame is ,” in Proceedings of the DiGRA (Digital Games Research Association) Conference: Changing Views-Worlds in Play , (British Columbia: University of Vancouver; ). [ Google Scholar ]
• Estévez A., Jáuregui P., Sánchez-Marcos I., López-González H., Griffiths M. D. (2017). Attachment and emotion regulation in substance addictions and behavioral addictions. J. Behav. Addict. 6 534–544. 10.1556/2006.6.2017.086 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ferguson C. J. (2015). Do angry birds make for angry children? A meta-analysis of video game influences on children’s and adolescents’ aggression, mental health, prosocial behavior, and academic performance. Perspect. Psychol. Sci. 10 646–666. 10.1177/1745691615592234 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ferguson C. J., Coulson M., Barnett J. (2011). A meta-analysis of pathological gaming prevalence and comorbidity with mental health, academic and social problems. J. Psychiatr. Res. 45 1573–1578. 10.1016/j.jpsychires.2011.09.005 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Festl R., Scharkow M., Quandt T. (2013). Problematic computer game use among adolescents, younger and older adults. Addiction 108 592–599. 10.1111/add.12016 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Gentile D. (2009). Pathological video-game use among youth ages 8 to 18: a national study. Psychol. Sci. 20 594–602. 10.1111/j.1467-9280.2009.02340.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Graham L. T., Gosling S. D. (2013). Personality profiles associated with different motivations for playing World of Warcraft. Cyberpsychol. Behav. Soc. Netw. 16 189–193. 10.1089/cyber.2012.0090 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Granic I., Lobel A., Engels R. C. (2014). The benefits of playing video games. Am. Psychol. 69 66–78. 10.1037/a0034857 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Greenberg B. S., Sherry J., Lachlan K., Lucas K., Holmstrom A. (2010). Orientations to video games among gender and age groups. Simul. Gaming 41 238–259. 10.1177/1046878108319930 [ CrossRef ] [ Google Scholar ]
• Griffiths M., Van Rooij A. J., Kardefeldt-Winther D., Starcevic V., Király O., Pallesen S., et al. (2016). Working towards an international consensus on criteria for assessing internet gaming disorder: a critical commentary on Petry et al. (2014). Addiction 111 167–175. 10.1111/add.13057 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Griffiths M. D., Davies M. N., Chappell D. (2004). Demographic factors and playing variables in online computer gaming. CyberPsychol. Behav. 7 479–487. 10.1089/cpb.2004.7.479 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hamari J., Keronen L. (2017). Why do people play games? A meta-analysis. Int. J. Inform. Manag. 37 125–141. 10.1016/j.ijinfomgt.2017.01.006 [ CrossRef ] [ Google Scholar ]
• Herodotou C., Kambouri M., Winters N. (2014). Dispelling the myth of the socio-emotionally dissatisfied gamer. Comput. Hum. Behav. 32 23–31. 10.1016/j.chb.2013.10.054 [ CrossRef ] [ Google Scholar ]
• Hilgard J., Engelhardt C. R., Bartholow B. D. (2013). Individual differences in motives, preferences, and pathology in video games: the gaming attitudes, motives, and experiences scales (GAMES). Front. Psychol. 4 : 608 . 10.3389/fpsyg.2013.00608 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Homer B. D., Hayward E. O., Frye J., Plass J. L. (2012). Gender and player characteristics in video game play of preadolescents. Comput. Hum. Behav. 28 1782–1789. 10.1016/j.chb.2012.04.018 [ CrossRef ] [ Google Scholar ]
• Hussain Z., Griffiths M. D. (2009). Excessive use of massively multi-player online role-playing games: a pilot study. Int. J. Mental Health Addict. 7 : 563 10.1007/s11469-009-9202-8 [ CrossRef ] [ Google Scholar ]
• Jeong E. J., Kim D. H. (2011). Social activities, self-efficacy, game attitudes, and game addiction. Cyberpsychol. Behav. Soc. Netw. 14 213–221. 10.1089/cyber.2009.0289 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kanfer F. H., Phillips J. (1970). Learning Foundations of Behavior Therapy. New York, NY: Wiley. [ Google Scholar ]
• Kessler R. C., Amminger G. P., Aguilar-Gaxiola S., Alonso J., Lee S., Ustun T. B. (2007). Age of onset of mental disorders: a review of recent literature. Curr. Opin. Psychiatry 20 359–364. 10.1097/YCO.0b013e32816ebc8c [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Király O., Urbán R., Griffith M. D., Ágoston C., Nagygyörgy K., Kökönyei G., et al. (2015). The mediating effect of gaming motivation between psychiatric symptoms and problematic online gaming: an online survey. J. Med. Int. Res. 17 : e88 . 10.2196/jmir.3515 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Klaghofer R., Brähler E. (2001). Konstruktion und teststatistische Prüfung einer Kurzform der SCL-90-R [Construction and statistical evaluation of a short version of the SCL-90-R]. Z. Klin. Psychol. Psychiatr. Psychother. 49 115–124. [ Google Scholar ]
• Knoll N., Rieckmann N., Schwarzer R. (2005). Coping as a mediator between personality and stress outcomes: a longitudinal study with cataract surgery patients. Eur. J. Personal. 19 229–247. 10.1002/per.546 [ CrossRef ] [ Google Scholar ]
• Ko C. H., Yen J. Y., Chen C. C., Chen S. H., Yen C. F. (2005). Gender differences and related factors affecting online gaming addiction among Taiwanese adolescents. J. Nervous Mental Dis. 193 273–277. 10.1097/01.nmd.0000158373.85150.57 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kowert R., Domahidi E., Festl R., Quandt T. (2014a). Social gaming, lonely life? The impact of digital game play on adolescents’ social circles. Comput. Hum. Behav. 36 385–390. 10.1016/j.chb.2014.04.003 [ CrossRef ] [ Google Scholar ]
• Kowert R., Domahidi E., Quandt T. (2014b). The relationship between online video game involvement and gaming-related friendships among emotionally sensitive individuals. Cyberpsychol. Behav. Soc. Netw. 17 447–453. 10.1089/cyber.2013.0656 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Krohne H. W., Egloff B., Kohlmann C. W., Tausch A. (1996). Untersuchungen mit einer deutschen version der positive and negative affect schedule (PANAS) [Investigations with a German version of the PANAS]. Diagnostica 42 139–156. [ Google Scholar ]
• Kuss D. J., Griffiths M. D. (2012). Internet gaming addiction: a systematic review of empirical research. Int. J. Mental Health Addict. 10 278–296. 10.1007/s11469-011-9318-5 [ CrossRef ] [ Google Scholar ]
• Laconi S., Pirès S., Chabrol H. (2017). Internet gaming disorder, motives, game genres, and psychopathology. Comput. Hum. Behav. 75 652–659. 10.1016/j.chb.2017.06.012 [ CrossRef ] [ Google Scholar ]
• Latham A. J., Patston L. L., Tippett L. J. (2013). The virtual brain: 30 years of video-game play and cognitive abilities. Front. Psychol. 4 : 629 . 10.3389/fpsyg.2013.00629 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Lemmens J. S., Hendriks S. J. F. (2016). Addictive online games: examining the relationship between game genres and internet gaming disorder. Cyberpsychol. Behav. Soc. Netw. 19 270–276. 10.1089/cyber.2015.0415 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Lemmens J. S., Valkenburg P. M., Peter J. (2011). Psychosocial causes and consequences of pathological gaming. Comput. Hum. Behav. 27 144–152. 10.1016/j.chb.2010.07.015 [ CrossRef ] [ Google Scholar ]
• Longman H., O’Connor E., Obst P. (2009). The effect of social support derived from World of Warcraft on negative psychological symptoms. Cyberpsychol. Behav. 12 563–566. 10.1089/cpb.2009.0001 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Lucas K., Sherry J. L. (2004). Sex differences in video game play: a communication-based explanation. Commun. Res. 31 499–523. 10.1177/0093650204267930 [ CrossRef ] [ Google Scholar ]
• Mathiak K. A., Klasen M., Weber R., Ackermann H., Shergill S. S., Mathiak K. (2011). Reward system and temporal pole contributions to affective evaluation during a first person shooter video game. BMC Neurosci. 12 : 66 . 10.1186/1471-2202-12-66 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mazurek M. O., Engelhardt C. R., Clark K. E. (2015). Video games from the perspective of adults with autism spectrum disorder. Comput. Hum. Behav. 51 122–130. 10.1016/j.chb.2015.04.062 [ CrossRef ] [ Google Scholar ]
• McCreery M. P., Krach S. K., Schrader P. G., Boone R. (2012). Defining the virtual self: personality, behavior, and the psychology of embodiment. Comput. Hum. Behav. 28 976–983. 10.1016/j.chb.2011.12.019 [ CrossRef ] [ Google Scholar ]
• Mehroof M., Griffiths M. D. (2010). Online gaming addiction: the role of sensation seeking, self-control, neuroticism, aggression, state anxiety, and trait anxiety. Cyberpsychol. Behav. 13 313–316. 10.1089/cyber.2009.0229 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mihara S., Higuchi S. (2017). Cross-sectional and longitudinal epidemiological studies of Internet gaming disorder: a systematic review of the literature. Psychiatry Clin. Neurosci. 71 425–444. 10.1111/pcn.12532 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Milani L., La Torre G., Fiore M., Grumi S., Gentile D. A., Ferrante M., et al. (2018). Internet gaming addiction in adolescence: risk factors and maladjustment correlates. Int. J. Mental Health Addict. 16 888–904. 10.1007/s11469-017-9750-2 [ CrossRef ] [ Google Scholar ]
• Möller I., Krahé B. (2009). Exposure to violent video games and aggression in German adolescents: a longitudinal analysis. Aggress. Behav. 35 75–89. 10.1002/ab.20290 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Müller K. W., Beutel M. E., Dreier M., Wölfling K. (2019). A clinical evaluation of the DSM-5 criteria for internet gaming disorder and a pilot study on their applicability to further Internet-related disorders. J. Behav. Addict. 8 16–24. 10.1556/2006.7.2018.140 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Müller K. W., Beutel M. E., Wölfling K. (2014a). A contribution to the clinical characterization of internet addiction in a sample of treatment seekers: validity of assessment, severity of psychopathology and type of co-morbidity. Compr. Psychiatry 55 770–777. 10.1016/j.comppsych.2014.01.010 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Müller K. W., Glaesmer H., Brähler E., Wölfling K., Beutel M. E. (2014b). Prevalence of internet addiction in the general population: results from a German population-based survey. Behav. Inform. Technol. 33 757–766. 10.1080/0144929X.2013.810778 [ CrossRef ] [ Google Scholar ]
• Müller K. W., Janikian M., Dreier M., Wölfling K., Beutel M. E., Tzavara C., et al. (2015). Regular gaming behavior and internet gaming disorder in European adolescents: results from a cross-national representative survey of prevalence, predictors and psychopathological correlates. Eur. Child Adolesc. Psychiatry 24 565–574. 10.1007/s00787-014-0611-2 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Müller K. W., Wölfling K. (2017). Both sides of the story: addiction is not a pastime activity: commentary on: scholars’ open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal (Aarseth et al.). J. Behav. Addict. 6 118–120. 10.1556/2006.6.2017.038 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Nestler S., Back M. D., Egloff B. (2011). Psychometrische Eigenschaften zweier Skalen zur Erfassung interindividueller Unterschiede in der Präferenz zum Alleinsein [Psychometric properties of two scales for the assessment of interindividual differences in preference for solitude]. Diagnostica 57 57–67. 10.1026/0012-1924/a000032 [ CrossRef ] [ Google Scholar ]
• Newzoo (2017). 2017 Global Games Market Report: Trends, Insights, and Projections Toward 2020. Available at: http://progamedev.net/wp-content/uploads/2017/06/Newzoo_Global_Games_Market_Report_2017_Light.pdf (accessed February 16, 2018). [ Google Scholar ]
• Ng B. D., Wiemer-Hastings P. (2005). Addiction to the internet and online gaming. Cyberpsychol. Behav. 8 110–113. 10.1089/cpb.2005.8.110 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Nolen-Hoeksema S. (2012). Emotion regulation and psychopathology: the role of gender. Annu. Rev. Clin. Psychol. 8 161–187. 10.1146/annurev-clinpsy-032511-143109 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Park J. H., Han D. H., Kim B. N., Cheong J. H., Lee Y. S. (2016). Correlations among social anxiety, self-esteem, impulsivity, and game genre in patients with problematic online game playing. Psychiatry Investig. 13 297–304. 10.4306/pi.2016.13.3.297 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Petry N. M., Rehbein F., Gentile D. A., Lemmens J. S., Rumpf H. J., Mossle T., et al. (2014). An international consensus for assessing internet gaming disorder using the new DSM-5 approach. Addiction 109 1399–1406. 10.1111/add.12457 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Pew Research Center (2018). 5 Facts About Americans and Video Games. Washington, DC: Pew Research Center. [ Google Scholar ]
• Primack B. A., Carroll M. V., McNamara M., Klem M. L., King B., Rich M. O., et al. (2012). Role of video games in improving health-related outcomes: a systematic review. Am. J. Prevent. Med. 42 630–638. 10.1016/j.amepre.2012.02.023 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Rehbein F., Staudt A., Hanslmaier M., Kliem S. (2016). Video game playing in the general adult population of Germany: can higher gaming time of males be explained by gender specific genre preferences? Comput. Hum. Behav. 55 729–735. 10.1016/j.chb.2015.10.016 [ CrossRef ] [ Google Scholar ]
• Rosenberg M. (1979). Conceiving the Self. New York, NY: Basic Books. [ Google Scholar ]
• Rubenstein C., Shaver P. R. (1982). “ The experience of loneliness ,” in Loneliness: A Sourcebook of Current Theory, Research, and Therapy , eds Peplau L. A., Perlman D. (New York, NY: Wiley-Interscience; ), 206–223. [ Google Scholar ]
• Ryan R. M., Rigby C. S., Przybylski A. (2006). The motivational pull of video games: a self-determination theory approach. Motiv. Emot. 30 344–360. 10.1007/s11031-006-9051-8 [ CrossRef ] [ Google Scholar ]
• Scharkow M., Festl R., Vogelgesang J., Quandt T. (2015). Beyond the “core-gamer”: genre preferences and gratifications in computer games. Comput. Hum. Behav. 44 293–298. 10.1016/j.chb.2014.11.020 [ CrossRef ] [ Google Scholar ]
• Schneider L. A., King D. L., Delfabbro P. H. (2018). Maladaptive coping styles in adolescents with Internet gaming disorder symptoms. Int. J. Mental Health Addict. 16 905–916. 10.1007/s11469-017-9756-9 [ CrossRef ] [ Google Scholar ]
• Schwarzer R., Jerusalem M. (1995). “ Generalized self-efficacy scale ,” in Measures in Health Psychology: A User’s Portfolio. Causal and Control Beliefs , eds Weinman J., Wright S., Johnston M. (Windsor: NFER-NELSON; ), 35–37. [ Google Scholar ]
• Schwarzer R., Schulz U. (2003). Soziale Unterstützung bei der Krankheitsbewältigung: die Berliner Social Support Skalen (BSSS) [Social support in coping with illness: the Berlin social support scales]. Diagnostica 49 73–82. 10.1026//0012-1924.49.2.73 [ CrossRef ] [ Google Scholar ]
• Skoric M. M., Teo L. L. C., Neo R. L. (2009). Children and video games: addiction, engagement, and scholastic achievement. Cyberpsychol. Behav. 12 567–572. 10.1089/cpb.2009.0079 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Stopfer J. M., Braun B., Müller K. W., Egloff B. (2015). Narcissus plays video games. Personal. Individ. Differ. 87 212–218. 10.1016/j.paid.2015.08.011 [ CrossRef ] [ Google Scholar ]
• Taquet P., Romo L., Cottencin O., Ortiz D., Hautekeete M. (2017). Video game addiction: cognitive, emotional, and behavioral determinants for CBT treatment. J. Thér. Comportementale Cogn. 27 118–128. 10.1016/j.jtcc.2017.06.005 [ CrossRef ] [ Google Scholar ]
• The Nielsen Company (2017). Games 360 U.S. Report. New York, NY: The Nielsen Company. [ Google Scholar ]
• Visser M., Antheunis M. L., Schouten A. P. (2013). Online communication and social well-being: how playing World of Warcraft affects players’ social competence and loneliness. J. Appl. Soc. Psychol. 43 1508–1517. 10.1111/jasp.12144 [ CrossRef ] [ Google Scholar ]
• von Collani G., Herzberg P. Y. (2003). Eine revidierte Fassung der deutschsprachigen Skala zum Selbstwertgefühl von Rosenberg [A revised German version of Rosenberg‘s self-esteem scale]. Z. Differ. Diagn. Psychol. 24 3–7. 10.1026/0012-1924/a000032 [ CrossRef ] [ Google Scholar ]
• Wang H. R., Cho H., Kim D.-J. (2018). Prevalence and correlates of comorbid depression in a nonclinical online sample with DSM-5 internet gaming disorder. J. Affect. Disord. 226 1–5. 10.1016/j.jad.2017.08.005 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Watson D., Clark L. A., Tellegen A. (1988). Development and validation of brief measures of positive and negative affect: the PANAS scales. J. Personal. Soc. Psychol. 54 1063–1070. 10.1037//0022-3514.54.6.1063 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Wölfling K., Beutel M. E., Müller K. W. (2016). “ OSV-S – skala zum onlinesuchtverhalten [AICA-S – Scale for the assessment of internet and computer game addiction] ,” in Diagnostische Verfahren in der Psychotherapie [Diagnostic Measures in Psychotherapy] , eds Geue K., Strauß B., Brähler E. (Göttingen: Hogrefe; ), 362–366. [ Google Scholar ]
• Wölfling K., Müller K. W., Beutel M. (2011). Reliabilität und Validität der Skala zum Computerspielverhalten [Reliability and validity of the scale for the assessment of pathological computer-gaming]. Psychother. Psychosom. Med. Psychol. 61 216–224. 10.1055/s-0030-1263145 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Wood R. T., Griffith M. D. (2007). A qualitative investigation of problem gambling as an escape-based coping strategy. Psychol. Psychother. 80 107–125. 10.1348/147608306X107881 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Yee N. (2006). Motivations for play in online games. Cyberpsychol. Behav. 9 772–775. 10.1089/cpb.2006.9.772 [ PubMed ] [ CrossRef ] [ Google Scholar ]

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Recovery from gaming addiction: A thematic synthesis

Vol.18, no.2 (2024).

https://doi.org/10.5817/CP2024-2-5

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• Author biographies
• Additional information

In recent years the field of gaming addiction has experienced an upsurge in empirical studies on various treatment approaches. Despite the advances in our understanding of how gaming addiction can be treated, the wider concept of recovery continues to be under-researched. The purpose of this review was to explore how individuals addicted to video games experience the process of recovery. Seven databases were systematically searched for qualitative studies. Eight studies representing the views of 225 participants were included in the review. Study findings were exported into NVivo software and analysed using Thematic Synthesis. Six themes were constructed: “developing awareness”, “deciding to change”, “the process of quitting”, “the challenges of quitting”, “recovery never stops” and “treatment for gaming addiction”. Except for the last, themes represent processes that most participants had gone through during recovery, though significant variation was found in how each process was experienced. In addition to overcoming addiction symptoms, recovery involved management of concomitant problems and various negative consequences of excessive gaming. Regarding practice implications, current findings suggest that treatment programs should adopt a multidimensional approach, providing evidence-based treatments, help for co-occurring problems, as well as pre- and post-treatment support to accommodate individuals at different stages of recovery. Further research is needed to expand our understanding of recovery, for instance, the impact of gender differences or how recovery experiences change based on different recovery goals (i.e., abstinence or reduced play time).

Ksenija Vasiljeva

Department of psychology, teesside university.

Ksenija Vasiljeva is a doctoral student on the program of Doctorate in Counselling Psychology at Teesside University. Her research interests include gaming addiction, depressive disorders, and cultural studies.

Alex Kyriakopoulos

Alexandros Kyriakopoulos is a Senior Lecturer in Counselling Psychology at Teesside University. He is interested in research regarding applied cyberpsychology; e-parenting; e-wellbeing; and using e-interventions to improve mental health and wellbeing.

Christopher Wilson

Department of psychology, school of social sciences, humanities and law, teesside university, middlesbrough, united kingdom.

Christopher Wilson is currently an Associate Professor in Psychology at Teesside University. He obtained his PhD from Maynooth University in 2010 where he was awarded a scholarship for doctoral research by the Irish Research Council (IRCHSS). His research interests include: Risk-taking and decision-making; attention and perception; Behaviour and cognition in virtual and online environments.

Studies marked with an (*) were included in the review.

*Beranuy, M., Carbonell, X., & Griffiths, M. D. (2013). A qualitative analysis of online gaming addicts in treatment. International Journal of Mental Health and Addiction , 11 (2), 149–161. https://doi.org/10.1007/s11469-012-9405-2

Best, D. W., & Lubman, D. I. (2012). The recovery paradigm: A model of hope and change for alcohol and drug addiction. Australian Family Physician , 41 (8), 593–597. https://pubmed.ncbi.nlm.nih.gov/23145400/

*Carmona, J., & Whiting, J. B. (2021). Escaping the escapism: A grounded theory of the addiction and recovery process in online video gaming. Qualitative Report , 26 (7), 2171–2188. https://doi.org/10.46743/2160-3715/2021.4643

*Chappell, D., Eatough, V., Davies, M. N. O., & Griffiths, M. (2006). EverQuest - It’s just a computer game right? An interpretative phenomenological analysis of online gaming addiction. International Journal of Mental Health and Addiction , 4 (3), 205–216. https://doi.org/10.1007/s11469-006-9028-6

Cooke, A., Smith, D., & Booth, A. (2012). Beyond PICO: The SPIDER tool for qualitative evidence synthesis. Qualitative Health Research, 22 (10), 1435–1443. https://doi.org/10.1177/1049732312452938

Costello, M. J., Sousa, S., Ropp, C., & Rush, B. (2020). How to measure addiction recovery? Incorporating perspectives of individuals with lived experience. International Journal of Mental Health and Addiction , 18 (3), 599–612. https://doi.org/10.1007/s11469-018-9956-y

Coyne, S. M., Stockdale, L. A., Warburton, W., Gentile, D. A., Yang, C., & Merrill, B. M. (2020). Pathological video game symptoms from adolescence to emerging adulthood: A 6-year longitudinal study of trajectories, predictors, and outcomes. Developmental Psychology , 56 (7), 1385–1396. https://doi.org/10.1037/dev0000939

Critical Appraisal Skills Programme. (2018). CASP qualitative checklist . https://casp-uk.net/casp-tools-checklists/

Dekkers, A., Bellaert, L., Meulewaeter, F., De Ruysscher, C., & Vanderplasschen, W. (2021). Exploring essential components of addiction recovery: A qualitative study across assisted and unassisted recovery pathways. Drugs: Education, Prevention, and Policy, 28 (5), 486–495. https://doi.org/10.1080/09687637.2021.1943315

Dong, G.-H., & Potenza, M. N. (2022). Considering gender differences in the study and treatment of Internet gaming disorder. Journal of Psychiatric Research , 153 , 25–29. https://doi.org/10.1016/j.jpsychires.2022.06.057

el-Guebaly, N. (2012). The meanings of recovery from addiction: Evolution and promises. Journal of Addiction Medicine, 6 (1), 1–9. https://doi.org/10.1097/ADM.0b013e31823ae540

Entertainment Software Association. (2023). 2023 essential facts about the U.S. video games industry. https://www.theesa.com/2023-essential-facts/

Ferreira, A. C. Z., Capistrano, F. C., Souza, E. B., Borba, L. O., Kalinke, L. P., & Maftum, M. A. (2015). Drug addicts treatment motivations: Perception of family members. Revista Brasileira de Enfermagem , 68 (3), 415–422. https://doi.org/10.1590/0034-7167.2015680314i

Gandolfi, E., Ferdig, R. E., Krause, K., Soyturk, I., Morris, G., & Delahanty, S. (2023). An exploration of why gaming communities may make younger and non-normative gamers vulnerable to Internet gaming disorder. New Media & Society . Advance online publication. https://doi.org/10.1177/14614448231215348

Gavriel-Fried, B., Serry, M., Katz, D., Hidvégi, D., Demetrovics, Z., & Király, O. (2023). The concept of recovery in gaming disorder: A scoping review. Journal of Behavioral Addictions, 12 (1), 26–52. https://doi.org/10.1556/2006.2023.00002

Goshorn, J. R., Gutierrez, D., & Dorais, S. (2023). Sustaining recovery: What does it take to remain in long-term recovery? Substance Use & Misuse, 58 (7), 900–910. https://doi.org/10.1080/10826084.2023.2196557

Goslar, M., Leibetseder, M., Muench, H. M., Hofmann, S. G., & Laireiter, A. (2020). Treatments for Internet addiction, sex addiction and compulsive buying: A meta-analysis. Journal of Behavioral Addictions , 9 (1), 14–43. https://doi.org/10.1556/2006.2020.00005

Grall-Bronnec, M., Guillou-Landreat, M., Caillon, J., Dubertret, C., Romo, L., Codina, I., Chereau-Boudet, I., Lanson, C., Auriacombe, M., JEU-Group, Harduin, J. B., & Reynaud, M. (2021). Five-year follow-up on a sample of gamblers: Predictive factors of relapse. Journal of Behavioral Addictions , 10 (1), 42–54. https://doi.org/10.1556/2006.2021.00009

*Haagsma, M. C., Pieterse, M. E., Peters, O., & King, D. L. (2013). How gaming may become a problem: A qualitative analysis of the role of gaming related experiences and cognitions in the development of problematic game behavior. International Journal of Mental Health and Addiction , 11 (4), 441–452. https://doi.org/10.1007/s11469-013-9427-4

Hofstedt, A., Mide, M., Arvidson, E., Ljung, S., Mattiasson, J., Lindskog, A., & Soderpalm-Gordh, A. (2023). Pilot data findings from the Gothenburg treatment for gaming disorder: A cognitive behavioral treatment manual. Frontiers in Psychiatry, 14, Article 1162492. https://doi.org/10.3389/fpsyt.2023.1162492

James, R. J. E., & Tunney, R. J. (2017). The need for a behavioural analysis of behavioural addictions. Clinical Psychology Review, 52, 69–76. https://doi.org/10.1016/j.cpr.2016.11.010

*Karhulahti, V.-M., Siutila, M., Vahlo, J., & Koskimaa, R. (2022). Phenomenological strands for gaming disorder and esports play: A qualitative registered report. Collabra: Psychology , 8 (1), Article 38819. https://doi.org/10.1525/collabra.38819

Kelly, J. F., & White, W. L. (2011). Recovery management and the future of addiction treatment and recovery in the USA . In J. F. Kelly & W. L. White (Eds.), Addiction recovery management: Theory, research and practice (pp. 303–316). Humana Press. https://psycnet.apa.org/record/2010-25515-016

Kim, H. S., Son, G., Roh, E.-B., Ahn, W.-Y., Kim, J., Shin, S.-H., Chey, J., & Choi, K.-H. (2022). Prevalence of gaming disorder: A meta-analysis. Addictive Behaviors, 126, Article 107183. https://doi.org/10.1016/j.addbeh.2021.107183

Kim, J., Lee, S., Lee, D., Shim, S., Balva, D., Choi, K. H., Chey, J., Shin, S. H., & Ahn, W. Y. (2022). Psychological treatments for excessive gaming: A systematic review and meta-analysis. Scientific Reports , 12 (1), Article 20485. https://doi.org/10.1038/s41598-022-24523-9

King, D. L., & Delfabbro, P. H. (2018) . Internet gaming disorder: Theory, assessment, treatment, and prevention . Elsevier Academic Press. https://psycnet.apa.org/record/2018-35840-000

Kotyuk, E., Magi, A., Eisinger, A., Király, O., Vereczkei, A., Barta, C., Griffiths, M. D., Székely, A., Kökönyei, G., Farkas, J., Kun, B., Badgaiyan, R. D., Urbán, R., Blum, K., & Demetrovics, Z. (2020). Co-occurrences of substance use and other potentially addictive behaviors: Epidemiological results from the psychological and genetic factors of the addictive behaviors (PGA) study. Journal of Behavioral Addictions , 9 (2), 272–288. https://doi.org/10.1556/2006.2020.00033

Kougiali, Z. G., Fasulo, A., Needs, A., & Van Laar, D. (2017). Planting the seeds of change: Directionality in the narrative construction of recovery from addiction. Psychology & Health, 32 (6), 639–664. https://doi.org/10.1080/08870446.2017.1293053

Kushnir, V., Godinho, A., Hodgins, D. C., Hendershot, C. S., & Cunningham, J. A. (2016). Motivation to quit or reduce gambling: Associations between self-determination theory and the transtheoretical model of change. Journal of Addictive Diseases , 35 (1), 58–65. https://doi.org/10.1080/10550887.2016.1107315

Laier, C., & Brand, M. (2014). Empirical evidence and theoretical considerations on factors contributing to cybersex addiction from a cognitive-behavioral view. Sexual Addiction & Compulsivity, 21 (4), 305–321. https://doi.org/10.1080/10720162.2014.970722

Leamy, M., Bird, V., Boutillier, C. L., Williams, J., & Slade, M. (2011). Conceptual framework for personal recovery in mental health: Systematic review and narrative synthesis. The British Journal of Psychiatry , 199 (6), 445–452. https://doi.org/10.1192/bjp.bp.110.083733

Lucas, P. J., Baird, J., Arai, L., Law, C., & Roberts, H. M. (2007). Worked examples of alternative methods for the synthesis of qualitative and quantitative research in systematic reviews. BMC Medical Research Methodology , 7, Article 4. https://doi.org/10.1186/1471-2288-7-4

Männikkö, N., Ruotsalainen, H., Miettunen, J., Pontes, H. M., & Kääriäinen, M. (2020). Problematic gaming behaviour and health-related outcomes: A systematic review and meta-analysis. Journal of Health Psychology, 25 (1), 67–81. https://doi.org/10.1177/1359105317740414

Marraudino, M., Bonaldo, B., Vitiello, B., Bergui, G. C., & Panzica, G. (2022). Sexual differences in Internet gaming disorder (IGD): From psychological features to neuroanatomical networks. Journal of Clinical Medicine, 11 (4) , Article 1018. https://doi.org/10.3390/jcm11041018

Martinelli, T. F., Roeg, D. P. K., Bellaert, L., Van de Mheen, D., & Nagelhout, G. E. (2023). Understanding the process of drug addiction recovery through first-hand experiences: A qualitative study in the Netherlands using lifeline interviews. Qualitative Health Research, 33 (10), 857–870. https://doi.org/10.1177/10497323231174161

Mihara, S., & Higuchi, S. (2017). Cross-sectional and longitudinal epidemiological studies of Internet gaming disorder: A systematic review of the literature. Psychiatry and Clinical Neurosciences, 71 (7) , 425–444. https://doi.org/10.1111/pcn.12532

Müller, K. W., Wolfling, K., Dickenhorst, U., Beutel, M. E., Medenwaldt, J., & Koch, A. (2017). Recovery, relapse, or else? Treatment outcomes in gambling disorder from a multicenter follow-up study. European Psychiatry, 43, 28–34. https://doi.org/10.1016/j.eurpsy.2017.01.326

Nakayama, H., Matsuzaki, T., Mihara, S., Kitayuguchi, T., & Higuchi, S. (2020). Relationship between problematic gaming and age at the onset of habitual gaming. Pediatrics International, 62 (11) , 1275–1281. https://doi.org/10.1111/ped.14290

Neale, J., Tompkins, C., Wheeler, C., Finch, E., Marsden, J., Mitcheson, L., Rose, D., Wykes, T., & Strang, J. (2015). “You’re all going to hate the word ‘recovery’ by the end of this”: Service users’ views of measuring addiction recovery. Drugs: Education, Prevention and Policy, 22 (1), 26–34. https://doi.org/10.3109/09687637.2014.947564

Newzoo. (2023). Global games market report. https://newzoo.com/resources/trend-reports/newzoo-global-games-market-report-2023-free-version

Nilsson, A., Simonsson, O., & Hellner, C. (2023). Reasons for dropping out of Internet-based problem gambling treatment, and the process of recovery – A qualitative assessment. Current Psychology, 42, 10987–10998. https://doi.org/10.1007/s12144-021-02368-1

Oakes, J., Pols, R., & Lawn, S. (2019). The ‘merry-go-round’ of habitual relapse: A qualitative study of relapse in electronic gaming machine problem gambling. International Journal of Environmental Research and Public Health, 16 (16) , Article 2858. https://doi.org/10.3390/ijerph16162858

Ofcom. (2023). Online nation: 2023 report. https://www.ofcom.org.uk/research-and-data/online-research/online-nation

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … & Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ , 372 , Article n71. https://doi.org/10.1136/bmj.n71

*Park, J. J., Wilkinson-Meyers, L., King, D. L., & Rodda, S. N. (2021). Person-centred interventions for problem gaming: A stepped care approach. BMC Public Health , 21 , Article 872. https://doi.org/10.1186/s12889-021-10749-1

Pickering, D., Spoelma, M. J., Dawczyk, A., Gainsbury, S. M., & Blaszczynski, A. (2020). What does it mean to recover from a gambling disorder? Perspectives of gambling help service users. Addiction Research and Theory , 28 (2), 132–143. https://doi.org/10.1080/16066359.2019.1601178

Prochaska, J. O., & DiClemente, C. C. (2005). The transtheoretical approach. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (2 nd ed., pp. 147–171). Oxford University Press. https://doi.org/10.1093/med:psych/9780195165791.003.0007

Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: Applications to addictive behaviors. The American Psychologist , 47 (9), 1102–1114. https://doi.org/10.1037//0003-066x.47.9.1102

Reith, G., & Dobbie, F. (2012). Lost in the game: Narratives of addiction and identity in recovery from problem gambling. Addiction Research and Theory , 20 (6), 511–521. https://doi.org/10.3109/16066359.2012.672599

Scott, C. K., & Dennis, M. L. (2011). Recovery management checkups with adult chronic substance users . In J. F. Kelly & W. L. White (Eds.), Addiction recovery management: Theory, research and practice (pp. 87–101). Humana Press. https://psycnet.apa.org/record/2010-25515-006

Sherer, J., & Levounis, P. (2022). Technological addictions. Current Psychiatry Report, 24, 399–406. https://doi.org/10.1007/s11920-022-01351-2

*Sim, T., Choo, H., Low-Lim, A., & Lau, J. (2021). Adolescents’ and parents’ perspectives: A gaming disorder intervention in Singapore. Family Relations , 70 (1), 90–103. https://doi.org/10.1111/fare.12474

Sirola, A., Savela, N., Savolainen, I., Kaakinen, M., & Oksanen, A. (2021). The role of virtual communities in gambling and gaming behaviors: A systematic review. Journal of Gambling Studies, 37, 165–187. https://doi.org/10.1007/s10899-020-09946-1

Snodgrass, J. G., Dengah, H. J. F. 2 nd , Lacy, M. G., & Fagan, J. (2013). A formal anthropological view of motivation models of problematic MMO play: Achievement, social, and immersion factors in the context of culture. Transcultural Psychiatry , 50 (2), 235–262. https://doi.org/10.1177/1363461513487666

Stefani, C. (2023). Determinants of initiation of natural recovery in the case of slot machine abusers. Journal of Community Positive Practices, 1 , 84–95. https://doi.org/10.35782/JCPP.2023.1.07

Stevens, M. W. R., Dorstyn, D., Delfabbro, P. H., & King, D. L. (2021). Global prevalence of gaming disorder: A systematic review and meta-analysis. Australian and New Zealand Journal of Psychiatry , 55 (6), 553–568. https://doi.org/10.1177/0004867420962851

Stevens, M. W. R., King, D. L., Dorstyn, D., & Delfabbro, P. H. (2019). Cognitive-behavioral therapy for Internet gaming disorder. A systematic review and meta-analysis. Clinical Psychology & Psychotherapy, 26 (2) , 191–203. https://doi.org/10.1002/cpp.2341

Sugaya, N., Shirasaka, T., Takahashi, K., & Kanda, H. (2019). Bio-psychosocial factors of children and adolescents with Internet gaming disorder: A systematic review. BioPsychoSocial Medicine, 13 , Article 3. https://doi.org/10.1186/s13030-019-0144-5

Sun, Y., & Zhang, Y. (2021). A review of theories and models applied in studies of social media addiction and implications for future research. Addictive Behaviors, 114, Article 106699. https://doi.org/10.1016/j.addbeh.2020.106699

Sussman, S. Y., Ayala, N., & Pokhrel, P. (2022). Reflections on the continued popularity of the transtheoretical model. Health Behavior Research, 5 (3), Article 2. https://doi.org/10.4148/2572-1836.1128

Thomas, J., & Harden, A. (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology, 8, Article 45. https://doi.org/10.1186/1471-2288-8-45

Tseng, M.-F., Huang, C.-C., Tsai, S. C.-S., Tsay, M.-D., Chang, Y.-K., Juan, C.-L., Hsu, F.-C., & Wong, R.-H. (2022). Promotion of smoking cessation using the transtheoretical model: Short-term and long-term effectiveness for workers in coastal central Taiwan. Tobacco Use Insights , 15 , 1–10. https://doi.org/10.1177/1179173x221104410

Watkins, N., Brown, A. M., & Courson, K. (2021). Identity transformation through substance use disorder recovery: Introducing the six stage model. Qualitative Report , 26 (7), 2127–2151. https://doi.org/10.46743/2160-3715/2021.4918

*Wendt, L. M., Austermann, M. I., Rumpf, H. J., Thomasius, R., & Paschke, K. (2021). Requirements of a group intervention for adolescents with Internet gaming disorder in a clinical setting: A qualitative interview study. International Journal of Environmental Research and Public Health , 18 (15), Article 7813. https://doi.org/10.3390/ijerph18157813

White, W. L. (2007). Addiction recovery: Its definition and conceptual boundaries. Journal of Substance Abuse Treatment , 33 (3), 229–241. https://doi.org/10.1016/j.jsat.2007.04.015

White, W. L., & Kelly, J. F. (2011). Recovery management: What if we really believed that addiction was a chronic disorder? In J. F. Kelly & W. L. White (Eds.), Addiction recovery management: Theory, research and practice (pp. 67–84). Humana Press. https://psycnet.apa.org/record/2010-25515-005

Witkiewitz, K., Montes, K. S., Schwebel, F. J., & Tucker, J. A. (2020). What is recovery? Alcohol Research: Current Reviews , 40 (3), Article 1. https://doi.org/10.35946/arcr.v40.3.01

World Health Organisation. (2018, September 14). Inclusion of “gaming disorder” in ICD-11. https://www.who.int/news/item/14-09-2018-inclusion-of-gaming-disorder-in-icd-11#:~:text=Gaming%20disorder%2C%20with%20its%20online%20and%20offline%20variants%2C,in%20personal%2C%20family%2C%20social%2C%20educational%20or%20occupational%20functioning.

World Health Organization. (2023). ICD-11: International classification of diseases (11 th revision). https://icd.who.int/

Xiao, Y., & Watson, M. (2019). Guidance on conducting a systematic literature review. Journal of Planning Education and Research, 39 (1), 93–112. https://doi.org/10.1177/0739456X17723971

Yates, R., & Malloch, M. S. (2010). The road less travelled? A short history of addiction recovery . In R. Yates, & M. S. Malloch (Eds.), Tackling addiction: Pathways to recovery (pp. 15–31). Jessica Kingsley Publishers.

Authors’ Contribution

Ksenija Vasiljeva: conceptualization, methodology, investigation, formal analysis, writing—original draft. Alexandros Kyriakopoulos: conceptualization, writing—review & editing, supervision. Christopher Wilson: supervision.

Editorial Record

First submission received: October 19, 2023

Revisions received: March 3, 2024

Accepted for publication: March 11, 2024

Editor in charge: Lenka Dedkova

Introduction

According to Newzoo report, there were 3.38 billion video game players globally in 2023, and this number is forecast to rise to 3.79 billion by 2026 (Newzoo, 2023). In the UK, 56% of adults and 91% of children play video games (Ofcom, 2023). Similarly, the statistics for the US are 62% and 76% respectively (Entertainment Software Association, 2023). Although gaming is an important recreational activity for many people, some individuals may play excessively to the detriment of their health, wellbeing, interpersonal relationships, and occupational opportunities (Mihara & Higuchi, 2017; Sugaya et al., 2019). A longitudinal study by Coyne et al. (2020) found that participants who played games excessively had elevated levels of anxiety, depression, aggression, shyness, and cell phone use. Problematic gaming behaviour has been linked to adverse health outcomes, such as poorer sleep quality, reduced physical activity and hand and wrist pain (Männikkö et al., 2020). Socially, excessive gaming can result in deteriorating personal relationships, occupational problems, and overall worse quality of life (Carmona & Whiting, 2021).

Mounting evidence of the negative impact of excessive gaming led the World Health Organisation to include a diagnosis of “Gaming disorder” (GD) in the latest edition of International Classification of Diseases (ICD-11; WHO, 2018, 2023). According to ICD-11, three criteria must be met over a period of 12 months for a diagnosis of GD: impaired control over gaming behaviour (e.g., duration, termination), gaming is given priority over other life interests and activities, and gaming is continued or escalates despite the occurrence of negative consequences (WHO, 2023). Stevens and colleagues (2021) estimated that the global prevalence of GD is 3.05%, which was reduced to 1.96% when including studies that met strict sampling criteria. A meta-analysis by H. S. Kim et al. (2022) similarly found that the global prevalence of GD was 3.3%. Both studies found that young age and male gender were associated with higher prevalence.

Recovery is a “process of behavior change characterized by improvements in biopsychosocial functioning and purpose in life” (Witkiewitz et al., 2020, p. 9). It is a multidimensional and complex phenomenon. Leamy and colleagues (2011), for instance, argue that recovery consists of the following five dimensions: connectedness (relationships, community participation), hope and optimism about the future (motivation to change, aspirations), identity (rebuilding identity, overcoming stigma), meaning in life (spirituality, quality of life) and empowerment (personal responsibility, control over life). This theoretical conceptualisation is supported by the experiences of individuals in recovery. For instance, in Dekkers et al. (2021) study participants’ recovery encompassed developing a new sense of self, feeling supported by others, finding safe places of growth, and working towards a better future. In a study of participants in residential treatment, recovery was conceived as abstinence coupled with positive gains on at least one of the following psychosocial dimensions: psychological, physical health, spiritual, occupational, social relations, or daily life functioning (Costello et al., 2020).

Our evolving understanding of recovery has directly shaped the development of treatment approaches. Historically, addiction was conceptualised as a physical disease that deprived people of free will; hence, it was believed that recovery was only achievable through medical interventions (Yates & Malloch, 2010). Treatment often took the form of acute care (i.e., crisis support and inpatient treatment), a person was considered “cured” from addiction at the end of treatment (White & Kelly, 2011). Although the disease model is still prevalent, the emphasis has shifted to viewing addiction as a chronic condition (Best & Lubman, 2012). This re-conceptualisation brought with it the idea that addiction should be treated similarly to other chronic conditions by offering ongoing long-term support (Scott & Dennis, 2011). Recovery-oriented treatments focus on early detection and intervention, provision of community services, peer support groups and residential programs (Kelly & White, 2011). Although acute care is still used at crisis points, preference is given to administering treatment in the community and helping individuals achieve their personal recovery goals. This aligns with service users’ experience of recovery as a long-term process that is more about personal growth and psychosocial improvement than achieving a definitive “cure” (Costello et al., 2020; Neale et al., 2015; Pickering et al., 2020). Therefore, the way we treat addiction has changed as a result of re-conceptualising recovery as a chronic condition.

Within the field of gaming addiction, the notion of recovery is only starting to take shape. Gavriel-Fried et al. (2023) conducted a scoping review, investigating how GD treatment studies ( n = 47) conceptualised recovery. Most studies ( n = 42) used terms “decrease/reduction” and/or “increase/improvement” of symptoms to describe changes in participants’ GD before and after interventions. Although the term “recovery” was mentioned by 18 studies, only 5 of them discussed it in relation to study aims, hypotheses, sample characteristics or findings. These studies conceptualised recovery as reduction in GD scores and/or no longer meeting the criteria for a GD diagnosis. Despite the limited use of the term “recovery”, all 47 studies included at least one psychological ( n = 32), neurobiological ( n = 20) and/or social ( n = 7) measure to evaluate the impact of treatment. It was found that certain personality traits (impulsivity, higher aggression, harm avoidance) and comorbid disorders (ADHD, depression) hinder patient recovery, whereas treatment (psychotherapy, medication) and social factors (family support) promote recovery. Although the review showed that the efficacy of GD treatments was evaluated against various psychosocial and neurobiological dimensions, there was no fundamental agreement on what “recovery” is beyond a person no longer meeting the diagnostic criteria for GD. Furthermore, only 13 studies in this review measured positive improvement (e.g., wellbeing, family cohesion, quality of life). This contrasts with the notions of recovery discussed earlier that advocate for focusing less on pathology and amelioration of disease in favour of helping individuals develop strength and resilience to live the life of greatest value to them (Witkiewitz et al., 2020).

Cognitive-Behavioural Therapy (CBT) is currently considered to be the gold standard of GD treatment (Stevens et al., 2019). Therapy covers topics such as stimulus control, cognitive restructuring, behavioural activation, relapse prevention and others (Hofstedt et al., 2023). Treatment usually lasts between 8 to 12 weeks, with follow up at 2 to 6 months (Stevens et al., 2019). Although CBT is an effective treatment, the way it is often delivered as a standalone intervention with no further support provided aligns more closely with the acute, rather than the chronic care provision pathway. J. Kim et al. (2022) evaluated different psychological interventions for GD and concluded that CBT+mindfulness, CBT+family therapy, and mindfulness were superior treatments to standalone CBT. Addiction recovery research emphasises that the best treatment outcomes are achieved when adopting a holistic approach that combines personal, relational, and contextual aspects (Dekkers et al., 2021) which may explain why combined treatments were more effective than standalone CBT in J. Kim et al. (2022) study.

It has been argued that Internet-based addictions (gaming, gambling, pornography, shopping, social media) share common aetiology, developing through behavioural conditioning, with predisposing neurobiological, individual and social factors (James & Turney, 2017; Kotyuk et al., 2020; Laier & Brand, 2014; Sun & Zhang, 2021). CBT for Internet Addiction (includes behaviour modification, cognitive restructuring, harm reduction) has been recommended as the treatment of choice for all Internet-based addictions, irrespective of the type (Goslar et al., 2020; Sherer & Levounis, 2022). However, even if Internet-based addictions develop through similar mechanisms, they are qualitatively and experientially different. Gaming is unique in that it offers highly rewarding, immersive and interactive environments, creating a more appealing reality than individuals’ day-to-day experiences (King & Delfabbro, 2018). Some individuals may use in-game achievements to compensate for their perceived offline “failures”, becoming overly invested in gaming to satisfy psychological needs (Snodgrass et al., 2013). Being part of an online gaming community is important for the development of gaming-related identity (Sirola et al., 2021). However, it was also shown that online communities play an important role in informing GD (Gandolfi et al., 2023), and community engagement can motivate escalation of gaming and in-game purchasing behaviours (Sirola et al., 2021). Furthermore, unlike many other addictive behaviours, gaming is accessible to very young children. Earlier onset of habitual weekly gaming (5 years old and younger) increases the risk of problematic gaming in adolescence (Nakayama et al., 2020). From these examples it can be seen that despite sharing aetiology with other addictions, there are key differences that may affect treatment prospects and recovery.

To reiterate, having a robust definition of recovery is fundamental for developing better treatments. However, at this point in time, there is no shared understanding of what recovery from GD looks like, and whether it is different to other Internet-based addictions. Our current conceptualisation of recovery is based on quantitative evidence which is limited to investigating changes in psychosocial and neurobiological symptoms (Gavriel-Fried et al., 2023). However, as discussed above, recovery may encompass processes not easily captured by psychometric measures, such as identity change, meaning in life and empowerment (Leamy et al., 2011). To the best of the author’s knowledge this is the first review sought to develop a conceptualisation of GD recovery by employing qualitative methodology to investigate the topic of recovery inductively, drawing on lived experiences of individuals affected by GD. The guiding review question was:

RQ1: How do individuals addicted to playing video games experience recovery?

Search Strategy

The literature review protocol was registered with PROSPERO. The review adopted a systematic search methodology in accordance with PRISMA guidelines (Page et al., 2021). The following databases were searched: PubMED, PsycINFO, PsycArticles, Scopus, Cinahl, Web of Science and MedLine. Search terms were chosen according to selection criteria using SPIDER framework (Cooke et al., 2012). Key terms included a combination of synonyms for “gaming”, “addiction”, “interview”, “experience” and “qualitative” (see Table A1 for a full list of terms). The searches were run on 1 st November 2022. References were exported into Mendeley. Articles were sifted by title and abstract, articles that clearly did not meet the selection criteria were excluded. Full-text articles were retrieved for the remaining records and assessed for eligibility. Additional articles were identified through reference lists of included studies and Google Scholar. The search and sifting were carried out by the first author.

Selection Criteria

Studies were included if they represented original qualitative research and had information relevant to recovery from gaming addiction. Studies could use any method of data collection or analysis. Importantly, studies had to represent opinions, insights and experiences of people who are or have been addicted to video games. Sample could include individuals of any age and could be clinical (diagnosis of GD) or non-clinical (self-reported addiction to video games). Since this review was primarily interested in people’s experiences of gaming addiction, rather than homogeneity of results, a diagnosis of GD was not considered essential. No restrictions were set based on the year of publication. Only peer-reviewed articles in English were included. Studies were excluded, if they: 1. had quantitative design, 2. focused on individuals without gaming addiction (e.g., healthy gamers, parents and spouses of people with GD, health professionals), 3. had no information relevant to recovery from gaming addiction, 4. thesis or grey literature.

Data Extraction

Descriptive data was entered into an Excel spreadsheet. The following information was extracted: Title, Authors, Year, Country, Aims/Questions, Theoretical framework, Context, Method of recruitment, Participants ( N; age: M, range; N : female), Method of data collection, Method of analysis, Notes. See Table A3 for the full data extraction table. To prepare qualitative data for analysis, findings of included studies were copied into separate Word documents and uploaded to Nvivo 12 . In this study, “findings” were considered to be everything in the “Results” section, including text, tables, participant quotes and authors’ interpretations. However, since the review is interested in the recovery process from the perspective of individuals addicted to gaming, accounts of parents and health professionals were not included in the analysis, even if they were present in the “Results” section.

Data Analysis

Data was analysed using thematic synthesis (Thomas & Harden, 2008). During the planning stages of the review the first author scoped the literature to determine whether there was sufficient material for a review. The extent to which recovery was discussed differed greatly across studies. Some studies had a separate theme dedicated to it, while others mentioned it in passing, meaning that findings would need to be re-analysed to identify processes relevant to recovery. Therefore, chosen analytical strategy had to be interpretative, rather than descriptive or aggregative. Thematic synthesis is a flexible interpretative approach, suitable for drawing together common elements from heterogenous studies (Lucas et al., 2007). Furthermore, it aims to produce new, higher-order constructs that go beyond individual findings of primary studies (Xiao & Watson, 2019). Given that the aim of this review was to develop a conceptualisation of GD recovery, thematic synthesis was considered to be a suitable method of analysis.

Analysis was conducted in three stages: free line-by-line coding, organisation of free codes into descriptive themes and creation of analytical themes. Line-by-line coding is inductive analysis of each sentence to consider its meaning and content. This process ensures that all data is carefully considered, even if not all sentences get coded (Thomas & Harden, 2008). More than one sentence could make up a code, as well as several codes could be applied to one sentence. For instance, a quote “I’m really torn though, I lead a guild and have [a lot] of friends in-game, but I’d like to quit and live my life” (Carmona & Whiting, 2021) was coded as “Deciding to quit is difficult” and “Social pressure to continue playing”. Each transcript was analysed in turn. Although codes could be used across transcripts, the emphasis during this stage of analysis was on capturing the richness and diversity of data in codes. Line-by-line coding yielded 268 codes. After this all transcripts were reviewed again to a) check the validity of codes, and b) determine if any additional coding was needed. This process resulted in multiple codes being added, removed or amended, bring the final number of codes to 290.

Codes were grouped together based on similarities in meaning. A new label was given to each group, making them into descriptive themes. For instance, “Deciding to quit is difficult”, “Weighing up advantages and disadvantages” and “Decreasing gaming time as a conscious choice” were grouped into “Deciding to quit” descriptive theme. There were 17 descriptive themes. In order to “go beyond” the data to generate new insights and concepts (Thomas & Harden, 2008) the first (KV) and the second (AK) authors, guided by the research question, reviewed descriptive themes in terms of their relevance to the process of recovery from GD. Several themes representing recovery were identified, such as “Process of realization”, “Deciding to quit”, “Social support” and “Quit or reduce playtime”. Through this process it was noted that the unifying characteristic of most studies was that participants went through similar stages on their journey through gaming addiction. Therefore, the analytic themes were developed around these stages, trying to capture key (sometimes different or conflicting) processes of each stage.

Included Studies

The search returned 9,262 records. After sifting by title and abstract, 31 records remained. Excluded records focused on other behavioural addictions, sports, serious games, gaming as a therapeutic tool, exergaming, and quantitative studies on GD. After assessing full-text records, 5 records met the inclusion criteria. Additional 3 records were identified through reference lists of included studies and Google Scholar. In total, 8 studies were included in the review. These studies were marked with an (*) in the list of references. See Figure 1 for PRISMA diagram.

Figure 1. PRISMA Diagram.

Study characteristics can be found in Table A3. Studies were published in the period between 2006 and 2022. Research was conducted in seven different countries: Spain, Chile, The Netherlands, Finland, New Zealand, Singapore, and Germany. In total, there were 225 participants. The sample was predominantly male (92%). Reported mean age ranged from M = 15.3 (Sim et al., 2021) to M = 30.4 (Karhulahti et al., 2022). Most studies recruited participants who were either undergoing or completed treatment. Participants were recruited through various institutions (hospitals, treatment programs, addiction centres) and in the community (adverts, flyers, posters, snowballing). Two studies obtained data from online forums, so no participant characteristics were obtained (Carmona & Whiting, 2021; Chappell et al., 2006).

All studies employed qualitative methodology. Data was collected through semi-structured interviews or forum posts. Data was analysed using Grounded Theory, Interpretative Phenomenological Analysis, Thematic Analysis or Qualitative Content Analysis. The primary aim of five studies was to understand gaming addiction through a qualitative lens from the perspective of individuals affected by it (Beranuy et al., 2013; Carmona & Whiting, 2021; Chappell et al., 2006; Haagsma et al., 2013; Karhulahti et al., 2022). Two studies evaluated GD treatment programs for adolescents (Sim et al., 2021; Wendt et al., 2021). One study sought to identify optimal components of a health care system for early intervention and treatment of gaming addiction (Park et al., 2021).

Quality Appraisal

Quality appraisal was conducted using the Critical Appraisal Skills Program checklist for qualitative studies (CASP, 2018). The purpose of quality appraisal is to evaluate the rigour of studies included in the review. CASP checklist consists of 10 questions evaluating studies’ methodology, ethical issues and application of findings. Questions are answered either with “yes”, “can’t tell” or “no”. If a question was answered with “yes”, then the criterion was met. If a question was answered with “can’t tell” or “no”, the criterion was not met. CASP guidelines do not provide a scoring system, therefore, studies’ quality was judged by the authors based on the number of met criteria (CASP, 2018). No studies were excluded based on their quality.

Three studies met between 9–10 criteria and were considered of excellent quality (Carmona & Whiting, 2021; Karhulahti et al., 2022; Park et al., 2021). Two studies met between 7–8 criteria and were considered of good quality (Sim et al., 2021; Wendt et al., 2021). Finally, three studies met 6 criteria and were considered of medium quality (Beranuy et al., 2013; Chappell et al., 2006; Haagsma et al., 2013). The best reported elements were whether qualitative methodology was appropriate to answer the research question(s), whether data was collected in a way to answer the research question(s), and whether there was a clear statement of findings; all studies met these criteria. The least reported element was whether the relationship between the researchers and participants was considered; only two studies mentioned it (Carmona & Whiting, 2021; Karhulahti et al., 2022). See Table A2 for full details.

Thematic Synthesis

Articles included limited data on the process of recovery. Only one study had a theme dedicated to recovery (Carmona & Whiting, 2021), and another one had a theme on decreasing gaming time (Haagsma et al., 2013). Other studies discussed recovery in the context of participants’ wider stories of addiction (Beranuy et al., 2013; Chappell et al., 2006; Karhulahti et al., 2022; Park et al., 2021) or in terms of treatment impact (Sim et al., 2021; Wendt et al., 2021). Recovery processes were captured in six themes: “Developing awareness”, “Deciding to change”, “The process of quitting”, “The challenges of quitting”, “Recovery never stops” and “Treatment for gaming addiction”. An overview of themes and subthemes with contributions of each study can be found in Table A4.

Developing Awareness

Developing an understanding that gaming was a problem often appeared as the first step to recovery. For a small number of people, the realization came instantly, like a lightbulb moment: “Then it hit me I had been obsessing over this game in the same fashion for a long time” (Haagsma, 2013). However, the majority described a process of dawning realization, whereby they developed an awareness of their problematic behaviour over time. This was often driven by the negative consequences of excessive gaming, such as loss of relationships, failing at school/university, losing work, deteriorating physical and mental health.

Awareness could also be developed through changing sense of identity or life goals. Individuals realised that their personality has changed because of gaming: “I went from a person who gained energy, pleasure and release from being sociable … to someone who finds it taxing to spend many hours around family and friends” (Carmona & Whiting, 2021). Recognising the destructive impact of gaming on identity drove individuals to re-evaluate their engagement with it: “One day I just started to feel sick, I had to leave and go find myself again … I’ve only now come to understand what [those years] cost me” (Karhulahti et al., 2022). Furthermore, individuals realised that gaming stood in the way of their life aspirations, they would be unable to achieve their goals if they continued playing excessively.

In some cases, awareness was developed when individuals’ relationship with gaming changed. Players realised that despite enjoying gaming initially, at some point it stopped being fun and satisfying:

“I eventually did get burned out and had thoughts of quitting the game entirely... I hadn’t even realized I had been playing in such an obsessive fashion up to that point.” (Haagsma, 2013)

This was supported by a realisation that achievements and skills obtained through gaming were meaningless outside of it. No matter how well individuals performed in gaming, most of the skills and knowledge could not be transferred to real life.

Deciding to Change

Becoming aware of the detrimental impact of gaming led individuals to a shift in perspective to the importance of gaming in their lives, and a subsequent decision to change their behaviour. People used different ways to facilitate this process, e.g., weighing up advantages and disadvantages of playing or re-evaluating their current priorities in life. But in the end, they realised that gaming was an obstacle to whatever they wanted to achieve in real life. Individuals developed a sense that they were missing out on life, realising that other activities were more valuable than gaming: “I can do other things, which is more meaningful than playing computer for the whole day, like reading a book, doing my homework, and having family time” (Sim et al., 2021). Individuals compared virtual and real lives, and the former started losing its attractiveness, consolidating participants’ decision to change their behaviour:

“I have begun to realise how much of a time sink EQ [ EverQuest ] is. I often think about how having a meaningful romantic relationship just doesn’t fit with EQ dominating my life. For the last few months I have let EQ be my social life, and it’s just recently begun to dawn on me how pathetic it’s become.” (Chappell et al., 2006)

Although many participants did want to fully quit gaming, others wanted to achieve a reduction in gaming time. Individuals who wanted to quit gaming felt that it stopped being a meaningful activity for them, and if they continued, it would only be taking away from their life. They have already lost many valuable things, like time, relationships, or health, so they no longer wanted gaming influencing their lives any further: “[I am] trying to quit, why, [because] this game [has] made me lonely, so god damn lonely that it hurts and I break down crying sometimes” (Carmona & Whiting, 2021). On the other hand, some individuals wanted to continue playing, but change how they engaged with gaming. In Sim et al. (2021) study five out of ten participants chose to reduce gaming time rather than abstain, and in Wendt et al. (2021) study a treatment goal was to teach participants how to control their gaming behaviour, rather than to promote abstinence.

The Process of Quitting

Some individuals were able to quit nearly instantly by crossing gaming out of their lives (Carmona & Whiting et al., 2021; Chappell et al., 2006). There seemed to be very little time passing between an individual deciding to quit and doing it: “I went back to the dorm, said goodbye to my EverQuest friends, and logged off for the last time” (Chappell et al., 2006). Others, by contrast, found it very difficult to cut all ties with gaming, instead going through a process of slowly withdrawing from it: “I have been slowly weaning away but thinking about anything but the game has been hard” (Carmona & Whiting, 2021).

Change was achieved via different ways. Help was sought from hospitals, counselling, addiction recovery centres and specialised programs. Practical strategies for quitting were finding activities to replace gaming, getting rid of gaming accounts and hardware, installing applications blocking access to gaming content, quitting with another person, restrictions set by parents, and taking on real-life responsibilities (Carmona & Whiting, 2021; Haagsma et al., 2013; Karhulahti et al., 2022). Social support was mentioned as an important factor that helped individuals follow through with quitting (Carmona & Whiting, 2021; Karhulahti et al., 2022). Several individuals attributed their successful recovery efforts to receiving support from family, partners or friends: “I am so lucky that my sister loved me enough to save me from myself” (Chappell et al., 2006).

The Challenges of Quitting

Social ties.

One of the key elements that made quitting difficult was the social pull of the game. As many individuals became high-ranking players, they felt that their teammates were relying on them to successfully complete in-game challenges. Hence, there was a deep sense of responsibility, not wanting to let other people down: “I’m really torn though, I lead a guild and have [a lot] of friends in-game, but I’d like to quit and live my life” (Carmona & Whiting, 2021).

Furthermore, individuals forged ties of friendship with other players. When trying to quit, therefore, they often faced pressure from their online friends to come back to the game and play again: “The other day one of my clan told me to connect and play with them. I told them that not yet, maybe later” (Beranuy et al., 2013). One study noted that gaming culture discouraged help-seeking and normalised playing long hours, making individuals feel ashamed of coming out to their online friends about having a “gaming problem” (Park et al., 2021).

However, the forging of strong in-game social ties came at the expense of negative real-life consequences. Gaming provided access to online social communities that were friendly and welcoming, a haven from the outside world. On the flip side, becoming heavily involved with online communities often meant that players withdrew from real-life social interactions. Through the process of quitting some individuals had to face up to their loneliness and a lack of social support in real life. Although some tried to keep in touch with their online friends outside of gaming, this often proved difficult. Gaming was their only common interest, and speaking to these friends rekindled the desire to play:

“A friend just asked me to come and play again, as there was an event that gives a free mount [virtual game item] … I’ve already decided to never play again let alone collect any mounts, and then I hear that I might lose a mount that I’d never ever want, and I will instantly start wanting it and feel disappointed.” (Karhulahti et al., 2022)

An Exciting Activity

Even though it was mentioned in “Developing awareness” that over time gaming stopped being fun, this was not the case for all individuals. Though they spent years playing, some still found gaming to be the most engaging and stimulating activity in their lives. Despite understanding the negative consequences it brought them, there was sadness to having to give up gaming: “When I play, it’s like all the cells in my body scream ‘this is what we were made for!’ It is such a pleasurable, activating and stimulating feeling … and that’s very sad” (Karhulahti et al., 2022). These people recognised that they could not play casually without getting too invested and spiralling into addiction. This made the process of quitting even more difficult, as these individuals felt that they may never encounter an activity that would be as fun and fulfilling as gaming.

An Ingrained Habit

Over the months and years of playing, gaming has become an integral part of peoples’ lives, and their main way of managing and occupying free time. Individuals often resorted to gaming when feeling bored or lonely: “One day, in which you’re home alone, have nothing to do and nobody calls you … I’ve just moved for my basic necessities, take food and that´s all, just play” (Beranuy et al., 2013). Thus, an important element of recovery was to engage in new activities and develop new hobbies to fill the free time left after quitting. However, doing so was often challenging, as individuals found they had reduced motivation and focus, felt controlled by gaming, or no longer had real-life friends to spend time with.

A Way of Coping

People who started playing as a way of escaping the troubles of real life continued to rely on gaming as their main way of dealing with life’s difficulties. Although gaming helped individuals cope, it came at the cost of spiralling into addiction again: “[But] I didn’t even get any interviews, so then one day I went to see a friend with my laptop, started playing again and … that’s a blur for next half a year again” (Karhulahti et al., 2022). Thus, it was difficult to stop gaming in the absence of more adaptive coping mechanisms.

Recovery Never Stops

Coming to terms with loss.

In some accounts there was a sense that the action of giving up gaming was, in some ways, only the first step to recovery (Carmona & Whiting, 2021; Chappell et al., 2006; Karhulahti et al., 2022). What followed was a long process of rebuilding one’s life anew. Quitting gave individuals space and time to fully acknowledge how gaming has impacted their lives. Often this meant recognising and coming to terms with the negative consequences. Many regretted picking up gaming in the first place, because the impact of addiction was damaging and long-lasting. As an example, a participant in Chappell et al. (2006) study lost his job and family because of the addiction, but even after quitting he could not put things right, as his wife met somebody else, and he rarely saw his children.

Abstinence Is the Only Option

Although some players chose a reduction of gaming time as their recovery goal (Sim et al., 2021; Wendt et al., 2021), others were adamant that complete abstinence from gaming was their only choice (Chappell et al., 2006; Karhulahti et al., 2022). Individuals often framed their decision in biological terms, such as having an “addictive personality” or something being wrong with their brain: “I’ve been trying to tackle other elements around addiction such as alcohol and marijuana, but the truth is I have an addictive personality that extends to many areas of my life” (Park et al., 2021). Such language demonstrates individuals’ conviction that gaming addiction is (at least partly) biologically determined, so they would be unable to control their gaming behaviour if they tried playing casually.

Desire to Continue Playing

Despite recognising the destructive impact of gaming, the desire to play never fully went away. Staying clean from gaming was seen as a constant battle, a difficult choice that individuals had to make every day, prioritising their wellbeing over the thrill of gaming:

“It is so difficult, maybe because I am weak, but even though I consider my life to be successful and happy, there is always EQ , sitting there at the back of my mind, and the desire to play is strong, almost like the pull of the ring in LOTR [ Lord of the Rings ].” (Chappell et al., 2006)

In addition to these cravings, some people experienced withdrawal-like symptoms. One player mentioned that not having the ability to play made them feel nervous and anxious. When not playing, individuals were preoccupied with thoughts about gaming. The urge to play again could be triggered by talking to friends who still play, watching videos about gaming, visiting gaming-related websites, thinking about how good gaming felt and others.

Relapse was mentioned briefly by four studies (Bearnuy et al., 2013; Carmona & Whiting. 2021; Haagsma et al., 2013; Karhulahti et al., 2022). Individuals relapsed after not playing for weeks or even months. Some felt that they could play casually but quickly spiralled into addiction again. Others came back for their social communities, or after being convinced to play again by friends. Relapse could also be triggered by the same factors that started the addiction, e.g., to escape stress or conflict. Several individuals described having an on-off relationship with gaming, stopping for a short while, then coming back to it and playing even more intensely to make up for the progress lost while not playing. Several players mentioned that they came back after a new expansion or update was released.

Being Free From Gaming

One study described the positive impact of recovery (Carmona & Whiting, 2021). The recovery journey was long and difficult for many, so upon finally quitting they felt a great sense of relief and achievement. Individuals described a sense of liberation: they escaped the clutches of gaming and were now free to spend their time on more meaningful activities. People felt excited and hopeful, looking forward to a future without the influence of gaming.

Treatment for Gaming Addiction

Barriers to treatment-seeking.

Various psychological, social and physical barriers have been cited as reasons for not seeking help for problematic gaming (Park et al., 2021). The addiction itself could dominate a person’s life to such an extent that seeking help became difficult:

“The fact that I did not have the willpower to break away made me feel weak and made me even more depressed! I was on the verge of going to my doctor and asking for some pills, or therapy, or something… but that would break into my WoW-time!” (Carmona & Whiting, 2021)

Individuals reported feeling a deep sense of shame and embarrassment at admitting that they had a “gaming problem”. They felt that gaming was a “soft addiction”, not as severe as substance misuse or other mental health issues. This view was reinforced by perceived negative social attitudes and stigma towards problematic gaming.

Many practical barriers were reported, such as a lack of knowledge/availability of services; the cost of paying for services; services perceived to be geared towards treating adolescents, rather than adults, and others. Some individuals who tried accessing support felt that services did not understand what GD was and how to treat it. Lack of services reinforced the idea that problematic gaming was not a problem worthy of treatment.

Helpful Treatment Components

Two studies (Sim et al., 2021; Wendt et al., 2021) explored adolescents’ experiences with group treatment for gaming addiction. Participants thought that it was important for therapists to be understanding, non-judgemental and trustworthy. In Sim et al. (2021) study therapists acted as role models, for instance, showing how to play games in a healthy way by regulating gaming time during therapeutic group gaming sessions. Regarding treatment elements, participants found the following useful: psychoeducation, understanding the roots of problematic gaming, exploring individual problems, time management, developing a daily plan, and having individual therapy sessions. Most participants were in favour of the group setting of therapy, as it encouraged participants to build real-life social connections and support each other on their recovery journey. Furthermore, when someone successfully achieved a goal, it motivated others to work harder. Participants engaged with treatment better if they were allowed to have fun in sessions, play together and engage in other activities, such as outdoors games.

Unhelpful Treatment Components

The unhelpful treatment components primarily concerned group composition and dynamics (Sim et al., 2021; Wendt et al., 2021). Treatment group in Wendt et al. (2021) study had mixed group composition (in-patient and community) which participants found difficult to adjust to. Some individuals found it challenging to be open in front of other group members due to being shy or having social anxiety. There was also a concern that therapists did not equally allocate time to every person, instead focusing on two or three individuals each session. Some participants were dissatisfied if modules covered in treatment were not personally relevant.

Positive Impact of Treatment

Individuals reported that treatment was helpful in a range of ways, for instance, it improved their insight and made them feel more mature (Sim et al., 2021; Wendt et al., 2021). Treatment helped participants to develop skills for controlling their gaming behaviour (such as time management), and, as a result, reduced gaming time. It improved family relations and academic performance. Group composition gave participants an opportunity to create real-life friendships and learn new skills through activities.

The purpose of this review was to understand how individuals addicted to video games experience recovery. Of eight studies included in the review, only two discussed recovery in a separate subtheme (Carmona & Whiting, 2021; Haagsma et al., 2013), showing that this concept has been under-explored in qualitative research. The core finding of the review is that individuals go through five processes on the road to recovery from gaming addiction: develop awareness of the problem, make a decision to change their behaviour, employ change strategies, address setbacks and difficulties, and work on sustaining recovery.

Even though these processes could be found across studies, there was significant variation in how participants experienced them. Awareness of gaming being a problem could come like a lightbulb moment or develop gradually over time. A decision to change could be motivated by positive aspirations (wanting to get a new relationship, complete a degree) or negative consequences (failing at school, relationship breakdown). Individuals differed based on whether they wanted to quit gaming and abstain from it in the future or reduce play time and maintain a healthy level of engagement. Finally, when it came to quitting, some individuals were able to quit instantly (i.e., decided to quit and did it straight away), whereas for others it was a long and drawn-out process. Thus, though unified by the same processes, there was significant diversity to how recovery from gaming addiction was experienced.

Reiterating the definition given in the introduction, recovery is a “process of behavior change characterized by improvements in biopsychosocial functioning and purpose in life” (Witkiewitz et al., 2020, p. 9). This definition can be applied to the concept of recovery developed in this review. Individuals sought to change their gaming behaviour by using various strategies (e.g., seeking treatment, selling gaming accounts/hardware), and their life improved as a result. The benefits of overcoming gaming addiction were improved relationships, better academic performance, improved self-awareness, and others. Although the definition implies that a shift in individuals’ purpose in life accompanies behaviour change, current findings suggest that it happens prior to change occurring. After acknowledging that gaming has had a negative impact on their lives, participants re-evaluated their life priorities and aspirations which often led to a realisation that gaming was an obstacle to achieving meaningful things in life, and this became motivation for behaviour change.

Recovery processes identified in this review appear to align with the stages of change proposed by the Transtheoretical Model (TTM; Prochaska et al., 1992). The model has been used extensively to study recovery in other addiction fields and to inform practice (Ferreira et al., 2015; Kushnir et al., 2016; Tseng et al., 2022), meaning that this conceptual framework can also be adapted to gaming addiction and to the present findings. The model holds that every individual goes through five stages while trying to change their behaviour: precontemplation, contemplation, preparation, action, and maintenance (see Table 1). Progression between stages is facilitated by 10 change processes that represent a shift in individuals’ thinking, behaviour or affect. For instance, moving from “precontemplation” to “contemplation” stage is facilitated by a process of consciousness-raising as individuals become aware of the causes, consequences, and cures of their problems (Prochaska & DiClemente, 2005, p. 150).

“Precontemplation” stage was not identified in this study, as most studies included participants who were in recovery or undergoing treatment, indicating that they were already at later stages of change. Theme “Developing awareness” represents the “contemplation” stage when individuals realised that their gaming was problematic. “Deciding to change” was also assigned to “contemplation” stage, as it encompasses individuals thinking about overcoming their addiction, weighing up advantages and disadvantages of doing so. Unfortunately, with the available data, it was not possible to determine whether a decision to change may have also represented an active intention to change behaviour, otherwise this theme would have been assigned to “preparation” stage. Themes “The process of quitting” and “The challenges of quitting” represent the “action” stage of the model. Individuals actively attempted to change their behaviour to overcome the addiction, and encountered various difficulties while doing so, such as struggling to let go of online friendships, finding activities to replace gaming, or developing new coping strategies. Finally, “Recovery never stops” is about “maintenance”, continuing to engage in new behaviours, coming to terms with loss, battling old habits, and managing the desire to play and relapse.

Table 1. Stages of Change and Current Themes.

TTM conceptualises change as a spiral, arguing that achieving long-lasting “maintenance” may require multiple attempts and relapses, it is an iterative process (Prochaska et al., 1992). The present findings support this notion with participants describing episodes of relapse, as well as encountering various challenges that hindered their progression through the stages. Even though studies in the current review tended to mention relapse briefly, research shows that relapse is a core element of addiction recovery, it allows individuals to develop greater awareness of their problematic behaviour and learn better coping strategies (Kougiali et al., 2017).

However, present findings also differ from the TTM conceptualisation of change. Beyond the spiral of relapse, progression through stages is sequential and linear within the model (Prochaska et al., 1992). However, in line with the model’s criticisms (Sussman et al., 2022), current findings indicate that individuals may not necessarily progress through all five stages on their road to recovery. For instance, it could be argued that individuals who quit gaming instantly upon realising it was problematic have gone straight from “contemplation” to “action” stage, missing the “preparation” stage. Similarly, although TTM argues that developing awareness of one’s problematic behaviour is crucial for recovery (Prochaska et al., 1992), other researchers have argued that insight may not be necessary for change to occur (Sussman et al., 2022; White, 2007). Supporting this notion, treatment evaluation studies in this review (Sim et al., 2021; Wendt et al., 2021) contributed limited data to “Developing awareness” theme, indicating that insight may not be necessary to engage in gaming addiction treatment.

While TTM focuses on internal motivation for change, this review found that individuals’ social environments could have a significant impact on the course of recovery. For instance, being part of an online social community and/or not having real-life friends could make it difficult to quit. Previous research has established that removing distractions and creating a secure environment (i.e., going into residential treatment or taking time off work) was important for stability during the initial stages of recovery (Martinelli et al., 2023). Another study found that supportive relationships and mutual aid communities are key to successful recovery (Goshorn et al., 2023). Many individuals in this review felt that social support received from family and friends was imperative for successful recovery.

In line with previous research (Watkins et al., 2021), current review found that identity transformation played an important role in the process of recovery. Addiction “spoils” identities, and recovery involves “identity reverting” (re-engaging in roles and responsibilities individuals had prior to addiction), as well as establishing new roles (developing relationships, gaining employment and education; Reith & Dobbie, 2012). Changing identity from a substance “user” to “non-user” not only allows individuals to think and feel differently about themselves, but also gives a qualitatively different way of relating to others (Martinelli et al., 2023). Present findings similarly indicate that recovery from gaming addiction involves transformation of identity. For instance, over the course of recovery some individuals developed a belief that they were biologically susceptible to addiction. This had implications for self-perception (i.e., their sense of agency, control over gaming behaviour), how individuals made sense of their experiences, and recovery behaviours (i.e., choosing abstinence over reduced play time to stay well). Although the process of identity transformation is considered to be occurring organically in the course of recovery (Watkins et al., 2021), current findings suggest that participants may also consciously engage in it. At the stage of “Developing awareness” individuals actively considered the negative impact of excessive gaming on their identity compared to how they were like before becoming addicted (e.g., becoming reclusive, losing social skills). This realisation caused a dissatisfaction with the present state of self which contributed to individuals’ desire to change their behaviour.

The process of recovery from gaming addiction is comparable to recovery from gambling addiction. Recognition that gambling is problematic comes over time as the negative consequences become more severe (Stefani, 2023), and developing insight is a prerequisite for recovery (Pickering et al., 2020). Identity transformation plays a central role in gambling recovery, with many participants talking about having an “authentic” self and a “gambling” self that are in conflict with each other (Pickering et al., 2020; Reith & Dobbie, 2012; Stefani, 2023). The behaviour of the “gambling” self is perceived as incongruous with people’s values and aspirations which facilitates the process of change (Pickering et al., 2020; Reith & Dobbie, 2012; Stefani, 2023). Similarly to the current study, participants in recovery from gambling underline the significance of having supportive social networks (Nilsson et al., 2023; Pickering et al., 2020).

The question of whether gaming should be studied separately to other Internet-based addictions was raised earlier in the paper. While there is a lot of overlap in how gambling and gaming addictions are experienced, there are also clear differences. This review found that in-game social connections played an important role in the maintenance of gaming addiction. By contrast, engaging with gambling online communities appears to be a protective factor against excessive play (Sirola et al., 2021). Also notably, money plays a crucial role in gambling addiction, but it has not been identified as an issue in the current study. Among participants with gambling addiction many recovery goals are tied to gaining financial stability, employment, and paying off loans (Oakes et al., 2019; Pickering et al., 2020; Reith & Dobbie, 2012). Therefore, it can be seen that the process of recovery from gaming addiction shares similarities with recovery from gambling, but there also unique features.

There were several recovery processes mentioned by the gambling studies that have not been identified by the current study. Participants in Pickering et al. (2020) study spoke about the daily struggles of recovery, such as managing gambling triggers, urges and cravings. Relapse also plays a much bigger role, being a source of significant anxiety, it instilled feelings of hopelessness around the possibility of change (Nilsson et al., 2023; Pickering et al., 2020). Erroneous cognitions and thinking biases were shown to interfere with gambling recovery (Oakes et al., 2019; Pickering et al., 2020). These experiences may be relevant to gaming addiction too, but further research is needed in this area.

Practice Implications

A unique finding of this review was that that individuals’ recovery efforts could be compromised by online friendships, social isolation, a feeling of boredom, a lack of daily structure and other activities/hobbies, and poor coping mechanisms. To address these complexities, treatment interventions must adopt a multidimensional approach. A comprehensive service should offer individuals access to reliable information on GD, validated screening tools, evidence-based treatments, peer support networks, and assistance for co-occurring issues (Park et al., 2021).

Recognizing boredom as a significant barrier to recovery, it is advisable to establish non-gaming activity groups for patients. Furthermore, given that boredom is an obstacle to recovery, it would be useful to organise non-gaming activity groups for patients. There groups would give individuals opportunities to expand their real-life social networks and develop hobbies outside of gaming. In addition, it may also be helpful to introduce pre- and post-treatment support. The review found that some individuals may struggle with insight into their problematic behaviour and may feel ambivalent about change. Research shows that having strong internal, but not external, motivation to change increases the likelihood of being further along the TTM change continuum and feeling more ready to change (Kushnir et al., 2016). Thus, a pre-treatment intervention could provide psychoeducation and screening to raise clients’ self-awareness and foster their internal motivation to engage in treatment. Post-treatment support could provide help around adjustment to life without the addiction, managing cravings to play and relapse. A multi-stage treatment model like this one could address the needs of clients at different points in their recovery journey.

Theme “Recovery never stops” demonstrates that even after individuals quit or improve their gaming behaviour, their recovery continues in the form of coming to terms with loss, managing withdrawal symptoms, cravings to play and relapse. A gambling addiction follow-up study showed that 43.7% of patients relapsed at least once, the average time of a relapse occurring was 1.39 years after first observed recovery (Grall-Bronnec et al., 2021). However, a recent review of the efficacy of cognitive-behavioural therapy for gaming addiction found that follow-ups were conducted 8 weeks to 6 months after treatment (Stevens et al., 2019) which in light of the previous findings may be insufficient to detect relapse and long-term impact of treatment. Therefore, it is suggested that treatments ought to incorporate relapse prevention strategies, and follow-ups should be conducted at longer time-periods.

Limitations and Future Directions

There were several limitations to the current study. The first limitation was that this review was carried out and written primarily by the first author which could have introduced bias into the review process. The second author was involved as the supervisor of the project and provided support around refining superordinate themes and preparing the manuscript. To minimise risk of bias, the first author kept a reflective diary throughout the study, and both authors held regular meetings to discuss how the review process was going.

The second limitation was that the majority (92%) of participants were male. A meta-analysis by Stevens et al. (2021) established that GD male to female prevalence ratio is 2.5:1. None of the studies in this review met this participant ratio, and three studies had male-only samples (Beranuy et al., 2013; Haagsma et al., 2013; Sim et al., 2021). There are sex differences in how GD is experienced, for instance, male gamers score higher on impulsivity and aggression scales, whereas female gamers score higher on depression and social phobia scales (Marraudino et al., 2022). Therefore, it has been suggested that GD treatment should target executive functioning in men and emotional distress in women (Dong & Potenza, 2022). However, further research is needed to test these assumptions and develop better understanding of how recovery processes may vary for men and women.

The third limitation was that the majority of included studies did not discuss recovery directly. Instead, information relevant to recovery had to be inferred from participants’ narratives of addiction. The implications of this for current findings are that, firstly, potentially relevant recovery processes or experiences may not had been mentioned, and secondly, given limited amount of available data, the importance of certain elements could have been over- or under- emphasised. To illustrate, many participants in included studies chose to quit gaming which could give the impression that abstinence is the preferred recovery goal. However, GD treatment studies measure recovery in terms of symptom reduction (Gavriel-Fried et al., 2023) which aligns more with reduced play time recovery goal, rather than abstinence. A gambling addiction treatment follow-up study found that out of 70% of participants who no longer met the criteria for a gambling disorder, 40% abstained and 30% continued to gamble without adverse consequences (Müller et al., 2017). Therefore, it would be useful to explore how the experiences of people who chose reduced play time versus quitting recovery goals may be different. For instance, it is unclear whether experiences identified in themes “The process of quitting” and “The challenges of quitting” would still apply to those who chose reduced play time recovery route.

Although all studies included in the review recruited participants who had some form of addiction treatment, it is unclear what role treatment plays in recovery. “Treatment for gaming addiction” theme outlines the benefits of intervention programs for gaming addiction. However, it is well-known in other addiction fields that people can recover naturally, without ever seeking professional support (el-Guebaly, 2012). Understanding the role of treatment in recovery would allow us to develop more effective ways of supporting individuals battling gaming addiction.

Conclusions

This review offered unique insights into the recovery process from gaming addiction by highlighting that individuals with gaming addiction go through similar processes on their recovery journey: develop awareness of the problem, decide to change their behaviour, employ change strategies, address challenges and setbacks, and work on maintaining recovery after getting better. However, it was also discovered that there is significant variation in how each process is experienced, for instance, whether an individual decides to quit or reduce their play time. Recovery processes identified in this review support previous findings on the role of TTM, social support and identity change in addiction recovery. Nevertheless, further research would be needed to expand our understanding of recovery from gaming addiction, such as about the role of gender differences or the impact of treatment in recovery. Current findings have implications for treatment of gaming addiction, highlighting the importance of a multidimensional treatment approach to address comorbid conditions and co-occurring problems, as well the potential benefits of introducing pre- and post-treatment support.

Conflict of Interest

The authors have no conflict of interests to declare.

Acknowledgement

The literature review protocol was registered with PROSPERO (CRD42022302202).

Table A1. SPIDER Framework.

Table A2. Quality Appraisal—CASP Qualitative Checklist .

Table A3. Data Extraction .

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Copyright © 2024 Ksenija Vasiljeva, Alex Kyriakopoulos, Christopher Wilson

Correlates of Video Game Addiction

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Video game addiction often leads to a tremendous burden on those afflicted with the condition, draining their time, resources, and life away until they have nothing left. To further elucidate the problem of video game addiction, the current research examines the level of video game addiction of 111 participants, along with their motivation for their addictive behaviors, the quality of life of addicted individuals, and possible relations between video game addiction and other forms of addiction. Results of the current research indicate a correlation between addictive video game use and depression, alcohol use, a desire for escapism, a need for … continued below

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Langley, Alex December 2010.

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• University of North Texas Place of Publication: Denton, Texas

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Video game addiction often leads to a tremendous burden on those afflicted with the condition, draining their time, resources, and life away until they have nothing left. To further elucidate the problem of video game addiction, the current research examines the level of video game addiction of 111 participants, along with their motivation for their addictive behaviors, the quality of life of addicted individuals, and possible relations between video game addiction and other forms of addiction. Results of the current research indicate a correlation between addictive video game use and depression, alcohol use, a desire for escapism, a need for social interaction, and lack of self-control. The results of a multiple regression indicate that, amongst the various research factors, depression is the factor with the most significant link to addictive video game use, implying a dangerous correlation between mental health and an addictive behavior that some erroneously disqualify as a true addiction.

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• Depression, Mental.
• Video game addiction -- Psychological aspects.
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Home > GRADUATE > THESES > 1067

Masters Theses & Specialist Projects

(don't) stop playing that game: a rhetorical analysis of the video game addiction stereotype.

Chet Daniel Breaux , Western Kentucky University Follow

Publication Date

Advisor(s) - committee chair.

Dr. Jane Fife (Director), Dr. Elizabeth Weixel, Dr. Wes Berry

Degree Program

Department of English

Degree Type

Master of Arts

The growing popularity of game addiction discourse has necessitated study of how video game critics rhetorically construct addiction. In the following thesis, I analyze contemporary examples of texts that link game addiction to drug abuse. I use Robert Cover’s analysis of how game addiction stereotypes form in conjunction with Aristotle’s rhetorical principles to isolate the persuasive appeals used by authors to rhetorically construct game play as addictive. These addiction arguments, however, are rooted in a larger historical context, and I present examples of game guidebooks and comic books published in the late 1970s and early 1980s to illustrate their rhetorical responses to game addiction rhetoric. I found addiction arguments utilize fear appeals combined with ethos, pathos, and logos to persuade audiences to reject games as potentially dangerous and worthless virtual pursuits. The authors of early game texts use ethos, pathos, and logos to dismantle fear appeals and present video games as a new genre that can be mastered through skill and practice rather than a meaningless virtual experience. This research provides ground for further explorations of game addiction rhetoric, and implications for the continued study of video games.

• Disciplines

Communication Technology and New Media | Other Film and Media Studies

Recommended Citation

Breaux, Chet Daniel, "(Don't) Stop Playing That Game: A Rhetorical Analysis of the Video Game Addiction Stereotype" (2011). Masters Theses & Specialist Projects. Paper 1067. https://digitalcommons.wku.edu/theses/1067

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Video Game Addiction

The argument against video game addiction, many researchers are skeptical that video games are truly "addictive.".

Updated July 3, 2023 | Reviewed by Devon Frye

• What Is Video Game Addiction?
• Find a therapist near me
• Video games have many benefits for gamers.
• Research on gaming disorder—aka video game addiction—is flawed and not sufficiently conclusive.
• Because video games are less socially acceptable, they may be unfairly targeted.
• There are other explanations for many reports of video game addiction, including autism, ADHD, and depression.

This is half of a pair of articles that highlight the evidence for and against the existence of video game addiction . Read the counter-argument here .

For decades, psychologists, parents, and gamers have asserted that video games can be addictive. Although video games seem to influence enthusiasts differently from those of other hobbies, there is insufficient empirical evidence to designate them as an actual addiction . Further, video games are a fun and socially beneficial activity for many, so labeling them as addictive would prevent many from accessing these benefits.

For example, video games connect lonely or introverted people with one another , relieve stress , and even help people explore their own identities . Some therefore argue that, because of video games’ benefits and popularity, gaming addiction should not be considered an official diagnosis until overwhelming evidence supports this assertion.

Flawed Research

Several studies have concluded that gaming disorder qualifies as an addiction. Because addictions share several characteristics, researchers created theoretical criteria that a gamer must meet to have the diagnosis. For example, people with addictions suffer consequences in various aspects of their life and struggle to quit without help. This is true regardless of the substance.

Based on the assumption that people with video game addiction must be affected similarly, researchers have surveyed gamers on similar criteria to determine what percent have an addiction. These include questions such as, “How often do you find it difficult to stop gaming?” and “Have you deceived a family member, significant other, employer, or therapist regarding the amount of time spent engaging in gaming activities?”

Although questions like these may reasonably assess someone’s behavior, researchers use too many different questionnaires to be compared cleanly. Even when researchers use the same survey, they sometimes interpret the results differently.

In other words, someone would need to answer “Yes” to six of the eleven Gaming Addiction Screening questions to be considered addicted. They would need to respond “Sometimes” or “Often” to five or more of the ten questions in the Ten Item Internet Gaming Disorder Test to qualify. If the same person took both surveys, one survey might conclude that they had an addiction and the other might not. Further, some studies only measure how many hours per week a person spends gaming instead of targeting the effect games have on their functioning.

This has resulted in wildly different estimates of gaming addiction’s prevalence. It is difficult to draw meaningful conclusions from these data until researchers use standardized measures.

It is also very difficult to estimate one’s actual screen time each week. One meta-analysis of the research found that in 95 percent of studies, participants did not accurately report how much time they spend on screens . This calls into question all studies which rely on participants’ subjective estimates of how they use their time because they have based their conclusions on a statistic that is likely inaccurate.

Why Not Other Hobbies?

Other critics of the diagnosis point out that gaming has been unfairly targeted and pathologized. A person who plays golf instead of spending time with family is inconsiderate. A person who plays video games instead of spending time with family is addicted.

This demonstrates a clear bias . Society considers video games a waste of time, so an enthusiastic gamer is criticized more harshly than someone with a more acceptable hobby.

What Else Might Account for Excessive Gaming

Many of my clients report that they feel addicted to technology. When I continue the assessment process, many report that they were previously diagnosed with autism or ADHD . This complicates the diagnostic process because many people with these disorders already struggle to stop scrolling through social media or playing video games.

Most of us have looked up from our phones and realized that half an hour or more had suddenly passed. The hypnotic “flow” which we experienced blinded us to the passage of time. Autistic people* and those with ADHD are especially susceptible to this phenomenon. So if, for example, a person with ADHD finds it particularly difficult to turn off a game, does that person have an addiction or is it simply how this kind of stimulus affects those with ADHD?

Some research has found that heavy gamers have reduced gray matter in areas of the brain associated with attention , impulse control. However, these studies do not sufficiently demonstrate that gaming caused the differences, only that they are associated. Correlation is not causation. Some studies even show that brain scans for people with ADHD look remarkably similar to scans of those with gaming disorder , even after treatment.

One researcher pointed out this conundrum by relating it to depression . “We would not diagnose depressed individuals with hypersomnia with a comorbid ‘bed addiction.’” In other words, someone with depression might stay in bed for days, but this does not mean that they are addicted to the bed. In the same way, an autistic person or someone with depression or ADHD might appear to be addicted to video games even when they are not. In short, many diagnosed with gaming disorder may simply be autistic or have ADHD.

It is possible that video games are addictive. However, the current body of research is too flawed to state decisively that the negative consequences outweigh the benefits the games afford players. It is premature to consider gaming disorder to be an official addiction.

*Although many refer to autistic people as “people with autism” or “people with autism spectrum disorders,” almost 90 percent of autistic adults prefer “autistic person.” This language is used here to respect that preference.

Bean, A. M., Nielsen, R. K. L., van Rooij, A. J., & Ferguson, C. J. (2017). Video game addiction: The push to pathologize video games. Professional Psychology: Research and Practice, 48 (5). Retrieved from http://psycnet.apa.org/record/2017-29288-001

Diament, M. (2022, December 2). 'Autistic' or 'person with autism'? It depends. Disability Scoop. https://www.disabilityscoop.com/2022/12/02/autistic-or-person-with-auti…

Fishman, A. (2019, January 22). Video games are social spaces. Psychology Today. https://www.psychologytoday.com/us/blog/video-game-health/201901/video-…

Fishman, A. (2022, November 7). Why it's so hard to walk away from a video game. Psychology Today. https://www.psychologytoday.com/us/blog/video-game-health/202211/why-it…

Fishman, A. (2023, February 20). How gamers use video games to explore their gender identity. Psychology Today. https://www.psychologytoday.com/intl/blog/video-game-health/202302/how-…

Gentile, D. (n.d.) Gaming Addiction Screening. University of California, Santa Cruz. https://caps.ucsc.edu/pdf/gaming-addiction-screening.pdf

Han, D.H., Bae, S., Hong, J., Kim, S.M., Son, Y.D., & Renshaw, P. (2019). Resting-state fMRI study of ADHD and Internet Gaming Disorder. Journal of Attention Disorders, 25 (8). Retrieved from https://journals.sagepub.com/doi/10.1177/1087054719883022

Király, O., Bőthe, B., Ramos-Díaz, J., Rahimi-Movaghar, A., Lukavska, K., Hrabec, O., Miovsky, M., Billieux, J., Deleuze, J., Nuyens, F., Karila, L.M., Griffiths, M.D., Nagygyörgy, K., Urbán, R., Potenza, M., King, D.L., Rumpf, H., Carragher, N., Lilly, E., & Demetrovics, Z. (2019). Ten-Item Internet Gaming Disorder Test (IGDT-10): Measurement invariance and cross-cultural validation across seven language-based samples. Psychology of Addictive Behaviors, 33 (1). Retrieved from https://www.researchgate.net/publication/328615597_Ten-Item_Internet_Ga…

Parry, D.A., Davidson, B.I., Sewall, C.J.R., Fisher, J.T., Mieczkowski, H., & Quintana, D.S. (2021). Nature Human Behavior, 5 . Retrieved from https://www.nature.com/articles/s41562-021-01117-5

van Rooij, A.J., Ferguson, C., Carras, M.C. Kardefelt-Winther, D., Shi, J., Aarseth, E., Bean, A., Bergmark, K.H., Brus, A., Coulson, M., Deleuze, J., Dullur, P., Dunkels, E., Edman, J., Elson, M., Etchells, P.J., Fiskaali, A., Granic, I., Jansz, J...& Przybylski, A.K. (2018). A weak scientific basis for gaming disorder: Let us err on the side of caution. Journal of Behavioral Addictions, 7 (1) Retrieved from https://www.researchgate.net/publication/323542721_A_weak_scientific_ba…

van Rooij, A.J., Schoenmakers, T., van den Eijnden, R.J.J.M., Vermulst, A.A., & van de Mheen, D. (2012). Video Game Addiction Test: Validity and psychometric characteristics. Cyberpsychology, Behavior, and Social Networking, 15 (9). Retrieved from https://www.researchgate.net/publication/230696095_Video_Game_Addiction…

Andrew Fishman is a licensed social worker in Chicago, Illinois. He is also a lifelong gamer who works with clients to understand the impact video games have had on their mental health.

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