Conceptualization, prevention and treatment of internet gaming disorder as a behavioral or process addiction.

1. Treatment Considerations
Internet Gaming Addiction
LEIGH HOLMAN, PH.D., LPCS, RPTS, NCC, SCS
AMHCA DIPLOMATE AND CMHC
PRESIDENT-ELECT INTERNATIONAL ASSOCIATION OF
ADDICTION & OFFENDER COUNSELORS

2. Assess & Treat Co-morbid Diagnoses
2x more likely to be diagnosed with ADD/ADHD than gamers
who play recreationally (Batthyany, Muller, Benker, &
Wolfling, 2009; Bioulac, Arfi, & Bouvard, 2008; Chan &
Rabinowitz, 2006; Gentile et al., 2011; Han et al., 2009).
Depression (Gentile et al., 2011; Peng & Liu, 2010).
 MMORPG depressive symptoms (sadness, hopelessness, crying spells,
insomnia, concentration problems) are related to habitual computer
gaming at night b/t 10-6 (Lemola et al., 2011)
Anxiety & Social Phobia – longitudinal data suggest
pathological gamers exhibit higher levels of depression,
anxiety & social phobia during follow-up than normal gamers
(Gentile et al., 2011), but the relationship may be reciprocal.

3. Conceptualizing the Problem
Griffiths, 2010) Video Game Addiction
Theory
Porter et al. (2010)
• Problematic Online Game Use Model (Kim & Kim, 2010)
• Demetrovics et al. (2012) Integrative Approach

4. Griffiths, (2010) Video Game Addiction Theory
Indicators of High Engagement (Charlton &
Danforth, 2007, 2008)
1. Salience
• Gaming becomes the most important activity in the person’s
life and dominates his/her thinking, feelings (i.e. cravings), &
behavior
• Preoccupation & Cognitive Distortions
• Deterioration of Socialized Behavior
1. Mood Modification
 Gamers report both an arousing ‘buzz or high” and
 Distressing tranquilizing feeling of “escape or numbing”
1. Tolerance
• Increasing amounts of time are required to achieve the
former effects

5. Griffiths, (2010) Video Game Addiction Theory
Central Role in Addiction (Charlton & Danforth, 2007, 2008)
4. Withdrawal Symptoms
 Unpleasant feeling states or physical effects when not gaming or
reduced time gaming
 Shakes, moodiness, irritability
5. Conflict
• Interpersonal conflict with important relationships
• Conflict with time spent on other activities (hobbies, work,
school, social life)
• Intra-psychic conflict – feelings of loss of control
6. Relapse
 Tendency for repeated reversions to earlier patterns of gaming
after abstinence or control has been established

6. Porter et al., (2010)
Excessive use of one/more video games
Resulting in a preoccupation
With and a loss of control over playing video
games, and
Resulting negative psychosocial and/or physical
consequences

7. Problematic Online Game Use Model,
(Kim & Kim, 2010)
Integrative Model
5 dimensions:
Euphoria
Health Problems
Conflict
Failure of Self-Control
Preference of Virtual Relationship

8. Integrative Approach
(Demetrovics et al., 2012)
 Integrative Approach
 6 Dimensions:
 Preoccupation
 Overuse
 Immersion
 Social Isolation
 Interpersonal Conflicts
 Withdrawal

9. Risk & Prognostic Factors
Environmental:
 Computer availability
 Internet connection
 Speculation that helicopter parenting or very controlled home
environments might generate higher risk situations
Genetic & Physiological:
 Adolescent males at higher risk
 Asian environmental and/or genetic background is a risk factor
suggested by literature, but clear evidence isn’t available

10. Etiology
Neurobiological Aspects:
 Cue induced gaming urge activates the same brain regions
activated by gambling in pathological gamblers and substance
use in substance addicts (Han et al., 2011; Ko et al., 2009).
 Working memory may be affected similarly as is in substance
dependence (Kim et al., 2012).
 Need more studies

11. Etiology
Personality Aspects:
 Low Emotional Stability (Charlton & Danforth, 2010; Mehroof &
Griffiths, 2010; Nagygyorgy, Mahalik, & Demetrovics, 2012;
Peters & Malesky, 2008).
 Low Agreeableness (Charlton & Danforth, 2010; Peters &
Malesky, 2008).
 Low Extroversion (Charlton & Danforth, 2010).
 Neuroticism
 Amount of time playing – Decreased quality of interpersonal
relationships and increased social anxiety (Lo, Want, & Fang,
2005).
 Problematic Gaming is negatively correlated with offline social
self-efficacy and positively correlated with online social self-efficacy
(Jeong & Kim, 2011, Porter et al., 2010).

12. Etiology
 Personality Aspects Continued
 Inadequate self-regulation (Seay & Kraut, 2007)
 Low Self-Esteem ( Ko, Yen, Chen, Chen, & Yen, 2005); Lemmens et
al., 2011)
 Low Emotional Intelligence (Herodotou, Kambouri, & Winters, 2011)
 Above Average State Trait Anxiety (Mehroof & Giffiths, 2010)
 Increased Loneliness (Lemmens et al., 2011; Seay & Kraut, 2007)
 Narcissistic Personality (Kim et al., 2008)
 Aggression (Kim et al., 2008; Mehroof & Griffiths, 2010)
 Lower life satisfaction (Ko et al., 2005; Wang, Chen, Lin, & Want,
2008)
 Decreased Psychosocial Well-being compared to other gamers
(Lemmens et al., 2011)

13. Etiology
Motivational Aspects:
 Motives play in important role in the development and maintenance of
problematic online gaming (Demetrovics et al., 2011; Kuss & Griffiths, 2012)
 Bartle (1996) 4 motivational types: achievers, explorers, socializes, & killers of
MUD players
 Yee (2006) tested Bartle’s model with MMORPG players. Using EFA, identified
10 motivational components that belong to 3 main factors:
 Achievement: advancement (desire to gain power, progress rapidly & accumulate
in-game symbols of wealth/status), mechanics, and competition;
 Social Factor & Discovery: socializing, relationship, and teamwork;
 Immersion: role-playing, customization, and escapism (use of online environment
to avoid thinking about real-life problems)
 Demetrovics et al. (2011): Motives for Online Gaming Questionnaire (MOGQ): 7
factors
 Social, escapism, coping, fantasy, skill development, recreation, competition

14. Etiology
Motivation (Cont.) Cyber Junkie by Kevin Roberts
 Achievement – increases self-esteem – good at something
 Escape – emotional escape, interpersonal difficulties
 Role Playing: “Their online persona often possesses attributes that they
wish they had in real life” (p. 14). “Driven to become someone else, to
exist in a different time, or to live lives filled with meaning.” Rely on the
game for social interaction.
 Control: often products of strict/helicopter parenting - cyber world as a
refuge where they have a sense of power and purpose
 Aggression: Teabagging – kneeling over an opponent’s on-screen
character after you kill them to show dominance & humiliate them –
Aggression and anger management issues precede online gaming – a way
to act out aggression – generally suffer from emotional avoidance
 Discovery: satisfaction comes from finding new twists to a game or
uncovering a glitch that no one has yet discovered. Often genius level IQ
and underachieving/bored in life/school/job – desire to feel fully alive &
game is a substitute

15. Etiology
Structural Characteristics in Online Gaming:
 High degree of realism (realistic sound, graphics, and setting), a rapid
absorption rate, character development, the ability to customize the game,
multiplayer features, winning and losing features, and ability to save the
game at regular intervals viewed as essential by gamers (Weed et al., 2004).
 King et al. (2010) Theoretical Model of 5 Structural Features:
 Social Features: how players communicate, creation of cooperative &
competitive community of players.
 Manipulation & Control Features: how players interact with and control in-game
properties using a physical control scheme
 Narrative & Identity Features: how players take on another identity in the
game – sense of self
 Reward & Punishment Features: how players are reinforced for skillful play
(winning) and punished for loosing – Problem gamers report significantly
higher enjoyment of management of in-game resources, earning points,
getting 100% in the game, and mastering the game – leveling up (earning
meta-game rewards) – fast loading times
 Presentation Features: Aesthetics – Realism of sound and look

16. Etiology
Structure Continued:
 Instant but Intermittent Reinforcement (people keep
responding in the absence of reinforcement hoping that
another reward is just around the corner).
 Magnitude of the Reinforcement (high points score for doing
something in-game – large rewards lead to fast responding and
greater resistance to extinction
Amount of Time
 Excessive game play is not a sufficient condition of addiction
 More time = higher risk

17. Prevention
Family & friends should initiate direct conversations with
problematic players by showing true interest toward the game, the
gamer, and everything the gamer likes in the virtual environment.
Facilitates communication and emotional attachment with the user.
Parents choose games with children/adolescents.
Encourage children to play with other real life friends because it
helps develop personal relationships & communication &
cooperation skills learned online can be transferred more easily to
real-life situations.
(Griffiths, 2003, 2008, 2010; Griffiths & Meredith, 2009)

18. Prevention
Set gaming time together.
Follow game manufacturer’s recommendations for monitor
brightness, distance from the monitor, taking short and
frequent breaks, and not playing if fatigued.
Gamers need other recreational activities in addition to
gaming.
Positive effects: increased self-esteem; improved reflexes,
reaction time, memory, logical and strategic thinking, social
and communication skills; etc.
(Griffiths, 2003, 2008, 2010; Griffiths & Meredith, 2009)

19. Treatment
Support forums:
Parents & other family members who discuss
the nature of the problem, share their
experiences, & support each other
Self-help forums (Online Gamers
Anonymous)
Established & administered by professionals

20. Treatment
Specialty Addiction Clinics
 Improve pro-social skills through social activities &
real-life activities that replace time spent gaming.
 Psychotherapy to address co-morbid or underlying
issues
Management skills development to help players
control their behavior
 Support Groups

21. Treatment
Couples and/or Family Therapy
Medication:
 Buproprion SR – decrease problem behavior & depression (Han et
al., 2011; Ko et al., 2009; Kuss & Griffiths, 2012).
Wilderness Camp or Ropes Courses
 Increase self-efficacy and interpersonal skills through bringing
clients into activities they can complete similar to the types of
adventures or activities their avatars might complete (sans violence).
 China & South Korea – High Intensity Physical Activity in natural
surroundings

22. Treatment of Internet Addiction: 2000-2012

23. Resources
 Video Game Addiction Information:
 http://www.video-game-addiciton.org
 ReSTART
 http://www.netaddictionrecovery.com/the-problem/signs-and-symptoms.html
 The WEEK article
 http://theweek.com/article/index/255964/the-psychology-of-video-game-addiction
 CNN Video:
 http://www.addictionrecov.org/Addictions/?AID=45
 Online Gamers Anonymous
 http://www.olganon.org/
 Helpguide.org
 http://www.helpguide.org/articles/addiction/internet-and-computer-addiction.htm
 Gaming Addiction Treatment
 http://drug-alcohol-treatment-centers.org/
 http://www.addictionrecov.org/Addictions/?AID=45
 http://www.psychguides.com/guides/video-game-addiction-treatment-program-options/