1

Exploring Gaming Addiction

Janina Guerra & Keith Eggen

Counselling Psychology, City University of Seattle

CPC 529: Psychology of Addiction

Cindy Negrello, MA Psych CCC, RPC, MPCC-S

Sheri Mayhew, Ed.D

August 25, 2022

2

Exploring Game Addiction

This paper on gaming addiction will focus on history, mental health and trauma factors,

treatment theories, interventions, harm reduction, and medical and psychiatric support. A

summary of findings from the literature on gaming addiction will also be provided. An

exploration of Internet gaming disorder is included in the Diagnostic and Statistical Manual of

Mental Disorders (5th ed.; DSM–5; American Psychiatric Association [APA], 2013) as one of

the addictions stemming from Internet addiction. Cultural and ethical considerations will be

given for each section.

History

After the creation of the Internet in 1969, Dr. Ivan Goldberg, as a parody of the DSM,

created a fictional problem called “Internet addiction disorder.” Internet addiction is compulsive

Internet use that results in negative consequences (Alderson, 2020). The introduction of the

Internet generated a few causes of concern. Internet gaming addiction has been researched

heavily as a controversial behavioural addiction coming to the forefront in recent years

(Alderson, 2020). This research has found that there are gamers who spend hours playing online

but do not necessarily experience negative results.

It is important to note that gaming addiction is under the umbrella of Internet addiction

(Alderson, 2020). Kimberley Young, one of the first researchers to address the phenomenon of

Internet addiction, proposed five types of addictions stemming from Internet addiction

(Alderson, 2020). Types of addictions identified were computer games, cybersex, cyber-

relationships, information overload and net compulsions (Alderson, 2020). Other researchers

view Internet addictions on a spectrum (Alderson, 2020). Using a spectrum emphasizes the

importance of distinguishing between addictions to the Internet and addictions on the Internet
3

(Alderson, 2020). Research on the spectrum of addiction types has failed to find broader support.

The belief that other addictions stem from Internet addiction is more accepted (Alderson, 2020).

One of the controversies surrounding Internet gaming addiction is its exact nature

(Alderson, 2020). The addictive properties of a game, its genre, and the amount of time spent

playing all contribute. According to Alderson (2020), the most played games associated with

Internet gaming disorder (IGD) are role-playing, first-person shooter, and real-time strategy

games. The most popular consoles, Xbox, Nintendo and PlayStation, are designed to be played

online and have also contributed to the development of problematic use (Alderson, 2020). The

DSM-5 has considered gaming addiction as a possible disorder and labelled it as Internet gaming

disorder (IGD) (APA, 2013). This may demonstrate the slow recognition of behavioural

addictions, especially with the recent inclusion of gambling disorder in the DSM-5 as the only

non-substance-related disorder.

Mental Health and Trauma

Alderson (2020) mentions three central themes to gaming addiction: escapism,

entertainment, and online friendships. A study by von der Heiden et al. (2019) found that

individuals who use gaming as a distraction have a more general negative affect and low life

satisfaction. They also prefer solitude and lack social support. While playing video games,

however, they exhibit a more general positive affect (von der Heiden et al., 2019). In contrast,

individuals who play to improve real-life abilities have more online connections and have higher

levels of general positive affect (von der Heiden et al., 2019). It is important to note the benefits

of playing video games, such as improved social connection (Alderson, 2020). Acknowledging

the benefits emphasizes the importance that not all players or highly engaged players are not

necessarily the ones experiencing IGD. Kuss (2013) mentioned gaming addiction as a public
4

health concern in Southeast Asia, to which Japan has responded by creating “fast camps”. These

fasting camps target the individual to be completely cut off from technology (Kuss, 2013) but

also raise the idea that a lack of acceptance of gaming addiction may further stigmatize the

behaviour and contribute to higher rates of addiction. It also highlights the ethical and cultural

nuances of gaming disorder. As mentioned before, there are benefits to playing video games, and

it may be why gaming addiction poses a controversy as being labelled as an addiction.

Trauma is another factor to consider when determining the origin of addiction (Oskenbay

et al., 2016). There are two main mechanisms involved in computer game addiction: the need to

escape from reality and the acceptance of the role of the other (Oskenbay et al., 2016).

Contributing factors to the addiction include personality features among adolescents such as

searching for new experiences, aggression and anxiety, antisocial coping strategies, emotional

alienation and low communicative competence (Oskenbay et al., 2016). Individuals who have

become disconnected from their emotions and body have a skewed perception of the world and a

negative view of themselves (Maté, 2012). When the trauma is unresolved, masking it with

addiction can create more problems in the future (Maté, 2012).

Treatment Theories

To administer effective treatments, easily understood measurement tools are valuable

(Busner & Targum, 2007). There are a few different scales used within video game addiction

treatment. The most current examples include the Internet Gaming Disorder Scale Short Form

(IGDS-SF; Lemmens et al., 2015) and the Game Addiction Scale for Adolescents (GASA;

Lemmens et al., 2009), and the Internet Gaming Disorder Test (IGD-20; Pontes et al., 2014). The

variation in these scales is based on the behaviours measured and the populations targeted.
5

The basis for the majority of these scales is a biopsychosocial approach. In general, most

interventions are on this basis; however, the mix of these three factors varies. For example, the

IGDS-SF measures nine areas, preoccupation, tolerance, withdrawal, persistence, escape,

problems, deception, displacement and conflict. A short-form version of the GASA (GASA-SF)

measures salience, tolerance, mood modification, relapse, withdrawal, conflict and problems

using seven questions (Goswami & Singh, 2022). The categories of tolerance, withdrawal and

problems directly overlap between the IGDS-SF and the GASA-SF. Many of the remaining

categories ask the same question. For example, under salience, the GASA asks, “did you think

about playing a game all day long” (Goswami & Singh, 2022, p. 167)? Compare this to “have

there been periods when all you could think of was the moment you could play a game” (Lemens

et al., 2015). The efficacy of interventions can be partially measured using these scales. For

example, Goswami & Singh (2022) used the IGDS-SF to measure.

Overall, these two scales only differ in their target audience, mature versus adolescent.

This is reflected in the language used (Goswami & Singh, 2022; Lemens et al., 2015). A

significant reason for the similarities is the scales attempt to replicate the DSM-5 criteria for

internet gaming disorder. There are cultural implications of using these scales to measure IGD.

Most IGD scales are normed using South Korean populations (Costa & Kuss, 2019). Therefore,

anyone from outside this group may not be appropriately scored. Should an individual be given

treatment unnecessarily or denied treatment based on their GASA or IGDS score, it would

qualify as a suboptimal outcome. From an ethical perspective, this is problematic under

maximizing benefit and minimizing harm (Canadian Psychological Association, 2017).

Culture and the biopsychosocial perspective

6

Most IGD scales consider IGD in the context of a biopsychosocial perspective.

Considering the biopsychosocial model in the context of culture has implications for treatment

and counselling. A variety of behavioural impacts are produced at a biopsychosocial level (Baum

& Posluszny, 1999; Leventhal et al., 2008). Three primary examples are emotions or patterns of

behaviours, the impact of disease from a risk or protection perspective, and the cultural impacts

of how a disorder such as IGD is interpreted, cared for, and observed as its progression and

manifestation. This cultural aspect is critical from a counselling point of view (Hatala, 2012).

Often culture is defined narrowly. Within the biopsychosocial model, there can be a tendency to

focus too heavily on the distinctions between the three areas of biology, psychology, and

sociology (Baum & Posluszny, 1999).

The tendency to place an individual in the centre of a series of concentric circles forms

one theory on the biopsychosocial model and culture. This means that while the interaction

between the individual, their biology, and the disease is often observed, other interaction

between their sociology and its impact on psychological issues can be missed (Suls & Rothman,

2004). This problem can be exacerbated when biopsychosocial factors are further delineated into

heredity, ecology, consciousness, sociology, biology, cultural factors, and religion. With the

biopsychosocial approach, Hatala et al. (2012) urge the intersection of all cultural factors be

considered to avoid a myopic point of view.

Interventions

CBT is a standard individual intervention used for IGD. Sessions for individual CBT

range from eight to ten sessions in length (Costa & Kuss, 2019). Sessions are typically between

one to two hours and focus on individuals learning to determine what emotions they are

experiencing. Specific focus is placed on cognitive distortions that inhibit the individual from
7

correctly perceiving reality. Further along in the process, coping skills are introduced to correct

these cognitive distortions (Orzack et al., 2006). Coping skills are essential in preventing relapse

as they can be relied upon when conditions in the individual’s life change (Young, 2007).

CBT is effective in an IGD context because it helps the individual find what thoughts

support their continued gaming use as an escape from reality (Griffiths & Meredith, 2009). CBT

alone is often not enough to solve the problem. Although it can help to examine underlying

emotional motives, this is only an initial step. In addition to coping skills, other techniques aid

finding gaming alternatives. Under the biopsychosocial model, gaming serves to fulfil needs in

their life that are not being met (Orzack et al. 2006). The first goal of CBT therapy is to ensure

the individual understands that psychological factors underlie their addiction. One approach is

psycho-educative training (Torres-Rodrígue et al., 2019). Motivational interviewing (MI) can

also be helpful (Griffiths & Meredith, 2009).

MI is also beneficial in helping the individual to take control of changing their habits.

This is the second step of an overall treatment approach to IGD. Another helpful intervention in

the intermediary stage between psychoeducation and recovery is sleep hygiene. This process has

psycho-educative components, especially in teaching the individual the harms of poor sleep

hygiene (Eickhoff et al., 2015). Sleep deprivation is associated with poor mood, low focus,

inability to concentrate, and anger. In extreme cases, it can cause symptoms mirroring psychosis

and ADHD (Petrovsky et al., 2014; Cassoff, 2012). The stimulation from excessive exposure to

screens and video games is destabilizing to circadian rhythms (Eickhoff et al., 2015).

Additionally, the time spent playing games can begin to take away from time usually

spent sleeping. Once the individual is convinced sleep hygiene is beneficial to their treatment, in

combination with the beforementioned CBT goals, specific methods to improve sleep quality can
8

be introduced. A non-exhaustive list includes eye coverings, ways to dampen sound, and scented

candles, as interventions to be applied while sleeping (Herscher et al., 2021). Before sleeping,

reducing screen time at least one hour before bed, non-caffeinated beverages, and relaxing music

are all beneficial. Reduction in screen time will naturally improve sleep. Combined with sleep

hygiene, reducing other sleep deprivation symptoms will accelerate recovery. Once this process

begins, making contracts to plan how much time will be spent playing video games and making

lists of alternative activities can aid recovery (Costa & Kuss, 2019).

Harm Reduction

Harm reduction is an approach aimed at reducing the harm from addictive behaviour but

does not require complete abstinence (Canadian Mental Health Association, n.d.) In the context

of video game addiction, understanding why video gaming is important in an individual's life is

critical. It can reveal internal and external factors that have created or perpetuated the current

behaviour. This aligns with the bio-psycho-social addiction model (Alderson, 2020). Internal

factors such as poor socialization or external factors such as inherently addictive video game

designs can contribute to an individual's compulsion to play video games.

External harm reduction methods suggested for internet gaming disorder are age

restriction, convenience reduction, advertising and education, and warning labels (Shi et al.,

2017; Potenza et al., 2019; Kristiansen & Trabjerg, 2017). Age restrictions are the most heavily

researched approach, including age verification, use of fines, and availability restriction (Shi et

al., 2017). Any restrictions based on a person's identity, in this case, children, have the potential

to be culturally insensitive. Furthermore, from an ethical perspective restricting access to items

and services such as video games has issues. There is a requirement to weigh the risks and

benefits before implementing such changes. Some countries, such as the Netherlands, have
9

already instituted some of these policies (Prati, 2019). From a cultural perspective, regulation is

more common than in a country like the United States or Canada (Dogruel et al., 2013). For

legislated harm reduction methods to be effective, ethical, and culturally sensitive, they will need

to be tailored to the region in which it operates.

Activities and habits for internal harm reduction have also been researched (Xu et al.,

2012). For example, attention switching offers other activities to divert an IGD sufferer's

attention away from video games (Xu et al., 2012). Dissuasion involves the efforts of others to

change the individual's gaming habits and how the sufferer views these attempts. They can be

more successful if the individual believes they are being coaxed rather than forced or reasoned

with rather than coerced (Turel et al., 2011). Monitoring is a related factor that looks at how the

individual views their parent’s or partner’s relationship with their video gaming (Xu et al., 2012).

Observability of electronic gaming devices has been shown to positively affect recovery from

IGD (Park et al., 2007). The final factors, rationalization and education, involve teaching the

individual how their behaviour is problematic for them and their significant others (Xu et al.,

2012). This is similar to the CBT approaches discussed earlier (Costa & Kuss, 2019).

Medical and Psychiatric Support

Further medication and psychiatric resources have been researched in the literature

regarding treating IGD symptoms (Zajac et al., 2020). This study has seen the effects of

medications used to treat ADHD and depression (bupropion and methylphenidate) decrease IGD

symptoms significantly (Zajac et al., 2020). Additionally, combining CBT psychotherapy with

medication has improved IGD symptoms and time spent on video gaming (Zajac et al., 2020).

From an ethical standpoint assessing the basis for medication use and other possible client

disorders is essential. The presence of these factors may also contribute to IGD. As IGD is only
10

found in the appendix to the DSM-5, assessing what gaming looks like for the client before

making a diagnosis is vital (5th ed.; DSM–5; American Psychiatric Association [APA], 2013).

Medical and Psychiatric Support

Beginning with the invention of the Internet, this paper explored the progression of

internet addiction and a secondary addiction under this umbrella, gaming addiction. Research on

Internet gaming addiction has led to increased scrutiny over gaming and what benefits and

downsides it presents. The DSM-5 has labelled it as Internet gaming disorder (IGD) in its fifth

edition (APA, 2013). Escapism, entertainment, and online friendship were three themes central

to gaming addiction explored. Benefits such as improved social connection were also

highlighted. Discussion on fasting camps in Japan in response to public health concerns

highlighted ethical and cultural nuances with gaming disorder. Acceptance of gaming addiction

may further stigmatize the behaviour. In turn, it can contribute to higher addiction rates. Beyond

general mental health concerns, specific trauma-related concerns were raised, including the

origin of addiction, the need to escape from reality, and the acceptance of the role of the other.

The first area touched on was treatment theories to manage the issues associated with gaming

addiction. The benefits of efficient and effective measurement tools in the context of treatment

were brought to light. Ethical concerns over the inappropriate application of scales developed in

a specific cultural context were also discussed. This was elaborated on by a closer look at culture

and the biopsychosocial perspective. Concerns were raised regarding behavioural impacts,

emotions or patterns of behaviours, the impact of disease from a risk or protection perspective,

and the cultural impacts of disease interpretation and care in observing disease progression. By

highlighting the risks of defining culture too narrowing and not considering its impacts on all
11

aspects of the biopsychosocial model, the impetus for considering the intersection of all cultural

factors was stressed.

Knowing treatment theories led to an exploration of interventions and harm reduction

methods. CBT was described as a standard individual intervention, typically supported by

psycho-educative components, such as sleep hygiene. Harm reduction was also outlined to reveal

internal and external factors influencing its development. External harm reduction methods

suggested included age restriction, convenience reduction, advertising and education, and

warning labels. External restrictions require considering risks and benefits to be evaluated before

implementation. Some countries, such as the Netherlands, have instituted some of these policies.

Internal activities like attention switching, dissuasion, monitoring, rationalization and education

were also introduced as effective treatment methods. The paper concluded with medical support

like bupropion and methylphenidate, and medication-assisted CBT psychotherapy. Ethically the

benefits of a thorough case conceptualization were emphasized before proceeding with

medicated options to treat IGD.

12

References

Alderson, K. (2020). Addictions counseling today. SAGE Publications, Inc.,

https://dx.doi.org/10.4135/9781544392349

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental

disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Baum, A., & Posluszny, D. M. (1999). Health psychology: mapping biobehavioral contributions

to health and illness. Annual review of psychology, 50(1), 137-163.

Blakely, G., Skirton, H., Cooper, S., Allum, P., & Nelmes, P. (2010). Use of educational games

in the health professions: A mixed‐methods study of educators' perspectives in the UK.

Nursing & health sciences, 12(1), 27-32.

Brown, R. I. F. (1997). A theoretical model of the behavioural addictions–applied to offending.

Addicted to crime, 13-65.

Busner, J., & Targum, S. D. (2007). The clinical global impressions scale: applying a research

tool in clinical practice. Psychiatry (Edgmont), 4(7), 28.

Canadian Mental Health Association. (n.d.). Harm Reduction. Retrieved August 15th, 2022

from https://ontario.cmha.ca/harm-reduction/

Canadian Psychological Association. (2017). Canadian code of ethics for Psychologists- Fourth

Edition. https://cpa.ca/docs/File/Ethics/CPA_Code_2017_4thEd.pdf

Cassoff, J., Wiebe, S. T., & Gruber, R. (2012). Sleep patterns and the risk for ADHD: a

review. Nature and science of sleep, 4, 73-80.

Charlton, J. P., & Danforth, I. D. (2010). Validating the distinction between computer addiction

and engagement: Online game playing and personality. Behaviour & Information

Technology, 29(6), 601-613.

13

Charlton, J. P., & Danforth, I. D. (2007). Distinguishing addiction and high engagement in the

context of online game playing. Computers in human behavior, 23(3), 1531-1548.

Costa, S., & Kuss, D. J. (2019). Current diagnostic procedures and interventions for Gaming

Disorders: A Systematic Review. Frontiers in Psychology, 10, 578.

Dogruel, L., & Joeckel, S. (2013). Video game rating systems in the US and Europe: Comparing

their outcomes. International Communication Gazette, 75(7), 672-692.

Eickhoff, E., Yung, K., Davis, D. L., Bishop, F., Klam, W. P., & Doan, A. P. (2015). Excessive

video game use, sleep deprivation, and poor work performance among US Marines treated

in a military mental health clinic: a case series. Military Medicine, 180(7), e839-e843.

Goswami, V., & Singh, D. R. (2022). To study the extent of video game addiction and effect of

intervention among adolescents. International Journal of Home Science 2022; 8(1): 166-

168.

Griffiths, M. D., & Meredith, A. (2009). Videogame addiction and its treatment. Journal of

Contemporary Psychotherapy, 39(4), 247-253.

Hatala, A. R. (2012). The status of the “biopsychosocial” model in health psychology: Towards

an integrated approach and a critique of cultural conceptions. Open Journal of Medical

Psychology, 1(4), 51-62.

Herscher, M., Mikhaylov, D., Barazani, S., Sastow, D., Yeo, I., Dunn, A. S., & Cho, H. J.

(2021). A sleep hygiene intervention to improve sleep quality for hospitalized patients. The

Joint Commission Journal on Quality and Patient Safety, 47(6), 343-346.

Kristiansen, S., & Trabjerg, C. M. (2017). Legal gambling availability and youth gambling

behaviour: A qualitative longitudinal study. International Journal of Social Welfare, 26(3),

218-229.
14

Kim, S.M., Han D.H., Lee Y.S., & Renshaw P.F. (2012). Combined cognitive behavioral therapy

and bupropion for the treatment of problematic online game play in adolescents with

major depressive disorder. Computers in Human Behavior, 28(5), 1954–1959.

Kuss D. J. (2013). Internet gaming addiction: current perspectives. Psychology research and

behavior management, 6, 125–137. https://doi.org/10.2147/PRBM.S39476

Lemmens, J. S., Valkenburg, P. M., & Gentile, D. A. (2015). The Internet gaming disorder scale.

Psychological assessment, 27(2), 567-583.

Lemmens, J. S., Valkenburg, P. M., & Peter, J. (2009). Development and validation of a game

addiction scale for adolescents. Media psychology, 12(1), 77-95.

Leventhal, H., Weinman, J., Leventhal, E. A., & Phillips, L. A. (2008). AR Further. Annu. Rev.

Psychol, 59, 477-505.

Maté, G. (2012). Addiction: Childhood trauma, stress and the biology of addiction. Journal of

Restorative Medicine, 1(1), 56-63.

Orzack, M. H., Voluse, A. C., Wolf, D., & Hennen, J. (2006). An ongoing study of group

treatment for men involved in problematic Internet-enabled sexual behavior.

CyberPsychology & Behavior, 9(3), 348-360.

Oskenbay, F., Tolegenova, A., Kalymbetova, E., Chung, M. C., Faizullina, A., & Jakupov, M.

(2016). Psychological Trauma as a Reason for Computer Game Addiction among

Adolescents. International Journal of Environmental and Science Education, 11(9),

2343-2353.

Park, H. S., Kwon, Y. H., & Park, K. M. (2007). Factors on internet game addiction among

adolescents. Journal of Korean Academy of Nursing, 37(5), 754-761.

15

Petrovsky, N., Ettinger, U., Hill, A., Frenzel, L., Meyhöfer, I., Wagner, M., ... & Kumari, V.

(2014). Sleep deprivation disrupts prepulse inhibition and induces psychosis-like

symptoms in healthy humans. Journal of neuroscience, 34(27), 9134-9140.

Pontes, H. M., Kiraly, O., Demetrovics, Z., & Griffiths, M. D. (2014). The conceptualisation and

measurement of DSM-5 Internet Gaming Disorder: The development of the IGD-20

Test. PloS one, 9(10), e110137.

Potenza, M. N., Balodis, I. M., Derevensky, J., Grant, J. E., Petry, N. M., Verdejo-Garcia, A., &

Yip, S. W. (2019). Gambling disorder. Nature reviews Disease primers, 5(1), 1-21.

Prati, A. M. (2019). Video Games in the twenty-first Century: Parallels between loot boxes and

gambling create an urgent need for regulatory action. Vand. J. Ent. & Tech. L., 22, 215.

Shi, J., Colder Carras, M., Potenza, M. N., & Turner, N. E. (2021). A perspective on age

restrictions and other harm reduction approaches targeting youth online gambling,

considering convergences of gambling and videogaming. Frontiers in Psychiatry, 11,

601712.

Suls, J., & Rothman, A. (2004). Evolution of the biopsychosocial model: prospects and

challenges for health psychology. Health psychology, 23(2), 119.

Torres-Rodríguez, A., Griffiths, M. D., Carbonell, X., Farriols-Hernando, N., & Torres-Jimenez,

E. (2019). Internet gaming disorder treatment: A case study evaluation of four different

types of adolescent problematic gamers. International Journal of Mental Health and

Addiction, 17(1), 1-12.

Turel, O., Serenko, A., & Giles, P. (2011). Integrating technology addiction and use: An

empirical investigation of online auction users. MIS quarterly, 1043-1061.

16

von der Heiden, Juliane M, Braun, B., Müller, K. W., & Egloff, B. (2019). The association

between video gaming and psychological functioning. Frontiers in Psychology, 10,

1731-https://doi.org/10.3389/fpsyg.2019.01731

Young, K. (2009). Internet addiction: Diagnosis and treatment considerations. Journal of

Contemporary Psychotherapy, 39(4), 241-246.

Xu, Z., Turel, O., & Yuan, Y. (2012). Online game addiction among adolescents: motivation and

prevention factors. European journal of information systems, 21(3), 321-340.

Zajac, K., Ginley, M. K., & Chang, R. (2020). Treatments of internet gaming disorder: a

systematic review of the evidence. Expert review of neurotherapeutics, 20(1), 85-93.