How to Treat Gaming Disorder

An increasing number of people around the world are seeking treatment for gaming disorder. While research on defining gaming disorder has exploded in recent years, studies on effective interventions and treatment are still at the preliminary stages. In the meantime, many individuals and families are suffering and seeking help, and clinicians need to be equipped to help them.

This blog establishes what constitutes gaming disorder and explores the different treatment options used to help problem gamers and their loved ones.

What is gaming disorder?

Gaming disorder – also known as video game addiction, internet gaming disorder and gaming addiction – is recognized by the World Health Organization¹ as “a pattern of gaming behavior characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences.”

Common symptoms of gaming disorder include:

• Being restless and/or irritable when unable to play video games
• Preoccupied with thoughts of previous gaming activity or anticipating the next session
• Lying to friends or family about the amount of time spent playing
• Isolation from others in order to spend more time gaming
• Moodiness when not gaming
• Neglecting social activities
• Missing out on educational or professional opportunities
• Using gaming as an escape from everyday life.

 

Prevalence of gaming disorder

There are 3 billion gamers worldwide and the vast majority play recreationally.

Estimates in individual studies vary widely as to the number of people who suffer from gaming disorder. In 2020, a systemic meta-analysis was conducted of over 50 studies, representing more than 225,000 participants in 17 countries. They found a global prevalence of gaming disorder at approximately 2-3 % (Stevens et al. 2020).

Treatments for gaming disorder

Gaming disorder treatment often uses techniques borrowed from substance abuse, depression and behavioral disorders. This is partly due to the co-morbidities of gaming problems with substance use, depression and ADHD. In the absence of official treatment protocols for gaming disorder, clinicians and counselors adapt existing techniques using their experience and expertise. However, the clinical evidence has yet to catch up on providing support for these various techniques in treating gaming addiction.

Some of the most studied gaming disorder interventions are outlined below. It should be noted that there are three major limitations of clinical trials aimed at evaluating effective interventions for gaming disorder:

1. Studies often exclude people who have a co-morbid disorder. Given the high rate of co-morbidity of gaming disorder with other diagnoses, this is a major flaw that does not represent what clinicians face in their practice, as clients rarely present with gaming issues alone.
2. Differing criteria and assessment tools are used to define the problem, so that many trials include all forms of problem gaming, internet gambling, online pornography or other internet use. (Winkler et al. 2013²). Eventually, as consensus is reached around definitions of gaming disorder and screening tools, some of this confusion will resolve. However, for the moment, it adds muddle to an already confusing picture.
3. There are few randomized control trials, which limits the ability to make the claim that the intervention studied was responsible for any changes found.

 

Pharmacological interventions

Antidepressants have been effectively used to treat alcoholism, gambling addiction, nicotine addiction and methamphetamine addiction (Winkler et al. 2013³). The evidence pointing to the effectiveness of antidepressants at reducing the symptoms of gaming disorder has been limited, as with other pharmacological interventions. The two most common antidepressants used in clinical trials for gaming disorder are bupropion and escitalopram, with bupropion showing the strongest effectiveness (Song et al. 2016⁴).

Due to the co-morbidity of gaming and ADHD, methylphenidate and atomoxetine have also been trialed as interventions for youth gaming disorder with symptoms of ADHD, with promising results (Park et al. 2016⁵).

Meta-analysis to compare pharmacological versus psychotherapeutic treatments found no significant difference in reducing internet addiction symptoms in a review of 16 studies (Winkler et al. 2013⁶). This review was the first to evaluate the short-term and long-term efficacy of these treatments, but there were no statistical differences found between those who were given anti-depressants and those who had a form of therapeutic counselling. The analyses included studies using a broad definition of internet addiction, which included pornography, gaming and social media use.

Cognitive-behavioral therapy

One of the most studied types of psychological counselling for gaming disorder is cognitive behavioral therapy (CBT). However, the evidence from clinical trials is beset by methodological weaknesses that severely limit our ability to argue for its effectiveness. A systematic review of 30 international studies from Asian and Western countries found that most studies contained a critical design limitation in that they provided no follow-up measure to assess long-term impacts of treatment. Furthermore, many had very small sample sizes, and most were not randomized or using control groups (King et al. 2017⁷).

A randomized trial compared six weeks of twice weekly group CBT sessions to ‘basic supportive counseling’. Adolescents aged 12 – 19 showed significant reductions in gaming disorder symptoms after the six weeks, but there was no significant difference between the CBT and the supportive counselling condition (Li & Wang, 2013⁸, cited in Zajac et al, 2017⁹).

This could be interpreted as consistent with often cited findings from a wide range of healthcare settings which indicate that the quality of the therapeutic alliance, rather than specific intervention is an equally important factor in treating many mental and physical conditions (e.g. Kelley et al. 2016¹⁰; Krupnick et al. 1996¹¹). Clearly, much more research is needed as to specific interventions.

Other psychotherapeutic or group interventions

Motivational interviewing (MI), acceptance and commitment therapy (ACT), group counselling, and 12-step interventions have also been used to address gaming disorder. Clinicians may use these modalities in conjunction with other tools in their toolkit and refer clients to 12-step groups, for example, but due to a lack of peer-reviewed, high-quality clinical trials, the evidence for the effectiveness of these is currently negligible.

Family-based interventions

Given that gaming disorder usually arises within a family context, many practitioners favor family-based interventions. An advantage of family therapy is that each member of the family is encouraged to own their part of the gaming issue, both in terms of how they contribute to the issue and how they can contribute to resolving it.

One well-designed clinical trial compared six, two-hour sessions of family therapy in 46 adolescents with internet addiction and compared their outcomes to a waitlist control group (Liu et al. 2015¹²). The study found significant reduction in internet addiction in adolescents in the family therapy group over the control group, and this was sustained in a three-month follow-up. This study shows promising results; however, it would be more effective if the design included a comparison group of people receiving individual CBT, as well as a no-treatment group.

More well-designed clinical trials are required, but in the meanwhile many clinicians are employing family-based interventions for the treatment and counseling of gaming disorder clients and their families.

Web-based interventions

Internet interventions for gaming disorder have not been systematically studied as much as in-person interventions. However, this type of treatment ironically means more time spent online by the person with online gaming issues. It is too early to make reliable claims about the effectiveness of these web-based intervention tools.

Boot camps

A variety of residential and digital detox boot camps have emerged over the last decade. These boot camps are mostly available in East Asia, with a few in North America, and the efficacy of interventions remains dubious.

Military-style boot camp programs in China and South Korea take adolescent problem gamers, even involuntary participants, and remove them from any digital environment, replacing their daily activities with rigorous physical exercise. While these boot camps have been critiqued for harsh or unethical methods (King & Delfabbro, 2019¹³), mass media promote these camps (as per this YouTube¹⁴ video) making claims that participants reduce their gaming time and learn social, teamwork and leadership skills.

Parents who sign up their children to these camps are often motivated by despair and desperation, due to a lack of other options. While it may be the case that an adolescent removed from digital devices and forced to exercise cannot continue gaming, there is no evidence whether their behavior or mental health improves when they return home. The methods employed are not based on accepted mental health treatment protocols (King & Delfabbro, 2019), long-term follow-ups are not provided, and peer-reviewed papers on these treatment approaches and success rate are practically non-existent.

Gaming Disorder Clinical Training

The very limited and preliminary evidence about how to effectively treat people seeking help for gaming disorder is frustrating for both clinicians, problem gamers and their families.

At INTENTA, our internationally-accredited Gaming Disorder Clinical Training equips helping professionals with practical strategies, tools and skills to treat clients with problematic and disordered gaming. Get in touch to find out more.