In the ICD-11, gaming disorder is defined as impaired control over gaming with adverse effects on daily functioning, as evident for at least 12 months. According to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which is used in the US, internet gaming addiction would be the closest equivalent to the ICD-11’s condition.
Costs and Benefits of “Addiction”
Licensed clinical psychologist and co-founder and director of the Center for Cognitive Behavioral Therapy and Mindfulness, Suraji Wagage, PhD, JD, notes there are costs and benefits to defining extreme behaviors as an “addiction.” Wagage explains, “Some benefits include acknowledging that a behavior can become overwhelming or difficult to control, which can make it less blameworthy and engender understanding and compassion in others.” The framework of addiction can help to understand behaviour, according to Wagage. “We sometimes do things that are reinforcing in the short-term but detrimental in excess, and it can be surprisingly difficult to change the behavior when the immediate reinforcement is strong,” she says. By calling something an “addiction,” Wagage notes that it can also bring attention to the topic and encourage research on treatments, but there are also costs to framing certain behaviors as an addiction. Wagage explains, “Describing an issue as an addiction can actually make it feel more overwhelming and unchangeable than describing it in different terms, e.g. playing video games to the point that it is having negative effects on other areas of life, such as social, familial, academic, or professional life.” In this way, Wagage notes that calling something an addiction also runs the risk of pathologizing and stigmatizing behaviour that is in fact not problematic, particularly along generational lines. As an example, Wagage highlights how she had worked with a college student, whose parents were extremely concerned about the time that he spent playing video games when he was home during the pandemic and tried to impose rules and restrictions to limit his computer time. Although this client’s parents may have meant well with their actions, they had failed to understand how his videogame playing was an essential part of his social life, according to Wagage. “Limiting his computer time, not videogame playing, impaired his quality of life,” she says.
Time Accountability Can Be Helpful
Behavioral health medical director at Community Health of South Florida Inc., psychiatrist Howard Pratt, DO, says, “The whole issue with the devices is that they are a double-edged sword." Dr. Pratt explains, “Our devices are wonderful because they help us accomplish the things we need to accomplish, but they are also a source of entertainment so it’s a very slippery slope where you are looking at something through a device that is work-related and then you find yourself gaming.” Time accountability is encouraged by Dr. Pratt. “If you have been playing Minecraft or Roblox and find yourself on your third hour, you could have a problem. The most important thing is to realize when there is a problem and it’s the patient who usually tells me when there is one,” he says. Dr. Pratt notes that the consensus about gaming disorder within the community of mental health experts has yet to fully harden. “I don’t, for example, have many colleagues who fully embrace the diagnosis,” he says. For some people suffering from anxiety or emotional discomfort gaming can be therapeutic and self-soothing. Dr. Pratt highlights that it can be a band-aid approach to dealing with discomforts that need to be faced. Dr. Pratt explains, “Most people I know who game excessively want to stop doing so. Most people recognize when it’s a problem. Many who suffer with a gaming addiction will not provide games to their children.”
Gaining Some Distance from Gaming
Psychotherapist, Matt Glowiak, PhD, LCPC, says, “Although a condition such as a video game addiction is one that may be readily identified by a cluster of symptoms, each client experiences the condition differently.” Glowiak explains, “As patients share their lived experience, I am interested to learn how they perceive the problem, to what extent they experience it, their desire to change, past attempts to stop (if any), and what they are willing to do to work through it.” Given that abstinence from gaming is the most effective way to work through the addiction, this is where Glowiak begins, ideally. “The patient and I consider ways in which one may distance from gaming,” he says. Glowiak notes, “This may include limiting time on various devices or removing them altogether, removing programming from the devices, blocking certain websites and other communications, and finding other activities that not only bide one’s time but serve a meaningful purpose.” While minimizing gaming, Glowiak highlights that he explores the eight dimensions of wellness with clients, i.e. emotional, spiritual, intellectual, physical, environmental, financial, occupational, and social. Glowiak explains that as successes are attained, the incentive to game tends to go down. “For those who are completely resistant to stopping gaming altogether, harm reduction approaches may be implemented,” he says. It is important to note that video game addiction is not currently a formal medically diagnosable condition in the DSM-5, according to Glowiak. “It is mentioned but not a formally named condition,” he says. Glowiak explains, “Accordingly, attention to the problem has been more limited than recent statistics have indicated it should be. Regardless, studies are continually conducted—yielding more compelling evidence that video game addiction is, indeed, a clinical problem.” For more specific diagnostic and treatment protocols, Glowiak notes that official recognition of the condition will go a long way. “Treatment also goes beyond the video gaming itself but toward deeper rooted problems that have manifested themselves through problematic gaming,” he says.
Technology Comes at a Cost
Psychiatrist with Mindpath Health, Rashmi Parmar, MD, says, “All of us are constantly exposed to all kinds of electronics in today’s digital world.” Dr. Parmar explains, “Technology has gained a stronghold on all areas of a person’s life, whether it is for entertainment, education or work reasons. We have been increasingly relying on devices like laptops, smartphones, etc. Especially when technology proved to be a boon while combating the COVID-19 pandemic, Dr. Parmar notes that in the absence of appropriate monitoring and regulations around their use, there can be consequences. The recognition of video game addiction as a disorder by WHO settles a very controversial debate amongst experts, according to Dr. Parmar. “It makes it easier for healthcare professionals to apply standardized criteria to identify patients who need further intervention,” she says. With increasing awareness, clarity of symptoms and diagnostic criteria of videogame addiction, Dr. Parmar notes that treatment protocols have been evolving to address this challenge more appropriately over time. Dr. Parmar recommends cognitive behavioral therapy (CBT), which involves restructuring obsessive thoughts, as a patient may have coexisting mood and anxiety disorders which can be simultaneously addressed with CBT. Group therapy may also be beneficial to find motivation and support, according to Dr. Parmar. “Encountering other people with similar changes makes it easier to go through the recovery process and may introduce them to unique and creative strategies that work for others,” she says. Dr. Parmar explains that learning to set boundaries can play a key role in managing misuse. “Assign specific time limits while accessing electronic devices, and avoid use outside of work or school hours,” she says.
Deconstructing the Purpose Gaming Serves
Founder of Creative Psychological Health Services, play therapist, and psychologist Rachel Altvater, PsyD, RPT-S, says, “Those who have unhealthy gaming habits are in this space for the manner in which they are for a reason.” In response, Altvater leans in, and asks such questions as how come a person feels the need to escape to and/or remain in this space for extended periods of time and what purpose does this serve in their lives. Altvater explains, “When we uncover the why behind a behavior, we can coordinate a plan of action to assist them in finding improved balance in their lives. Ignorance does not facilitate insight.” With a specialty in child and adolescent mental health, Altvater notes that when clients show her their virtual spaces, she can begin to uncover and connect more impactfully with them. “Play therapy embraces meeting children where they are and speaking their language,” she says. Since play is a child’s natural mode of communication, Altvater underscores that toys symbolize their words and play is their language, so technology is the modern facilitator of language in the digital space. Children often lack the advanced cognitive and verbal abilities to articulate and understand what is occurring, according to Altvater. “I honor and remain curious about my clients’ digital and virtual worlds to support them through their mental and emotional health struggles in a manner that is comfortable, familiar, and important to them,” she says. In her clinical work, Altvater utilizes a variety of methods that are developmentally beneficial for clients, such as play, which can help them with processing, expression, developing awareness, and facilitating change. While the WHO classified gaming disorder as a condition in 2018, Altvater notes that research remains insufficient and shows mixed results. “Gaming interventions are being further researched to understand therapeutic benefits and to refine psychotherapy treatment protocols,” she says. Altvater highlights EndeavorRx®, a video game treatment for kids with ADHD approved by the United States Food and Drug Administration (FDA), that is clinically proven to improve ADHD-related impairments. Since technology is a culture, Altvater notes that when humans are unfamiliar with something different, they may reject it or distance themselves from an entity, out of fears of the unknown. Instead of labeling unfamiliar behaviors and connections as problematic, Altvater notes it would help to learn more. “Some of our problematic behaviors are actually rooted in a space of misperception and misunderstanding,” she says. Altvater explains, “There are many factors that impact one’s connection to their virtual space, and it is important for us to develop insight so we can acquire deeper understandings about what contributes to unhealthy use and connections in this space.” By encouraging others to self-reflect on their relationship with and perception of technology, Altvater notes how individuals view the world through their own lens and attach meaning based on that. Altvater says, “If we are proponents for technology, we will view it more positively. If we are opponents of technology, we will view it more negatively. It’s most beneficial to maintain a neutral stance and explore both positions from a place of curiosity and clarity.”
