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Screen play ideas: A speculative look at trends in video game addiction

Gaming addiction has become a topic of increasing research interest. Over the last decade there has been a significant increase in the number of scientific studies examining various aspects of video game addiction. This has resulted in a wide-ranging selection of review papers focusing on different aspects of the topic. These include general literature reviews of video game addiction, reviews of online (as opposed to offline) gaming addiction, reviews of the main methodological issues in studying video game addiction, reviews of structural characteristics and their relationship with video game addiction, reviews of video game addiction treatment, reviews of video game addiction and co-morbidity/convergence with other addictions such as gambling addiction and Internet addiction, and miscellaneous review papers on very specific aspects of video game addictions such as social responsibility, screening instruments, or reviews refuting that video game addiction even exists.

Furthermore, the amount and the quality of research in the gaming addiction field has progressed much over the last decade but is still in its infancy compared to other more established behavioural addictions, such as pathological gambling. Today’s blog briefly provides a considered (and somewhat speculative) examination of what might happen in the gaming addiction field from a number of different standpoints (e.g., methodological, conceptual, technological). These are taken from a paper I recently published in Current Psychiatry Reviews with Dr. Daniel King (University of Adelaide, Australia) and Daria Kuss (Nottingham Trent University, UK). These trends were loosely modeled on a 2011 paper I wrote on the technological trends in gambling and published in Casino and Gaming International.

  • There is likely to be an even bigger increase in empirical research into problematic video game playing and video game addiction. This will of course be dependent on both appropriate funding streams and/or whether gaming addiction ends up being included in future psychiatric disorder classifications (e.g., Diagnostic and Statistical Manual, International Classification of Diseases, etc.). Future research is likely to include more epidemiological and/or general population data on media use, leading to better insights into the onset and course of problematic video game play and addiction.
  • Given the many different screening instruments that have been developed over the last decade, there is likely to be a refinement of video game addiction measures and greater consensus on its conceptualization, either as a single disorder and/or incorporated into other known disorders (e.g., impulse control disorder). This is also likely to lead to improved assessment tools based on such conceptualization(s).
  • Measures of gaming use and subsequent behaviour are likely to diversify in terms of media use, including social networking sites (SNS) and associated Internet resources. Already, games such as Call of Duty and Battlefield 3 are being released with their own SNS (e.g., COD Elite) that track player behaviour and provide feedback to players as to how to improve their game (thus functionally reinforcing video game play and thus have implications for excessive and/or potentially addictive play).
  • Gaming on the move is likely to be a big growth area that may have implications for excessive gaming via ‘convenience’ hardware such as handheld gaming consoles, PDA devices, mobile phones, tablet computers, and MP3 players.
  • Given the fact that the Internet is gender-neutral, there is likely to be increasing feminization of gaming where increasing numbers of females not only engage in the playing of online games, but also develop problems as a result. Casual gaming online is already popular among females. However, the biggest difference between male and female gaming is likely to be content-based (e.g., males may prefer competitive type gaming experiences whereas females may prefer co-operative type gaming experiences).
  • Given the increasing number of research teams in the gambling field being given direct access to gambling companies behavioural tracking data, there is likely to be an increasing number of such collaborations in the gaming studies field.
  • Given the increased importance of additional research into the structural and situational characteristics of consumptive behaviours (e.g., smoking nicotine, drinking alcohol, gambling, etc.), it is likely that research on design features within games and their psychological impact (including potential addiction) will increase as well. Such research has already begun (including quite a few studies by our gaming research unit).
  • As the diagnosis of video game addiction becomes more legitimate in psychiatric and medical circles, it will lead to better randomized control trials on interventions for problematic video game play than the ones already carried out. There is also likely to be an increase in the online medium itself being used as a treatment channel. The reasons that people like to engage in some online leisure activities (i.e., the fact that the online environment is non-face-to-face, convenient, accessible, affordable, anonymous, non-threatening, non-alienating, non-stigmatizing, etc.) may also be the very same reasons why people would want to seek advice, help and treatment online rather than in face-to-face situations.

Based on our review paper there are several noticeable trends that can be drawn from our recent reviews of problematic video game play and video game addiction.

  • There has been a significant increase in empirical research decade by decade since the early 1980s.
  • There has been a noticeable (and arguably strategic) shift in researching the mode of video game play. In the 1980s, research mainly concerned ‘pay-to-play’ arcade video games. In the 1990s, research mainly concerned stand alone (offline) video games played at home on consoles, PCs or handheld devices. In the 2000s, research mainly concerned online massively multiplayer video games.
  • There has been a noticeable shift in how data are collected. Up until the early 2000s, data about video game behaviour was typically collected face-to-face, whereas contemporary studies collect data online, strategically targeting online forums where gamers are known to (virtually) congregate. These samples are typically self-selecting and (by default) unrepresentative of the general population. Therefore, generalization is almost always one of the methodological shortcomings of this data collection approach.
  • Survey study sample sizes have generally increased. In the 1980s and 1990s, sample sizes were typically in the low hundreds. In the 2000s, sample sizes in their thousands – even if unrepresentative – are not uncommon.
  • There has been a diversification in the way data are collected including experiments, physiological investigations, secondary analysis of existing data (such as that collected from online forums), and behavioural tracking studies.
  • There has been increased research on adult (i.e., non-child and non-adolescent) samples reflecting the fact that the demographics of gaming have changed.
  • There has been increasing sophistication in relation to issues concerning assessment and measurement of problematic video game play and video game addiction. In the last few years, instruments have been developed that have more robust psychometric properties in terms of reliability and validity. However, there are still some concerns as many of the most widely used screening instruments were adapted from adult screens and much of the video game literature has examined children and adolescents. In other papers I have co-written with Dr. King, we have asserted that to enable future advances in the development and testing of interventions for video game-related problems, there must be some consensus among clinicians and researchers as to the precise classification of these problems. (In fact, we’ve just had a major review paper accepted on assessing video game addiction in Clinical Psychology Review which I examined in a previous blog).

Clearly, there exist a number of gaps in current understanding of problematic video game play and video game addiction. There is a need for epidemiological research to determine the incidence and prevalence of clinically significant problems associated with video game play in the broader population. There are too few clinical studies that describe the unique features and symptoms of problematic video game play and/or video game addiction. While the current empirical base is relatively small, gaming addiction has become a more mainstream area for psychological and psychiatric research and is likely to become an area of significant importance given the widespread popularity of gaming.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Additional input: Daria Kuss and Daniel King

Further reading

Griffiths, M.D. (2010). Online video gaming: What should educational psychologists know? Educational Psychology in Practice, 26(1), 35-40.

Griffiths, M.D. (2011). Technological trends and the psychosocial impact on gambling. Casino and Gaming International, 7(1), 77-80.

Griffiths, M.D., Kuss, D.J. & King, D.L. (2012). Video game addiction: Past, present and future. Current Psychiatry Reviews, 8, 308-318.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2009). The psychological study of video game players: Methodological challenges and practical advice. International Journal of Mental Health and Addiction, 7, 555-562.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2010). Video game structural characteristics: A new psychological taxonomy. International Journal of Mental Health and Addiction, 8, 90-106.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2010). The role of structural characteristics in problem video game playing: A review. Cyberpsychology: Journal of Psychosocial Research on Cyberspace. Located at: http://www.cyberpsychology.eu/view.php?cisloclanku=2010041401&article=6.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2010). The convergence of gambling and digital media: Implications for gambling in young people. Journal of Gambling Studies, 26, 175-187.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2010). Cognitive behavioural therapy for problematic video game players: Conceptual considerations and practice issues. Journal of CyberTherapy and Rehabilitstion, 3, 261-273.

King, D.L., Delfabbro, P.H., Griffiths, M.D. & Gradisar, M. (2011). Assessing clinical trials of Internet addiction treatment: A systematic review and CONSORT evaluation. Clinical Psychology Review, 31, 1110-1116.

King, D.L., Delfabbro, P.H. & Griffiths, M.D. (2012). Clinical interventions for technology-based problems: Excessive Internet and video game use. Journal of Cognitive Psychotherapy: An International Quarterly, 26, 43-56.

King, D.L., Delfabbro, P.H., Griffiths, M.D. & Gradisar, M. (2012). Cognitive-behavioural approaches to outpatient treatment of Internet addiction in children and adolescents. Journal of Clinical Psychology: In Session, 68, 1185-1195.

King, D.L., Haagsma, M.C., Delfabbro, P.H.,Gradisar, M.S. &, Griffiths, M.D. (2013). Psychometric assessment of pathological video-gaming: A systematic review. Clinical Psychology Review, 33, 331-342.

Scaling up: A brief look at the latest tool to assess addictive gaming

To date, there has been a lack of agreement among researchers as to the precise name and definition of video game addiction (both online and offline). However, there is a general consensus that excessive gaming can lead to a wide range of physical and psychological problems, and therefore necessary to explore the nature and the scale of the phenomenon. In doing so, it is important to use psychometrically validated measurement tools. Unfortunately, there is lack of these in the literature so far. Along with some colleagues (led by Dr. Daniel King), we recently published a paper examining all the instruments that have been used to assess problematic video gaming in the journal Clinical Psychology Review.

Our paper noted that pathological video-gaming, or its proposed DSM-V classification of “Internet Use Disorder”, is of increasing interest to scholars and practitioners in allied health disciplines. Our systematic review was designed to evaluate the standards in pathological video-gaming instrumentation and guidelines for sound psychometric assessment. We assessed a total of 63 quantitative studies, including eighteen instruments (representing 58,415 participants). Our findings indicated that the instruments were generally characterized as inconsistent. The strengths of available measures included: (i) short length and ease of scoring, (ii) excellent internal consistency and convergent validity, and (iii) potentially adequate data for development of standardized norms for adolescent populations. However, the key limitations included: (a) inconsistent coverage of core addiction indicators, (b) varying cut-off scores to indicate clinical status, (c) a lack of a temporal dimension, (d) untested or inconsistent dimensionality, and (e) inadequate data on predictive validity and inter-rater reliability. An emerging consensus suggested that pathological video-gaming is commonly defined by (1) withdrawal, (2) loss of control, and (3) conflict.

Most of the tools in current use have been modified from other questionnaires without their reliability and validity being tested. This includes those based on internet addiction (e.g., Kimberley Young’s Internet Addiction Test), pathological gambling (using the DSM–IV criteria), or behavioural addictions. An additional problem is that many of the measures focus exclusively on Massively Multiplayer Online Role Playing Game (MMORPG) users. In order to cover the whole range of online gamers, I recently helped co-develop an empirically based questionnaire consisting of 18 items called the Problematic Online Gaming Questionnaire (POGQ) that we published in the journal PLoS ONE.

In a recent 2011 study, some of my Hungarian colleagues (led by Dr. Koronczai) claimed in the journal Cyberpsychology, Behavior and Social Networking that a suitable measure should fit the following six criteria. It should have: (i) comprehensiveness (i.e., examining more, possibly all, aspects of problematic online gaming); (ii) brevity (in order to assess the more impulsive population as well and to facilitate incorporation into time-limited surveys); (iii) reliability and validity for different methods of data collection (e.g., online, paper-and-pencil self-rating, face-to-face); (iv) reliability and validity for different age groups (e.g., adolescents and adults); (v) cross-cultural reliability and validity; (vi) been validated on clinical samples. The measure should also serve as a basis for defining cutoff scores for dependence.

The POGQ is a short comprehensive measure and therefore fits to the first two requirements. It was also found to be a psychometrically adequate measure in a large convenience sample of adult online gamers. However, there is great need for a measure that is also suitable for survey type research in an offline data collection setting, and is reliable and valid for adolescents. Therefore, we modified the original POGQ to a 12-item version and applied it to an offline adolescent sample using pen-and-pencil data collection method (and published the findings in the journal Cyberpsychology, Behavior and Social Networking). This way both the third and the fourth points of the six criteria above were fulfilled.

The aim of or most recent study was twofold. The first goal was to explore the psychometric properties of the POGQ on a nationally representative adolescent sample as until recently it had only been used on adult gamer samples. The second goal was to assess the prevalence of problematic online gaming in a nationwide adolescent sample, as there have been only two nationally representative studies carried out on adolescents in the US and Germany.

The results of or study showed that the 12-item POGQ-SF had appropriate psychometric properties according to the statistical analysis performed on a nationally representative sample of adolescents. The analysis showed that 8.2% of gamers (4.6% of the whole sample) belonged to the at-risk group. We also found an additional 13.3% of adolescents (23.9% of gamers) showed symptoms of problematic online gaming above the average. Gamers belonging to the at-risk class were more likely to be male, more likely to play for five or more hours a day, have lower grade point average, have lower self-esteem, and higher depression score than gamers belonging to the other two classes. All these results are in line with findings of other studies confirming the validity of the measurement tool.

Despite the robustness of the study, an important limitation was that it was only carried out among Hungarian adolescents. For generalizability it must be applied and psychometrically tested on cross-cultural samples as well (see the aforementioned Criterion 5). It is also a future goal to confirm the POGQ on clinical samples (Criterion 6). This would allow all the six criteria requirements presented in the introduction to be met. The current POGQ is both short (Criterion 2) and comprehensive (Criterion 1), and assesses problematic online gaming in different age groups (Criterion 4) with different data collection methods (Criterion 3). We hope that the POGQ will facilitate future research and will serve as an adequate tool for assessing problematic online gaming.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Demetrovics, Z., Urbán, R., Nagygyörgy, K., Farkas, J., Griffiths, M.D., Pápay, O. & Oláh, A. (2012). The development of the Problematic Online Gaming Questionnaire (POGQ). PLoS ONE, 7(5): e36417. doi:10.1371/journal.pone.0036417.

Gentile, D. (2009). Pathological video-game use among youth ages 8 to 18: A national study. Psychological Science, 20, 594-602.

Gentile, D.A., Choo, H., Liau, A., et al. (2011). Pathological video game use among youths: A two-year longitudinal study. Pediatrics, 127, E319-E329.

King, D.L., Haagsma, M.C., Delfabbro, P.H.,Gradisar, M.S., Griffiths, M.D. (2013). Toward a consensus definition of pathological video-gaming: A systematic review of psychometric assessment tools. Clinical Psychology Review, 33, 331-342.

Koronczai, B., Urban, R., Kokonyei, G., et al. (2011). Confirmation of the three-factor model of problematic internet use on off-line adolescent and adult samples. Cyberpsychology, Behavior and Social Networking, 14, 657–664.

Kuss, D.J. & Griffiths, M.D. (2012). Online gaming addiction in children and adolescents: A review of empirical reearch. Journal of Behavioral Addictions, 1, 3-22.

Pápay, O., Urbán, R., Griffiths, M.D., Nagygyörgy, K., Farkas, J. Kökönyei, G., Felvinczi, K., Oláh, A., Elekes, Z., Demetrovics, Z. (2013). Psychometric properties of the Problematic Online Gaming Questionnaire Short-Form (POGQ-SF) and prevalence of problematic online gaming in a national sample of adolescents. Cyberpsychology, Behavior, and Social Networking, doi:10.1089/cyber.2012.0484.

Rehbein, F., Kleimann, M, & Mossle, T. (2010). Prevalence and risk factors of video game dependency in adolescence: results of a German nationwide survey. CyberPsychology, Behavior and Social Networking, 13, 269–277.