You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.
 

 

CME / ABIM MOC / CE

What Do We Know About “Gaming Disorder”?

  • Authors: News Author: Batya Swift Yasgur, MA, LSW; CME Author: Laurie Barclay, MD
  • CME / ABIM MOC / CE Released: 5/12/2023
  • Valid for credit through: 5/12/2024
Start Activity

  • Credits Available

    Physicians - maximum of 0.50 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.50 ABIM MOC points

    Nurses - 0.50 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)

    Physician Assistant - 0.50 AAPA hour(s) of Category I credit

    IPCE - 0.50 Interprofessional Continuing Education (IPCE) credit

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for psychiatrists, family medicine/primary care clinicians, internists, pediatricians, adolescent medicine clinicians, nurses, pharmacists, physician assistants, and other members of the health care team who care for patients with gaming disorder.

The goal of this activity is for members of the healthcare team to be better able to describe current thinking about gaming disorder, based on a review of etiology, a systematic review of randomized controlled trials of interventions (group counseling, craving behavioral intervention, transcranial direct current stimulation, an acceptance and cognitive restructuring intervention program, and short-term cognitive behavioral therapy), and a review highlighting the concept of recovery.

Upon completion of this activity, participants will:

  • Assess current thinking about the etiology of gaming disorder, based on a review
  • Evaluate current thinking about treatment and recovery in gaming disorder, based on a systematic review of randomized controlled trials of interventions and a review highlighting the concept of recovery
  • Outline implications for the healthcare team


Disclosures

Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.


News Author

  • Batya Swift Yasgur, MA, LSW

    Freelance writer, Medscape

    Disclosures

    Batya Swift Yasgur, MA, LSW, has no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

    Disclosures

    Laurie Barclay, MD, has no relevant financial relationships.

Editor/Compliance Reviewer

  • Yaisanet Oyola, MD

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Yaisanet Oyola, MD, has no relevant financial relationships.

Nurse Planner

  • Stephanie Corder, ND, RN, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Stephanie Corder, ND, RN, CHCP, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.


Accreditation Statements



In support of improving patient care, Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

This activity was planned by and for the healthcare team, and learners will receive 0.50 Interprofessional Continuing Education (IPCE) credit for learning and change.

    For Physicians

  • Medscape, LLC designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.50 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

    The European Union of Medical Specialists (UEMS)-European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 credit™ into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

    College of Family Physicians of Canada Mainpro+® participants may claim certified credits for any AMA PRA Category 1 credit(s)™, up to a maximum of 50 credits per five-year cycle. Any additional credits are eligible as non-certified credits. College of Family Physicians of Canada (CFPC) members must log into Mainpro+® to claim this activity.

    Through an agreement between the Accreditation Council for Continuing Medical Education and the Royal College of Physicians and Surgeons of Canada, medical practitioners participating in the Royal College MOC Program may record completion of accredited activities registered under the ACCME’s “CME in Support of MOC” program in Section 3 of the Royal College’s MOC Program.

    Contact This Provider

    For Nurses

  • Awarded 0.50 contact hour(s) of nursing continuing professional development for RNs and APNs; 0.00 contact hours are in the area of pharmacology.

    Contact This Provider

  • For Physician Assistants

    Medscape, LLC has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 0.50 AAPA Category 1 CME credits. Approval is valid until 5/12/2024. PAs should only claim credit commensurate with the extent of their participation.

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read about the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or print it out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate, but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period, you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.

CME / ABIM MOC / CE

What Do We Know About “Gaming Disorder”?

Authors: News Author: Batya Swift Yasgur, MA, LSW; CME Author: Laurie Barclay, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 5/12/2023

Valid for credit through: 5/12/2024

processing....

Clinical Context

Video game playing is now one of the most popular hobbies across sex and age groups, but a small proportion of gamers develop negative symptoms affecting their mental and physical health and causing functional impairment.

Inclusion of gaming disorder (GD) in the International Classification of Diseases, 11th revision, resulted from a fairly broad expert consensus. To date, there are no authoritative guidelines for what makes an effective GD intervention, nor is the concept of recovery fully applied to GD.

Study Synopsis and Perspective

Three studies provide new insight into the growing problem of GD, including the condition’s genesis, its effective treatments, and the need for a greater focus on recovery.

A team of international researchers led by Orsolya Király, PhD, from the Institute of Psychology, Eötvös Loránd University, Budapest, Hungary, reviewed the characteristics and etiology of GD. They concluded that its genesis arises from the interaction of environmental factors, game-specific factors, and individual factors, including personality traits, comorbid psychopathology, and genetic predisposition.

“The development of GD is a complex process, and we identified 3 major factors involved,” study coauthor Mark Griffiths, PhD, distinguished professor of behavioral addiction and director of the International Gaming Research Unit, Psychology Department, Nottingham Trent University, United Kingdom, told Medscape Medical News. Because of this complexity, “prevention and intervention in GD require multiprofessional action.”

The review was published in the April issue of Comprehensive Psychiatry.[1]

In a second paper, Chinese investigators reviewing randomized controlled trials (RCTs) presented “compelling evidence” to support 4 effective interventions for GD: group counseling, an acceptance and cognitive restructuring intervention program (ACRIP), short-term cognitive behavioral therapy (CBT), and craving behavioral intervention (CBI).

The review was published online February 6 in Frontiers in Psychiatry.[2]

A third paper, in which researchers analyzed close to 50 studies of GD, found that the concept of “recovery” is rarely mentioned in GD research. Lead author Belle Gavriel-Fried, PhD, senior professor, Bob Shapell School of Social Work, Tel Aviv University, Israel, told Medscape Medical News that recovery is a “holistic concept that taps into many aspects of life.”

Understanding the “differences in the impact and availability” of negative and positive human resources and their effect on recovery “can help clinicians to customize treatment,” she said.

That review was published online March 14 in the Journal of Behavioral Addictions.[3]

Complex Interplay

GD is garnering increasing attention in the clinical community, especially since 2019, when the World Health Organization included it in the International Classification of Diseases, 11th revision.

“Although for most individuals gaming is a recreational activity or even a passion, a small group of gamers experiences negative symptoms which impact their mental and physical health and cause functional impairment,” write Dr Király and colleagues.

Dr Griffith explained that his team wanted to provide an “up-to-date primer, a ‘one-stop shop,’ on all things etiologic concerning gaming disorder for academics and practitioners” as well as others, such as health policy makers, teachers, and individuals in the gaming industry.

The researchers identified 3 factors that increase the risk of developing GD, the first being gaming-related factors, which make video games “ ‘addictive’ in a way that vulnerable individuals may develop GD,” they write.

For example, GD is more prevalent among online versus offline game players, possibly because online multiplayer games “provide safe environments in which players can fulfil their social needs, while remaining invisible and anonymous.”

Game genre also matters, with massively multiplayer online role-playing games, first-person/third-person shooter games, real-time strategy games, and multiplayer online battle arena games most implicated in problematic gaming. Moreover, the “monetization techniques” of certain games also increase their addictive potential.

The researchers point to individual factors that increase the risk of developing GD, including male sex and younger age, personality traits such as impulsivity and sensation-seeking, and comorbidities including attention-deficit/hyperactivity disorder, anxiety, and depression.

Poor self-esteem and lack of social competencies make gaming “an easy and efficient way to compensate for these deficiencies, which in turn heightens the risk to develop GD,” they add. Neurobiological processes and genetic predisposition also play a role.

Last, the authors mention environmental factors, including family and peer-group issues, problems at work or school, and cultural factors.

“The take-home messages are that problematic gaming has had a long history of empirical research; that the psychiatric community now views GD as a legitimate mental health issue; and that the reasons for GD are complex, with many different factors involved in the acquisition, development, and maintenance of GD,” said Dr Griffiths.

Beneficial Behavioral Therapies

Yuzhou Chen and colleagues, from Southwest University, Chongqing, China, conducted a systematic review of RCTs investigating interventions for treating GD. Despite the “large number of intervention approaches developed over the past decade, as yet there are no authoritative guidelines for what makes an effective GD intervention,” they write.

Few studies have focused specifically on GD, but instead have focused on a combination of internet addiction and GD. But the interventions used to treat internet addiction may not apply to GD. And few studies have used an RCT design. The researchers therefore set out to review studies that specifically used an RCT design to investigate interventions for GD.

They searched 6 databases to identify RCTs that tested GD interventions from the inception of each database until the end of 2021. To be included, participants had to be diagnosed with GD and receive either a “complete and systematic intervention” or be in a comparator control group receiving no intervention or placebo.

Seven studies met the inclusion criteria (N = 332 participants). The studies tested 5 interventions:

  • Group counseling with 3 different themes (interpersonal interaction, acceptance and commitment, cognition and behavior)
  • CBI, which addresses cravings
  • Transcranial direct current stimulation (tDCS)
  • ACRIP with the main objectives of reducing GD symptoms and improving psychological well-being
  • Short-term CBT, which addresses maladaptive cognitions

The mean duration of the interventions ranged from 3 to 15 weeks.

The primary outcome was GD severity, with secondary outcomes including depression, anxiety, cognition, game time, self-esteem, self-compassion, shyness, impulsivity, and psychological well-being.

Group counseling, CBI, ACRIP, and short-term CBT interventions had “a significant effect on decreasing the severity of GD,” whereas tDCS had “no significant effect.”

Results for secondary outcomes are listed in Table 1.

Behavioral therapy “exerts its effect on the behavioral mechanism of GD; for example, by reducing the association between game-related stimuli and the game player’s response to them,” the authors suggest.

Table 1. Results for Secondary Outcomes in Systematic Review of RCTs

Intervention Reduction Increase
Group counseling Depression
Maladaptive cognition
Number of hours spent gaming
Anxiety
 
Short-term CBT Depression  
ACT Maladaptive cognition Self-compassion
CBI Number of hours spent gaming  
CBT Shyness  
ACRIP   Psychological well-being

Behavioral therapy “exerts its effect on the behavioral mechanism of GD; for example, by reducing the association between game-related stimuli and the game-players responses to them,” Dr Chen and colleagues suggest.

Recovery vs Pathology

Recovery “traditionally represents the transition from trauma and illness to health,” Dr Gavriel-Fried and colleagues note.

Two paradigms of recovery are “deficit-based” and “strength-based.” The first assesses recovery in terms of abstinence, sobriety, and symptom reduction, and the second focuses on “growth, rather than a reduction in pathology.”

But although recovery is “embedded within mental [health] addiction policies and practice,” the concept has received “scant attention” in GD research.

Most studies (n = 32) consisted of exclusively male subjects. Only 10 included both sexes, and female participants were in the minority.

Most studies (n = 42) did not address the concept of recovery, although all studies did report significant improvements in gaming-related pathology. Typical terminology used to describe changes in participants’ GD were “reduction” and/or “decrease” in symptom severity.

Although 18 studies mentioned the word “recovery,” only 5 actually discussed issues related to the notion of recovery, and only 5 used the term “abstinence.”

In addition, only 13 studies examined positive components of life in patients with GD, such as increased psychological well-being, life satisfaction, and quality of life; improved emotional state, relational skills, and executive control; and improved self-care, hygiene, sleep, and interest in school studies.

“As a person and researcher who believes that words shape the way we perceive things, I think we should use the word ‘recovery’ rather than ‘pathology’ much more in research, therapy, and policy,” said Dr Gavriel-Fried.

She noted that because GD is a “relatively new behavioral addictive disorder, theories are still being developed and definitions of the symptoms are still being fine-tuned.”

“The field as a whole will benefit from future theoretical work that will lead to practical solutions for treating GD and ways to identify the risk factors,” Dr Gavriel-Fried said.

Filling a Research Gap

Commenting for Medscape Medical News, David Greenfield, MD, founder and medical director of the Connecticut-based Center for Internet and Technology Addiction, noted that 3 decades ago, there was almost no research into this area.

“The fact that we have these reviews and studies is good because all of the research adds to the science providing more data about an area we still don’t know that much about, where research is still in its infancy,” said Dr Greenfield, who was not involved with the present study.

“Although we have definitions, there’s no complete agreement about the definitions of GD, and we do not yet have a unified approach,” continued Dr Greenfield.

He suggested that “recovery” is rarely used as a concept in GD research perhaps because there is a “bifurcation in the field of addiction medicine in which behavioral addictions are not seen as equivalent to substance addictions,” and particularly with GD, the principles of “recovery” have not yet matured.

“Recovery means meaningful life away from the screen, not just abstinence from the screen,” said Dr Greenfield.

The study by Dr Chen and colleagues was supported by grants from the National Social Science Foundation of China, the Chongqing Research Program of Basic Research and Frontier Technology, and the Fundamental Research Funds for the Central Universities. The authors have reported no relevant financial relationships. Dr Griffiths has reported receiving research funding from Norsk Tipping (the gambling operator owned by the Norwegian government). The study by Dr Király and colleagues received support from the Hungarian National Research Development and Innovation Office and the Janos Bolyai Research Scholarship Academy of Sciences to individual investigators. A coauthor has received funding for a number of research projects in the area of gambling from Gamble Aware. The study by Dr Gavriel-Fried and colleagues received support from the Hungarian National Research Development and Innovation Office and the Janos Bolyai Research Scholarship Academy of Sciences to individual investigators. Dr Gavriel-Fried has reported receiving grants from the Israel National Insurance Institute and the Committee for Independent Studies of the Israel Lottery. Disclosures for the other authors are listed with the article. Dr Greenfield has reported no relevant financial relationships.

Study Highlights

  • Dr Király and colleagues note that GD development is a complex process, resulting from an interplay among gaming-related, individual, and environmental factors, none of which alone are sufficient to cause GD.
  • GD prevention and intervention require multiprofessional action.
  • Gaming-related factors, including monetization techniques and online versus offline, increase the addictive potential of video games in vulnerable individuals.
  • Online multiplayer games provide safe environments for players to fulfill their social needs while remaining invisible and anonymous.
  • Game genres most implicated in GD are multiplayer online role-playing, first-person/third-person shooter, real-time strategy, and multiplayer online battle arena games.
  • Individual factors increasing risk of developing GD include male sex, younger age, impulsivity, sensation-seeking, and comorbidities including attention-deficit/hyperactivity disorder, anxiety, and depression.
  • Gaming may help players compensate for poor self-esteem and lack of social skills, which increases risk of developing GD, as do neurobiological processes and genetic predisposition.
  • Environmental factors include family and peer-group issues, early life experiences, work/school problems, and cultural factors including the popularity of esports.
  • A systematic review analyzed 7 RCTs testing GD interventions lasting 3 to 15 weeks, identified from a search of PubMed, Embase, PsycINFO, CNKI, WanFang, and VIP.
  • Group counseling (regarding interpersonal interaction, acceptance and commitment, and cognition and behavior), CBI, ACRIP aiming to reduce GD symptoms and improve psychological well-being, and short-term CBT interventions addressing maladaptive cognitions significantly reduced GD severity; tDCS had no significant effect.
  • Reducing the association between game-related stimuli and the game player’s response to them may underlie behavioral therapy benefits.
  • As this review identified shortcomings in the conceptualization of GD, experimental design, sample representativeness, and reporting quality, future studies should have more rigorous research designs and use established standards to obtain more credible evidence informing development of GD interventions.
  • A literature review designed to explore the state of the art on GD recovery noted the classic definition as symptom reduction, and more recent definitions as a process of improvement in health, wellness, and other life domains.
  • Two paradigms of recovery are deficit-based, assessing abstinence, sobriety, and symptom reduction, and strength-based, highlighting growth rather than reduced pathology.
  • Of 966 studies identified, 47 met inclusion criteria, 42 did not address the concept of recovery, and only 5 used the term “abstinence.”
  • Changes in GD were described as reductions in symptom severity, or improvement in health, wellness and other life domains, primarily measured by scales assessing symptom reduction and/or improvement in GD and other psychopathologies.
  • Only 13 studies examined positive life components (eg, increased psychological well-being, life satisfaction, and quality of life; improved emotional state, relational skills, and executive control; and improved self-care, hygiene, sleep, and interest in school studies).
  • The reviewers recommend that therapists, researchers, and policy makers aim to promote and integrate the notion of recovery in GD as the transition from trauma and illness to health, and as the ability to handle conflicting feelings and emotions without external mediation.

Clinical Implications

  • GD development is complex, resulting from interaction among gaming-related, individual, and environmental factors.
  • Group counseling, CBI, ACRIP, and short-term CBT interventions, but not tDCS, significantly reduced GD severity.
  • Implications for the Health Care Team: Clinicians, therapists, researchers, and policy makers should aim to promote and integrate the notion of recovery in GD.
 

Earn Credit

  • Print