do i have a problem?

Although Internet Gaming Disorder is an official diagnosis according to the World Health Organization (WHO), the WHO also recognizes that “[…] only a small proportion of people who engage in digital- or video-gaming activities […]” go on to develop problematic behaviors (WHO, 2018). Like the WHO, it is my belief that videogames can be a healthy part of adolescent and adult functioning, and that overemphasis on “addiction” may lead to unnecessary stigma or pathologizing of video games in general. Indeed, some have suggested that the opposite of depression is play, and that when people are engaged in video games they are actually engaged in goal-oriented, reward-seeking behavior, the opposite of depression (Cole, Yoo, & Knutson, 2012). Many have also suggested that the link between depression and video games is not because video games cause depression, but because depressed individuals are likely to use videogames as a means of coping with their depression.

At the same time, use of videogames as our exclusive, or even primary way of coping with difficulties can lead us to problems. It tends to lead to substantial numbing, avoidance, procrastination, and perhaps worst of all, isolation in our pain. This usually only exacerbates our underlying depressive concerns, which of course leads to more videogaming. This then becomes a vicious cycle that is hard to escape.

In my eyes, videogame “addiction” does exist, but only sets in when we find ourselves stuck using videogames as a way of coping with our own videogaming. In other words, when we are playing videogames to cope with feeling bad, find that videogames aren’t lessening our symptoms, and then play more to try and get rid of these feelings (rather than turning off the console/PC), we might have a problem. Unfortunately, a large number of videogamers do report this sort of behavior, with about 2 in 5 videogamers reporting using to escape day-to-day life and about half of all gamers having problematic involvement with videogames (Billieux et al., 2014).

Thus, while the WHO has a list of criteria that are useful (e.g. impaired control over gaming, increasing priority given to gaming, continuation or escalation of gaming despite the occurrence of negative consequences), there are a couple quick diagnostics I find most useful in practice:

1. When something goes wrong in my day-to-day life, my first impulse is to think about or play videogames.

2. When I feel frustrated after a videogame match or round, I usually play another to try to feel better.

How do I get better?

In practice, most persons who contact me regarding concerns about their videogame use are also experiencing co-occurring depression or anxiety, with consistent feelings of numbness, irritability, and isolation. My treatment approach is thus to first understand the complete context of one’s videogaming. I mean this both with regard to the emergence of your play (when did you first start? What was going on in your family at this time? At school? With friends? What role did videogames play? How would you characterize your relationship to games at that time?) as well as the environmental context of your current play (When do you think about playing? When do you typically jump into a game? How are you feeling just before? What are your favorite games? What do you like and dislike about playing them? How long does a session last? How do you feel afterward?, etc.). This gives a sense of your motivations for playing as well as your specific life circumstances.

What I tend to find is that when clients first come to visit me, numbness is the biggest or perhaps only salient feeling they can locate. This numbness is usually the “secondary” emotion which is serving a very important role in managing pain. Underneath the numbness is frequently sadness, isolation, self-doubt, and/or a great deal of anger toward either primary attachment figures (e.g parents), friends, or others. Usually when we can come into contact with these underlying emotions which have been cut-off or disowned, we can begin to have a different response to them in our day-to-day lives. For example, someone may come to me saying they are concerned about their videogame use. They may mention to me that that they first started playing at age 14, and that at the time there was a great deal of conflict in their family. Their parents regularly argued or were relatively absent, and they found that they could easily hop onto the console or internet and find direction, purpose, and pleasure. They found they were good at games, being a gamer became a part of their identity, and gaming became a main source of reward. Eventually games took on a life of their own, with friends met through the online world and more and more time spent playing. Thus, games, while preventing the person from experiencing pain (through immediate gratification), are also preventing them from experiencing adaptive anger and primary sadness in useful ways. In therapy our work becomes identifying the role videogames are playing and “doing something different” with one’s sadness/anger—be it accepting/honoring it, providing the self with compassion, and/or sharing it with someone they trust. Treatment can also involve behavioral strategies to experiment with limiting videogames in ways that make sense to the person. For example, in that moment in which we feel extremely frustrated by a loss or angry at a game, choosing to turn it off and just sit with the anger, rather than play another round, is an enormous first step. Using other strategies, such as stimulus control (only playing games on the phone while on the elliptical, only playing between lunch and when I have to pick the kids up at 2:30), self-monitoring/daily activity logs, installing software controls such as Net Nanny or Kaspersky, or cognitive restructuring, can also be extremely helpful.

Sometimes we can manage our videogame use on our own without professional help. Oftentimes, however, it is impossible to feel what we have “cut-off” for so long through videogames without support from a trusting professional. Please don’t hesitate to reach out.