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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 35  |  Issue : 3  |  Page : 217-219

Managing online video gaming-related addictive behaviors through motivational interviewing


Department of Clinical Psychology, PsyClinic, Delhi, India

Date of Submission18-Dec-2018
Date of Decision25-Mar-2019
Date of Acceptance26-Apr-2019
Date of Web Publication30-Sep-2019

Correspondence Address:
Dr. Tarun Verma
PsyClinic, B-3/141, 2nd Floor, Paschim Vihar, Delhi - 110 063
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_113_18

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  Abstract 


Video gaming on the Internet has become quite common among teenagers, mainly boys. Excessive gaming is affecting the daily life of children, which includes studies, social life, and emotional health. Such addictive patterns of online gaming are causing significant distress to the child and family. The current case discusses the implementation of a psychological intervention technique called motivational interviewing to bring changes in a teenage boy's addictive online gaming behaviors who had left attending school with goals of becoming a professional gamer. The 12-session process is outlined here with brief details about five principal stages of change that helped the child in regaining motivation and interest in his studies while managing his addictive behaviors.

Keywords: Addiction, motivational interviewing, online, video game


How to cite this article:
Verma T. Managing online video gaming-related addictive behaviors through motivational interviewing. Indian J Soc Psychiatry 2019;35:217-9

How to cite this URL:
Verma T. Managing online video gaming-related addictive behaviors through motivational interviewing. Indian J Soc Psychiatry [serial online] 2019 [cited 2019 Dec 10];35:217-9. Available from: http://www.indjsp.org/text.asp?2019/35/3/217/268337




  Introduction Top


There are no guidelines to treat adolescents with excessive online gaming. Studies showing successful management of excessive gaming are few and focus on targeting gaming behaviors from the viewpoint of addictive disorders.[1] This is reflected in the fact that The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition has shown interest in the inclusion of this disorder as having promising prospects in dealing with this significant form of maladaptive gaming style. Internet gaming disorder, as it is generally called, has been proposed as a kind of addictive disorder. However, its status as a form of addiction is not yet clear.[2] A case of successful management of addictive gaming behaviors is described below through the application of motivational interviewing (MI).


  Case Report Top


The parents of a 15-year-old boy, who is studying in 10th standard at a prestigious private school, living at home in a nuclear family, having an elder sister of 18 years, came up with the complaints of his excessive use of video game (mainly online) for the past 1 year. His gaming has replaced his everyday activities and he has left going to school for the past 2 months. He has been getting aggressive and shouts at parents often to let him play his games. Parents are worried about his changed behaviors and are not able to convince him to limit his habit of gaming. He spends much of his time in his room playing the games, and generally misses meals and personal hygiene to keep himself busy with games. His sleep is disturbed with 5–6 h duration, does not eat with the parents and keeps his room locked for most of the time so that no one enters the room to distract him. He does not like talking to friends on the phone or social media. Only people he talks with are the ones whom he interacts on gaming platforms. He has social media accounts but only to interact for gaming purposes. For the past 3 weeks, he has been telling parents that he would discontinue schooling and wants to become a professional gamer. His parents are worried and want him to finish schooling for which they seek professional help.

Interview with parents revealed certain patterns of his reinforcements in the past few years. He started playing a few online games in 7th standard and his interests continued in 8th standard when he purchased his PS4. He was able to manage his time during this period and was not stubborn to play it all the time. Since then, he had begun planning to have his gaming computer and asked parents occasionally for the same. After a lot of insistence, his parents agreed to his interests and bought him an INR 1.5 lakhs gaming computer (when he was in 9th standard) which has costly parts such as random access memory (RAM), graphic cards and monitor. Since then, he has been playing multiplayer games online where he engages in online gaming with players from other countries. Most of these players fall in his age group of teenage, but few of them are quite older (>x20 years). The time he spends in playing has been increasing from 2–3 h in 8th standard to 5–7 h in 9th and 14–15 h currently.

Interventions started with convincing the boy to meet the psychologist for career counseling to pursue his dream of becoming a professional gamer. The primary concerns were motivating him to complete school and for that, focus on studies should be there. Since he was resisting to consider any change and was feeling forced for the consultation, it was considered appropriate that MI should be utilized for achieving outcomes of interest. MI is used commonly with substance disordered patients and considering his excessive use of gaming as a form of addiction, MI was used on similar lines with the child as is done with alcoholic or drug addict individuals.[3] Here, due to space constraints, details of work would not be discussed, rather stages of change during the process of therapy would be outlined. Throughout the intervention, core principles of MI were implemented, abbreviated as RULE, i.e., Resist the righting reflex, Understand the patient's motivation, Listen with a client-centered approach, and Empower the patient. Core skills used by the therapist can be abbreviated as OARS – Open-ended questions, Affirmations, Reflective listening, and Summaries.

Assessments were made as part of the regular process of therapy. Depression, anxiety, social anxiety, anger, and gaming addiction were assessed thrice during the course of therapy – at the beginning, after six sessions, at the end of the final 12th session. Scales used were Revised-Children's Anxiety and Depression Scale-47, Adolescent Anger Rating Scale -41, and Game Addiction Scale (GAS-7). The scores of the child at three points in therapy are given in [Table 1].
Table 1: Scores of the child during the therapy process on Revised-Children's Anxiety and Depression Scale, Adolescent Anger Rating Scale, and Game Addiction Scale

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  • Stage 1: Precontemplation (2 sessions) – To initiate, he was shown certain options as to how he can become a professional gamer. The psychologist did not resist or criticize his behaviors, as it would have affected his compliance and the purpose of counseling. The child was asked for his reasons to engage in gaming and how he developed his interests, what options he has chosen for himself, and whether he has any career path in front of him to follow in future. He was looking forward to participating in some competitions at an international level to make himself confident. He was asked about his time management and the reasons he has lost interest in studies. He rationally defended his choice and told that everyone wants money after all, so why not get that by following one's dreams. Regarding the importance of studies, he said that he will complete schooling through distance education programs. He was suggested to gather information about ways of making a career of his interest and explore options, as well as how studies can contribute to his goals
  • Stage 2: Contemplation (2 sessions) – Psychologist discussed changes in his lifestyle and how they are affecting his health. He was motivated that if he wants to pursue a career in gaming, he can approach it with less distress and with minimum negligence of daily activities. He was shown reading material about the effects of too much gaming on physical and mental health, and how maintaining a proper routine can help him in making the right decisions. The focus was given on the current dynamics at home and how this current state of emotional exchanges at home are putting barriers in his career growth. He agreed to work on some goals which can keep him emotionally calm, but with hesitations. He was motivated to keep interactions healthy at home with family members as his distress can put him at risk of developing depression and anger
  • Stage 3: Preparation (1 session) – He discussed his other life goals and how he sees himself in the future. He wants to visit different countries and plans to settle in Europe. He sees a larger scope of gaming career in Europe and would like to study gaming from technical aspects too. He came up with few more options, and the therapist was able to establish a behavioral contract with him about ways to change behaviors in the next few weeks. He was agreeing to give studies a second thought
  • Stage 4: Action (3 sessions) – He began taking intervals during gaming, maintained regular sleep patterns with 8 h sleep, interacted with parents positively and ate meals with them, did not start to study but agreed to take private tuitions with resistance. He showed less anger and felt less depressed in 4 weeks since the initiation of counseling [Table 1]
  • Stage 5: Maintenance (4 sessions) – He became regular in taking private tuitions, realized the importance of studies, wanted to complete 10th standard through distance learning, was actively playing games but reduced the number of people he used to interact with earlier online, began focusing on maintaining healthy patterns of gaming keeping in mind that he may get addicted and more distressed if he does not control himself, considered the importance of social interactions.


Apart from the individual sessions with the child, family counseling was done in one session at the beginning of therapy which included psychoeducation, and necessary changes to be made by parents in their actions and communications at home to let the child cope with distress that would facilitate the therapy.


  Discussion Top


The problem of addictive video gaming is becoming common among teenagers, especially boys, who show rebellious and disordered patterns of behaviors.[4] Their issues become complicated through unhealthy interactions at home and worrying parents generally escalate the problems by mishandling the child. Teenagers need to rationally understand their behaviors and the impacts these have on their mental health as well as functional outcomes. MI, cognitive behavioral therapy (CBT), and other related techniques [5] tend to modify maladaptive behavioral patterns associated with gaming addictions. Addictive behaviors are characterized by reduced cognitive control, disinhibitions in emotional regulations, and underlying negative cognitions relating to self and future.[6] Psychological interventions, like MI as described above, are effective in targeting comorbid issues [1] too like depression, anger, anxiety, sleep problems, loneliness, social skills, and stress. This case report provides a brief perspective into ways to manage a video game addicted teenager. The child showed changes in himself through the application of motivational techniques by the therapist, and very brief emphasis was given on altering his cognitions. As can be seen, the therapy process was collaborative and based on acceptance of the child's current state. Less emphasis was put on changing the child through suggestions and compelling to do necessary activities that are generally provided in CBT. The work of the therapy can be described in the abbreviation PACE – Partnership with patient, Acceptance, Compassion, and Evocation of emotions about himself that were neglected at home. [Table 1] indicates that the MI reduced the scores of the child's depression, anxiety, anger, and addiction in the course of 12 sessions over 2 months. He is currently not addicted to video gaming, based on cutoff criteria of GAS. Therefore, this is a case of treatment success without the employment of in-depth cognition-behavior analysis. Future studies with a large number of participants and with elaborate designs for comparative analysis may throw light on the effect of MI across other kinds of addicted individuals (drug vs. alcohol vs. game addiction). Studies are also needed to understand differences between various therapeutic interventions (CBT vs. MI vs. acceptance commitment therapy) on game addict individuals.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dong G, Potenza MN. A cognitive-behavioral model of internet gaming disorder: Theoretical underpinnings and clinical implications. J Psychiatr Res 2014;58:7-11.  Back to cited text no. 1
    
2.
Brand M, Laier C, Young KS. Internet addiction: Coping styles, expectancies, and treatment implications. Front Psychol 2014;5:1256.  Back to cited text no. 2
    
3.
Miller WR. Motivation for treatment: A review with special emphasis on alcoholism. Psychol Bull 1985;98:84-107.  Back to cited text no. 3
    
4.
Przybylski AK, Weinstein N, Murayama K. Internet gaming disorder: Investigating the clinical relevance of a new phenomenon. Am J Psychiatry 2017;174:230-6.  Back to cited text no. 4
    
5.
Przepiorka AM, Blachnio A, Miziak B, Czuczwar SJ. Clinical approaches to treatment of internet addiction. Pharmacol Rep 2014;66:187-91.  Back to cited text no. 5
    
6.
Lemmens JS, Valkenburg PM, Peter J. Psychosocial causes and consequences of pathological gaming. Comput Hum Behav 2011;27:144-52.  Back to cited text no. 6
    



 
 
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