Advancing cognitive behaviour therapy for gaming disorder: A call for collaborative action

Abstract

Gaming is a globally popular form of digital entertainment, but there is growing recognition of the negative consequences associated with problematic use. Gaming disorder (GD) – the most severe form of problem gaming – is a behavioural addiction sharing diagnostic features with other recognized addictive disorders, including gambling and substance use [1]. Although GD has attracted some academic debate [2], it has gained acceptance in major health nomenclature, including the current International Classification of Diseases (ICD-11).

In parallel with efforts to measure and diagnose GD effectively, increasingly there are more studies of possible treatments, including case reports [3], feasibility studies [4], non-randomized trials [5] and randomized controlled trials [6]. An inspection of recent literature reveals at least 12 systematic treatment reviews, see [7, 8], for example, as well as reviews on treatment for ‘internet addiction’ (an umbrella term commonly used to encompass GD) [9]. Although many treatment approaches exist [10], the evidence seems to primarily favour cognitive behavioural therapy (CBT). CBT has the largest evidence base and has consistently demonstrated efficacy in reducing GD symptoms and associated comorbidities [11, 12], and may also supplement pharmacological interventions [7].

While advancements in GD treatment research are promising, in this letter we draw attention to a critical roadblock to progress: the ‘silo effect’, where information and guidance on CBT approaches for GD are not widely shared or available. Unlike other addictive disorders, such as gambling disorder – where treatment manuals, protocols, and resources are published and freely available – similar information for GD is scarce. Published works vary in their reporting; providing either brief overviews of CBT protocols or modules or tabular summaries of session themes and objectives [13], and many studies are published in non-English languages. No standardized treatment guidelines [e.g. akin to the UK National Institute for Health and Care Excellence (NICE) guidance] and very few practical clinical texts (e.g. books or specialist book chapters) exist for GD. As a result, it is unclear how clinicians in different settings (e.g. inpatient vs outpatient) should administer CBT, and how therapy delivery should vary across individuals, groups and families, or depending upon the individual characteristics (e.g. age, gender, comorbidity, intellectual ability, etc.). At present, therefore, it is often difficult to determine the optimal approach or best practice in CBT delivery for GD.

To advance the promising international work in this area, there is a need for a collective focus on and commitment to principles of transparency, standardization and collaboration. We propose the following practical recommendations: (i) the sharing (including language translation) of treatment protocols and manuals for teaching, training, scientific evaluation and replication purposes; (ii) the publication of illustrative case studies that showcase CBT approaches across diverse client presentations; (iii) an international Delphi study of CBT and other psychological treatments for GD, to consolidate existing knowledge into best practice guidelines; and (iv) the establishment of a professional society or formal network to share expertise, build consensus and identify priority areas of action for GD treatment. We believe that these suggested collaborative actions would greatly advance research and clinical practice for GD, and ultimately improve the outcomes for vulnerable individuals and their families.

Marcela Radunz: Conceptualization; writing—original draft. Matthew W. R. Stevens: Writing—review and editing. Sanni Behm: Writing—review and editing. Zsolt Demetrovics: Writing—review and editing. Paul Delfabbro: Writing—review and editing. Daniel L. King: Conceptualization; funding acquisition; writing—review and editing.

The authors alone are responsible for the views expressed in this letter and they do not necessarily represent the official position, policies, views or decisions of any other organization.