Red box, green box: A self-report behavioral frequency measurement approach for behavioral addictions research.

Behavior frequency measures in behavioral addictions research fail to account for how engagement in the activity relates to each respondent's personal circumstances. We propose a "Red Box, Green Box" method, an alternative to conventional self-report behavior questions. Participants report two distinct time-based values: (1) Green box: time spent engaged in the activity during 'free' time, and (2) Red box: engagement in the activity at times when the respondent should be doing something else (e.g., studying, working, sleeping, exercising, etc.). Some practical examples of the 'red box, green box' method are provided. This method may help to calibrate behavioral frequency for each respondent and yield clearer insights into displacement effects and risks associated with frequency of use. We suggest some future research directions to test the feasibility and utility of this approach in different implementations.

Impaired control and gaming-related harm in relation to gaming Disorder.

The concept of impaired control (IC) over gaming is an important element of assessment and interventions for problem gaming and gaming-related harm. Past studies have reported that gaming disorder (GD) is associated with various negative consequences, but there is limited research on the relationship between IC over gaming and negative outcomes. To address this gap, the study investigated the relationship between impaired control and gaming-related harm among individuals with self-identified gaming disorder. It was hypothesized that IC would be positively associated with gaming-related harm and harm severity. In addition, it was predicted that IC would be a significant predictor of harm when controlling for age, gender, psychological distress, and gaming urges. The current study recruited 513 participants through an online survey platform. The Impaired Control Over Gaming Scale (ICOGS) was used to measure IC, and modified items from Browne et al.'s taxonomy of gambling harms were used to assess gaming harm severity. The logistic regression results showed that IC was positively related to all forms of harm, after controlling for other variables. The predictive value of IC was similar across financial, psychological, relationship, social and work/school domains. These results supported the importance of IC as a mechanism that contributes to the experience of gaming-related harm, and the need to target IC in interventions for GD.

Reconsidering item response categories in gaming disorder symptoms measurement.

Gaming disorder (GD) screening often involves self-report survey measures to detect the presence of symptoms. Studies have shown that gamers' responses vary greatly across survey items. Some symptoms, such as preoccupation and tolerance, are frequently reported by highly engaged but non-problematic gamers, and therefore these symptoms are thought to lack specificity and are suggested to be less important in classification decisions. We argue that the influence of response categories (e.g., dichotomous responses, such as 'yes' or 'no'; or frequency categories, such as 'rarely' and 'often') on item responses has been relatively underexplored despite potentially contributing significantly to the psychometric performance of items and scales. In short, the type of item response may be just as important to symptom reporting as the content of survey questions. We propose some practical alternatives to currently used item categories across GD tools. Research should examine the performance of different response categories, including whether certain response categories aid respondents' comprehension and insight, and better capture pathological behaviours and harms.

Gaming disorder and stigma-related judgements of gaming individuals: An online randomized controlled trial.

BACKGROUND AND AIMS: The inclusion of gaming disorder (GD) in the International Classification of Diseases 11th Revision (ICD-11) has generated scholarly debate, including claims about its potential stigmatizing effects on the wider gaming population. The present study aimed to estimate the effect of addiction-based and non-addiction-based conceptualizations of problem gaming on stigma of gamers. DESIGN: This preregistered experiment involved a 2 (health information: addiction-related or non-addiction-related) × 3 (vignette: problem, regular or casual gamer) randomized, between-subjects design. SETTING: An international sample of participants was recruited via Prolific in June and July 2021. PARTICIPANTS: Participants were eligible (n = 1228) if they were aged 35 to 50 years, played video games for no more than 6 hours per week and did not endorse DSM-5 or ICD-11 criteria for GD. INTERVENTION AND COMPARATOR: Participants were provided with an explanation of problem gaming as related to either an addictive disorder (i.e. 'addiction' explanation) or personal choice and lifestyle factors (i.e. 'non-addiction' explanation). MEASUREMENTS: The Attribution Questionnaire (AQ) and Universal Stigma Scale (USS) assessed stigma toward each gamer vignette. Vignettes described a problem gamer (with features of GD); a regular gamer (frequent gaming; some life interference); and a casual gamer (infrequent gaming; no life interference). FINDINGS: Problem gamer vignettes (mean [M] = 113.3; 95% CI = 111.5-115.4) received higher AQ stigma ratings than regular (M = 94.0; 95% CI = 91.9-95.9) and casual gamers (M = 80.1; 95% CI = 78.2-82.1). Although significant, the effect of health information type on AQ stigma ratings was negligible (addiction group [M = 97.6; 95% CI = 95.9-99.1], non-addiction group [M = 94.1; 95% CI = 92.6-95.8]). However, the addiction information group scored lower on USS blame and responsibility than the non-addiction information group with at least a small effect (99.1% confidence). CONCLUSIONS: Framing of problem gaming as an addictive disorder or non-addictive activity appears to have a negligible effect on stigma of different gamers among middle-age adults with minimal gaming experience. The concept of 'gaming addiction' seems unlikely to be an important influence on public stigma of gaming.

Impaired control over gaming scale (ICOGS): Development, confirmatory factor validation, and psychometric evaluation.

Background and aims: The concept of impaired control is central to addictive disorders, including gaming disorder in the DSM-5 and ICD-11. Impaired control refers to the recurrent inability to resist impulses to engage in certain activities or behaviours and the failure to limit or stop this engagement. Although numerous screening tools for gaming disorder symptoms have been developed, these instruments have limited capacity for measuring the nature and extent of impaired control. To address this limitation, the present study reports on the creation of the Impaired Control Over Gaming Scale (ICOGS), an 8-item screening tool to assess gaming-related impaired control. Methods: A total of 513 gamers, including 125 gamers (24.3%) who met the DSM-5 criteria for gaming disorder, were recruited from Prolific, an online crowd-sourcing platform. Results: The ICOGS demonstrated promising psychometric properties. Exploratory and confirmatory factor analysis using two samples provided robust support for a 2-factor model and high internal consistency of the scale. ICOGS scores were significantly and positively associated with gaming disorder symptoms, gaming-related harms, gaming frequency, psychological distress, and neuroticism. Using receiver operating characteristic analysis, the ICOGS differentiated between non-problem gamers and those who met the criteria for GD. Discussion and conclusions: Overall, the ICOGS appears to be a valid and reliable scale for use in studies of problem gaming, and may be useful for assessing outcomes of GD interventions that employ self-regulation and stopping techniques to reduce or eliminate problem gaming behavior.

Gaming disorder and the COVID-19 pandemic: Treatment demand and service delivery challenges.

Gaming activities have conferred numerous benefits during the COVID-19 pandemic. However, some individuals may be at greater risk of problem gaming due to disruption to adaptive routines, increased anxiety and/or depression, and social isolation. This paper presents a summary of 2019-2021 service data from specialist addiction centers in Germany, Switzerland, Japan, and the United Kingdom. Treatment demand for gaming disorder has exceeded service capacity during the pandemic, with significant service access issues. These data highlight the need for adaptability of gaming disorder services and greater resources and funding to respond effectively in future public health crises.

Hairdressers as a source of social support: A qualitative study on client disclosures from Australian hairdressers' perspectives.

Hairdressing is one of the few non-health professional occupations where workers physically interact with clients, who are often comfortable in confiding private information to them. Despite this, relatively little is known about how hairdressers understand and experience this role as informal confidants. This study aimed to address this using an in-depth qualitative approach to capture what hairdressers are hearing from clients, and how hairdressers respond and feel about supporting clients. Participant led interviews with prompt questions were conducted in South Australia in 2019, transcribed and analysed using Thematic Analysis. Results indicate clients disclose information about family, health, identity, mental health and women's health. Important themes generated in relation to the role of hairdressers included: their need to have a client focus; blurring role boundaries; behaving like a therapist and, providing a place of safety and advice, while also maintaining confidentiality. Hairdressers reported feeling undervalued, emotionally drained, and in need of support in their role, but conversely, also reported having good job satisfaction. Further research is needed to examine whether hairdresser-client interactions may promote better mental and physical health outcomes for clients due to psychological buffering arising from the social support provided by hairdressers, as well as the impact on hairdressers and implications for their training.

Associations Between Adverse Childhood Experiences and Trauma Among Young People Who Offend: A Systematic Literature Review.

This systematic review synthesized current knowledge about the prevalence of adverse childhood experiences (ACEs) among young people known to have offended and examined evidence of associations between ACEs, trauma symptoms, and offending behavior. A systematic search of English-language, peer-reviewed studies published from the year 2000 onwards was conducted. A final pool of 124 studies that reported quantitative data were included in the review. The Cambridge Quality Checklist for the assessment of studies on offending was used to assess methodological quality of included studies. Pooled data indicated that almost 87% of justice-involved young people across 13 countries experienced at least one traumatic event. The odds of experiencing at least one ACE were over 12 times greater for justice-involved young people compared with nonjustice-involved young people. Prevalence of individual ACEs ranged from 12.2% for childhood sexual abuse to 80.4% for parental separation among justice-involved young people. Those who reported both a higher number and multiple types of ACEs were more likely to be diagnosed with post-traumatic stress symptoms. However, when considering only high-quality studies, there was minimal evidence to suggest that a higher incidence of ACEs predicted trauma symptoms or that trauma symptoms mediated the association between ACEs and offending behavior. Further research is needed to elucidate factors that differentiate young people exposed to ACEs who go on to offend from those who do not. This research is essential to understanding whether ACEs and trauma are drivers of offending behavior and for informing prevention and intervention strategies.

Addressing Intergenerational Trauma in an Adolescent Reunification Program: Case Studies Illustrating Service Innovation.

Adolescents in out-of-home care generally have poor prospects for reunification with their birth families. However, for some adolescents in care, with deliberate support and intervention, there may opportunities for successful reunification. The Adolescent Reunification Program (ARP) is an Australian program designed to assist young people aged 12-17 years return home to their families. The program focuses on supporting families, mentoring young people so as to meet their developmental and educational needs, and providing a safe home environment. It also included an innovative therapeutic component which focused on addressing the consequences of intergenerational trauma in order to help repair relationships between parents and children. The purpose of this paper is to describe the therapeutic component of the program and to examine the potential value of therapy in a family reunification context with a particular focus on client receptivity and preliminary evidence on outcomes. Using case illustrations, this paper describes the therapeutic component of the ARP and provides a preliminary evaluation of these components using a mixed methods approach, including standardised psychological assessments, qualitative interviews with parents and young people, and reflections from the program workers. The therapeutic component of the ARP may have helped to break the cycle of intergenerational trauma by bringing focus to the interrelationships between how people feel and how they act. This was done through the work of therapists attempting to combine non-judgmental exploration and positive therapeutic framing with practical support within the context of the environment where the family reunification occurred. Therapy in conjunction with practical supports within a multidisciplinary collaborative approach may help to facilitate better outcomes for reunification when working with complex families.

Player-avatar interactions in habitual and problematic gaming: A qualitative investigation.

BACKGROUND AND AIMS: Previous studies have reported that stronger avatar identification and negative self-concept are associated with gaming disorder (GD). This study aimed to examine the value and significance of avatars based on firsthand accounts from regular and problematic gamers, and to identify any potential links between avatar-related experiences and excessive gaming. METHODS: An online survey of 993 adult gamers yielded 3,972 text responses. Qualitative analysis of 59,059 words extracted 10 categories of avatar-related perspectives. RESULTS: Some problem and non-problem gamers employed sentimental language (e.g., 'dear friend', 'like a child', 'part of my soul') to refer to their avatar. However, most participants perceived avatars as a means of achieving in-game goals and enabling greater interactivity (e.g., socializing). When asked to reflect on hypothetically losing their avatar, participants generally anticipated feeling temporary frustration or annoyance due to lost time and effort invested into the avatar. Although some participants reported that their avatar 'mattered', avatars were often considered as superficial ('just pixels') and peripheral to the primary reinforcement of achieving in-game rewards and objectives. Some broader psychological and identity issues such as gender dysphoria, rather than 'addiction', were cited as motivating persistent avatar-related interactions and attachment. DISCUSSION AND CONCLUSIONS: Participants reported diverse views on the psychological value and function of avatars, but the relationship between avatars and problematic gaming or GD was largely unclear or inconsistent, and refuted by some participants. Future research with clinical samples may lead to a better understanding of player-avatar processes, including whether avatar-stimuli facilitate the development of maladaptive gaming habits, particularly among psychologically vulnerable players. Future investigations should be mindful of 'overpathologizing' avatar-related phenomena and recognize their important role in socializing, storytelling, and creative expression among gamers.

Prevention Strategies to Address Problematic Gaming: An Evaluation of Strategy Support Among Habitual and Problem Gamers.

Psychosocial problems arising from excessive gaming are a public health issue across the developed world. In its most serious form, problematic gaming is recognized as gaming disorder (GD) in the ICD-11. Research has tended to focus on the value of outpatient treatment for GD, but less attention has been paid to broader prevention strategies to address less serious but nevertheless harmful gaming behaviors. Another gap in this literature has been the lack of involvement of the gaming community as stakeholders to identify feasible prevention approaches. This study investigated: (1) regular and problematic gamers' level of support for different prevention strategies within primary, secondary, and tertiary approaches; and, (2) whether self-efficacy is associated with greater support for prevention strategies, as predicted by the Health Belief Model. A total of 992 participants completed an online survey that evaluated support for problem gaming prevention strategies and included measures of self-efficacy, gaming involvement, and GD symptoms, psychological distress, and mental health help-seeking behaviors. Participants reported stronger support for primary prevention strategies, including education, screening, and warning labels, than for other prevention approaches. Overall, 61% of participants expressed support for primary prevention as compared to secondary (39%) and tertiary (36%) approaches. There was stronger support for outpatient care (48%) than inpatient services (25%). In-game shutdown features received the lowest support (65% disapproval). Contrary to the Health Belief Model, self-efficacy was not associated with prevention support. Younger, female, and less frequent gamers were more likely to support primary and secondary prevention strategies. These findings suggest that gamers may be more favorable toward prevention measures aligned with informed decision-making, autonomy, and self-directed actions. Gamers may be strongly opposed to modifications to the structure of gaming activities (e.g., shutdown features). Future research should evaluate the efficacy and cost-effectiveness of problem gaming prevention measures in different populations and regions.

Avatar identification and problematic gaming: The role of self-concept clarity.

Some video-gaming activities feature customizable avatars that enable users to fulfil self-identity needs. Research evidence (e.g., fMRI and survey studies) has suggested that poorer self-concept and stronger avatar identification are associated with problematic gaming. Player-avatar relationships have thus been proposed to require attention in gaming disorder assessment and interventions. To examine the interplay of player-avatar interactions in problematic gaming, this study investigated whether avatar identification differed according to avatar characteristics and game types, and whether the association between avatar identification and problem gaming was mediated by self-concept clarity. A total of 993 adult respondents completed an online survey that assessed problematic gaming, avatar identification, and self-concept clarity. The results indicated that avatar identification scores were generally unrelated to avatar characteristics (e.g., human resemblance, degree of customizability, and in-game perspective). Avatar identification was significantly positively related to problematic gaming and significantly negatively related to self-concept clarity. There was a significant indirect relationship between avatar identification on problem gaming mediated through self-concept clarity. These findings suggest that poorer self-concept clarity may be one mechanism by which avatar identification affects problem gaming. Future research with clinical samples may help to gain a better understanding of avatar-related processes and psychological vulnerabilities related to problematic gaming.

Global prevalence of gaming disorder: A systematic review and meta-analysis.

BACKGROUND: Gaming disorder was included in the latest revision of the International Classification of Diseases (11th ed.). Worldwide, prevalence estimates of gaming disorder are considerably heterogeneous and often appear to be exceedingly high. However, few studies have examined the methodological, cultural and/or demographic factors that might explain this phenomenon. This review employed meta-analytic techniques to compute the worldwide-pooled prevalence of gaming disorder and evaluate the potential contributing factors for varied prevalence estimates. METHOD: Prevalence estimates were extracted from 53 studies conducted between 2009 and 2019, which included 226,247 participants across 17 different countries. Study findings were meta-analyzed using a random-effects model. Subgroup and moderator analyses examined potential sources of heterogeneity, including assessment tool and cut-off, participant age and gender, sample size and type, study region, and year of data collection. RESULTS: The worldwide prevalence of gaming disorder was 3.05% (confidence interval: [2.38, 3.91]); this figure was adjusted to 1.96% [0.19, 17.12] when considering only studies that met more stringent sampling criteria (e.g. stratified random sampling). However, these estimates were associated with significant variability. The choice of screening tool accounted for 77% of the variance, with the Lemmens Internet gaming disorder-9, Gaming Addiction Identification Test and Problematic Videogame Playing scales associated with the highest estimates. Adolescent samples, lower cut-off scores and smaller sample size were significant predictors of higher prevalence. Gaming disorder rates were approximately 2.5:1 in favor of males compared to females. CONCLUSION: The worldwide prevalence of gaming disorder appears to be comparable to obsessive-compulsive disorder and some substance-related addictions, but lower than compulsive buying and higher than problem gambling. Gaming disorder prevalence rates appear to be inflated by methodological characteristics, particularly measurement and sampling issues.

"Diagnostic inflation" will not resolve taxonomical problems in the study of addictive online behaviours. •.

This article suggests that the type of Internet-enabled device should not be prioritised when conceptualizing diagnostic categories of addictive online behaviours. The diagnostic distinction between "predominantly mobile" and "predominantly non-mobile" forms of Internet use disorders (IUD) is not empirically based, may not be clinically useful and may lead to "diagnostic inflation." Problems with the concepts of smartphone use disorder and IUD on which the proposed distinction is largely based call for their re-examination. Future proposals for the taxonomy of addictive behaviours may not need to be based on online/offline and mobile/non-mobile dichotomies.

Avatar- and self-related processes and problematic gaming: A systematic review.

The concept of self has become increasingly relevant to understanding the psychological mechanisms of problematic online gaming. Many gaming activities feature in-game avatars that enable the adoption of, and experimentation with, different roles and identities. Avatars enable players to compensate for perceived deficiencies in their real-world self (e.g., lack of physical strength, beauty, or social status). Currently, how avatar- and self-related processes may develop and maintain problematic gaming, including gaming disorder (GD), is unclear. This systematic review examined 18 quantitative studies of avatar- and self-related concepts and problematic gaming, including 13 survey-based and 5 neuroimaging studies. Despite variability in the conceptualization and measurement of avatar/self-related concepts, survey-based studies have consistently reported that negative self-concept, avatar identification, and large self-avatar discrepancies are significantly associated with problematic gaming. Poor self-concept appears to be a risk factor for GD, particularly for games that facilitate role-playing and identity formation. Further research and clinical evidence are needed to explain how avatar- and self-related processes may relate to the addictive mechanisms of GD (e.g., cognitive distortions, reward-seeking, inhibitory control, self-regulation systems), amid calls for problem gaming-related assessment and interventions to incorporate a focus on avatar identification.

Problematic online gaming and the COVID-19 pandemic.

Stay-at-home mandates and quarantines related to the coronavirus (COVID-19) pandemic have led to greatly increased participation in online gaming. Initiatives such as #PlayApartTogether that promote gaming for socializing and stress reduction may achieve positive outcomes. Although gaming can be a healthy coping strategy for the majority, it can also pose risks to some vulnerable individuals. Protracted periods of social isolation and technology-based activity pose the danger of solidifying unhealthy lifestyle patterns, leading to difficulties to readaptation when the COVID-19 crisis has passed. Balanced and effective approaches to gaming during the COVID-19 pandemic are needed to support physical and psychological wellbeing.

Face validity evaluation of screening tools for gaming disorder: Scope, language, and overpathologizing issues.

AIM: Critics of gaming disorder (GD; i.e., Internet gaming disorder in the DSM-5; Gaming disorder in the ICD-11) have expressed concerns about the potential risks of misclassification (e.g., false positives). An important consideration of relevance to this discussion is the extent to which commonly used screening instruments contain appropriate, sensible, and relevant items. The aim of this review was to evaluate the face validity of items within current tools for GD. METHODS: A systematic review of databases identified 29 instruments. An item bank (n = 417 items) was independently evaluated by three professional raters (i.e., a senior academic in clinical psychology, a senior psychometrician, and an academic/clinical psychologist) according to guidelines for defining and measuring addiction and gaming disorder. FINDINGS: Evaluation of the item bank identified issues related to: scope (i.e., "scope creep" or items of questionable relevance); language (i.e., confusing language, unusual wording or syntax); and overpathologizing (i.e., pathologizing typical and/or beneficial aspects or consequences of gaming). A total of 71 items across 23 tools had at least one face validity issue. CONCLUSIONS: Most items (83%) demonstrated satisfactory face validity and were consistent with either the DSM-5 or ICD-11 GD classification. However, many tests contain at least one item that may pathologize normal gaming behaviors. Such items refer to basic changes in mood when gaming, a desire to play or continue playing games, and experiencing immersion when gaming. This analysis highlights the challenges of screening for problematic behaviors that are thought to arise within the context of normal recreational activities.