J Behav Addict. 2017 Dec 1;6(4):572-578. doi: 10.1556/2006.6.2017.084.
Buono FD1, Griffiths MD2, Sprong ME3, Lloyd DP1, Sullivan RM1, Upton TD4.
Abstract
Background
Internet gaming disorder (IGD) was introduced in the DSM-5 as a way of identifying and diagnosing problematic video game play. However, the use of the diagnosis is constrained, as it shares criteria with other addictive orders (e.g., pathological gambling).
Aims
Further work is required to better understand IGD. One potential avenue of investigation is IGD’s relationship to the primary reinforcing behavioral functions. This study explores the relationship between duration of video game play and the reinforcing behavioral functions that may motivate or maintain video gaming.
Methods
A total of 499 video game players began the online survey, with complete data from 453 participants (85% white and 28% female), were analyzed. Individuals were placed into five groups based on self-reported hours of video gaming per week, and completed the Video Game Functional Assessment – Revised (VGFA-R). Results The results demonstrated the escape and social attention function were significant in predicting duration of video game play, whereas sensory and tangible were not significant.
Conclusion
Future implications of the VGFA-R and behaviorally based research are discussed.
KEYWORDS: Internet gaming disorder; VGFA-R; functional assessment; video games
PMID: 29280397
Discussion
This is the first study to examine whether reinforcing behavioral functions differ by the amount of weekly video game play using the VGFA-R. The results demonstrated a positive linear relationship between the hours of play and two of the four behavioral functions (social attention and escape) when compared with other functions at higher rates of play. Interestingly, this study is consistent with and extends Sprong et al.’s (2014) initial findings that escape maintained behaviors are predominantly found among individuals who play video games more than 24 hr/week.
Compared with the other behavioral functions, escape maintained behaviors are more often negatively maintained, such as those via the avoidance of responsibilities. From a behavioral theoretical approach to addiction (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996), avoidance behaviors are more likely to lead to negative consequences, which can result in a reinforcement cycle. Frequent avoidance of responsibilities can lead to problems, for which additional avoidance can be even more reinforcing (Mentzoni et al., 2011; Yee, 2007). Therefore, what maintains a video game player’s initial motivation for playing a few hours a week would differ from those who play frequently. For example, an individual engaging in a game played via mobile applications (e.g., Candy Crush) for less than 5 hr/week is presumably maintained by the tangible function (gaining access to the next level or unlocking a new item) as compared with an individual who engages in over 24 hr/week, who may exhibit escape or combination of functions that maintain their game play.
The social attention condition can be maintained through either positive or negative reinforcement. The current research extends Yee’s (2007) work on motivations of play, in particular attention, by indicating that social attention and duration of play have a direct relationship. Moreover, current video games incorporate social attention aspects to retain and provide enticement (Christou, 2014), and by incorporating social attention into a game’s design, game developers can increase duration of play. The social attention framework is counter to escape maintained functions, in which escape maintained behaviors are generally extrinsic to the video game, whereas social attention is directly tied to the video game. Understanding this factor of social attention from a behavioral framework within the context of a video game needs further examination to provide a better understanding of how it might produce meaningful change in players.
Future research should investigate the process of change within maintaining behavioral functions of video game play. The current findings are consistent with research on other addictive behaviors (e.g., pathological gambling) (Weatherly, Miller, Montes, & Rost, 2012; Weatherly, Miller, & Terrell, 2011). Weatherly et al. (2011) found higher incidents of negative contingencies impacting pathological gamblers when evaluating the positive and negative contingencies that reinforce the problem behavior compared with matched controls. Escape maintained behaviors are primarily found within negative contingencies; although the current findings are consistent with a behavioral theoretical perspective, these findings are cross-sectional. Longitudinal studies are needed to better elucidate the development of reinforcement patterns over time and how they pertain to video game play.
The proposed diagnostic criteria in the DSM-5 for IGD (Petry, Rehbein, Ko, & O’Brien, 2015) discuss the impact of reinforcing motivations of online video game play. Of the symptoms listed earlier in the paper, five are consequences of an overreliance on a single reinforce (e.g., loss of interest in other activities, overuse, use to relieve anxiety or guilt, lying about use, and lost opportunity or relationship), while duration of play is indirectly mentioned in the criteria of IGD diagnosis (Criteria 3 and 6; APA, 2013). The amount of video game use, even among individuals with high levels of play problems, needs to be further evaluated. Thus, a limitation of this study was that we did not examine how IGD symptoms were associated with amount of use or behavioral maintaining functions. However, symptom criteria may be viewed as closely related to escape behaviors; other behavior functions could result in the same symptoms. Consequently, a direct evaluation of the relationship between reinforcing functions and diagnostic symptoms, including individuals diagnosed with IGD and those without, is needed.
There were some additional limitations of the current research. First, a majority of participants were recruited through online forums and blogs. Several scholars discuss the disadvantages of recruiting video game players online (Griffiths, 2010b; Griffiths, Lewis, Ortiz de Gortari, & Kuss, 2015; King, Delfabbro, & Griffiths, 2009). There are four specific issues when it comes to recruiting online: (a) threat responses, (b) dishonesty, (c) lack of awareness, and (d) incentive. All these issues were addressed using proactive strategies outlined by King et al. (2009). These challenges were addressed by including a precautionary message during orientation alerting potential participants to the credibility of the research study by displaying the university’s logo and the lead author’s signature page. In addition, participants were placed in a lottery draw to win one of four $50 gift cards. Second, the exact number of hours of self-reported game use per week was not assessed, because participants selected the category of hours of use that was most appropriate to their gaming usage. A continuous measure would have provided greater statistical flexibility to evaluate linear and non-linear relationships with the outcome. However, we chose the measure to be consistent with other recent studies of the amount of video game play (e.g., Buono, et al., 2016; Sprong et al., 2014; Van Rooij & Prause, 2014) as self-reported hours of video game use tends to be under reported, possibly due to a perceived stigma of the implications of frequent use. Third, in our attempt to control for this study, we only excluded for cigarette usage, pathological gambling, and alcohol usage. It should be noted that none of the participants self-reported any usage on these measures above the threshold for exclusion. IGD is a complex disorder and understanding other co-occurring diseases or disorders needs to be evaluated in greater detail. Finally, more research needs evaluate if the maintaining motivations (i.e., social attention, escape, tangible, and sensory) are interdependent or independent of themselves. The present research found these functions as independent, which reinforces previous research by Sprong et al. (2014). In examining therapeutic treatments for IGD, firmly establishing a function’s potential independence is of critical importance to assess for a given treatment’s efficacy.
Although IGD was not directly assessed, the present results have clinical implications. The VGFA-R provides a comprehensive assessment that can be used for functional analysis of behavior, a common initial step in behavioral and cognitive-behavioral treatments of addiction. By understanding the factors motivating the individual to continue game play, therapists can work with patients to determine methods to reduce problematic game use or to establish if current patterns of play are of clinical or behaviorally significant. The findings of this study suggest that treatment would likely need to address escape/avoidance and social attention behavior provided by high levels of game use, targeting alternative reinforcing behaviors to replace the functions that the video game play provides, or address the need or desire for avoidance directly.
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