Behavioral Treatment Protocol

The behavioral treatment methods described in this document are designed as an intervention to prevent and treat video game addiction. This treatment protocol is based on the idea that video game addiction is similar to other addictions in that it is the result of neural connections ("wiring") and chemical changes in the reward pathway of the brain. To adequately treat the addiction, interventions that create new wiring in these pathways to mediate the wiring causing the addiction, and not abstinence, that will effect curative treatment. The science behind this theory is based on addiction research from the National Institute on Drug Abuse. For more information on the basis for this assumption, see this article. This theory is also based on more than a decade of clinical work and the successful use of this protocol, even in the absence of other psychological care.

The simplest way to conceptualize this is to consider video game play as behavioral conditioning with the game's design characteristics (i.e. competitive structure, reinforcement schedules), the players's characteristics (i.e. genetics, life experiences) and "sufficient" amounts of play time resulting in an individual becoming psychologically dependent (addicted). Effective treatment, therefore will extinguish this behavioral conditioning through continued play, but now with reduced rewards of play. As the game play becomes less rewarding, the player will naturally lose motivation to play. While we cannot alter the game characteristics, we can reduce the amount of play and indirectly lower the rewards of play. This protocol is also designed to prevent dependency by reducing the amount of allowed play time to "safe" levels. Here are the three basic elements of this treatment protocol:

Reduce Amount of Play Time

By reducing the amount of game play, the quantity of moment-to-moment reinforcement is obviously reduced. But more importantly, even a modest reduction in the amount of game play can significantly lower the game’s overall rewards. This occurs through a reduction in direct rewards (i.e. loot), competitive factors such as lowered team/player rankings resulting in lowered motivation to play, and finally, limiting the rewards of associated activities such as on-line socializing or engaging in “pseudo-play” activities. These are activities such as watching others play through YouTube, streaming or “eSports”, researching game tricks/cheats or visiting web sites and forums discussing the game play. Continued play with gradually reducing rewards of play will, presumably lower the gamer’s expectation of rewards of such play and lower the individual’s motivation for play.

While lowering game and pseudo play time sounds straightforward, it is not that easy. First, the amount lowered should be based on the client's ability to cope as well as the types of games played. The rate at which play time is lowered is another important consideration. If you lower the game play beyond an individual's ability to cope, negative reactions could compromise treatment. The extreme example is taking away the gaming completely and sending them into a suicidal rage followed by a psychiatric hospitalization. A less extreme example is where the individual acts out (i.e. threats, violence or manipulation) toward caregivers. This can result in caregiver avoidance behaviors such as allowing additional, unapproved gaming time, not following agreed-upon contingent strategies or even the abandonment of treatment altogether.

Then there is the problem of reduction mechanics. Recommending a client monitor and limit their own game play time will likely be ineffective, although this should still be the first strategy for adult clients. Ultimately, external controls will most likely be necessary. Even this is problematic as it likely these have failed in the past. Unfortunately, operating system and gaming console parental controls are often not effective in stopping a motivated adolescent or adult as they are too easily bypassed. Since the addict is often more technically knowledgeable than those setting limits, parents are usually at a disadvantage when attempting to enforce limits.  The Sentinel Gaming System was designed for this specific behavioral treatment protocol and provides many features to improve treatment adherence.  

Reduce Complementary Rewards

There are a number of complementary rewards associated with computer game play. Often these complementary rewards come from the technology itself. Parents would be counseled to not buy new or better gaming equipment or allow their child to build their own computer or purchase new accessories related to gaming (i.e. advanced controllers). Parents would seek to inform other family member as well.

Increase Competing Rewards: Enrichment

As less time is available for gaming and more time is spent on competing activities (homework, employment, socializing), it is anticipated that these activities will become sufficiently rewarding (i.e. better grades). Parents are counseled to find new enrichment activities for their child. If necessary, limited extra computer/video game time can be used to motivate the initiation of competing activities. This is particularly challenging as an individual will initially have little interest in other activities other than gaming and media consumption.

Older gaming addicts must find meaning and purpose in their life and pursue new or revived passions that, over time, will offer more significant rewards than the gaming. Career assessment/counseling, individual, family and marital counseling are but a few ways to help clients through this life transition.