case study on online game

• Open access
• Published: 09 February 2022

Learning in digital play: a dual case study of video gamers’ independent play

• Weimin Toh   ORCID: orcid.org/0000-0002-6468-227X 1 &
• Fei Victor Lim   ORCID: orcid.org/0000-0003-3046-1011 2  

Research and Practice in Technology Enhanced Learning volume  17 , Article number:  6 ( 2022 ) Cite this article

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This paper explores the implications of youths’ out-of-school gaming practices for teaching and learning in formal and informal learning contexts. We report on a study where we examined the video game play of two youths using a case study approach. User experience approaches, e.g. the think-aloud protocol and interviews, were grounded in the theoretical framework of social semiotics to analyse the gameplay videos and to discuss the implications for the youths’ learning. The paper contends that youths are demonstrating critical thinking, empathy, and multimodal literacy through their gameplay. We offer suggestions for how adults can use video games for youths’ learning.

Introduction

People learn as they play (Oliver & Carr, 2009 ). Digital play involves the use of technology, including computers and laptops, tablets, smartphones, electronic toys, and console games for playing and learning activities (Marsh et al., 2016 ). The boundaries between online and offline spaces have become blurred in digital play as communication and play move across physical and virtual domains and integrate material and immaterial practices (Garcia, 2020 ; Giddings, 2014 ; Marsh et al., 2016 ). Digital play is rooted in children’s everyday experiences and can promote cognitive and imaginative development (Edwards, 2011 ). Engagement with video games is a type of digital play that can bring about learning (Toh & Lim, 2021 ; Squire, 2011 ) as they incorporate sound learning principles, such as “just in time learning” that can be used for teaching various subjects in schools (Gee, 2003 ).

Digital play motivates learning because it engages with the students’ “lifeworld” (New London Group, 1996 ). Digital play can be integrated into schools to intrinsically motivate students for their self-directed (Karakas & Manisaligil, 2012 ) and peer-to-peer learning (Butler, 2017 ). For example, Beavis et al. ( 2015 ) reported that teachers were able to improve students’ learning and engagement by connecting teaching to students’ lifeworlds and redesigning their English and literacy curriculum to leverage the joy of gameplay to build students’ literacy proficiency over time. Digital play can also be an effective way for students to demonstrate new literacies needed for the future workforce (Apperley & Walsh, 2012 ). Playing video games is a common pastime of many people, especially amongst males (Jansz, 2005 ). Video game play has also been described as a literacy practice (Steinkuehler, 2010 ; Steinkuehler & King, 2009 ). When video games are used in the school curriculum, it can motivate students (Deng et al., 2016 ) and draw on their funds of knowledge (Risko & Walker‐Dalhouse, 2007 ) for the learning activities. Digital play has been integrated into formal educational contexts for STEM learning (e.g. Ibáñez & Delgado-Kloos, 2018 ) and to motivate L2 vocabulary learning (e.g. Butler, 2017 ), argumentation and persuasion writing (e.g. Dickey, 2011 ), as well as social skills (e.g. Craig et al., 2015 ), creativity (e.g. Ott & Pozzi, 2012 ), critical thinking (e.g. Barab et al., 2012 ), ethical thinking (e.g. Schrier, 2015 ), and mathematical thinking and problem-solving skills (e.g. Kiili et al., 2015 ).

Video games incorporate a whole set of fundamentally sound learning principles that can be used for teaching and learning activities in schools (Gee, 2003 ). Gee ( 2005 ) also explicated the principles of learning that are built into successful games. These include empowering players as active agents who can co-design the learning experience as well as learning through well-ordered problems in which learners are scaffolded to learn how to proceed when they face harder problems later in the game. Squire ( 2002 ) also argued that examining how gameplay can be used to support learning in formal learning environments can be productive. Games like SimCity and Civilisation can mediate our understandings of other phenomena, and they can be used to support learning in formal and informal learning contexts. Pedagogical activities can be integrated into the game design or teachers can adapt the game to engage students in meaningful practices and critical thinking by using scaffolding questions for students to think about how games can be used as a tool for answering historical questions.

Shaffer et al. ( 2005 ) posited that video games are powerful contexts for learning because they make it possible to create virtual worlds and acting in such worlds help to develop the situated understandings, effective social practices, powerful identities, shared values, and ways of thinking of important communities of practice. For instance, Railroad Tycoon can help players to learn economic and geographic issues faced by railroad engineers in the 1800s by allowing them to engage in design activities when playing the game. However, the authors also highlighted that it was challenging to integrate game-based learning into institutional education because games encourage exploration, personalised meaning-making, individual expression, and playful experimentation with social boundaries, factors which conflict with institutional modes of teaching and learning that emphasise conformity, one size fits all curriculum, and standardised testing and assessment practices.

A game-based curriculum informed by the theoretical framework of digital play has been designed and integrated into classrooms to teach persuasion writing to seventh grade students (Barab et al., 2012 ). The results indicated statistically significant differences in learning and engagement between the control and experimental groups where the students in the game-based curriculum demonstrated significant improvements in their learning gains. The authors explained that the technological affordances of well-designed videogame play supported the students’ engagement and learning by allowing them to play out new possible selves, such as scientists, historians, or investigative reporters in the virtual world to enact disciplinary expertise.

Studies have also shown that commercial video games, such as The Walking Dead can be integrated into classrooms for teaching domain-specific content, such as ethical theories when teachers are able to orchestrate the learning activities with appropriate teaching approaches to support student learning and engagement (de Sousa et al., 2018 ). Playing commercial video games has been found to improve the desirable skills and competencies sometimes referred to as “graduate attributes” in higher education students. Using a laboratory-based randomised controlled trial, Barr ( 2017 ) reported that students in the gameplaying group obtained highly significant positive changes in their adaptability, resourcefulness, and communication skill.

The studies on digital play described here have been conducted in formal pedagogical contexts. However, there is a knowledge gap in terms of our understanding of youths’ gameplaying activities and the types of learning that are demonstrated in their gameplaying process in the informal space. As such, the goal of this study is to identify the types of learning, such as critical thinking, empathy, and multimodal literacy, that can be demonstrated from the players’ gameplaying activities. In our previous study (Toh & Kirschner, 2020 ), we have investigated how Participant 1 adopted an inquiry-based learning approach to progress the same game segment examined in this paper. The inquiry-based learning approach has been integrated into a self-directed learning framework in video games for that study. In an upcoming paper (Toh & Kirschner, 2022 ), we examine how Participant 2 exhibited resilience in his learning of the stealth option to progress the same game segment analysed in this paper. Resilience has been integrated into a social-emotional learning model in that paper. In this study, we adopt a case study approach through a multimodal discourse analysis of the gameplay videos to surface the types of learning that can be identified in two youths’ gameplay recordings. Our paper aims to answer the following research question: What is the learning that can be demonstrated through video gameplay?

The theoretical orientation of social semiotics informs our lenses on youths’ gaming practices (Kress, 2010 ; Kress & van Leeuwen, 2001 ). The participants’ gameplay interactions are described using social semiotic theory, which models meanings according to the sociocultural contexts where the interactions took place. Bezemer and Kress ( 2016 , p. 4) argue it is important to respond “theoretically to the social”, recognise the ways for making meaning, and describe the “semiotic work done”. From this argument, the tenets of multimodal social semiotics have been adopted in the analysis and interpretation of the data to understand youths’ gaming practices.

The first tenet recognises that youths communicate with multimodal ensembles, drawing from language, visual, and the verbal modes to constitute interactivity. The second tenet recognises signs of learning (Kress & Selander, 2012 ). Making meaning is guided by interest, and learning occurs as the learners’ entire set of resources is augmented and transformed when they integrate new ways of conceiving the world. The third tenet focuses on how semiotic modes and digital technologies facilitate different pedagogic relations in human–computer interaction and offer learning opportunities. From the participants’ gameplay interaction, we discuss the learning demonstrated by the participants in their gameplay, the affordances of the video games that supported their expression of these literacies, and pedagogical implications of digital play and learning.

Research design overview

This paper adopts a qualitative case study approach method (Creswell, 2013 ) through a multimodal discourse analysis of the gameplay videos produced by two youths. The qualitative case study approach involves the exploration of case(s) over time through detailed, in-depth data collection involving multiple sources of data. The rationale for a qualitative case study approach is that it allows for a holistic understanding of a phenomenon within real-life contexts from the perspective of those involved (Merriam, 1988 ; Stake, 1995 , 2005 ; Yin, 2009 ) and allows the researcher to grasp the intricacies of a phenomenon (Stake, 2005 ).

The think-aloud protocol (Hu & Gao, 2017 ; Li et al., 2012 ) was adapted for use in the study by asking participants to verbalise their gameplay experience. Participants were asked to explain how and why (Gillern, 2016 ) they made a specific choice or perform an action during and after gameplay. They were also instructed to record their natural reactions and comments in the game recordings. When they verbalised their experience as they played the game, the method used was concurrent think-aloud protocol (Kelley et al., 2015 ) that involved the participants thinking-aloud while simultaneously performing an activity in usability studies. When the participants discussed their experience after gameplay, retrospective think-aloud (Ji & Rau, 2019 ) was used to reflect on their game experience. The think-aloud protocol is an effective method to elicit the participants’ demonstration of their learning because of the prompt response of the participants when a problem is experienced (Ericsson & Simon, 1993 ), which shows how they overcome the problem to progress the game. As the participants were able to refer to their gameplay recordings during the interviews, stimulated recall (Dempsey, 2010 ) was also used to review their gameplay recordings.

The framework of multimodal discourse analysis (O’Halloran & Lim, 2014 ; Kress, 2012 ; O’Halloran, 2004 ) was adopted to analyse the video recordings of the participants. The multimodal discourse analysis approach integrates the tenets from social semiotics, discourse analysis, think-aloud protocol, and the interviews to examine the player experience in their video recordings. The multimodal combination of language, visual, verbal, and action semiotic modes in the gameplay recordings are combined to form the ludonarrative frame for video games, which conceptualises the gameplay, the narrative, and the player as a whole (Toh, 2018 ). A semiotic mode can be understood as a distinct way for meaning-making (Jewitt, 2009 ) and the multimodal discourse analysis approach to examining the gameplay recordings is relevant because video games are highly multimodal artefacts. A central tenet of multimodal discourse analysis is that a text is embedded within the sociocultural context (Guo, 2017 ) in which it is produced and the text’s meaning is never fixed but contingent on different external factors, such as the cultural background and prior gaming experience of the participants (Toh, 2018 ).

Data collection

Multiple sources of data were used to interpret the lived experience of the participants through the method of data triangulation and method triangulation. Data triangulation (Denzin, 2009 ) has been used to gather data from different players, and method triangulation (Bauwens, 2010 ) has been used for data gathering and analysis. The different methods of data collection include the interviews of the participants, the observation of the participants’ gameplay in the laboratory, and the gameplay recordings. Member checking has been adopted during the qualitative interviews to validate the interpretations of the participants’ gameplay recordings (Iivari, 2018 ).

Prior to the start of the study, the participants filled up a written survey to provide demographic information and gaming habits. During the first gameplay session, the participants played their selected game from the start for one to three hours in a computer laboratory. Their gameplay was streamed and recorded using Fraps (computer) and a PS3 recorder on a nearby computer whereby the researcher was using to observe their gameplay. At the end of the first gameplay session, the first author conducted a one-to-two-hour interview with the participants. The interview questions asked during the first gameplay session were more general and open-ended. Some of the questions that the interviewer asked the participants included whether they liked the scripted game sequences, whether they were clearly able to see a divide between narrative and gameplay in the game, and whether the information provided by the characters helped them to make decisions to progress the game.

The first author then instructed the participants to record their subsequent gameplay sessions at home. The participants incorporated their natural reactions with their think-aloud verbalisations in their gameplay recordings. A total of 15 and 14.8 h of think-aloud video recordings were collected and analysed for Participants 1 and 2, respectively. After they have completed the game, the first author arranged a final interview to review their gameplay recordings together with them and discuss their gaming experiences. A total of 7 and 6.7 h of interview recordings were collected for Participants 1 and 2, respectively. More specific interview questions were asked during the final session with the participants. For instance, the researcher asked Participant 1 to explain whether specific objects in the game world such as the spark plug and the pillow helped him to progress the game and how he figured out the sequential order to progress the game. For Participant 2, an example of a specific question the researcher asked him was whether playing as Joel after Ellie caused him to feel worried for Ellie’s safety and motivated him to progress the game to find out the story.

Participants

The data were obtained from the first author’s study on the player experience. The research aim for the study was to propose an original theoretical framework, the ludonarrative model for studying video games, and this model was grounded on the empirical data of a group of players in Singapore. For the study, participants were recruited through convenience and snowball sampling via advertisements posted on the university’s website. Consent was obtained from the participants to share their video recordings, which included their voices, for research purposes. This study was approved by the university’s Institutional Review Board.

The data from two of the participants were selected for analysis. The two participants were selected because they were experienced players (Soylu & Bruning, 2016 ). Participant 1 is a 22-year-old male undergraduate student with 11–15 years of gaming experience. He mentioned that he played a variety of games such as shooters, puzzle games, action games, and so on a few times a week. The game he chose for the study was The Walking Dead Season 1, Episodes 1–5. Participant 2 was a 24-year-old male undergraduate student with 11–15 years of gaming experience. He mentioned that he played a variety of games such as role-playing games, strategy games, shooters, and so on a few times a week. He chose The Last of Us .

Description and rationale of game choices

The Walking Dead (PC game) is set in a fictional world in which a zombie apocalypse has occurred. The player controls Lee Everett to explore the story world and is accompanied by several survivors, including Clementine, a young girl. The Last of Us (PS3 game) is set in a post-apocalyptic world in which a mutated strain of the Cordyceps fungus has infected humans and transformed them into zombie-like creatures. The player controls Joel to explore the story world and is accompanied by Ellie, a young girl.

Data analysis

The thematic analysis (Braun & Clarke, 2006 ) has been used to code the types of learning of Participants 1 and 2. Theoretical thematic analysis involves the use of theoretical frames in a deductive way to search across the data set in the form of the think-aloud verbalisations and players’ reflections in the gameplay recordings and the interviews to discover repeated patterns of meaning. The coding categories were developed a priori from relevant literature (e.g. Toh & Lim, 2021 ) and included the three main types of learning, namely, critical thinking, empathy, and multimodal literacy. During the thematic analysis, the researchers familiarised themselves with the data by watching the gameplay recordings and listening to the interviews multiple times. During each review of the data, the researchers generated initial codes and then collated these codes into themes. The themes were then reviewed and defined to arrive at the final analytic scheme (Braun & Clarke, 2006 ). The two authors of the paper coded the data, and they have received prior training to conduct the analysis. The data were independently coded by the two authors, and disagreements were discussed to reach a consensus.

Case 1 Footnote 1 involved Participant 1, who played The Walking Dead Season 1, Episode 1. The selected gameplay segment was set at the Travelier Motel. In a previous scene, Glenn, the non-player character (NPC), had gone searching for supplies and gas at the motel for Lee’s group. He noticed a woman, Irene, in a boarded-up room on the upper level of the motel. When Glenn tried to talk to her, she asked him to leave. Walkers emerged from the forest, and Glenn was forced to hide in an icebox until Lee and Carley arrived to rescue him. The trio then decided to rescue Irene together.

The analysis of this gameplay segment indicated that Participant 1 adopted a problem-solving and inquiry-based approach (Toh & Kirschner, 2020 ; cf. Squire & Jan, 2007 ) to reach Irene. Participant 1 performed the following actions sequentially and iteratively: understand (orientate), plan (conceptualise), act (apply), and reflect (evaluate). First, Participant 1 understood how to proceed by listening to the characters. For example, Lee hinted that stealth was important to proceed by saying that “Noise attracts these things”. At 3:16, Participant 1 demonstrated his understanding of using stealth to reach the objective by repeating that “noise attracts these things”.

At 4:12, the game hinted to Participant 1 that peeking too long will result in a “game over” if the zombies detected him. The linguistic text warned Participant 1: “Peek too long, and you will be seen”. Simultaneously, Participant 1 saw the visual display turning red and heard the heartbeat sound as he peeked over the wall to observe the setting. In his first attempt, Participant 1 peeked too long, so a “game over” occurred. Participant 1 laughed loudly at 4:22 as Lee died comically (Newman, 2016 ). Participant 1’s unsuccessful first attempt demonstrated how he experimented with the game rules to understand and plan his actions to progress the game. After his first failure, he understood that one specific condition that could result in a “game over” for him was his exposure to the zombies beyond a specific time limit.

Participant 1 continued to understand and plan the correct sequential order to reach the objective. As he crossed the road to go towards the recreational vehicle (5:05), the game hinted to him that he needed a weapon to kill the zombies by having Lee verbalise that he was not sure whether he could take out the zombies even if he had a weapon. This was followed by the camera’s zooming in on the zombies who were obstructing Lee. The game also hinted to Participant 1 by having Lee verbalise, while being shown the car and the zombie, that he could use the car to kill the zombies (6:10). However, before Participant 1 can use the car, he must remove the zombie who was lurking near the front of it.

Participant 1 then noticed an awl inside a locked vehicle, which he assumed can be used to kill the zombie lurking near the car (6:25). Participant 1 chose to hit the glass but was unsuccessful (6:33). Glenn hinted to Participant 1 that his action had attracted the zombie’s attention. At 6:50, Participant 1 reflected that the awl was the weapon that he needed and he must find some way to get it quietly. He planned his next action by commenting that he had to kill the zombie with the awl before using the car to kill something else (7:05).

When Participant 1 returned to the brick wall, he found a pillow on the other side of the wall. He planned to use the pillow to smother the zombie and kill him quietly with some other implement. Carley reaffirmed Participant 1’s plan by hinting, “Good luck smothering them to death”. Returning to the front of the vehicle, he killed the zombie quietly by smothering him with the pillow and asking Carley to shoot him with her gun. Participant 1 then reflected that the action will not work in real life because the gun did not have a silencer.

After removing the zombie, Participant 1 opened the car’s door, retrieved a spark plug, unlocked the gear shift, and opted to push the vehicle towards the wall to immobilise a zombie there (10:34). Returning to the car with the awl inside it, Participant 1 used the porcelain on the spark plug to break the car window to retrieve the awl (11:42). Finally, Participant 1 reflected that he can use the awl to kill the other three zombies (12:12). He then killed these zombies with the awl (13:25, 14:00) and retrieved the axe from the wall (14:27). Finally, Participant 1 reflected that he felt safer with the axe (14:32). He easily killed the last two zombies to reach the trapped survivor (15:22).

Case 1 demonstrates how Participant 1 adopted a problem-solving and inquiry-based approach to reach the game goal. Participant 1’s ability to perform his actions in the correct sequential order in an iterative manner enabled him to remove the zombies obstructing him from reaching the woman trapped on the upper level of the house across the street. Our analysis of his think-aloud shows how he safely removed the zombies through critical thinking and reflection before he succeeded in reaching the trapped woman to save her.

Case 2 Footnote 2 involved Participant 2, who played The Last of Us . The segment that we analysed occurred in the winter chapter when Ellie escaped from David, the antagonist, after his failure to recruit her into his group. Joel was searching for Ellie when she escaped from David. This gameplay segment involved Participant 2’s alternating control of Joel and Ellie. This alternating control allowed Participant 2 to demonstrate empathy for both characters, the understanding of their thoughts, feelings, and actions through embodied play and perspective shifting (Toh & Lim, 2021 ; Elliott et al., 2011 ).

Ellie killed James (David’s partner) with the chopper on the table when he was distracted while talking with David. She escaped and grabbed a knife from a nearby table for protection as David attempted to shoot her but missed. The cutscene ended as Ellie escaped into the snow, and Participant 2 was given control of Ellie in the snow outside (19:10). He controlled her to take shelter in a nearby building. Ellie’s verbal utterance and subtitles informed Participant 2 that Ellie needed to find a gun to protect herself (19:28). Inside the building, Participant 2 overheard David ordering his people to find Ellie (20:20). He controlled Ellie to sneak into another building and planned to wait for David’s people to come inside for him to kill them individually (21:17). When the first man came in, Participant 2 stealthily stabbed him and obtained a revolver (21:45). He repeated his action on the other man who entered the building (22:09).

As the game progressed, the video showed that he faced difficulties when Ellie had to fight two or more men simultaneously. This led to Ellie’s being surrounded and killed. In a later gameplay segment, he planned to distract and kill David’s men inside another building (34:20). He succeeded (34:48), but Ellie was killed by a nearby enemy who detected Ellie and shot her (35:05). This heightened Participant 2’s feeling of vulnerability when he played as Ellie. He said that he had to retry the game segment (35:07). When he replayed this segment, he was killed again as he controlled Ellie to fight the two men directly instead of stealthily (36:30). He reflected that he had to sneak into that room (36:40). During the third (37:30), fourth (38:24), and fifth attempts (39:47), he failed again when Ellie was surrounded and killed. He reflected: “The idea was there—the execution (39:50)”. Finally, on the sixth try, he cleared this segment by separating David’s men and stealthily killing them one at a time (40:30).

Participant 2 entered the open area in a restaurant and triggered the fight with David (45:58). During the fight, Participant 2 used Ellie’s stealth ability to track David’s location and planned his attacks. Participant 2’s ability to use Ellie’s ability to track David’s movements by sound was key to performing a stealth attack on him.

After Participant 2 stabbed David thrice, the game changed perspective and allowed him to control Joel to search for Ellie (56:25). When Participant 2 entered a nearby building, he heard David’s men searching for Ellie (57:05). It was easier for Participant 2 to play as Joel because he could choose to engage in close combat and kill enemies with a single blow of the axe (57:29, 57:48) or use stealth attacks. With Ellie, he could only use stealth attacks. As Participant 2 cleared several gameplay segments, he entered the slaughterhouse and found Ellie’s backpack (1:09:04). From Joel’s verbalisation, “What is this? Why is Ellie’s stuff here?”, Participant 2 understood that Joel was worried about Ellie (1:09:19). He picked up a meat ledger note that indicated the amount of meat that David’s men, who were cannibals, had collected for supplies (1:09:30). This note, along with the human corpses in the meat locker (1:09:50) and Joel’s utterance “I gotta find her”, (1:09:55) further underscored Participant 2’s understanding of Joel’s concern for Ellie’s safety. Participant 2 had just played as Ellie and understood the danger Ellie faced as she fought against David and his men.

Case 2 shows how Participant 2’s ability to control 2 characters allowed him to demonstrate empathy by understanding their thoughts, feelings, and actions through embodied play and perspective shifting. Our analysis of his think-loud and observation of his actions during the gameplay shows how Participant 2’s empathetic concern for Ellie motivates him to find her when he played as Joel.

Critical thinking

In the field of education, Bloom’s ( 1956 ) taxonomy is the most widely cited source when it comes to teaching and assessing higher-order thinking skills. Bloom’s ( 1956 ) taxonomy consists of the lower-order thinking skills, such as remember (recall, recognise), understand, and apply as well as the higher-order thinking skills, such as analyse, evaluate, and synthesis, which are frequently said to represent critical thinking (Kennedy et al., 1991 ). The analysis of Participant 1’s gameplay recording showed his ability to select information from the game world, reflect on it (e.g. failure to progress the game), and integrate it into a coherent whole in a mental model to gain a deeper understanding of the story, rules, and mechanics (Toh, 2018 , Buckingham, 2015 ). When he played the game, we observed that he was applying his critical thinking: the selection, evaluation, and integration/synthesis of information provided by digital texts (Salmerón et al., 2018 ) by adopting the inquiry-based learning approach (Toh & Kirschner, 2020 ) to reach the objective.

Participant 1 demonstrated an iterated approach of using a mixture of lower and higher-order critical thinking skills to progress the game. At the start of this gameplay segment, Participant 1 demonstrated lower-order critical thinking skills, such as recognising through his counting of the number of zombies that must be overcome to reach the objective. He demonstrated understanding by explaining what he had to do for this gameplay segment through his think-aloud “Ya, so basically, we are here rescuing Glenn from [the zombies]”. He also demonstrated recall by commenting on what happened previously in the game “He [Glenn] came to top up petrol from the motel but he got into a bit of trouble and now we have to rescue this survivor upstairs over here, yes.”, which is followed by understanding as he explained what he had to do to achieve the gameplay objective “So, we have to kill all the zombies to rescue her. So, let’s find some way to kill them quietly”.

At 4:10, Participant 1 experienced how the losing condition of the game could happen by peeking over the wall at the zombie eating the dead person on the ground. However, he spent too long peeking and Lee ended up being eaten by the zombie. On his second attempt, he demonstrated his understanding (a lower-order critical thinking skill) of the losing condition of the game by commenting that “Oh, it looks like a timed thing” and controlled his character not to long too long over the wall. At 5:36, Participant 1 demonstrated the use of evaluate, a higher-order critical thinking skill as he reflected on how Lee can see over the wall but not when he was running.

At 7:05, from Participant 1’s verbalisation that he had to kill a zombie in front of the vehicle with an awl (“the screwdriver”) before using the car to kill another zombie, he demonstrated planning and analysis, which is a higher-order critical thinking skill. At 8:54, Participant 1 demonstrated the use of the lower-order critical thinking skills when he applied his plan and chose the action in the dialogue option to kill the zombie quietly by covering him with the pillow and asking Carley to shoot him with her gun. Finally, Participant 1 demonstrated a higher-order critical thinking skill, such as evaluation from his verbalisation that the action would not have worked in real life because the gun did not have a silencer.

Likewise, a learning observed from the participants’ gameplay is empathy, that is the ability to understand and share the feelings of others (CASEL, 2015 ). This was observed in Participant 2’s gameplay. For example, when the game allowed Participant 2 alternate control of Ellie and Joel, he used embodied action to gain a better understanding of both characters’ playstyle through situated and just-in-time learning (Gee, 2005 ). Another example observed in the gameplay recordings was when Participant 2 discovered Ellie’s backpack, the meat ledger, and the hanging corpses, and he showed his concern for Ellie’s safety. For instance, in 1:09:19, Participant 2 verbalised that Joel felt worried for Ellie when he found her backpack in the slaughterhouse. He appreciated that Joel’s actions had been driven by his fear for Ellie’s safety. Participant 2 demonstrated his empathy in an interview:

So later on, when you shift to Joel to control him to save Ellie, did you feel an even more urgent need to save her? Because you discovered Ellie’s backpack.

Because you played what Ellie’s going through right? So, you know that she needs help. So, in that sense, you can empathise more with what Joel is feeling, as in Joel doesn’t know what is happening to Ellie, but you know the emergency. So …

When you discover all her objects, huh?

And then the slaughterhouse.

Um-hmm. So, he knows that she’s not in a good place.

In the above interview, Participant 2 explained how his ability to control two different player characters one after the other during the gameplay allowed him to understand both characters’ thoughts, feelings, and actions. Because Participant 2 was given control of Ellie early in the Winter chapter of The Last of Us , he was able to feel Joel’s sense of fear for Ellie’s safety when the game later offered him control of Joel to look for her. As Participant 2 had been able to play as Ellie, he could understand her precarious situation in the game world when she met the antagonist, David with his group of cannibals while searching for supplies to take care of Joel. David appeared to Ellie as a compassionate man who looked out for her needs and he even fought together with Ellie against waves of Infected enemies during their initial encounter.

However, as the chapter progressed, Ellie discovered that David and his group were cannibals. David captured Ellie and offered her a place in his group. When she rejected his offer, David and his man attempted to slaughter Ellie for food, but she managed to escape. The game then switched control to allow Participant 2 to play as Joel after playing as Ellie. He could then feel a greater connection to both player characters because he possessed more information than either of the player characters possessed on their own in the game world. The perspective shift (Toh & Lim, 2021 ) in the game therefore allowed Participant 2 to demonstrate empathy when playing the game.

Multimodal literacy

We also observed that the participants demonstrated multimodal literacy in their engagement with the multimodal orchestration in the game, such as the verbal mode of the NPCs, the linguistic mode of the game hints, the visual representations of the characters, and the characters’ actions and gestures to gain an overall idea of how to progress the game. Multimodal literacy (Jewitt & Kress, 2003 ; van Leeuwen, 2017 ) involves both critical and creative engagement with multimodal representations that reflect a semiotic awareness (Lim, 2021a ; Lim, 2021b ). Multimodal literacy also involves an understanding of the affordances of the different meaning-making resources and how they work together to produce a coherent and cohesive multimodal text (Mills, 2016 ). The player’s multimodal literacy refers to their sensitivity to the design features in the video games, including knowing how to work across different semiotic modes, such as language, visuals, audio, music, and action to perform critical and creative actions in the game.

Participant 1’s multimodal literacy can be observed at the beginning of the gameplay segment. He demonstrated verbal awareness by listening to the characters’ verbal interactions in the cutscene before commenting through his think-aloud to show his understanding that he must rescue the survivor in the house across the street, to achieve the winning condition of this gameplay segment. We see how he showed a visual awareness of the objective, by pointing at the house across the street with the mouse pointer to indicate his understanding that he must reach the objective, the house to progress the game. He showed us his linguistic awareness by following the game hints provided through the linguistic prompts, such as “peek over the wall”, “push car”, “look at truck”, “open door”, “examine window”, amongst others to perform the micro actions of the gameplay so that he can reach the gameplay objective. He also demonstrated an action awareness, which refers to his understanding of the dynamic interplay between game and player (Toh, 2018 ; Apperley & Beavis, 2013 ; Beavis, 2014 ) by selecting the specific actions in the correct sequential manner to interact with the zombies and overcome them to reach the woman in the house across the street. He combined his verbal awareness, visual awareness, linguistic awareness, and action awareness in the gameplay to reach the objective and progress the story.

Participant 1 also demonstrated his multimodal literacy in quickly making sense of the orchestration of multimodal meanings through the semiotic resources. He combined the visual mode of the entire screen turning red, the auditory mode of a pulsating heartbeat, the linguistic mode of a text that warned him not to peek for too long, and the verbal mode of the player character’s announcing that the zombie had discovered him to come to his understanding of the losing condition of this gameplay segment. Participant 1 verbalised his reading of the situation through his think-aloud that “it looks like a timed thing” to reflect his understanding that his peeking over the wall beyond a certain time limit resulted in the losing condition whereby his character was killed when the zombies discovered where he was hiding.

The findings of this study affirm the findings from previous studies that playing video games can allow players to demonstrate critical thinking (e.g. Gumulak & Webber, 2011 ) and empathy (e.g. Hilliard et al., 2018 ). Additionally, our study adds to the field of knowledge by showing that players can demonstrate multimodal literacy (Lim, 2021b ) during gameplay by learning how to combine information from semiotic modes, such as the language, verbal, visual, and aural modes to come to an overall understanding of the game. Their demonstration of their multimodal literacy is evidenced in their think-aloud verbalisations where they articulated how they understood, planned, acted, and reflected on how to progress the game by selecting and integrating information from multiple semiotic modes, such as language and visuals during the gameplay process. From an educational standpoint, we have noted that there is a difference between demonstrating these skills within a game context and having the players transfer skills such as critical thinking in digital play to academic subjects or real-world situations. We recognise that the demonstration of these skills in video gameplay does not mean that players are able to transfer the critical thinking to academic subjects or empathy to real-world situations. With this in mind, we have explored ways in which educators can design for digital play in the classrooms, such as introducing a pedagogic metalanguage for digital play (Toh & Lim, 2021 ; Lim & Toh, 2022 ) which teachers can use to guide players in transferring their critical thinking and empathy through reflection questions during classroom activities.

The affordances of video games that can facilitate the expression of these multiliteracies include immediate feedback from semiotic resources in the game world (Nadolny et al., 2020 ) and a safe space (LaFleur et al., 2017 ) that allows the player to retry again after failing the gameplay segment. Additionally, scaffolded learning in the form of virtual learning companions (Calvert, 2017 ) and multilinear pathways (Roswell & Wohlwend, 2016 ) in the gameplay can allow players to try out different approaches of solving a problem to demonstrate their critical thinking. Finally, the player’s ability to take control of two player characters during gameplay to understand their thoughts, emotions, and actions (Toh & Lim, 2021 ) can support their demonstration of empathy.

In contrast to empirical studies that suggest learning occurs in stages (e.g. Luft & Buitrago, 2005 ), our findings showed that learning is a nonlinear and iterated process where sometimes the learner may experience progress in their learning, but at other times, they may experience failure if they uncritically applied one approach that worked in a previous context on a different context. For instance, Participant 2 failed when he tried to play Ellie using Joel’s direct approach of attacking enemies in the open instead of adopting stealth when fighting multiple enemies.

Digital play is arguably attractive to people from all ages but is especially appealing to children and youths because of design features, such as immediate feedback, social affordances, and the presence of multisensory stimuli when using mobile devices and games to interact with others (Marlatt, 2018 ; Oliver & Carr, 2009 ). Notwithstanding the value of digital games, concerns have also been raised about the risks, such as exposure to sexual (Tompkins & Lynch, 2018 ) and violent content (Elson & Ferguson, 2014 ) as well as potential addiction (Grüsser et al., 2007 ) and health issues (Saunders & Vallance, 2017 ) related to the prolonged screen time with mobile devices. While these concerns are understandable, it is also acknowledged that studies have found no evidence of negative effects that playing violent video games has on youths (e.g. Ferguson & Olson, 2014 ). In addition, to mitigate the concerns on the possible ills of digital play, strategies of integrating digital play and learning into pedagogical context, such as the use of metacognitive scaffolding for inquiry-based learning activities (Ibáñez & Delgado-Kloos, 2018 ) and reflection questions to allow teachers to guide students’ digital play (Toh & Lim, 2021 ) have been proposed.

With the increasing ubiquity of mobile devices and gaming activities amongst youths and children, we argue that adults should not disregard youths’ use of video games. Instead, they can design learning experiences with video games using a series of learning activities and scaffolding questions structured by theoretical frameworks, such as Cope and Kalantzis’ ( 2015 ) learning by design framework or the metalanguage that we have developed for digital play (Toh & Lim, 2021 ; Lim & Toh, 2022 ). The framework allows adults to design learning using guided inquiry techniques, such as reflection and conversational prompts after gameplay for youths’ learning.

Given the resistance typical schools may have towards the use of video games for learning (Bourgonjon et al., 2013 ; Gee, 2005 ), we recognise that the degree of integration of video games into formal learning contexts will depend on the receptiveness and attitude of the educators, parents, and students (Mifsud et al., 2013 ). Nonetheless, video games can be used well in the classrooms for teaching and learning STEM subjects (e.g. Ormsby et al., 2011 ) or content subjects involving ethical thinking (e.g. Schrier, 2015 ), decision-making (Toh, 2021 ), and narrative concepts (Ostenson, 2013 ) in many schools.

In this study, we have explored the digital play of two players using a qualitative case study approach to examine the display of critical thinking, empathy, and multimodal literacy in their gameplay. These are important life skills that overlap with the skills required in school and the workplace. Through this study, we hope to advance the call for educators to harness video games in teaching, given how it can bring about different types of learning in the youths.

We also acknowledge that the limitations of the study include the male gender bias of the subjects recruited for the study due to the snowball and convenience sampling method used. Additionally, the qualitative research methods used, such as interviews, think-aloud protocol, and observations in the laboratory can be complemented with more objective measures in future studies, such as galvanic skin conductance, eye tracking, and brain scans to triangulate the findings. Future studies can also use a broader range of games to elicit the different types of learning that are demonstrated by gameplayers.

Availability of data and materials

The video recordings of the data analysed in the study have been provided in the endnotes of the manuscript for case study 1: https://tinyurl.com/Case00001 and case study 2: https://tinyurl.com/Case000002 .

The analysis of the scene started at 1:10 and ended at 16:40. https://tinyurl.com/Case00001 .

The analysis of the scene started at 17:54 and ended at 1:10:45. https://tinyurl.com/Case000002 .

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This work was supported by the National Youth Council’s National Youth Fund (NYF) grant and the National Institute of Education, Nanyang Technological University, Singapore’s Planning Grant PG 03/20 VLF “Multimodality and Pedagogy (MaP): A Systematic Review” (2020–2021).

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Idea: FVL and WT; Literature review: WT; Methodology: WT; Data analysis: WT; Case studies: WT; Findings and conclusions: FVL and WT; Writing (original draft): WT and FVL; Final revisions: FVL and WT; Project design and funding agency: FVL. Both authors read and approved the final manuscript.

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Weimin Toh is Research Fellow at the National Institute of Education, Nanyang Technological University, Singapore. His research interests are social semiotics, multimodal discourse analysis/multimodality, game studies, and game-based learning.

Fei Victor Lim is Assistant Professor at the National Institute of Education, Nanyang Technological University, Singapore. He researches and teaches multiliteracies, multimodal discourse analyses, and digital learning. He is editor of Multimodality and Society and author of the book Designing Learning with Embodied Teaching: Perspectives from Multimodality published in the Routledge Studies in Multimodality.

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Toh, W., Lim, F.V. Learning in digital play: a dual case study of video gamers’ independent play. RPTEL 17 , 6 (2022). https://doi.org/10.1186/s41039-022-00182-2

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How Do Online Game Communities Retain Gamers? Social Presence and Social Capital Perspectives

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Fan-Chen Tseng, Han-Chung Huang, Ching-I Teng, How Do Online Game Communities Retain Gamers? Social Presence and Social Capital Perspectives, Journal of Computer-Mediated Communication , Volume 20, Issue 6, 1 November 2015, Pages 601–614, https://doi.org/10.1111/jcc4.12141

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While online game communities have been found to be useful for retaining gamers, the mechanism underlying this phenomenon is not fully understood. Knowledge about such mechanism enables managers of online games to effectively retain their customers. This study thus investigates how network convergence and interdependence—2 characteristics of online game social networks—fuel gamers' continuance intention. Social presence and social capital theories were used for developing the study hypotheses, and responses from 1,467 online gamers were used in the analysis. The findings indicate that both network convergence and interdependence are positively related to sense of community and relational switching cost (coefficients ranging from .20 to .50), which further contribute to gamer continuance intention (coefficients ranging from .13 to .72).

Social networks in various online media have been widely investigated. Among them, online games have been a recent focus in both the literature on communication (e.g., Taylor, Jenson, de Castell, & Dilouya, 2014 ; Yoon, Duff, & Ryu, 2013 ) and electronic commerce ( e.g., Hsiao & Chiou, 2012 ; Wu & Liu, 2007 ). Focal issues include why gamers continue to play online games, and social aspects have been verified as providing critical impetus. Specifically, continuance intention of online gamers has predictors such as gratification ( Wu, Wang, & Tsai, 2010 ), online community position ( Hsiao & Chiou, 2012 ), team participation, compliance to social norms ( Teng & Chen, 2014 ), trust, and enjoyment ( Wu & Liu, 2007 ). The literature has demonstrated the relevance of social networks to gamer retention, while leaving the process by which this happens insufficiently studied. Research clarifying the process can enhance academic knowledge on social network formation in online games, and can provide a competitive advantage to game service providers by assisting them in the development of social networks for retaining their customers.

The literature has identified socialization as one major motivation for the playing of online games. Researchers indicated social interactions are important predictors for continuance intention among online gamers ( Wu et al., 2010 ), implying that social interactions can help explain continuance intention among online gamers. However, little research has examined continuance intention among online gamers by taking into account the social presence ( Kim, 2011 ) and social capital ( Hsiao & Chiou, 2012 ) theories. Inclusion of these theories can provide a novel framework to clarify how social networks help retain users within online gaming communities. Therefore, this study adopts the perspective of two theories, i.e., the social presence theory and the social capital theory, to build a theoretical model to explain whether and how network convergence and interdependence impact gamers' continuance intention through sense of community and relational switching costs. This study should deepen the understanding of how gamers' communication networks retain other gamers. This study also provides insights that could be valuable to electronic commerce managers in their efforts to capitalize on social networks to boost users' continuance intention.

In contrast to a recent study ( i.e., Teng, Chen, Chen, & Li, 2012a ) that examined the positive relationship between interdependence and continuance intention (i.e., loyalty in that study), the current study innovates to clarify the mechanism underlying this relationship. Specifically, the current study hypothesized that sense of community and relational switching cost play important roles in mediating the relationship between interdependence and continuance intention. Moreover, one recent study by Teng and Chen ( 2014 ) has examined the relationship between team participation and gamer loyalty (or continuance intention). Compared with that study, the present study is new in using interdependence, network convergence, sense of community, and relational switching cost to explain the gamer loyalty. All of these determinants were not covered in that study ( Teng & Chen, 2014 ).

Social Presence Theory

Social presence theory explains how individuals communicate with each other in communication media and indicates that social presence assists such media to achieve successful outcomes ( Richardson & Swan, 2003 ). Presence, as the core in the social presence theory, should be firstly provided by Heeter ( 1992 ). Short, Williams, and Christie ( 1976 ) and Heeter ( 1992 ) defined social presence to be the feeling of being there, particularly between two communicating parties through a communication medium.

Social presence plays a central role in online communication behavior ( Kim, 2011 ). The prevalence of high-speed Internet and the advancement of multimedia technologies make online games vivid communication media through which gamers can experience strong social presence.

Drawing on the literature on social presence theory, Kim ( 2011 ) enriched the definition of social presence to be the perception of links and affiliation among the users. Kim ( 2011 ) proposed four dimensions of social presence, i.e., (1) a sense of community, (2) mutual attention and support, (3) open communication, and (4) affective connectedness. Among these four dimensions, sense of community, i.e., how users perceive a sense of group membership, should be highly relevant in online games, as stronger sense of community may increase gamer loyalty ( Hsu & Lu, 2007 ).

In online game communities, gamers often share their friends or social networks, a phenomenon called “network convergence,” defined as the extent to which people develop a common social circle ( Parks & Floyd, 1996 ). Hence, the more online gamers share their friends, the greater the network convergence is likely to be. The sharing of friends increases interpersonal relationships and common interests, and subsequently sharing a sense of membership as a group, i.e., a sense of community among online gamers ( Blanchard & Horan, 1998 ). Thus, network convergence leads to a sense of community, and the present study hypothesizes:

H1: Network convergence positively contributes to sense of community.

Interdependence is the degree to which members in a community rely on each other to make decisions and take actions ( Parks & Floyd, 1996 ). Online gamers often form teams or guilds to solve missions or to achieve common goals, or rely on other members' feelings and opinions to shape their avatar outlooks or social interactions with others. That is, gamers depend on each other for opinions and support. Such mutual interdependence among members is one of the most essential elements of community ( Rovai, 2002 ). Thus, the present study hypothesizes:

H2: Interdependence positively contributes to sense of community.

Furthermore, a sense of community motivates gamers to become strongly affiliated to other members in the same community. Consequently, if gamers switched to other games, they would lose contact with the members they are strongly affiliated to, resulting in a significant relational switching cost ( Lin, Cheng, Wang, & Chang, 2012 ; Tseng & Teng, 2014 ). Thus, the present study hypothesizes:

H3: Sense of community positively contributes to relational switching cost.

A sense of community also has an impact on the continuance intention toward computer/Internet- mediated communication systems such as social network services and web-based bulletin board systems ( Zhang, 2010 ).

As a high-quality communication system, online games provide a virtual world where gamers communicate with each other by using rich interactive multimedia. This would facilitate communication among online gamers and enhance the development and maintenance of interpersonal relationships. Since individuals have an innate need in developing and maintaining interpersonal links to other persons, online gamers would have strong intention to continue engaging in online games to maintain the sense of community. Therefore, this study hypothesized a positive link from sense of community to continuance intention.

H4: Sense of community positively contributes to continuance intention.

Social Capital Theory

Social capital is a construct which describe the resources owned by social organizations ( Putnam, 1995 ); such resources should foster coordination and cooperation to increase mutual benefit ( Putnam, 1995 ). These resources include norms and social trust, reside in the relationship networks formed by the members in a group ( Nahapiet & Ghoshal, 1998 ). Therefore, social capital can be defined as the resources an entity can obtain from the relationship networks ( Nahapiet & Ghoshal, 1998 ).

As Internet gained increasing popularity, it is believed that social capital also exists in cybernetworks, i.e., social networks in cyberspace ( Lin, 1999 ). Social capital theory thus has been applied to cyberspace, including social networking sites ( Lin & Lu, 2011 ). Social capital helps builds mutual trust ( Coleman, 1990 ), and promotes social participation ( Guillen, Coromina, & Saris, 2011 ). Therefore, we use this theory, i.e., the social capital theory, for exploring how social networks affect continuance intention in online gaming communities.

In social networks, individuals likely share friends, and thus increase the extent to which users have common friends. Such an extent is defined as network convergence ( Parks & Floyd, 1996 ). Individuals who have common friends develop relationships more easily and quickly than those who do not ( Davis, 1967 ). Moreover, the number of shared friends is typically related to the number of total friends, which can strongly predict perceived social support. Gamers devote time and energy to interact with friends within a certain game to build their social capital, and thus stronger network convergence should imply more social capital. Gamers would possibly lose such social capital if they decided to switch to another game. That is, gamers may incur relational switching costs. Such costs in online games should be the losses accompanied with the breaking of the bonds that have been formed with other gamers ( Lin et al., 2012 ; Tseng & Teng, 2014 ). As a gamer accumulates more social capital with more network convergence, the gamer may incur more relational relationship losses when switching to another game, because the social networks in one game may not be easily carried over to another. Hence, this study hypothesizes:

H5: Network convergence is positively related to relational switching cost.

In online games, gamers likely form interdependent relationships because through cooperation they can overcome challenges, which in turn are related to gamers' continuance intention toward a game ( Teng, 2013 ). In interdependent relationships, users consult and respond to each other when making decisions ( Parks & Floyd, 1996 ). The responsiveness is reciprocated and creates upward spirals of responsiveness, fueling quality relationships ( Canevello & Crocker, 2010 ). Such interdependent relationships are members' social capital since they can utilize them to achieve goals ( Lin, 2001 ). If gamers switch to other online games, they will lose such social capital (highly responsive partners and quality relationships), incurring a relational switching cost ( Lin et al., 2012 ; Tseng & Teng, 2014 ). Therefore,

H6: Interdependence is positively related to relational switching cost.

Relational switching cost comprises the friendships and relationships users would lose if they switched to other service providers ( Lin et al., 2012 ; Tseng & Teng, 2014 ). Friends are resources in social networks that can help members achieve goals; therefore, friends can comprise members' social capital, accordingly ( Lin, 2001 ). Social capital should be valuable to gamers and thus they are motivated to retain it, leading them to play an online game continually. Hence,

H7: Relational switching cost positively contributes to continuance intention.

Figure 1 illustrates the research framework. Hypotheses were ordered according to the underlying theories. That is, H1 to H4 were developed using the social presence theory. H5 to H7 were developed using the social capital theory. Such an approach helps achieve brevity and connectedness between hypotheses.

Research Framework

Sample, the Process of Collection, and the Data

This study is a cross-sectional one. This study collects the data by utilizing an online questionnaire. The invitations had been posted on popular online gaming forums and community websites during 5 weeks. Therefore, the sampling population was online gamers who visited those forums and community websites. The researchers selected gaming forums and community websites that are famous and popular among online gamers. More than 20 forums were chosen among www.gamer.com.tw , www.ptt.cc , and www.gamebase.com.tw . Gamers from these forums and websites indicated that their favorite online games are (one gamer nominated one game): League of Legends (40.4%), Baseball Online (15.8%), Diablo (9.2%), Dungeon & Fighter (8.7%), Lineage (2.5%), World of Warcraft (2.2%), and others. Notably, most of them are multiplayer games.

Prospective respondents were directed via an online link to the online questionnaire, which indicated that this study would focus on gamer evaluation of online games. When respondents completed and submitted their responses, those who submitted a valid response had the opportunity to join in a lottery, which involved 50 winners and a US$7 gift certificate for each winner. The lottery was held to express gratitude for gamers' participation.

In total, 1,650 responses were obtained. Among them, 183 were judged as invalid and excluded. Table 1 lists the criteria and associated number of invalid responses. After the screening process, 1,467 gamers provided valid responses and generated a valid ratio of 88.9%.

Data Validity Criteria and Associated Number of Invalid Responses

Note . # denotes number of invalid and excluded responses.

The high ratio of valid responses to total responses may be owing to several reasons. First, only interested gamers were attracted to click through the link and gain access to the study questionnaire. Second, the online questionnaire enabled automatic checking of whether all the study items were completed. Third, the associated lottery served as an incentive for providing accurate and sincere responses.

Measurement Items and Psychometric Properties

The seven items measuring network convergence and the five items measuring interdependence were adapted from Parks and Floyd ( 1996 ). The four items measuring sense of community were adapted from Kim ( 2011 ). The four items measuring relational switching cost were modified from the literature, i.e., Lin et al. ( 2012 ) and Tseng and Teng ( 2014 ). Continuance intention was measured using seven items that came from Zeithaml, Berry, and Parasuraman ( 1996 ).

To verify the instrument reliability, this study adopted a criterion that item-to-total correlation should exceed .50, with items that did not meet such a criterion being dropped. Moreover, the instrument validity was verified using a factor analysis. This study dropped items loading on constructs other than theoretically assumed. Dropping items of poor reliability and validity should improve the overall measurement quality, and is one commonly used approach in conducting psychological measurements. The numbers of original items, deleted items and resultant items for every construct are depicted in Table 2 .

Summary of Number of Measurement Items

As shown in Table 2 , this study kept 20 items for measuring five constructs, with at least three items being retained to measure any one construct. This study conducted a confirmatory factor analysis (CFA) for directly assessing the psychometric properties, i.e., reliability and validity, of the study items. Table 3 summarizes the results of the CFA. Notably, each construct had items generating a Cronbach's α value larger than .80. Moreover, the 95% confidence intervals of α values have low bounds exceeding .78, indicating sufficient reliability. Additionally, composite reliability (CR) values were larger than .85 and average variance extracted (AVE) values were larger than .62, further supporting adequate reliability.

Summary of Confirmatory Factor Analyses

Note. λ denotes indicator loading; CR denotes composite reliability; AVE denotes average variance extracted; C.I . denotes 95% confidence interval.

All indicator loadings exceeded .65, indicating sufficient convergent validity. The minimum AVE (.62) exceeded the maximum squared correlation (.53), indicating sufficient discriminant validity. Moreover, the measurement model fits our empirical data acceptably, supported by the performance of various fit indices. Specifically, the comparative fit index (CFI) = .97 and the incremental fit index (IFI) = .97, fulfilling the criteria (CFI ≥ .90, IFI ≥ .90). The nonnormed fit index (NNFI) = .97, satisfying the criterion (NNFI ≥ .90). The goodness of fit index (GFI) = .90, and the root mean square error of approximation (RMSEA) = .08, indicating sufficient performance of model fit (GFI ≥ .90, RMSEA ≤ .10). This study did not regard χ 2 and χ 2 /df as critical indices, because they are sensitive to sample size.

Table 4 exhibits how the study constructs are related with each other. The correlations were between .33 and .73. This study proposed an alternative measurement model by assuming that all constructs could be explained by common method variance (CMV). The alternative model has a significantly higher χ 2 value, i.e., 1941.54 - 1678.58 = 262.96. The test on χ 2 difference is made upon five degrees of freedom, i.e., 165–160 = 5, which lead to a threshold value of χ 2 of 11.07 (χ 2 (α = .05, df = 5) = 11.07). The χ 2 difference (262.96) exceeded the threshold value (11.07), indicating our measurement model significantly explains our empirical data better than an alternative model, i.e., CMV model. Such analytical results support the minimum of CMV herein.

Correlations Among the Study Constructs

denotes p  < .05.

Demographic Distribution of the Sample

Table 5 summarizes participant profile. Among the participants, most were male (88.1%), aged no more than 30 years (92.1%), had attended college or university (64.6%), and had a monthly income of either US$ 200 or less (54.9%) or US$ 1,001 or more (13.1%). Averagely, the participants were 22.07 years old. Their ages ranged from 11 to 52 years old. Averagely, they played their favorite online game for 2.55 years (SD = 2.48 years) and played the game for 13.64 hours per week on average (SD = 14.68 hours).

Summary of the Participant Profile

Hypothesis Testing

We utilized the structural equation modeling technique for examining the hypotheses. The analytical results supported all the study hypotheses. Specifically, network convergence positively contributes to sense of community (path coefficient = .20, p  < .05), supporting H1. Interdependence positively contributes to sense of community (path coefficient = .50, p  < .05), supporting H2. Sense of community further positively contributes to relational switching cost and continuance intention (path coefficient = .72 and .45, p  < .05), supporting H3 and H4. Network convergence is positively related to relational switching cost (path coefficient = .18, p  < .05), supporting H5. Interdependence is also positively related to relational switching cost (path coefficient = .06, p  < .05), supporting H6. Finally, relational switching cost is positively related to continuance intention (path coefficient = .13, p  < .05), supporting H7. Table 6 summarizes the testing results.

Results of Hypothesis Testing

denotes p  < .05. All coefficients are standardized path coefficients.

To increase persuasiveness of the work, this study further included two control variables, i.e., years of playing the favorite game and hours per week of playing the game and their impact on continuance intention. As support for including the two variables, the two variables are significantly related to continuance intention (coefficient = −.07 and .07, p  < .05). However, inclusion of these two variables does not change the analytical results regarding the hypotheses testing, demonstrating the robustness of the study findings.

Theoretical Implications

Yoon et al. ( 2013 ) used the technology acceptance model and found that enjoyment, usefulness, and economic value impact gamers' attitude to online games. While the study of Yoon et al. ( 2013 ) emphasized the economic value of online gaming, this study highlights the social value of online gaming. Specifically, gamers enjoy social activities with real people within computer-mediated environments to experience sense of community and build social capital. The relationships with others in such environments are useful and valuable, implying the loss a gamer would incur when switching to another game (i.e., relational switching cost). That is, the accumulation of social capital can form significant switching cost for gamers.

Wu and Liu ( 2007 ) utilized the theory of reasoned action to identify subjective norms (what others expect) as one determinant for continuance intention in online gaming. The present study is in line with Wu and Liu ( 2007 ) in identifying determinants for continuance intention. However, it is unique in introducing the social presence and social capital theories to identify sense of community and relational switching cost as two novel mediators for continuance intention in online gaming. Findings of the present study elucidate the fertile opportunities for introducing classic psychological and communication theories to the further understanding of this issue.

One of the most related studies is that of Hsiao and Chiou ( 2012 ), who also investigated how social networks fuel continuance intention in online gaming. Their study verified that community position is critical to explaining continuance intention. Findings of our study are compatible with such finding, for a sense that a gamer in a central position (where the gamer connects with the most other gamers) should have relatively high levels of network convergence and thus social capital in the community. Therefore, to avoid huge relational switching cost, such a gamer would have a strong continuance intention toward the game the gamer is playing. In short, the present study provides an alternative explanation for their findings.

Implications for Managers and Society

Although some problematic use of online games may cause annoyance and dissatisfaction ( Teng, Tseng, Chen, & Wu, 2012b ; Tseng & Teng, 2011 ), online games are still highly attractive to gamers. As revealed in the current study, one of the most attractive aspects is the social value offered. Managers of online games thus can take advantage of our findings to enhance continuance intention among their users. Four points are illustrated below.

First, sense of community is a strong predictor of continuance intention and positively influences relational switching cost. Therefore, managers are encouraged to foster a sense of community within their social networks. Managers can facilitate the sharing of recent statuses among network members and hold community events to draw members closer.

Second, relational switching cost positively contributes to continuance intention. Therefore, managers may devise various mechanisms to raise such costs to deter users from switching to other social networks. For example, managers may offer bonuses or privileges to members who have accumulated significant social capital in the network, so those members realize they might feel a strong sense of loss should they switch to another social network.

Third, network convergence indirectly contributes to continuance intention, indicating the importance of mutual friends among network members. Managers thus are encouraged to provide methods to enlarge the social networks of their members. For example, strategic inclusion of the use of Facebook or other social networking sites effectively introduces the social network of one member to another to enhance network convergence.

Finally, interdependence also contributes indirectly to continuance intention. Managers can thus develop small games within the current game that require collaboration/cooperation to increase interdependence among members. For example, while playing online games, gamers exert efforts to achieve challenging missions to earn gaming trophies. To reduce effort and maximize returns, they often form teams or partnerships for cooperation, thus establishing interdependence ( Teng et al., 2012a ).

Limitations, and the Associated Future Research Directions

This study is a cross-sectional study. Such a design should be acceptable for testing relationships among constructs. However, such a design is known to be limited in directly examining causality, restraining this study from claiming and examining exact causality among the study variables. Future studies are encouraged to replicate this study using big data approaches to directly examine the causality of the relationships observed in our study.

Our study sample mainly included participants in one single country, thus preventing problems of semantic equivalence among questionnaires of multiple languages and the confounding effects of cultural variables. However, the single-country sample restrained this study from examining how cultural differences impact the findings and how a specific culture impacts users' retention intention owing to social networks. Future studies could replicate this study in other countries and cultures to examine the above issues.

Participants of this study were asked to rate their favorite game, i.e., one gamer rated one game but not all gamers rated the same game. Such an approach includes various games, increasing the applicability and generality of the findings. However, such an approach is restrained from focusing on the uniqueness of each game. Since gamer interactions may differ among game genres, e.g., World of Warcraft players and Second Life players are distinctively different, future studies are encouraged to replicate this study using a specific game genre and further include unique aspects of that genre. This approach can provide further in-depth understanding of each game genre.

One of the merits of the study of Hsiao and Chiou ( 2012 ) was the collection of both subjective and objective data. This is particularly critical for examining the issue of community position, which can be both subjective and objective. The present study includes network convergence, which may be measured using objective data. However, it is unclear how the extent to which one gamer has shared friends with his/her in-game partner should be measured, e.g., by percentage of shared friends or other indicators. Moreover, it is also very difficult to obtain valid data by asking a gamer to provide a complete list of their friends. Therefore, the present study refrained from using objective data to measure network convergence. Nevertheless, the use of both subjective and objective data is a recommended approach for future studies.

Although the sample included users of numerous games, the sample was not randomly selected. Such an approach may suffer from the risk of self-selection bias, representing a limitation. To overcome such a limitation, researchers are suggested to seek for cooperation with large firms (e.g., Blizzard Entertainment) to obtain complete lists of potential participants that enables random sampling.

This study adopted self-reported data to measure network-related constructs (e.g., interdependence). Future studies can collect additional objective data. One suggested means is to develop software (e.g., an ad hoc app) which can collect Facebook friendship data. To successfully undertake this means, researchers should convince participants to download the app and use it, considering the participants' concerns of privacy and information security.

This study used two theories to construct the model. However, a model can hardly be exhaustive, since a complex real-world phenomenon can be explained using a large number of theories. Such a limitation likely applies to many studies in the literature, showing the fertile ground for future ambitious researchers to construct a highly comprehensive model to include all known theories regarding a specific issue and connect their key components.

Intuitively, high satisfaction levels and few quality alternatives likely increase continuance intention. Such impacts are known in the literature, motivating this study to examine new antecedents and their impact on continuance intention. However, future studies can examine whether the effects of known factors (i.e., satisfaction level and quality of alternative) outweigh the effects of new factors (i.e., network convergence and interdependence) on continuance intention. Such examination should provide further insight into the findings of this study.

Specifically, this study found that network convergence positively contributes to sense of community and relational switching cost. Similarly, interdependence is positively related to sense of community and relational switching cost. Moreover, the sense of community further positively contributes to relational switching cost. Both sense of community and relational switching cost positively contribute to continuance intention. Overall, the results show that the social presence and social capital theories can be applied to explaining how social networks retain users.

These findings provide useful insights for managers who operate online businesses. Managers should consider the facilitation of users' communication in social networks that can enhance the perceived performance of the medium (i.e., increasing a sense of community, a dimension of social presence). Moreover, users' social networks can build switching barriers that hinder users' switching behavior (i.e., increasing relational switching cost). In sum, social networks can effectively boost user retention and thus create a competitive advantage for managers.

Extant research on social networks has indicated that they can effectively fuel the continuance intention of online gamers. Our study contributes to the communication literature by elucidating the underlying mechanism on how social networks retain gamers. That is, gamers in social networks regard playing games as one way of interacting with real people and appreciate the social networks in games because such networks satisfy their need for sense of community and social capital. Therefore, online game providers should consider social networks as useful tools for building loyal user bases and devise means for fostering the formulation of social networks. In academics, our study lays the ground to assist future studies that intend to further understand how social networks impact online gamer psychology and behavior.

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Zeithaml , V. A. , Berry , L. L. , & Parasuraman , A. ( 1996 ). The behavioral consequences of service quality . Journal of Marketing , 60 ( 2 ), 31 – 46 . doi: 10.2307/1251929

Zhang , Z. ( 2010 ). Feeling the sense of community in social networking usage . IEEE Transactions on Engineering Management , 57 ( 2 ), 225 – 239 . doi: 10.1109/TEM.2009.2023455

Fan-Chen Tseng (Ph.D., National Taiwan University) is an Associate Professor in the Department of Multimedia and M-Commerce at Kainan University, Taiwan. His research focuses on online games and e-/m-commerce. Address: Department of Multimedia and M-Commerce, Kainan University, Taiwan, No.1 Kainan Road, Luzhu Dist., Taoyuan City 33857, Taiwan. E-mail: [email protected] .

Han-Chung Huang (Ph.D., Chang Gung University) is a Lecturer in General Education Center at China University of Technology, Taiwan. His research focuses on consumer psychology and behavior. Address: Graduate Institute of Business and Management, Chang Gung University, Taiwan, 259, Wenhua 1st Rd, Taoyuan 333, Taiwan. E-mail: [email protected] .

Ching-I Teng (Ph.D., National Taiwan University) is a Professor in the Graduate Institute of Business and Management at the Chang Gung University, Taiwan. His research focuses on online gamer psychology and behavior. Address: Graduate Institute of Business and Management, Chang Gung University, Taiwan, 259, Wenhua 1st Rd, Taoyuan 333, Taiwan. E-mail: [email protected] .

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The Online Gaming Industry in India [Case Study]

Manav Makhija

We all like to play games, as it is considered to be one of the most intriguing activities for amusement and leisure. Be it Candy crush or PUB-G the craze for games in India has been on top. It is often said that this fun activity has the power to make you happy as it increases your brain function, releases serotonin which is a chemical that makes us feel delightful.

Well, the allure of playing games is not new, be it board games or virtual games, the excitement of it has always increased in India. After the technological advancement and the history of gaming has completely changed and transformed.

The one prominent area which did not get relatively affected by the Covid-19 pandemic was the gaming industry all over the world. In fact, the pandemic lockdown gave a boost to this industry since people were forced to sit at their homes and explore some leisure activities.

According to a survey, there was a 30% increased in traffic in online mobile gaming in India during this period. Also, Paytm First Games reported that they saw an increase of 200% in the users of this online gaming platform.

Timeline of Gaming Industry The Current Gaming Scenario in India Gamers and their Preferences Top 10 online games in India Future of Gaming Industry in India FAQ

Timeline of Gaming Industry

18th Century: It was those times when people first discovered the concept of games in the Egyptian Dynasties. Later on in the 18th century as people started evolving the invention of card games and board games began to happen.

19th Century: People realized this leisure activity can be commercialized. Also this time people became advanced with the facilities of printing and manufacturing and hence started to produce the more vibrant and rich card and board games. For the first time, Monopoly was introduced in the year 1902 which is still a big sensation today when it comes to board games.

In the late 1930s, when computers were built the gaming advancements also began. The simple card games and board games were thought to be converted in the form of electronic means as well.

1950s–1990s: This was the era when the very first computer games and video games started becoming popular. Home computers had built-in games and portable video games became trendy. When mobile phones were released in the late 1990’s people in India were crazy about games like ‘Snakes’ on Nokia phones.

2000 – 2010: As the technology started upgrading and the mobile phones became better and better, the digital gaming industry valued around $5 billion.

2011 – 2016: When the technology rapidly started growing, VR games were introduced to people. The evolution of cameras, graphics, and sound quality enhanced the user experience in the gaming industry.

2016 – Today: Since 2016 till date, the global mobile gaming industry has never seen a huge downfall. Along with mobile phones, tablets, and laptops, people started purchasing specialized PCs that are designed to play heavy games with the most effective graphics and user interface. The trend of playing games professionally has also increased a lot in the Indian market.

The Current Gaming Scenario in India

In the past few years, the gaming industry in India is flourishing tremendously. From $62 billion in 2019 to $90 billion in 2020, the market continues to grow in robust ways. During the lockdown, the major segments that contributed to the growth were esports, mobile gaming, and real money gaming. The gaming industry has also been very significant in creating numerous job opportunities for people.

Today mobile gaming in India has reached millions of people. There are more than 600 million gamers around us and this is not going to stop anytime soon. India ranks 5th in engagement and awareness of gaming around the globe and this shows that people are totally involved in this segment.

Gaming firms have now started earning handsome revenues from this sector by generating a huge volume of game downloads, shooting advertisements, and elevating user experience. These companies also charge their customers some amount for premium game packs, subscriptions, purchases of coins, and other such chargeable extensions.

Gamers and their Preferences

Even though many games are considered to be gender-neutral, but there are games that are specifically designed for males or females. Today over 80% of the gamers population is below the age of 24 years while only 8% of the people age above 40. Youngsters tend to your internet more and play online games. According to the statistics, over 83% of the gamers’ population is male while only 17% is female.

While categorizing the genre of games, females prefer games that are related to puzzle or arcade games, whereas males prefer games that have action, sports, and thrill. Usually, such games are heavy in usage and require efficient devices. India has world-class infrastructure, IT skills, and more than that, the talent which has advanced gaming technology. The gamers enjoy the games developed by gaming centers like Microsoft , Disney, Sony , Playdom, UbiSoft, etc.

Top 10 online games in India

Here is the list of Top 10 games that Indians have absolutely loved and have been most trendy to date –

• PUB-G (now banned)
• Candy Crush
• Clash of Clans
• Call of Duty
• Subway Surfer
• 8 ball pool
• Counter-Strike

And a few more like Ludo, Rummy, Teen Patti, etc.

Future of Gaming Industry in India

1. Age and gender dominance is likely to improve in the near future. Online gaming will soon see a shift in the age and gender composition of the total population since the huge untapped market is likely to experience this world of gaming

2. Cloud gaming is going to get very popular especially in India. All people would need to have is a stable internet connection and they could get an experience of gaming like never before.

3. Freemium companies will help the industry to get better economic conditions. We are a very price-sensitive market and freemium gamers would continue to search for alternatives if the companies start charging for premium services.

4. Emerging technologies will help our country to uplift the gaming industry even more. The use of artificial intelligence augmented reality in games, virtual reality , modular technology, and cloud based gaming infrastructure will be the key drivers of the gaming industry in the future.

How big is the gaming industry in India?

The online gaming industry in India is expected to grow up to $2.8 billion till 2022.

How much does the gaming industry make 2020?

Global gaming industry is expected to surge $179 billion in 2020.

Which country has the most gamers?

According to Statista, Vietnam is the country with most number of gamers as of 2020.

The Indian online gaming industry is growing every month these days. Especially after the pandemic, when kids have more time and even the adults got introduced to this world of gaming. Moreover, it has even given opportunities to entrepreneurs to find more ways to market their products. Additionally, there are startups emerging in this industry and even investors are heavily funding these startups seeing their potential to grow in the country.

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After the Merger, RIL Might Just Have JioCinema as Its OTT Platform

According to a media report, Reliance Industries (RIL), the parent company of Star-Viacom18, is considering limiting itself to JioCinema as its only over-the-top (OTT) platform following the merger, subject to regulatory approvals. RIL is considering over a combination between Disney+ Hotstar and JioCinema, even though the former has more downloads.

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Video Gaming Addiction: A Case Study of China and South Korea

Posted by Ryan, Amanda | Dec 13, 2021 | American Politics(B) , Asia(B) , China(B) , U.S.(B) | 0 |

To wrap up summer vacation, the two leading countries combating internet and gaming addiction—China and South Korea—took a step in diverging directions. This raises the issue of which country serves as a better model for the U.S. government and American gaming companies. With both countries entering the year enforcing similar policies of reducing the amount of play time available to minors, it came as a surprise when China’s increase in limitations was met alongside South Korea’s plan to abolish the harsh restraints. Ultimately, South Korea recognized the flaws in their previous law and is modifying their game plan to include less restrictions and encourage more self-regulation. After reviewing scholarship and research studies which analyzed the previous laws enacted by China and South Korea, the latter’s new, more flexible approach appears to be most promising for the U.S. to take into consideration.

Douglas Gentile, developmental psychologist and the Director of Research for the National Institute on Media and the Family, estimated that over 8.5 percent of children and teenagers—roughly 3 million Americans—exhibit multiple signs of gaming addiction [1]. Currently in the Western world, video game-related regulations are limited to rating systems which evaluate content and maturity-levels rather than the overuse of gaming [2]. As video game addiction becomes increasingly prevalent, understanding, and ultimately comparing, the different prevention approaches is vital in protecting the health and development of younger generations.

What is Gaming Addiction?

Video gaming has beneficial and adverse effects on the cultural attitudes, psychological development, and lifestyle choices of young gamers [3]. For instance, a 2009 study in the Annual Review of Cybertherapy and Telemedicine found gaming can alleviate stress and depression; Dr. Daphen Maurer of the Visual Development Lab discovered gaming can improve eyesight and increase dopamine levels; and cognitive neuroscientists at the University of Rochester found video games can enhance decision-making skills [4]. Especially during the recent pandemic, where isolation and a lack of social interaction was prominent, the ability to engage with others via gaming provided much needed “social connection, escapism and relief for millions of kids and teens” [5].

Although the evolution of technology and the internet has brought numerous benefits, many negative ramifications have been uncovered as well. One of the most significant impacts of problematic internet-use gaining momentum is the onslaught of video gaming addiction. As a subset of internet addiction, video gaming addiction is often when gaming is taken to the extreme—ultimately impairing an individual’s ability to function either socially, academically, or financially [6]. In 2014, a study by Zhejiang Normal University discovered that gaming addiction can lead to “lower volumes of gray and white brain matter,” which can cause impairment in decision-making, regulating emotions, and impulse control [7]. Likewise, the comorbidity rate of the gaming disorder with depression, anxiety, and ADHD is significantly high, as many young gamers use gaming as a coping mechanism [8].

While the classification of video gaming addiction as a mental illness is somewhat controversial, organizations have recently spoken up about the issue. In 2013, the American Psychiatric Association (APA) included an Internet Gaming Disorder in the DSM-5 , and, in 2018, the World Health Organization (WHO) stated Gaming Disorder (GD) will be listed in the 11 th addition of the International Classification of Diseases [9]. With nearly three billion people playing video games worldwide, 3-4 percent of them—more than 60 million gamers—are likely to be suffering from gaming disorder [10].

In China, problematic video gaming has been recognized as a public health crisis [11]. In 2007, around 14 percent of Chinese adolescent internet users—about 10 million teenagers—met the diagnostic criteria for internet addiction [12]. According to the China Internet Network Information Center, this number increased 16 percent by 2018, with over 30 percent of minors suffering from gaming disorder [13]. With the issue growing in severity, China placed video gaming addiction on par with substance-abuse and drug addictions, labeling the activity as “spiritual opium” [14].

Similarly, South Korea considers internet addiction as one of the country’s most critical health issues [15]. By 2015, internet usage in South Korean households rose to 85.1 percent across all ages [16]. Comparable to the duration of a part-time job, the average South Korean teen spends over 23 hours per week playing video games [17]. In Seoul, the capital of South Korea, a common leisure activity for youths is to stop by a ‘PC bang’—an internet gaming room or cafe, typically open 24 hours, where players have access to comfortable seating and fast computers for a dollar an hour [18].

Following trend lines for the addiction in South Korea, in 2012, an estimated 2.55 million people were addicted to their smartphones and the internet [19]. For adolescents in particular, around 12.5 percent of teenagers were at risk for internet addiction disorder in 2014 [20]. And in 2019, the latest government-issued survey revealed over 20 percent of South Korea’s population—nearly 10 million citizens—were now at risk for the addiction [21]. Due to the isolating nature of the COVID-19 pandemic, many countries have reported an uptake in the amount of time minors spent gaming, suggesting a probable increase in problematic gaming for South Korean adolescents [22].

Initial Prevention Response Plans

International response and prevention plans vary, with some countries authorizing harsher, more hands-on restrictions than others. But how effective are these various responses in curbing behavioral addictions? China and South Korea provide case studies of possible responses and their likely consequences.

From 2000 until 2015, China banned the production and sale of popular gaming consoles—including Xbox and PlayStation—in an attempt to reduce the likelihood of children developing addictions [23]. However, many players worked around this obstacle by illegally purchasing consoles, or simply turning towards PC and mobile games instead. Shortly after the ban was lifted, their government placed restrictions and censors on the “harmful attributes” in video games, including the addictive qualities of in-game rewards and achievements, as well as the portrayal of violence [24]. Specifically, China introduced an Online Game Addiction Prevention System (Fatigue System) in 2007, which targeted the addictive qualities of games [25]. In this system, as the time a person spent gaming increased, the number of rewards they could obtain decreased and pop-up warnings of unhealthy playtime appeared in an effort to limit the gamer’s desire to keep playing. However, as mentioned in sections below, this system proved largely ineffective and was ultimately discarded [26].

As for treatment measures, China established centers aimed at rehabilitation to address problematic gaming, such as at the General Hospital of Beijing Military Region’s Internet Addiction Treatment Center [27]. Likewise, to further reduce the negative impact of the internet on minors, China passed the Minors Internet Protection Ordinance in 2016, which limited nighttime gaming, provided education to guide players, and required gaming companies to adhere to anti-addiction parameters [28]. Yet, with more minors continuing down a path towards addiction, a revision for the law was required [29]. In 2019, China went a step further and created tighter time restraints on how long minors were allowed to play video games—limiting players to 1.5 hours on weekdays, 3 hours on weekends and holidays, and only during daytime hours [30].

With over 720 million gamers by 2021, gaming culture prospered in China, leading the country towards becoming the largest market in the video gaming industry [31]. By having such a substantial portion of the population active in gaming, and with many of the previous restrictions easily circumvented, the need for an effective method in China to stop addiction became even more crucial.

South Korea:

In response to the rise in internet-related addictions, South Korea established the Internet Addiction Prevention & Resolution Comprehensive Plan in 2010 [32]. Led by the National Safety Administration-affiliated agency of the MSIP, the primary goal was to establish intervention systems for problematic game and internet use before addiction manifested [33]. Although, while posing many benefits for minors at risk, these approaches were also criticized for the lack of “inter-agencies collaboration and clinical conceptualization” [34].

To assist those already effected, many treatment centers were founded to support the recovery of youths suffering from gaming addiction [35]. One of these programs is the Jump Up Internet Rescue School, where internet or online gaming addicted children are sent to a camp designed for rehabilitation—guiding minors in their journey through adapting healthier hobbies and learning new coping mechanisms [36].

In 2011, South Korea passed the Youth Protection Act, also known as the Shutdown Law or “Cinderella Law,” restricting the hours minors could play video games [37]. Under this law, those under the age of 16 were unable to access online games between midnight and 6am in an effort to promote healthy sleeping habits, increase productivity and attentiveness in the classroom, and prevent the likelihood of addictions to develop [38].

2021 Modifications in Gaming Prevention

Although both countries enforced strict video gaming strictions in the past, their policies deviated in 2021: China pushing for even stricter regimens on gaming, while South Korea is tearing down their shutdown law in favor of more flexible moderating and a stronger emphasis on health services. For China, authorities claim that rolling out firmer measures to limit minors’ gaming exposure come from a desire to safeguard their physical and mental health—as well as to satisfy a concern from parents that the old policy was insufficient [39]. On the other hand, South Korea is moving in the opposite direction in hopes of “respecting the rights of the youth and encourage[ing] healthy home education,” and to break away from the shutdown law’s ineffectiveness [40].

Released by the National Press and Publication Association (NPPA), China tightened the 2019 restrictions of online gaming for minors to one hour per day—8 PM to 9 PM—on Friday, weekends, and public holidays [41]. In addition to strict time restrictions, identification systems were installed to ensure the rules are followed, essentially forcing minors to enter identification—such as real names, government-issued ID documents, or identification numbers—before playing [42]. However, since many gamers under 18 attempt to bypass this limitation by acquiring fake ID numbers or using VPNs, the policy also requires gamers to register their ID number for fact-checking in the national citizen database [43]. Following suit, gaming companies have launched new methods to increase the likelihood of player cooperation. Tencent, one of China’s major gaming companies, recently introduced “facial recognition technology and an algorithm that identifies underage players” [44].

Issues with China’s 2021 Modification

China is asserting a strong association of high playing time with addiction—where more hours spent gaming equals addiction. However, China’s emphasis on time as the determining factor leading to addiction is misguided [45]. In 2018, a study published in the Journal of Behavioral Addictions by Kiraly et al., analyzed the effectiveness of policy responses on problematic video game use. The study argued that the strict policy and regulation approaches limiting playtime “were not sufficiently effective” and henceforth called for more “integrative approaches” for improvement [46]. Additionally, another data set found that gaming time is “weakly associated with negative psychological factors” often found in problematic use [47].

According to WHO, the diagnostic criteria for the “gaming disorder” does not include a specific amount of playtime [48]. Rather, that gaming must cause distress, impairment in the gamer’s life and ability to function, and typically last for at least one year [49]. Like with many behaviors, there is a substantial difference between those who are simply enthusiastic about the activity and want to dedicate time towards it with those who are addicted to it. Ultimately, all behaviors exist on a continuum, and the point where an individual falls isn’t fully decided according to the amount of time allotted to the behavior.

Instead, the threshold differentiating regular gaming (unproblematic behavior) from a gaming disorder (problematic behavior) resides with the effect the activity has on the gamer—as well as the gamer’s response to those outcomes [50]. In other words, the amount of time a person spends breaking blocks in Minecraft , farming crops in Stardew Valley , or leading revolutions in Homefront doesn’t guarantee the development of an addictive behavioral disorder. Alternatively, if a person is so absorbed in their gaming that they repeatedly forget to pick up their kids from daycare, sneak in round after round of solitaire in the office instead of finishing a report, or demonstrate their gaming is negatively impacting their life on another significant level—and continue to game regardless—then that behavior can enter the realm of addiction. By itself, the amount of time spent gaming isn’t a reliable predictor of problematic use; therefore, for China to implement harsher time restraints as the primary driver of their response plan to video gaming addiction demonstrates their shortcomings in addressing the heart of this issue.

Another failure with China’s law is that it only effects the gameplay of minors. However, recent data has proven that the median age of gamers is 24, and a growing demographic in gaming addiction is people in their 20s and 30s [51]. According to a specialist in gaming addiction, adults often turn to video gaming for the same reason teens do: to escape the harshness of reality—unemployment, isolation, and relationship issues [52]. Hence, to properly address all vulnerable groups susceptible to gaming addiction, an approach geared towards more than just minors is needed.

Similar Issues with South Korea’s 2011 Law

Regarding South Korea’s shutdown law, Jiyun Choi et al. in the Journal of Adolescent Health analyzed data collected from the Korea Youth Risk Behavior Web-based survey from 2011 to 2015, concluding the “shutdown policy had practically insignificant effects in reducing Internet use for target adolescents” [53]. Among middle school students, the effects of the initiative were null on internet abuse, and only increased sleep duration by a mere 2 minutes [54]. In fact, the shutdown law’s strategy was indicated to have an overall damaging effect—both on the average player’s experience and leaving “the players wanting more,”—consequently raising the potential for addiction [55].

Mainly, as explained with China’s new law, the shortcomings may be linked to the fact that the policies outlined “only address or influence specific aspects of the problem” and fail to recognize the individual differences between gamers [56]. For instance, the forementioned 2018 study by Kiraly et al. revealed that the policies by China and South Korea tended to focus on only one of the following: (i) reducing time spent gaming, (ii) changing the addictive potential, (iii) trying to help gamers by looking at psychological and motivation factors behind their desire to game [57]. Tackling video gaming addiction through only one of the forementioned approaches isn’t sufficient to properly address the issue, rather the most efficient mode of attack requires a cohesive regulation approach that targets multiple aspects. Additionally, according to the study, another method to solve this issue is through a targeted prevention approach: where warnings can be customized to target problem behaviors without encroaching on the “non-problematic gamers’ enjoyment of a largely healthy pastime activity” [58].

South Korea’s 2021 Plan

Ten years after the controversial shutdown law, South Korea is removing government-controlled time restraints in gaming to stay up to date on digital trends, respect young people’s rights, and allow households to enforce limitations themselves [59]. By the end of the year, following the modification of the Youth Protection Act, South Korea will be relying on the “choice permit system,” where parents and underage gamers can request a permit to designate their own playing hours [60]. The Korea Association of Game Industry is in favor of the decision, expecting the new plan to release the hold the previous law held over their gaming industry and children’s rights, as well as reducing the likelihood for addiction to significantly manifest [61].

Notably, one of China’s concerns and motivators behind their aforementioned time restrictions revolve around the misdirection of priorities. It is true that children repeatedly opting to game over completing their algebra homework, or game late into the night instead of getting a full eight hours of sleep, can hinder their ability to learn and satisfy academic responsibilities—as studies in China have shown that problematic video gaming interferes with “sleep, mood, and social learning in children and adolescents” [62].

However, forcibly removing gamers from the gaming environment ‘cold turkey’ can cause considerable distress and negate the benefits that games have demonstrated [63]. It’s important to acknowledge that gaming can generate positive impacts as well. In a study exploring the benefits of gaming, published by the National Center for Biotechnology Information, it was discovered that children who regularly play video games in healthy doses develop an improvement in cognitive abilities—such as deductive reasoning, processing speeds, mathematical intelligence, and skills pertaining analogy—over those who do not game [64].

The notion of time constraints isn’t completely invalid, but should be executed on a moderate level according to each case—and in combination with education and treatment programs—to keep individuals focused on their priorities while demonstrating safe ways to game. To achieve this goal, South Korea’s abolishment of the restriction is paired with a shift in attention: one that focuses on “strengthening the monitoring of harmful game content,” supporting “media and game-use education,” and increasing the implementation of prevention and recovery methods—such as counseling and rehabilitation camps [65]. Moreover, with an aim to raise awareness of problematic gaming habits, outreach programs pertaining the nature of gaming culture, media literacy, and the risks for addiction are included in this renewed focus on education [66].

Hwang Hee, Minister of Culture, Sports and Tourism in South Korea, expressed that gaming is an important avenue for youths to release stress and connect with others; therefore, the new measures strive to encourage these benefits by “establish[ing] a healthy culture of gaming and leisure for teenagers in a flexible manner” [67]. This revised system is more permissive than China’s reinforced gaming restrictions, subsequently leaving “China as the only nation to restrict gaming hours by law” [68].

Technology will only continue to evolve and integrate into our daily routines. There’s no going back to an age where smart phones and online platforms aren’t essential to everything we do, whether that be flaunting vacation pictures on social media, calculating a tip at the end of a meal, buying the latest Barbie on Amazon for Christmas, or paying taxes at the touch of a button. We have the world at our fingertips; however, as with every device or tool at our disposal, there is a potential for abuse.

And with the gaming industry booming, there’s no denying video gaming addiction is becoming an increasingly significant threat—especially amidst the youngest generation. By identifying the best ways to approach the issue, backed by relevant strategies that don’t take away from the benefits and experience of gaming, the ramifications can be better contained and predicted in the United States. Particularly in the wake of the recent pandemic, where gaming, streaming, and other forms of content consumption on the internet have risen exponentially to fill the void of stimulus in people’s lives.

With South Korea’s newfound direction in their efforts against video gaming addiction, and WHO adding the problematic behavior on the list of addictions, the international awareness regarding the consequences of overusing technology can receive the attention it deserves. Additionally, by analyzing these two contrasting policies, the United States can determine which aspects are most effective and gear similar techniques towards their own prevention plans. While political and cultural differences may limit the capacity for the U.S. government to fully implement all of the policies previously mentioned, gaming companies have more control on a self-regulatory basis. This could include providing built-in parental controls, warning messages for high levels of playtime, and rating systems to evaluate the addictive potential of games.

Above all, there’s a collective responsibility for parents, educators, clinicians, game developers, and the U.S. government to recognize the issue for what it is and work towards protecting all vulnerable demographics. For policymakers and community members to pay attention, take this addiction seriously, identify addict-risk teens, introduce the necessary information, and provide effective treatment programs for those in recovery.

[1] Spajic, Damjan. (December 30, 2019). Video Gaming Addiction Statistics: Real Problem or Phony Panic? Retrieved from: https://kommandotech.com/statistics/video-gaming-addiction-statistics-real-problem-or-phony-panic/

[2] Kiraly, O., et al. (September 2018). Policy responses to problematic video game use: A systematic review of current measures and future possibilities. NCBI: Journal of Behavioral Addictions. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426392/

[3] Watkins, M. (October 26, 2021). Video Game Addiction Symptoms and Treatment. American Addiction Centers. Retrieved from https://americanaddictioncenters.org/video-gaming-addiction

[4] Lange, J. (August 31, 2021). Let the Kids Play Video Games. The Week. Retrieved from https://theweek.com/culture/1004360/1-hour-of-video-games-isnt-enough

[5] Goodfellow, J. (August 31, 2021). How Will Marleters Adapt to China’s Video-Game Restrictions for Kids? U.S.: Campaign. Retrieved from https://www.campaignlive.com/article/will-marketers-adapt-chinas-video-game-restrictions-kids/1726000

[6] (n.d.). Internet Gaming. American Psychiatric Association. Retrieved from https://www.psychiatry.org/patients-families/internet-gaming

[7] Staff. (June 10, 2020). Are video games and screens another addiction? Mayo Clinic Health System. Retrieved from https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/are-video-games-and-screens-another-addiction

[8] Kuss, D. J. (October 1, 2018). Policy, prevention, and regulation for Internet Gaming Disorder Commentary on: Policy responses to problematic video game use: A systematic review of current measures and future possibilities. Journal of Behavioral Addictions. V. 7, Issue 3. Pages 553-555. Retrieved from https://akjournals.com/view/journals/2006/7/3/article-p553.xml

[9] Lopez-Fernandez, O., and Kuss, D. (May 2020). Preventing Harmful Internet Use-Related Addiction Problems in Europe: A Literature Review and Policy Options. Research Gate. Retrieved from https://www.researchgate.net/publication/341684121_Preventing_Harmful_Internet_Use-Related_Addiction_Problems_in_Europe_A_Literature_Review_and_Policy_Options

[10] Adair, C. (n.d.). Video Game Addiction Statistics 2021—How Many Addicted Gamers Are There? Game Quitters. Retrieved from https://gamequitters.com/video-game-addiction-statistics/

[11] Ibid .

[12] Block, J. (March 1, 2008). Issues for DSM-V: Internet Addiction. The American Journal of Psychiatry. Retrieved from https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2007.07101556

[13] Xing, D. (September 3, 2021). China steps up its war on underage online video gaming and not everyone is happy. News. Retrieved from https://www.abc.net.au/news/2021-09-04/china-cracks-down-on-children-online-video-gaming/100428138

[18] Sullivan, M. (July 30, 2019). South Korea Says About 20 Percent of its Population is at Risk For Internet Addiction. NPR. Retrieved from https://www.npr.org/2019/07/30/746687204/south-korea-says-about-20-percent-of-its-population-is-at-risk-for-internet-addi

[19] (November 28, 2012). Wired South Korea to Stem Digital Addiction from Age 3. Retrieved from: https://www.usatoday.com/story/tech/2012/11/28/wired-south-korea-to-stem-digital-addiction-from-age-3/1731371/

[20] Lee, Claire. (April 22, 2015). More Teenagers at Risk of Internet Addiction. The Korean Herald. Retrieved from: http://www.koreaherald.com/view.php?ud=20150422001211

[23] McGregor, G. (September 3, 2021). China’s gaming market was built on free and addictive games. Can Beijing stop kids from playing them? Fortune. Retrieved from https://fortune.com/2021/09/03/china-video-gaming-mobile-smartphone-addiction-free-to-play/

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A method to develop accessible online serious games for people with disabilities: a case study.

1. Introduction

2. background, 2.1. visual disabilities.

• Normal vision.
• Moderate visual disability.
• Severe visual disability.

2.2. Motor Disabilities

• Structure of head and neck region.
• Structure of shoulder region.
• Structure of upper extremity.
• Structure of pelvic region.
• Structure of lower extremity.
• Structure of trunk.

2.3. Hearing Disabilities

• Slight/mild hearing loss (26–40 dB).
• Moderate hearing loss (41–60 dB).
• Severe hearing loss (61–80 dB).
• Profound hearing loss (over 81 dB).

2.4. Cognitive Disabilities

3. method and materials.

• Game title: A name for the serious game.
• Intended game systems: The platforms on which the serious game could be played (mobile, console, pc, etc.).
• Systems requirements: The minimum requirements that are necessary to execute the serious game. This includes the Internet speed connection.
• Target age of players: The profile and age of the recommended user for the serious game.
• Game story summary: Describe a review of the story that the serious game will tell. It should cover the details necessary to understand the serious game through precise and short wording.
• Game Flow: Briefly describe the flow of the game’s action in the context of the locations the player will be in. The flow of the game should describe information such as the challenges that will be presented, the rewards for solving challenges, the gameplay in the story and the conditions to win the game.
• How will the characters look?
• What skills will the characters have?
• How will the characters relate to the story of the game?
• G1. Adequate distributed virtual controls. A very useful feature for people with limited mobility and vision. It is recommended that the video game allows for reconfiguring the controls to suit the player’s needs. For example, a user who can only use one hand may prefer to bring the controls closer to restrict movement in a smaller area. This feature can make a difference in the experience of a video game.
• G2. Sensitivity sliders. There are some disabled players who have little strength, dexterity, mobility or involuntary movements. The ability to set the level of sensitivity allows players to transfer small movements of the controller to large actions on the screen or larger movements on the contrary will lead to more precise game actions. This feature translates into less effort on the part of the player.
• G3. Controls compatible with assistive technology. Players with motor disabilities have specific requirements that are commonly translated into the use of specialized hardware. Systems such as flicker detectors, micro-switches that are assigned to buttons or keystrokes/mouse or eye tracking are often used. Adapting to video games for simple movements that can be interpreted by this type of hardware is an important feature to consider.
• G4. Adjustable sensitivity/error tolerance. There is no sensitivity level for all video games or players. In addition to personal preferences, some types of players have a restricted range of motion and therefore require very high sensitivity. On the other hand, some players have difficulty with accuracy so they require very little sensitivity and even more so when using alternative input devices.
• G5. Use simple language. Using a very specific language may cause the player to not understand the instructions to continue with a video game. For this reason, it is recommended to use a language that allows one to tell a simple and easy-to-follow story and set aside terms that most players cannot understand.
• G6. Voice or text repetition. It is advisable to incorporate the possibility of repeating voice messages or texts within a video game. The repetition feature is used by players when dialogues or texts are difficult to follow.
• G7. Appropriate words-per-minute. It is very important to transmit information through subtitles, especially for deaf people. Thus, the number of words per minute must be taken into account—for example, considering the TV industry guidelines [ 54 ]. Taking into account an adequate number of words allows players with different disabilities to read the subtitles so that they can fully understand the conversation or instruction.
• G8. Subtitles. Subtitles, especially for people with hearing disabilities, have become an essential feature. The incorporation of subtitles in video games allows players to have a more pleasant experience in the history of the video game, as well as allowing them to receive instructions in a clearer way.
• G9. Pause while text is being read. In a video game, it is helpful to pause the execution of a text. This feature gives players more time to read the instructions or dialogues of the video game.
• G10. Save points. Some video game players may find it difficult to remain seated for long periods of time. This occurs in some cases due to conditions of diseases, such as muscular dystrophy, multiple sclerosis and/or other neurological disorders. For this reason it becomes important to incorporate in the video game Saving Points in order that the player can save his progress and resume it when necessary.
• G11. Use explicit visual rewards. People with different learning disabilities require receiving explicit visual or auditory rewards, either for animation or video, as motivation to keep their attention in the video game. This feature will allow the player’s skills to increase and motivate them to reach new video game challenges.
• G12. No timing essential to gameplay. There are video games in which time requirements are necessary but in others it is not. One recommendation is to avoid time requirements if they are not strictly necessary. This will allow players to enjoy the video game more casually and in a calm manner.
• G13. Simple-to-difficult progression. Allow for the modification of degrees of difficulty to a greater extent than usual in games. For example, for real time strategy games, add a speed slider or allow the game to change to a turn mode.
• G14. Visual indication of who is currently speaking. Conversations in a video game can be difficult to follow when the player cannot distinguish between different accents and voices. A different color for each character, placing the text on the side of the screen where the character is, naming him or even representing his face, are useful for a person with a disability, so they can recognize the character that is speaking at that moment.
• G15. Controls reminder during gameplay. Complex controls can sometimes be difficult for any player to remember and much more for those with memory problems. For this reason, it is helpful that players can access reminders of controls and their specific actions in the development of the history of the video game.
• G16. Simple controls. The controls are simple and quite intuitive. Even the default control settings should follow how most games work, so people with experience in video games will find it even easier.
• G17. Challenges repetitions. On many occasions the players do not have enough ability to overcome the different challenges of video games. This occurs more frequently in the case of people with disabilities. For this reason it is important to allow the challenges to be repeated countless times or at least the video game should enable this option to be activated. The challenges do not require extreme accuracy in order to be overcome by the players and, if they fail, they can be repeated.
• G18. No multiple actions required. Players with motor disabilities often have difficulty pressing the controls of a video game. For this reason it is important to avoid executing several actions that involve pressing several buttons at the same time. In the case of the video game, the player must only advance and jump at the same time for certain obstacles, but no challenge should require the user to press more than two buttons at the same time.
• G19. No repetitive mechanics. For many players, especially those with motor disabilities, it is often complex to perform repetitive actions during the development of the video game. Thus, it is recommended to avoid the use of repetitive mechanics such as pressing quickly and many times a button.
• G20. Easy execution. Young children and people with cognitive disabilities often have problems in video games in which many configurations or steps are required to start playing. For this reason it is important that the start of a video game is as simple as possible avoiding navigation through multiple menus.
• G21. High contrast. People with low vision commonly have trouble appreciating the scenes of a video game. It is for this reason that the ability to alter the contrast and other graphic features of the video game, such as lighting, may be helpful for the scenes to be displayed more clearly for the player.

4. Case Study

4.1. development.

• Game title: PC TRAVEL.
• Intended game systems: Roblox platform allows the following systems: – Android OS from version 4.0.3 onwards. – iOS from version 8 onwards. – Amazon Fire OS, 3rd generation onwards, except Amazon Fire HD 2013. – PC from Windows XP OS onwards. – MAC from version 10.7(Lion) onwards. – Chrome OS from version 53 onwards. It is important to indicate that Roblox is compatible with virtual reality systems, such as Oculus Rift and HTC Vive.
• Systems requirements: The minimum requirements that a computer requires to run Roblox are: – Graphics card that supports DirectX 9 and Shader Model 2.0. – Recent processor, released in 2005 or later, with a speed of 1.6GHz or better – 1 GB of RAM minimum – 10 MB of storage space at least Finally, the required Internet speed is a minimum of 4-8 Mbps for the connection and also 3G or higher networks in the case of mobile devices.
• Target age of players: The online serious game is recommended for 6-year-old individuals and those that are older. The game is educational and informative, so it has a large amount of text since the information given is based on dialogues. For this reason it is recommended that the player knows the English language for a better experience.

Click here to enlarge figure

• Coins: They are elements that the player must collect throughout the game. All collected coins accumulate in a total score. The presence of a coin implies important information for the player.
• Interactive Doors: There are two types of interactive doors in the serious game. The first one opens when the player correctly answers one of the questions posed by the helper. On the other hand, the second door opens or closes depending on whether a button is kept pressed or not.
• Interactive Stairs: There are two types of interactive stairs in the online serious game. The first are a system of blocks that appear and disappear in a simple sequence that the player must synchronize with the jumps in order to reach the other end. The second are segments of a bridge that appear when a question is correctly answered. If the player on the other hand responds badly, the block on which the character is standing disappears leaving them to fall into the void.
• Interactive Platforms: The three interactive platforms are in the last block. They are part of a challenge where the player must answer some questions. If the player answers correctly, it will turn green and the game will end. If the answer is wrong, a door in the platform will turn red and then drop the player to the void to repeat the section.
• Mobility button: forward, back, left, right.
• Functions buttons: jump, hit, shoot, run, etc.
• Menu button: to access the options.
• Interact through dialogues in search of information and answer questions.
• Collect coins in the online serious game to give the incentive a reward to the player.
• Jump to overcome obstacles by measuring distances and times in which it is done.
• G5. Use simple language. This guideline is represented in Figure 8 (Left). As we can see, the texts used do not contain a very technical language and difficult to assimilate in such a way that the player can understand it without problems.
• G10. Save points. In Figure 8 (Right), an example of the use of save points is presented. The user stands on the black mark and the game progression will be saved.
• G14. Visual indication of who is currently speaking. In Figure 9 (Left) we can see this feature in the video game.
• G18. No multiple actions required. In the case of the video game, the player must only advance and jump at the same time for certain obstacles, but no challenge requires the user to press more than two buttons at the same time.
• G21. High Contrast. In the Figure 10 , one can see the elements with which the player must interact, which have a neon color. Shiny coins, for example, are easy to place visually for their neon glow.

4.2. Results

5. discussion, 6. conclusions, author contributions, conflicts of interest, abbreviations.

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Share and Cite

Jaramillo-Alcázar, A.; Cortez-Silva, P.; Galarza-Castillo, M.; Luján-Mora, S. A Method to Develop Accessible Online Serious Games for People with Disabilities: A Case Study. Sustainability 2020 , 12 , 9584. https://doi.org/10.3390/su12229584

Jaramillo-Alcázar A, Cortez-Silva P, Galarza-Castillo M, Luján-Mora S. A Method to Develop Accessible Online Serious Games for People with Disabilities: A Case Study. Sustainability . 2020; 12(22):9584. https://doi.org/10.3390/su12229584

Jaramillo-Alcázar, Angel, Paz Cortez-Silva, Marco Galarza-Castillo, and Sergio Luján-Mora. 2020. "A Method to Develop Accessible Online Serious Games for People with Disabilities: A Case Study" Sustainability 12, no. 22: 9584. https://doi.org/10.3390/su12229584

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A case study of Internet Game Addiction

Lee, Eun Jin R.N., Ph.D., APRN 1

1 Fayetteville State University, Fayetteville, NC, USA

Address correspondence to Eun Jin Lee 1200 Murchison Rd, Nursing Building 311, Fayetteville, NC 28301. E-mail: [email protected]

Internet game addiction is becoming a severe problem in adolescents. The purpose of this article was to present a case study on Internet game addiction. The effects of a new program to treat Internet game addiction based on cognitive-behavioral therapy, behavior modification, and a 12-step program are described. The subject in this case study was a 16-year-old Korean adolescent who lived in the United States. The adolescent received 5 counseling sessions which seemed ineffective in correcting his Internet game addiction. However, at follow-up, the adolescent showed improvement in game addiction. This article suggests that these 3 therapies could be combined to form a treatment model which could significantly benefit the patient and positively impact behavior change.

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Internet gaming addiction: current perspectives

Daria j kuss.

Psychology Research and Behavior Management, Birmingham City University, Birmingham, UK

In the 2000s, online games became popular, while studies of Internet gaming addiction emerged, outlining the negative consequences of excessive gaming, its prevalence, and associated risk factors. The establishment of specialized treatment centers in South-East Asia, the US, and Europe reflects the growing need for professional help. It is argued that only by understanding the appeal of Internet gaming, its context, and neurobiologic correlates can the phenomenon of Internet gaming addiction be understood comprehensively. The aim of this review is to provide an insight into current perspectives on Internet gaming addiction using a holistic approach, taking into consideration the mass appeal of online games, the context of Internet gaming addiction, and associated neuroimaging findings, as well as the current diagnostic framework adopted by the American Psychiatric Association. The cited research indicates that the individual’s context is a significant factor that marks the dividing line between excessive gaming and gaming addiction, and the game context can gain particular importance for players, depending on their life situation and gaming preferences. Moreover, the cultural context is significant because it embeds the gamer in a community with shared beliefs and practices, endowing their gaming with particular meaning. The cited neuroimaging studies indicate that Internet gaming addiction shares similarities with other addictions, including substance dependence, at the molecular, neurocircuitry, and behavioral levels. The findings provide support for the current perspective of understanding Internet gaming addiction from a disease framework. The benefits of an Internet gaming addiction diagnosis include reliability across research, destigmatization of individuals, development of efficacious treatments, and the creation of an incentive for public health care and insurance providers. The holistic approach adopted here not only highlights empirical research that evidences neurobiologic correlates of Internet gaming addiction and the establishment of a preliminary diagnosis, but also emphasizes the necessity of an indepth understanding of the meaning, context, and practices associated with gaming.

Introduction: the mass appeal of Internet gaming

Internet gaming is a booming market. In 2012, more than one billion individuals played computer games, which fuelled the 8% growth of the computer gaming industry in the same year. 1 A recent report by the market research company Niko Partners has estimated the People’s Republic of China’s online gaming market at $12 billion in 2013. 2 Massively Multiplayer Online games (MMOs) offer the possibility to play together with many other players and can be differentiated based on game content and player experience. A latent profile analysis of survey data from 4,374 Hungarian online gamers (91% male, mean age 21±6 years) indicated that the most prominent MMOs were role-playing games, first-person shooters, real-time strategy, and other games. 3 First-person MMO shooter games are based on skill because they require good reaction time and attention, and competition is a key aspect of these games. In real-time MMO strategy games, players organize teams, develop their skills, and play for status in the game. 4

Massively Multiplayer Online Role-Playing Games (MMORPGs), on the other hand, appear of particular interest to players because they offer a variety of incentives for play relative to other game genres. Of all online gamers, 46% play MMORPGs, 3 confirming their position as the most popular online games. MMORPGs are game universes inhabited by thousands of players at the same time (massively multiplayer) with no spatial or temporal boundaries because they are played online, and they allow players to adopt various virtual personas vis-à-vis their avatars (role playing). 5 Today’s most popular MMORPG is “World of Warcraft”, the latest game in Blizzard’s Warcraft series, situated in the fantasy world of Azeroth that is populated by members of the opposing factions of the Alliance and the Horde. 6 According to a recent report published by the Entertainment Software Association, 7 World of Warcraft’s extension “Cataclysm” was among the top five selling computer games in 2011. In 2013, eight million players immersed themselves in the world of Azeroth, 8 clearly demonstrating the game’s mass appeal. The game tailors to most age groups, both sexes, and various player interests and preferences, 6 making it an MMORPG success story par excellence.

Online games such as World of Warcraft satisfy various gaming motivations. The analysis by Yee 9 of 3,000 MMORPG players’ gaming motivations revealed that MMORPGs allow players to achieve game goals, be social, and immerse in the game. Each of these factors is composed of a number of subcomponents as particularized by the gamers. First, achievement includes advancing in the game, namely progressing via leveling up, acquiring status and power in the game, the game’s mechanics, including the possibilities for optimizing game play, and competition, including challenging and dominating others. 9 Reputation and admiration from the gaming community for gaming achievements are further key factors motivating players to keep playing. 6 The game mechanics or structural characteristics have been claimed to reinforce the potentially addictive qualities of games because they contribute to initiation, development, and maintenance of gaming. 10

Second, the social factor is composed of socializing, including chatting and making new friends in the game, forming new relationships, and working in a team. 9 Research 11 suggests that the social element in MMORPGs is particularly important for gamers because it is an integral component of the enjoyment of playing. Moreover, it denotes a complex interaction between real and virtual social networks, further blurring the boundaries between these networks, making MMORPGs inherently social spaces. 12

Third, immersion in the game is denoted by discovery, ie, exploring the game and “hidden” game content, role-playing via one’s avatar, customization of one’s online character (such as sex, race, profession, appearance), and escapism, ie, playing in order to avoid real life. 9 Escapism is an aspect of mood modification whereby individuals suffering from addictions induce a subjective shift in their mood by way of engaging in an addictive behavior, making the latter a coping strategy to deal with everyday problems. 13

The variety of gaming motivations satisfied by MMOR-PGs indicates that these types of games are particularly versatile because they can be tailored to individual players with different game preferences. Consequently, one could assume that there are many ways that might lead some individuals to get hooked on MMORPGs. In a sample of 696 MMORPG players (93% male, mean age 26±7.4 years), achievement, socializing, and escapism motivations were found to be predictive of addictive play, together with sex accounting for 19% of variance in the MMORPG addiction score. 14 Similarly, in a sample of 175 primarily Dutch MMORPG players (87% male, mean age 21±6.5 years), escapism and game mechanics predicted excessive gaming over and above the contribution of the time spent gaming, together explaining 46% of the variance in problematic gaming. 5 In a nutshell, the mass appeal of MMORPGs rests on their versatility because they are tailored to gamers young and old, male and female, who have different game preferences. MMORPGs are particularly good at meeting various players’ different needs. This mass appeal may have contributed to findings from research which indicate that online games, and specifically MMORPGs, are more addictive than any other types of both offline and online games 15 because they reward players on partial reinforcement schedules, leading to maintenance of play. 16

Internet gaming addiction

In recent years, research about Internet gaming addiction has increased both in quantity as well as in quality. Research on gaming addiction dates back to 1983, when the first report emerged suggesting that video gaming addiction is a problem for students. 17 Shortly thereafter, the first empirical study on gaming addiction was published by Shotton, 18 based on self-reports of young male players who claimed they were “hooked” on their games. The early studies suffered from a lack of standardized psychometric instruments used for assessing gaming addiction. 19 However, research 20 indicates that self-reports correlate with standardized measures. Following on from that, further studies were carried out in the 1990s, initially assessing gaming addiction based on the criteria for pathologic gambling as stipulated in the third and fourth editions of the Diagnostic and Statistical Manual for Mental Disorders (DSM). 21 Although similar, pathological gambling and excessive gaming do not present with the same clinical picture, and some have argued that using the diagnostic criteria for pathological gambling in order to diagnose pathological gaming only taps into obsessive use and preoccupation rather than actual psychopathology. 22 In the 2000s, online games became popular, while studies of Internet gaming addiction emerged. 23 , 24

The studies on Internet gaming addiction in the new millennium reported prevalence estimates which vary significantly and range from 0.2% in Germany 25 , 26 to 50% of Korean teenagers. 27 This discrepancy in estimates is due to various conceptualizations, diverse measurement instruments, as well as the different cutoff points used. Further, dissimilar constructs (“Internet gaming addiction”, “dependence”, “problematic”, and “excessive play”) are measured in various samples (children, adolescents, gamers) and cultures. In most studies, self-reports have been used, which puts the reliability and validity of the potential diagnosis in question. 28 However, research 20 indicates that self-diagnosis correlates with standardized measures of addiction, suggesting that the individual’s perception of problems can be relatively accurate.

In South-East Asian countries, the negative impacts of Internet gaming addiction have led governments and health care providers to take the problem seriously and to develop a series of initiatives to curb and alleviate the problem. In South Korea, Internet gaming addiction is viewed as a significant concern for public health, 29 and up to 24% of children who have been diagnosed with Internet addiction are hospitalized. 30 In Japan, the government has recognized the problem following a study by the Ministry of Education, which has led to the development of “fasting camps” where individuals suffering from Internet and gaming addiction are helped by being cut off from technology completely. 31 It has been stated that the higher the Internet penetration and social acceptance of gaming, the higher the prevalence of gaming problems, 32 partially explaining the higher prevalence rates reported in South-East Asian countries. In addition to this, there is good reason to think that the lower acceptance of excessive gaming in a culture, the more distress (not less) gamers experience in engaging in the activity, potentially fuelling problem perception. Therefore, a lack of acceptance of excessive gaming and thus stigmatization of the behavior might contribute to higher rates of addiction and problematic play in some way. Following growing concern, specialized treatment centers and programs have been established in Europe (including the outpatient clinic for behavioral addictions in Mainz, Germany, and the Capio Nightingale Hospital in London, UK) and the US (including the inpatient centers RESTART Internet Addiction Recovery Program in Seattle and the recently opened digital detoxification and recovery center in Pennsylvania), reflecting the growing need for professional help.

The concerns appear to be grounded as a growing number of studies indicate that Internet gaming addiction is associated with various negative consequences. 15 The psychological consequences include the following: sacrificing real-life relationships, other pastime activities, sleep, work, education, socializing, and relationships, 33 – 40 obsession with gaming and a lack of real-life relationships, 41 lack of attention, 33 , 42 aggression and hostility, 42 , 43 stress, 33 dysfunctional coping, 33 , 44 , 45 worse academic achievement, 38 , 46 problems with verbal memory, 47 and low well-being and high loneliness. 48 Moreover, psychosomatic consequences have been found in a number of studies. These included problems with sleeping, 41 , 47 seizures, 49 and psychosomatic challenges. 33 This long list indicates that Internet gaming problems must be taken seriously as they can affect the individual negatively in a variety of ways.

Internet gaming addiction is a behavioral problem that has been classified and explained in numerous ways. According to Griffiths, 13 biopsychosocial processes lead to the development of addictions, such as Internet gaming addiction, which include the following components. First, the behavior is salient (the individual is preoccupied with gaming). Second, the individual uses the behavior in order to modify their mood (ie, gaming is used to escape reality or create the feeling of euphoria). Third, tolerance develops (the individual needs increasingly more time to feel the same effect). Fourth, withdrawal symptoms occur upon discontinuation of the behavior (the individual feels anxious, depressed, and irritable if they are prevented from playing). Fifth, interpersonal and intra-personal conflict develops as a consequence of the behavior (the individual has problems with their relationship, job, and hobbies, and lack of success in abstinence). Finally, upon discontinuation of the behavior, the individual experiences relapse (they reinitiate gaming). 13

Although the core criteria appear to be established, the etiology of Internet gaming addiction has yet to be studied in detail. Research 15 indicates that a number of risk factors are associated with Internet gaming addiction. These risk factors include certain personality traits, gaming motivations, and structural game characteristics. The personality traits most commonly associated with Internet addiction include neuroticism, 37 , 50 aggression and hostility, 43 , 50 – 52 and sensation-seeking. 43 , 50 Factors that appear to protect frequent online gamers from developing problems with their gaming were found to be conscientiousness and extraversion, 53 suggesting that for different individuals the same behavior can have different psychological repercussions.

In addition to this, the following gaming motivations were found to be most commonly associated with gaming addiction: coping with daily stressors and escapism, 5 , 16 , 44 , 54 – 57 online relationships, 16 , 51 , 57 – 59 and mastery, control, recognition, completion, excitement, and challenge. 34 , 56 , 60 This indicates that the reasons for game play may be an important indicator of potential risk for Internet gaming addiction. Specifically, in comparison with non-MMORPG players, MMORPG players preferred their online friends over their real-life friends. 16 Similarly, significantly more dependent gamers were found to prefer spending time with their online friends than their offline friends relative to nondependent gamers and felt their social needs were met better online than offline. 44 Moreover, while online games provide nonaddicted players with satisfaction, addicted players play to avoid dissatisfaction, 55 which can be an indication of withdrawal symptoms they want to overcome by engaging in gaming compulsively. The motivational differences to play games between dependent and nondependent as well as MMORPG and other gamers appear to be useful clinical information because these motivations can be specifically targeted in treatment sessions. For instance, elements of exposure therapy may be used for the socially fearful in order to decrease discomfort and reintroduce clients to real-life social environments. Also, alternative pastime activities that are perceived as satisfying can be encouraged specifically in group therapy sessions. Encouraging engagement in group sports might satisfy both the need to engage in competitive and satisfying activities and the need to interact with peers in real life.

Moreover, a number of structural game characteristics have been found to increase the risk for developing Internet gaming addiction, namely online relative to offline gaming, 61 positive reinforcement, 62 the enjoyment of particular game features, such as adult content, finding rare in-game items, and watching game cut scenes, 63 and viewing one’s virtual persona as better than oneself. 64 These characteristics indicate that particular games can be more addictive than others, 15 which appears important for game developers and public prevention campaigns that focus on decreasing risk and raising awareness of potential problems. Prevention campaigns could target school-aged children, teachers, and parents in education settings. They could be based on the principles of providing information and a discussion platform concerning Internet and gaming use and possible negative consequences via psychoeducation, with the ultimate goal of encouraging healthy media use. Success could be determined over the long term using triangulation of data and reports obtained from the targeted populations.

Most reviews to date have primarily focused on specific aspects of Internet gaming addiction, including methods used to assess gaming addiction, 65 , 66 structural characteristics, 60 and treatment. 67 – 69 In light of this, the aim of this review is to provide an insight into current perspectives on Internet gaming addiction using a holistic approach, taking into consideration the mass appeal of online gaming, the context of Internet gaming addiction, and associated neuroimaging findings, as well as the current diagnostic framework adopted by the American Psychiatric Association. 70 It is argued that only by understanding the appeal of Internet gaming, its context, and neurobiologic correlates can the phenomenon of Internet gaming addiction be understood comprehensively. An evaluation of the findings will be presented in the overall discussion.

Gaming addiction: context

Research on gaming addiction has paid little attention to the context of online gaming. However, a few studies have now shed some light on the embedding of Internet gaming addiction in the context of the individual, 71 the game and gaming environment, 6 , 72 and the broader framework of culture. 73 Each of these will be addressed in turn.

Griffiths 71 provided case study evidence of two young men who spent an average of 14 hours a day playing MMORPGs in order to emphasize that the context of the individual’s life is an important factor demarcating gaming excess from gaming addiction. Aged 21 years, unemployed and single, “Dave” reported that gaming had a positive influence on his life because his social life revolved almost exclusively around the game, and playing boosted his self-esteem and gave structure to his everyday life. Dave did not perceive that his excessive gaming impacted upon his life negatively at all. For Dave, his extensive gaming did not lead to significant distress or have a negative impact in his daily life, and therefore his behavior cannot be classified as a condition that would fulfill the requirements of a mental disorder classification as outlined in the DSM-5. 74 Upon starting a new job and entering into a relationship with a woman he met in-game, his excessive gaming decreased significantly.

The second case reported was that of “Jeremy”, a 38-year old financial accountant who was married with two children and experienced detrimental consequences due to his “severe gaming addiction”, namely a relationship breakdown, lack of time for family activities, and loss of his job. Moreover, his playing time, craving for the game, and feelings of low mood and anxiety had increased dramatically. He used gaming to escape from his real-life problems and tried to quit on several occasions, but was unsuccessful in staying abstinent. This led to a number of relapse episodes. 71 The examples of Dave and Jeremy make a compelling case for how the same behavior (namely regular online gaming for excessive periods of time) can have almost diametrically opposed consequences due to different individual contexts, with one experiencing gaming as pleasurable and ultimately beneficial, whereas the other’s entire life was negatively affected by his excessive gaming.

In addition to the individual context, the context of the game appears important in determining the extent to which excessive gaming can truly be an addiction. 6 , 72 Karlsen 72 conducted 12 interviews with online gamers (75% male, mean age 23±2.4 years) who play World of Warcraft and used virtual ethnography 75 in order to assess the consequences of their excessive gaming. The results indicated that some of the players experienced behavioral addiction symptoms as specified by Griffiths, 13 namely salience, mood modification, tolerance, withdrawal, conflict, and relapse, with the latter two demarcating excessive from potentially addictive play. However, rather than advocating current diagnostic frameworks for “pathologizing” gaming, Karlsen 72 advocates to view gaming excess from the vantage point of game structure and gaming context, including the social practice and cultural meaning of games as well as the individual’s connection to the game from the perspective of game and media studies. This understanding entails a move away from the overly simplistic approach of focusing on the psychological rewards that reinforce gaming to include an indepth exploration of gaming motivations, gaming structure and mechanics, as well as the meaning of gaming for the individual. 72

Kuss 6 analyzed online gaming and potential gaming excess by interviewing eleven World of Warcraft players (72% male, mean age 27±7.3 years) and used virtual ethnography 75 as well as ludology principles 76 to understand how playing this particular game mirrors participation in popular media culture. In this context, media culture is understood as a flexible and evolving area of engagement that requires active participation. Potential gaming addiction was found to be associated with escapist motivations and in this context gaming was understood as fulfilling a “narcotic” function. The game context gained particular significance in one participant’s life because of two features of the game. First, he was able to enact heroic tales through his avatar and faction membership. As a member of the Horde, he fought the opposing faction, the Alliance, and was involved in killing their king, an episode “he would not forget until the end of his life”. Second, he was enabled to return to a familiar cultural context by means of his guild which consisted of fellow countrymen, after he had physically migrated to a foreign country. In this way, the provisions of the game (namely participation in the game’s narrative, 77 community, and belonging) 78 were utilized to a problematic extent, leaving the participant feeling “addicted to wow [World of Warcraft]”. Eventually, the analysis revealed that the meaning that is attached to the game can lead to excessive play which may cause a retreat from real life. 6

Snodgrass et al 73 surveyed 252 respondents (78% male, mean age 27±9.0 years) using Yee’s 9 motivational factors achievement, social and immersion to assess problematic MMORPG play in World of Warcraft from the perspective of culture under the supposition that gaming allows for formation of communities and cultures. 12 , 79 , 80 The cultural context situates the individual and his potentially addictive game play (assessed using Young’s Internet Addiction Test) 81 within the framework of commonly shared beliefs and practices. 82 Snodgrass et al 73 used an anthropological approach focusing on meaning, practice, and experience, mirrored in their understanding of gaming motivations and problematic play. They found that achievement motivation may lead to problematic play if players are less successful in real life (ie, less “culturally consonant”) and use game success to compensate, 73 causing stress and negative health outcomes. 83 In terms of social motivation, the extent to which online relationships gain significance over offline relationships was analyzed 73 because research indicates that lack of cultural consonance regarding social networks impacts negatively upon health. 84 Regarding immersion, the amalgamation of online and offline life and identities was assessed, 73 because association of the self with the game and the avatar could lead to dissociation. 85 , 86 The results indicated that game play in World of Warcraft mirrors cultural models of success regarding objectives and responsibilities, indicating that the game world can in some ways substitute the real world. Moreover, the culturally sensitive motivations achievement, social and immersion significantly predicted problematic MMORPG play if they were incongruent with real life, that is, if the game was used to compensate for lack of success and relationships in real life, and to dissociate from real life. 73

Taken together, the individual, game, and cultural contexts appear to have a significant impact upon the extent to which problems occur as a consequence of excessive gaming in terms of how Internet gaming addiction is conceptualized. In this way, the cultural context can be seen as a lens through which individuals and others around them perceive and give meanings to behaviors and their consequences. It is critical to understand gaming problems not only by means of the observable symptoms, but to situate them within the broader context of the game, the individual, and culture.

Gaming addiction: neuroscience

In the last decade, psychiatry has increasingly made use of neuroscientific evidence to understand and conceptualize mental disorders. 87 The major funding body for mental health research, the National Institute of Mental Health, has recently introduced research domain criteria to reclassify mental disorders as based on neuroscience and shared underlying pathophysiology rather than the more subjective approach of phenomenology and clinical presentation that has been utilized previously. 88 The ultimate aim is to improve the reliability and validity of clinical diagnosis and accordingly to deliver optimal treatment. 89 In accordance with this approach, research on Internet gaming addiction is now increasingly making use of neuroimaging techniques to allow for analysis of neurobiological changes due to excessive gaming and neurochemical correlates of addiction. 90

Some studies have shown that changes in brain activity and structure related to addiction are relevant for brain regions involved in reward, motivation, and memory, as well as cognitive control. 91 It has been hypothesized that initially the prefrontal cortex and ventral striatum are involved in the decision to initiate the addictive behavior. Over time, the individual habituates to the behavior and develops a compulsion to engage in it, which is accompanied by alterations of activity in the dorsal striatum as it becomes activated through dopaminergic innervation. There is some evidence for the idea that dopamine is released. 92 The longer the engagement continues, the more permanent the changes in the dopaminergic pathways become. It has been suggested that activity in the anterior cingulate, orbitofrontal cortex, and nucleus accumbens is modified in such a way that natural rewards are experienced as less pleasurable, further reducing control over the behavior. 93 , 94 Research suggests that over time, synaptic activity is reduced, leading to long-term depression and neuroadaptation, 95 as well as behavioral sensitization. The synapses in the ventral tegmental area become stronger, glutamate in the nucleus accumbens is reduced, and activity in the amygdala and hippocampus (related to memory) is increased, which can in turn result in craving 91 , 96 and increased response to the availability and particular context of the addictive behavior. 93 , 97 Some studies have shown that the addictive behavior becomes associated with these cues through activity in the nucleus accumbens, which reinforces the effects of the behavior. 98 With time, tolerance to the addictive behavior develops and natural rewards are depreciated, resulting in a reward system deficiency and activation of the antireward system. 99 The consequent lack of dopamine in mesocortical brain regions can lead to withdrawal symptoms, and in order to overcome these, renewed engagement in the addictive behavior ensues, and may ultimately impact upon the functions of the orbitofrontal cortex and cingulate gyrus. 91 , 100 , 101

Over the last decade, a number of neuroimaging techniques have been applied to Internet gaming research, allowing for an analysis of addiction correlates regarding both brain function as well as brain structure. Electroencephalograms measure brain activity via changes in voltage in the cerebral cortex via electrodes, 102 and were used in six studies of Internet and gaming addiction. 103 – 108 Positron emission tomography measures neuronal metabolism through photons from positron emissions via positively charged electrons. 109 Two studies 110 , 111 made use of positron emission tomography to measure Internet and gaming addiction. Like positron emission tomography, single photon emission computed tomography measures metabolic activity in the brain at the level of individual photons, 112 and was applied in one study of Internet addiction. 113 Eight studies 114 – 121 used functional magnetic resonance imaging to measure changes in blood oxygen levels in order to indicate brain activity in individuals with Internet and gaming addiction. 122 Finally, structural magnetic resonance imaging uses methods such as voxel-based morphometry 123 and diffusion-tensor imaging 124 to image brain morphometry, 125 and was used in two studies 126 , 127 in order to assess Internet addiction.

A systematic review of all Internet and gaming addiction studies using neuroimaging methods until 2012 90 revealed that Internet gaming addiction appears similar to other addictions, including substance-related addictions, at the molecular, neurocircuitry, and behavioral levels. From a molecular perspective, gaming results in the release of striatal dopamine. 111 On the other hand, it has been suggested that, in small samples, Internet and gaming addiction is associated with a reward deficiency whereby dopaminergic transporters in the brain are reduced. 110 , 113 In order to reinstate a biochemical equilibrium, 99 individuals whose reward system is deficient seek substances and activities which result in the release of dopamine. Under normal circumstances, pleasure drives (including eating and reproduction) are natural rewards that are craved, whereas unnatural rewards include psychoactive substances and addictive behaviors. 128 Over time, the individual habituates to the hedonic feelings produced by Internet gaming and develops abstinence symptoms, tolerance, and withdrawal. 129 Internet gaming addiction is initiated and maintained. 90 The decreased dopaminergic transporters in Internet gaming addiction may explain its frequent co-occurrence with depression, 130 bipolar disorder, 131 and borderline personality disorder and dissociative symptoms. 132

With regards to neural circuitry, when gaming, brain areas associated with addictions are frequently utilized and therefore the activity in regions such as the orbitofrontal cortex and cingulate gyrus is high, which over time can lead to significant alterations in neuronal connectivity 114 , 116 , 118 , 119 and brain structure. 115 , 126 , 127 Internet gaming becomes increasingly salient and individuals lose control over their gaming. 90 The individual is immanently motivated to play online games as they have learned the behavior, eventuating in continuous engagement. 133

In terms of behavior, excessive Internet gaming can result in problems with impulse control, behavioral inhibition, executive functioning, attention, and general cognitive functioning. 103 , 104 , 107 , 115 , 126 , 127 However, there are plus sides as well, in that the frequent gamer develops and improves a number of other capabilities, namely the integration of perceptual information into the brain and hand-eye coordination. 118 , 120

Taken together, research on Internet gaming addiction has made use of various neuroimaging techniques in order to shed light upon the neurochemical and neuroanatomic correlates of addiction. Although in most studies the direction of the relationship has not been investigated (ie, it is unclear whether Internet gaming addiction causes changes in brain structure and activity or vice versa), the current evidence suggests a relationship between brain alterations and Internet gaming addiction. Neuroimaging studies of Internet gaming addiction contribute to the current understanding of addiction as based on a disease framework. 128 , 134 This indicates that, similar to cardiovascular diseases, lifestyle (ie, excessive gaming) can result in changes to underlying neurobiology. Moreover, the utilization of sophisticated imaging methods in Internet gaming addiction research is in line with research domain criteria, 88 which makes a significant contribution to our understanding of Internet gaming addiction as a chronic neurobiological disease requiring professional care and adequate treatment. 135

Gaming addiction: clinical diagnosis

Following nearly two decades of research, the American Psychiatric Association has now officially recognized Internet Gaming Disorder as a condition that requires consideration by clinicians and researchers. In June 2013, Internet gaming disorder appeared in the appendix of the updated version of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) for the first time. 70 It stands alongside the only other behavioral addiction, ie, pathological gambling, situating it clearly within the diagnostic category of Substance-Related and Addictive Disorders. Internet gaming disorder has pulled ahead of other behaviors that can become addictive, such as exercise, 136 , 137 work, 138 and shopping. 139

Up until now, researchers have understood Internet addiction or Internet gaming addiction as similar to either impulse control disorders in general or pathological gambling specifically, 140 – 142 substance dependence, 33 , 38 or a combination of the two. 143 , 144 This has led to the development of multiple psychometric instruments, each measuring different aspects associated with Internet gaming problems and addiction. 144 – 153 The multiplicity of conceptualizations used for Internet gaming addiction have led to a diagnostic conundrum leading some researchers to question its existence, 29 and have called for commonly agreed upon criteria which increase reliability across studies and advocate adequate and efficacious treatment. 15

Under the new DSM-5 framework, Internet gaming disorder refers to the “persistent and recurrent use of the Internet to engage in games, often with other players, leading to clinically significant impairment or distress as indicated by five (or more) [criteria] in a 12-month period”. 70 The diagnostic criteria are a preoccupation with gaming, withdrawal symptoms, tolerance (ie, spending more time gaming), lack of control, loss of other interests, use despite negative consequences, deception, mood modification, and losing a relationship, job, and similarly important aspects of life. 70 From a public health perspective, an official diagnosis of Internet gaming addiction is necessary for a number of reasons. First, it will encourage individuals who suffer from associated symptoms to ask for professional help, decreasing morbidity rates, hospitalizations, and potential legal and medical problems. 30 Second, the diagnosis may decrease barriers to care and stigmata with regards to public perception of problematic Internet and gaming use. Third, the diagnosis will support research efforts. 134 Fourth, a diagnostic category will provide the necessary incentive for health care and insurance providers to develop, test, and finance adequate treatment. Ultimately, individuals who require professional care because of substantial distress, suffering, and individual impairment must be helped in an appropriate way. 74 Accordingly, an official diagnosis of Internet gaming addiction is critical for a number of reasons, further emphasizing the need to fully acknowledge and utilize it.

The aim of this review was to provide an insight into current perspectives on Internet gaming addiction using a holistic approach encompassing gaming appeal, context, neuroimaging research, and the diagnostic framework adopted for Internet gaming addiction. It has been shown that Internet gaming has gained increasing popularity since the new millennium, and has led to a substantial growth of the gaming industry and the player fan base. MMORPGs have further been highlighted as offering a wide variety of incentives for players to initiate and maintain playing because they satisfy a variety of needs and tailor to various gaming motives relative to alternative online game genres. Some of these motives, especially escapism, the game’s mechanics, achievement and socializing have been found to be indicative of gaming addiction, 5 suggesting that MMORPGs are more addictive than other offline and online games. 15

This review further shows that until now few studies have investigated the gaming context. Therefore, the context of the individual, the game and gaming environment, and the broader framework of culture are specifically addressed. It has been shown that the individual’s context is a significant factor that marks the dividing line between excessive gaming and gaming addiction. 71 Moreover, it has been emphasized that gaming cannot simply be medicalized if done in excess, but it must be understood from within the context of gaming and the meanings the individual attaches to it. 72 The game context can gain particular importance for players, depending on their life situation and gaming preferences, including the enactment of heroic tales as well as the re-embedding in a (virtual) cultural context that differs from the players’ real-life context. Ultimately, this may lead to a retreat from real life for some individuals. 6 In addition to this, the cultural context is significant because it embeds the gamer in a community with shared beliefs and practices, endowing their gaming with particular meaning. If gaming is used to compensate for lack of success and relationships in real life and to dissociate from real life, Internet gaming addiction can be the consequence. 73 In this context, the “disease” model of addiction can be viewed from the perspective of diseases other than those based on Mendelian genetic mutations or other simple biologically determined pathways. Cardiovascular diseases or adult onset diabetes appear as better models/prototypes for Internet gaming addiction, because these are medical conditions where lifestyles and experiences systematically reshape the body and thus “get under the skin”. That is, the cultural context can become the disease (here addiction) through repeated experiences. Alternatively, cultural norms related to how acceptable game-play is might structure the appeal of the game, which in turn promotes addictive play patterns, which would not be the case in places without such norms.

The cited neuroimaging studies of Internet gaming addiction and associated changes in brain structure and function furthermore correspond with the research domain criteria developed by the National Institute of Mental Health 88 because they emphasize a move away from phenomenology to focus on pathophysiology for clinical diagnosis. Internet gaming addiction was found to share similarities with other addictions, including substance dependence, at the molecular, neurocircuitry, and behavioral levels. These similarities include altered dopaminergic and neuronal activity and brain morphometry, as well as deficient impulse control, behavioral inhibition, and general cognitive functioning. However, there are no known biomarkers of Internet addiction at this point in time. Indeed, there are no known biomarkers of any mental disorder. Ever since Kraepelin, 154 and thus for a century, psychiatrists have been searching to understand mental disorders as underlying physiological diseases, providing an additional incentive to continue research on the neurobiological underpinnings of mental health problems, including Internet gaming addiction.

The findings provide support for the current perspective of understanding Internet gaming addiction from a disease framework. 128 , 134 The dependence classification adopted in previous classification systems 74 , 155 is stigmatizing to patients who require medication because dependence refers to a normal physiological response to the use of a substance (including medication) which, when discontinued, can lead to withdrawal symptoms. 74 The term addiction, on the other hand, denotes a chronic neurobiological disease, 135 which is less stigmatizing because it does not suggest that patients who require medication become “addicted” to their required psychopharmacological treatment. 156 Addiction, unlike dependence, leads to compulsively pursuing rewarding behaviors irrespective of associated biological, psychological, and social problems. 135 Ultimately, the current research base on Internet gaming addiction has led the American Psychiatric Association 70 to include Internet gaming disorder in the appendix of the DSM-5 as the second behavioral addiction alongside pathological gambling, suggesting that the problem is taken seriously. The benefits of such a diagnosis include comparability across research, destigmatization of individuals, development of efficacious treatment, and creation of an incentive for public health care and insurance providers. Once the behavioral problem has an official code, it is worthy of being taken seriously and treated adequately.

However, research concerning the natural course of Internet gaming addiction, the most appropriate interventions, and large-scale epidemiology is scarce, 157 suggesting that more work needs to be done to understand this behavioral problem more fully. King and Delfabbro 158 further question the blurring of the boundaries between Internet addiction and video gaming addiction, as this may “promote further confusion”. Instead, they advocate a conceptualization of Internet addiction which incorporates various subtypes of online behavior, and establishing a diagnostic category of “video gaming disorder” which applies to both online and offline gaming addiction. Ultimately, however, King and Delfabbro 158 concede that the research diagnosis has sparked discussion regarding the nature of behavioral addictions, which testifies to a move away from acknowledging substances only as potentially addictive, and to broaden our understanding of addiction in general.

Moreover, there appear to be problems with regards to the criteria for Internet gaming disorder adopted by the DSM-5 taskforce. Starcevic 29 points out that there exists a debate of whether tolerance is a valid criterion as researchers have validated scales on problematic video game use 159 and compulsive Internet use 160 that do not contain tolerance as a symptom, and some question whether tolerance is a factor involved in gaming. 44 This exemplifies the intricacy of measuring Internet gaming addiction, particularly in light of the reliability of studies as well as the equivalence of findings across studies. Based on these issues, Starcevic 29 recommends the following research approaches: understand when online gaming can be considered a mental disorder; study risk factors and comorbidities, and its position as primary or secondary condition; test a continuum of video gaming problems and video gaming disorder; and revisit its classification as “addiction” rather than an impulse control disorder. 161 Moreover, Pies 134 specifies further that only if the following criteria are satisfied, the condition would qualify to be understood as disease: identify a pattern of genetic transmission; understand its etiology, pathophysiology and/or pathological anatomy; and its course, prognosis, stability, and response to treatment. The current review indicates that research on Internet gaming addiction is on its way to fulfilling these requirements. In terms of understanding the context of Internet gaming addiction, more research is necessary.

Limitations, implications, and suggestions for future research

This review has shown that research on Internet gaming addiction has increased in quality and quantity, particularly over the last decade. Future research is required to overcome the limitations of current research, including closer scrutiny of gaming context (including the individual, game, and culture) and the direction of the relationship between Internet gaming addiction, as well as neuroanatomical and neurochemical changes. Specifically, the following research question requires further exploration: How do individual, game-related, and cultural factors contribute to the etiology, phenomenological experience, and treatment approaches of Internet gaming addiction? Furthermore, the causality of the relationship between neurobiological alterations and neurostructural abnormalities and Internet gaming addiction symptoms should be explored. The further exploration of these issues will enhance our understanding of this potential mental health concern. Moreover, a solid and unequivocal research base will enable the American Psychiatric Association and the World Health Organization to include Internet gaming addiction as an actual diagnosis in their diagnostic systems, which will in turn facilitate future research endeavors as well as clinical parlance.

The context appears crucial to the meaning of the game for the player, and is influenced by individual characteristics, the gaming culture, and the broader society that gamers are situated in. Ultimately, this will allow for developing treatment approaches which can be tailored to different individuals and meet idiosyncratic needs most effectively. The reviewed literature can inform procedures for improving the current treatment of Internet gaming addiction because it puts an emphasis on exploring the life and cultural context of the individual. In terms of neuroimaging studies, the reviewed empirical research has revealed associations between excessive online gaming and alterations in brain structure and function associated with substance addictions. However, understanding the direction of this relationship is crucial because it will provide invaluable insights into the etiology of Internet gaming addiction as well as its status as a primary or secondary disorder. In terms of treatment, establishing the treatment seeker’s most pressing present problem will allow an efficient and efficacious treatment plan to be developed and structuring of treatment sessions. Overall, this literature review suggests that targeting pathogenic neurobiological mechanisms and associated neurological and neurochemical alterations only does not suffice when the clinician’s goal is to alleviate the individual’s idiosyncratic problems. It indicates that Internet gaming addiction must be viewed from a holistic perspective, integrating the neurobiological, individual, game-related, and cultural factors contributing to pathogenesis and symptom experience.

The present review of current perspectives on Internet gaming addiction has shown that research has progressed significantly over the last decade, leading to a larger evidence base which includes important findings from neuroimaging research. Further, it indicates that contextual factors play an important part in our understanding of Internet gaming addiction as a holistic phenomenon. It is suggested that an official diagnosis of Internet gaming addiction must regard embedding of the problematic behavior within the context of the individual, the game, and gaming practices, as well as the broader sociocultural environment as the meaning of the gaming behavior derives from its context. The holistic approach adopted here not only highlights empirical research that confirms neurobiological correlates of Internet gaming addiction and establishment of a preliminary diagnosis, but also emphasizes the need for an indepth understanding of meaning, context, and practices associated with gaming. Ultimately, a holistic understanding will benefit individuals who seek professional help for problematic online gaming as treatment approaches become more targeted and consequently more efficacious.

The author reports no conflicts of interest in this work.

Linguistic Harbingers of Betrayal: A Case Study on an Online Strategy Game

Vlad Niculae , Srijan Kumar , Jordan Boyd-Graber , Cristian Danescu-Niculescu-Mizil

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[Linguistic Harbingers of Betrayal: A Case Study on an Online Strategy Game](https://aclanthology.org/P15-1159) (Niculae et al., ACL-IJCNLP 2015)

• Linguistic Harbingers of Betrayal: A Case Study on an Online Strategy Game (Niculae et al., ACL-IJCNLP 2015)
• Vlad Niculae, Srijan Kumar, Jordan Boyd-Graber, and Cristian Danescu-Niculescu-Mizil. 2015. Linguistic Harbingers of Betrayal: A Case Study on an Online Strategy Game . In Proceedings of the 53rd Annual Meeting of the Association for Computational Linguistics and the 7th International Joint Conference on Natural Language Processing (Volume 1: Long Papers) , pages 1650–1659, Beijing, China. Association for Computational Linguistics.

Online Gaming Addiction Intervention Case Study

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Client Information

Addiction information, hc addiction history.

The client HC, commonly referred to by his mother, is a 16-year-old male of Korean origin (Lee, 2011). Although he currently resides in the United States with his mother and brother, the client did not want to relocate from Korea. HC is a student and has a process addiction known as internet gaming addiction.

As noted above, HC suffers from online game addiction. Its principal physiological procedure is playing online video games at the expense of time spent used for other healthy activities (Lee, 2011). Although HC suffers from addiction, he is surrounded by an appropriate environment to stop this addiction. He has a supportive family (his brother, mother, and father) ready to help him overcome his obsession. For instance, his mother promises to reward him for the successful completion of therapy. His father is trying to reach out to him to perform healthy activities and spend time together (Lee, 2011). It is important to note that HC does not have friends suffering from online gaming addiction; instead, they spend time playing outdoor activities such as basketball. HC does not work and his friends at school adhere to the same principles as those who play basketball, meaning they discourage internet gaming addiction (Lee, 2011). HC’s philosophical stand is to stop the addiction, meaning that he is motivated and hopes that the obsession will end.

Although the gaming disorder was recently acknowledged by the World Health Organization (WHO) in the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11), released in June 2018, computers games development started in the 1960s (Griffiths & Pontes, 2020). At the time, computer games had not yet evolved to become online until the 1990s when networking of computers started. By this time, people had started suffering from gaming addiction described as the excessive use of time in playing computer games than healthy activities. The World Health Assembly approved online gaming addiction in 2019 as stipulated in ICD-11 that is set to take effect in 2022. It is worth noting that the American Psychiatric Association (APA) does not recognize it as a disorder but categorizes it as an ailment requiring further studies (Griffiths & Pontes, 2020).

The addiction process started at a very young age of 7 years, back when HC and his family members were in Korea before shifting to the US (Lee, 2011). When he moved to the US, he did not speak proper English, making it difficult for him to make friends. His social relationship skills continued to deteriorate, and he became a loner. Since his mother and brother came home in the evening, most of the time he was bored at home (Lee, 2011). HC resulted in playing online video games to kill the boredom, which in turn resulted in addiction.

HC’s internet gaming addiction has had adverse physiological effects on his behavior and mental processes since he is avoiding performing his daily chores such as homework. His mental process fails to comprehend simple physical activities that can lead to severe physical health complications. Online gaming addiction causes severe effects on HC behavior and cognitive function. HC has poor socializing skills and provides a negative response when confronted about his addiction to his socializing capabilities (Lee, 2011). Moreover, HC spends less time sleeping and fails to complete the homework provided.

At first, HC had a positive response to the treatment provided by completing several milestones, resulting in several badges. For instance, he started spending less time on online gaming activities during weekdays (Lee, 2011). The most notable milestone is his interest to learn golfing with his mother rather than spending time on online gaming activities. HC relapsed on the therapy sessions, but he could reduce the time spent on internet video games (Lee, 2011). For this reason, the therapy sessions could reduce the amount of homework to motivate the client from attending the session and increase the number of sessions since online gaming addiction is not something that can end within a short period; its behavioral modification requires time.

Griffiths, M. D., & Pontes, H. M. (2020 ). The Oxford Handbook of Digital Technologies and Mental Health. Oxford University Press.

Lee, E. J. (2011). A case study of internet game addiction. Journal of Addictions Nursing, 22 (4), 208-213.

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A Qualitative Analysis of Online Gaming Addicts in Treatment

• Published: 27 October 2012
• Volume 11 , pages 149–161, ( 2013 )

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• Marta Beranuy 1 ,
• Xavier Carbonell 1 , 3 &
• Mark D. Griffiths 2  

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Online gaming addiction is a relatively under-researched area and there have been few studies examining online gamers in treatment. This paper reports the findings from a qualitative interview study of nine players undergoing treatment for their addictive playing of Massively Multiplayer Online Role Playing Games (MMORPGs). A face-to-face interview study with nine online gaming addicts was carried out using Grounded Theory. The six most reported phenomena by the participants were: (i) entertainment search, (ii) virtual friendship, (iii) escapism and/or dissociation, (iv) game context, (v) control versus no control, and (vi) conflict. The findings suggest that players’ initial gaming motivation is because of three factors: (i) entertainment, (ii) escapism, and/or (iii) virtual friendship. MMORPG addiction appears once the playing time significantly increases, coupled with a loss of control and a narrow behavior focus. These factors lead to problems and result in psychological dependence and serious life conflicts. The consequences of MMORPG addiction are similar to the consequences of more established substance addictions including salience, mood modification, loss of control, craving, and serious adverse effects. Additionally, in some cases, tolerance and relapse may also be present.

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Acknowledgments

We thank Josep Cañete and Àngels González (Hospital of Mataró, Spain), Rosa Díaz (Hospital Clínic of Barcelona, Spain), Susanna Petri and Núria Aragay (Hospital of Terrassa, Spain) and Felix Cova and Maruzella Valdivia (Clínica de Atención Psicológica of University of Concepción, Chile).

Part of this study was carried out thanks to grant no. AP2005-2426 (Ministerio de Educación y Ciencia, Spanish Government) and FPCCE Blanquerna grant no. CER05/08-105C06.

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Beranuy, M., Carbonell, X. & Griffiths, M.D. A Qualitative Analysis of Online Gaming Addicts in Treatment. Int J Ment Health Addiction 11 , 149–161 (2013). https://doi.org/10.1007/s11469-012-9405-2

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Mumbai: Sessions Court Convicts 25-Yr-Old Man For Stabbing Neighbour Over Online UNO Game In 2018

While seeking bail in november 2018, the accused argued that he acted out of sudden provocation by the deceased and had not premeditated the attack..

The sessions court on Thursday convicted a 25-year-old man from Agripada for stabbing his neighbour to death after an argument over an online game called UNO on March 3, 2018.

According to the case registered with the Agripada police, the accused, Noor Mohammed Mansoori, and the victim, Abuza Ansari, 25, were playing UNO cards and the game led to a quarrel, after which both returned to their homes. The deceased’s family claimed that while Ansari was standing next to his mother, Mansoori ran to his house, picked up a knife, and attacked Ansari. Mansoori inflicted multiple injuries on Ansari, who was declared dead on arrival at the hospital.

Public prosecutor Iqbal Solkar presented evidence from the family members of the deceased, neighbours, medical officers, and the investigating officer to prove the case. The accused, however, maintained that he had no intention of killing Ansari.

While seeking bail in November 2018, the accused argued that he acted out of sudden provocation by the deceased and had not premeditated the attack. The prosecution countered by stating that Mansoori had inflicted serious injuries on vital parts of Ansari’s body, leading to his immediate death. The weapon used in the attack, a knife, was recovered during the investigation at Mansoori’s instance. Witnesses to the incident further implicated Mansoori in the murder. Based on the evidence and witness testimonies, the court found Mansoori guilty of stabbing Ansari to death.

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Young people who purchased a Nintendo Switch reported a larger positive impact on well-being than older people.

Childless adults with a PS5 reported a larger positive effect on their mental health compared to parents with the same console.

Peter Etchells of Bath Spa University commented:  “It highlights that, if we care about understanding how video games impact us, we need to be nuanced and specific about what it is that we’re measuring and how.”

This is just the first of several studies that would need to be done to test the effect of playing video games on mental well-being.

While the sample size for this study is large, the results are self-reported, and therefore may be unreliable.

However, this is a good starting point for future research, particularly as video games become ever more part of mainstream entertainment and culture.

If you want to read more about Nintendo, check out the Animal Crossing game that will be shut down .

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