At present, there is little research studying the different therapeutic approaches to the excessive use of video games and the Internet; therefore, there is no unanimous scientific recommendation for the treatment of this type of disorder. In practice, clinical practitioners use various therapeutic approaches, more or less specific depending on whether they directly target the behavior in question, the person’s emotional difficulties, or the family system as a whole. Some are inspired by treatments developed for substance addiction or gambling problems. The different approaches are frequently combined: for example, individual follow-up may be combined with family interviews or participation in a group.
With regard to the goal of treatment, moderate and controlled use of the internet is usually aimed at, as abstinence is usually neither realistic nor desirable. Indeed, clinical practice shows that for a majority of people, reducing the frequency of gambling spontaneously reduces some negative consequences. The main goal of treatment may be the person’s fulfillment in other areas of life (e.g., relationships, work, emotions), and it is common for people to spontaneously reduce the amount of time they spend gambling following a change in lifestyle (e.g., the start of training, a new job or a new relationship).
Treatment usually involves a comprehensive assessment of the gambling problem in a few sessions, during which the factors that motivate people to change are also addressed. The objectives of the treatment are then defined between the facilitator and the consultant and will be regularly discussed again throughout the course until the end of the follow-up. The following is a description of the most commonly used therapeutic approaches to gambling and Internet problems:
This is a recognized approach, particularly in the treatment of problems related to gambling. It is based on the principle that thoughts, emotions, and behaviors are linked and influence each other. Certain negative thoughts about oneself (e.g., “I’m not good enough”), the world, or others (“society is unfair”, “everyone is judging me”) tend to reinforce compulsive Internet use. Thus, the practice of video games and the Internet is seen as a temporary escape mechanism and would contribute to the avoidance of real or perceived dangerous or problematic problems. Therapeutic work focuses on challenging the user’s negative thoughts and developing more satisfying and adapted behaviors, taking into account the patient’s emotional experience. Treatments based on the cognitive-behavioral approach can be carried out in both individual and group formats.
Psychodynamic or psychoanalytic approach
The psycho-dynamic approach usually conceptualizes disorders as resulting from an intrapsychic conflict of the person. In the case of the problematic use of video games, it explores how the attraction to video games can be linked to the process of separation and emancipation of the “parental image” (symbol of authority and rules) inherent in the passage to adulthood. Through video games, the young person would seek a “sense of existence”, a need for “completeness” or “filling a gap” resulting from childhood. Through this, he may seek to symbolically express aggressiveness allowing him to separate himself from certain “parental objects”. Thus, the context of video games is considered to be protective insofar as, by this means, the user can neutralize his aggressive movements in a safe environment. The psychotherapeutic work in this approach will mainly focus on accompanying the person in a “work of mourning” which will allow him to separate himself from certain bonds and objects still attached to childhood. Through this mourning process, the person can accept the interdependence of his relationships with others.
Support groups are a common offer in the field of substance addiction, which can complement possible individual follow-up. They are still not very well developed in the field of non-substance addictions and especially problematic behaviors related to the Internet or video games, at least in the French-speaking context. The so-called “12-step” models, of the “Alcoholics Anonymous” type, are very widespread in Anglo-Saxon countries, for different types of addiction with and without substances. In recent years, we have also seen the development of online support groups, via forums or chats.
This approach is commonly used in the field of addictions in general and is quite relevant when dealing with the problematic use of video games or the internet. The principle is to support motivation for change, in a non-judgmental and collaborative spirit. Particular attention is given to exploring the person’s sense of ambivalence towards a change in the problematic behavior. The approach uses specific interview techniques, with particular attention paid to the relationship with the patient.
Excessive use of video games or the Internet often has repercussions on all family members. The systemic approach considers the family as a system, i.e. a set of interacting elements that are organized and constantly evolving. The excessive practice of one of the members can thus express a relational and/or emotional dysfunction of the family-system. Therapeutic work is initiated from a goal that is common and coherent to all members, which translates the problematic behavior into a relational and emotional angle. Families are frequently made aware of the excessive process itself (psychoeducation), as the entourage often shows difficulties in understanding the user’s loss of control.
At present, no pharmacological treatment is accredited for the specific treatment of problematic gambling or Internet gambling. However, any addictive conduct may be associated with an underlying psychiatric disorder(s). A psychotherapeutic intervention should therefore be preceded by a global evaluation, allowing for a possible diagnosis of an associated disorder (e.g. depressive disorders, anxiety disorders, attention deficit disorder). In such a case, pharmacological treatment should be considered and may, where appropriate, contribute to better overall mental health.
Hospitalization / residential cures
Hospital programs or residential care may exist among the range of care offered by public or private hospitals and clinics. It is rare for these programs to specifically target problems with video games or internet use; more generally, these are hospital programs that deal with addictions of all types, or even psychiatric care (aimed at the recovery of a depressive disorder or an anxiety disorder, for example). In some countries, the offer is almost exclusively hospital-based; in others, such as Switzerland, it is mostly ambulatory. Regardless of the type of program, it is advisable to find out in advance what costs the patient will have to pay and to check that the staff is medico-social (for a list of centers, see question 20).
People who have required hospitalization for a behavioral addiction problem are usually those with a severe disorder, often with another associated mental disorder. One study showed that those who preferred hospital treatment wanted to move away from their usual living environment to focus on their problem, while those who chose outpatient treatment did not want their treatment to impact their work or family life. In all cases, hospitalization may be necessary if there are criteria of acute psychological suffering requiring prompt and close care (e.g. significant suicidal ideation). Since addiction is a problem requiring long-term care, outpatient follow-up is generally indicated, even after hospitalization.