The NHS has opened the first specialist clinic to treat children and young adults who are addicted to gaming. The clinic opened just one year after the World Health Organisation’s decision to add gaming disorder to the International Classification of Diseases, and amid concerns about the amount of time children and young adults spend playing games and its impact on their mental health.
As part of the 2020 NHS APA Virtual Conference, Becky Harris, Service Manager and Family Therapist, and Dr Rebecca Lockwood, Consultant Clinical Psychologist, both from Central and North West London NHS Foundation Trust's National Problem Gambling Clinic, introduced the gaming disorder service, its treatment, and evidence-based research.
The National Centre for Gaming Disorders is part of the National Centre for Behavioural Addictions, which also provides support for internet addiction, and is located alongside the National Problem Gambling Clinic.
The centre, led by a consultant psychiatrist and staffed by psychologists and family therapists, provides treatment for problem gamers living in England and Wales and gives advice to family members and carers. Becky Harris explained: “Our criteria is to work with gamers aged 13 and over and we also work with parents where appropriate.”
Assessments began in December 2019 with treatment starting in January 2020; albeit normal activity paused between March and June 2020 due to the COVID-19 pandemic, which impacted treatment completions.
Becky said: “We have had 53 referrals, with around 69 percent aged between 13 to 18, 17 percent aged between 18 and 25 and a smaller number of people who are over 25. We have also been approached by parents and carers of children aged under 13; around eight percent and we will work with the parent in those cases. The majority (93 percent) of referrals are male.”
Gaming disorder can be defined by a number of concerning patterns set by three criteria according to Dr Lockwood: “They are not able to control or stop gaming; they consider gaming as more important than anything else; and they are still gaming despite negative consequences on their life.”
There are many complex processes that make this happen. “We know a lot of it is because of the way gaming companies have designed the games and their technology, said Dr Lockwood, “it is a very immersive and novel experience using reward systems based on contingencies and schedules meaning the gamer experiences adrenaline and dopamine as they wait for their rewards. There’s an element of conditioning and positive reinforcement – the rewards strengthen that response.”
There is also a negative reinforcement, “if the game is removed the desire to game and the stress this creates is then managed when gaming recommences.”
"Treatment models are a mixture of evidence-based treatments that already exist, an adaptive gambling programme, family therapy models, CBT and anxiety models."
The treatment service, which is being piloted with individuals and groups, is based on a mixture of varying existing evidence around addiction. Dr Lockwood said: “Treatment models are a mixture of evidence-based treatments that already exist, an adaptive gambling programme, family therapy models, CBT and anxiety models. We also look at regulating emotions, compassion, acceptance, and commitment therapies.”
The treatment pathways are reviewed constantly to see how best help young gamers and their families can be supported, and the lockdowns during the COVID-19 pandemic have shaped the way they are delivered. “We have been able to create new pathways with online treatments, which have made it easier for gamers to access it,” explained Becky.
The treatments are comprehensive and delivered through interactive workshop sessions to individuals and groups alongside in-depth advisory sessions for parents and carers to help them understand the issues, formulate an understanding on what started the behaviour, how it has been maintained and why it is difficult to make changes.
As with broader addiction therapies, time is given to understanding triggers, and managing urges and cravings. However, more specifically to gaming, much time is devoted to understanding emotions, and the cognition and beliefs that the gamer has developed. As Dr Lockwood explained: “We know a lot of the gamers struggle with regulating their emotions and gaming serves as a way for them to manage emotions which they can’t handle in everyday life.”
“Improving the family relationships, rebuilding trust and creating healthy boundaries are all key to achieving a positive role and a sense of identify that is separate from gaming."
A big part of the work is also focused on supporting gamers to changes their long-term habits, reducing isolation and reconnecting with everyday life by working on improving their communications skills, building their self-esteem in social situations, developing their values, goals, and future self while processing any unhelpful beliefs and trauma.
“Improving the family relationships, rebuilding trust and creating healthy boundaries are all key to achieving a positive role and a sense of identify that is separate from gaming,” Dr Lockwood said, “Many have said they have found it difficult to find support for gaming disorder, so this service has proved very meaningful for those involved.”
Watch the full presentation for in-depth information and explanations.