Development of the motivation-cognition-behaviour model of gaming disorder and implementation of the strength-based cognitive behavioural therapy intervention in Chinese adolescents

Abstract

Background: Gaming disorder (GD) is a newly recognised official mental health disorder. The high prevalence and significant negative consequences of GD require a thorough explanatory model and an effective intervention model, which are lacking in existing literature.

Objective: This thesis aims to (1) comprehensively review the influencing factors of GD review and identify the important factors with large correlational effect sizes; (2) comprehensively review mediating pathways that explain how important factors contribute to GD, identify the pathways with large mediating effect sizes, and develop a new explanatory model based on the findings; and (3) develop a new intervention model based on the explanatory model and conduct a randomised control trial (RCT) to examine its efficacy and explore the therapeutic mechanism.

Method: Study 1 conducted a systematic review to search for and code influencing factors of GD among Chinese studies and used a random-effects meta-analysis with Fisher’s z-transformation of correlations to compute the pooled correlational effect sizes. Study 2 conducted a systematic review to collect hypothetical mediating pathways and used one-way meta-analytic structural equation modelling to fit the pathways and identify those with large mediating effect sizes. The identified pathways were combined to develop an integrated explanatory model of GD. Study 3 discussed the implications of the explanatory model and proposed a new intervention model. A pre-post-follow-up RCT with a waitlist-control design was conducted. Seventy-seven Chinese adolescents were recruited randomly. The intervention outcomes included GD symptoms, time spent on gaming, gaming motivation, maladaptive gaming cognition, depression, and anxiety. Study 3 used the linear mixed-effects model (LMM) to examine the intervention effects, standard means difference (Hedges’s g) to measure the within-group between-group effect sizes and multivariate path analyses to examine the therapeutic mechanism. The analyses were based on the intention-to-treat population.

Results: Study 1 included 153 studies and identified 16 influencing factors strongly correlated with GD. Gaming motivation (r = .46) and maladaptive gaming cognition (r = .4) show the strongest correlations with GD. Study 2 included 104 studies and identified 20 pathways with large mediating effect sizes (IE = 0.09–0.24). A new motivation-cognition-behaviour model has been developed by combing the pathways. Study 3 developed a strength-based cognitive behavioural therapy model for GD (SBCBT-GD). The LMM showed significant group × time interaction for all outcomes (p < .01). Strong between-group effect sizes show on GD (g = 1.13–1.21), time spent on gaming (g = 0.99–1.2), gaming motivation (g = 1–1.26) and maladaptive gaming cognition reduction (g = 0.93–1.01) at posttreatment and follow-ups. Medium effect sizes show on depression reduction (g = 0.67–0.84) and anxiety reduction (g = 0.6–0.64). Path analysis shows SBCBT-GD lead to GD reduction through reducing gaming motivation and maladaptive gaming cognition (proportion mediated is 53.3%).

Discussion: The motivation-cognition-behaviour model has the advantages of being comprehensive with identifying important influencing factors and empirically validated pathways of GD. SBCBT-GD is an effective intervention model for GD reduction by reducing escapism, achievement motivation, and maladaptive gaming cognition. Future studies can apply and examine the new models for people in different cultures. (506 words)