Choice of Leisure Activities by Adolescents and Adults With Internet Gaming Disorder: Development and Feasibility Study of a Virtual Reality Program

Abstract

Background: Excessive internet game use frequently leads to various physical, psychological, and social problems, and internet gaming disorder (IGD) has become a serious public health issue worldwide. Recently, virtual reality (VR) therapy has emerged as a promising method to increase psychological treatment motivation and accessibility. However, few studies have examined the potential of VR technology for the management of IGD, and VR content tailored to IGD characteristics remains scarce.

Objective: This preliminary study aimed to examine the potential of a VR-based program that was designed to help users identify their leisure time use patterns, especially those related to gaming, and to modify their gaming overuse by alternative activities provided in the VR content. Moreover, to investigate whether users' VR activities reflect various clinical variables of IGD in youth, we examined the relationships among the leisure time activity selection pattern, built-in response, and speech data obtained from the VR program, as well as symptom severity of internet gaming, psychiatric comorbidities, and motivation of participants reported through relevant questionnaire data.

Methods: Three types of VR content (understanding my daily activities at home, finding an alternative activity to internet gaming at home, expressing contradictory opinions toward a friend's gaming beliefs) were developed by simulating the daily situations in which patients with IGD can select alternative free-time leisure activities. We examined internet addiction, mental health problems, and motivation for 23 IGD and 29 control participants. Behavioral and self-rated responses from VR, such as alternative activity selection data and speech patterns (speech time, speech satisfaction, and speech accordance), and results from various questionnaires were compared between groups. The correlations between IGD behaviors in VR and real-life behaviors assessed by questionnaire measures were analyzed.

Results: Significant correlations were found between internet gaming behavior and user activity data, such as speech and activity selection pattern, in our VR program. Our results showed that the IGD group had fewer leisure activities and preferred game or digital activities to other types of activities compared to controls, even in VR. There was a positive relationship between the viability of alternative leisure activities the participants selected in VR and the amount of perceived satisfaction from that activity (r=.748, P<.001). Speech accordance in the IGD group was lower than in the control group and was correlated negatively with Internet Addiction Test and Internet Addiction Test-gaming scores (r=.300, P=.03) but positively with users' motivation (r=.312, P=.02).

Conclusions: The results from our VR program can provide information about daily activity patterns of youths with IGD and the relationship between user VR activities and IGD symptoms, which can be useful in applying VR technology to IGD management.

Keywords: CBT; IGD; VR; cognitive behavioral therapy; internet game disorder; motivation; virtual reality.

Figure 1

Screenshots of apartment setting (A), gestural input (B), and questionnaire (VAS) and visual feedback for selected activities (C) in VR.

Figure 2

Frequency of digital and game activities in the virtual reality environment in Content 1: (A) number of selected activity categories in level 1, (B) frequency of the selection of digital and gaming activities, (C) proportion of the selection of gaming activities, (D) percentage of nongaming and gaming activities in each group. IGD: internet gaming disorder.

Figure 3

Relationships between the Internet Addiction Test (IAT) gaming score and (A) number of leisure activities in the virtual reality (VR) environment and (B) IAT score as well as relationships between the percentage of digital activity in the VR environment and (C) depression and (D) anxiety. BAI: Beck Anxiety Inventory; CES-D: Center for Epidemiological Studies Depression Scale.

Figure 4

(A) Comparison of the accordance of self-speech contents and opinion between the control and internet gaming disorder (IGD) groups and correlations between accordance of self-speech and opinion and (B) Internet Addiction Test (IAT) score, (C) IAT-gaming score, and (D) Free Time Motivation Scale (FTMS)-intrinsic motivation.

Figure 5

Correlation between speech satisfaction and (A) Free Time Motivation Scale (FTMS)-intrinsic motivation, (B) perceived pleasure, (C) depression, and (D) percentage of digital activities in virtual reality (VR). CES-D: Center for Epidemiological Studies Depression Scale.