Cognitive Behavioural Therapy in the Treatment of Gaming Disorder: A Narrative Review

Abstract

Gaming disorder, recognized by the International Classification of Diseases (ICD-11) as a behavioral addiction, is characterized by impaired control over gaming, increasing prioritisation of gaming over daily activities, and continuation of the behaviour despite negative consequences. It is associated with reduced quality of life and various psychiatric comorbidities, highlighting the need for effective therapeutic interventions.

Cognitive behavioral therapy (CBT), widely recognised for its efficacy in treating behavioural addictions, has emerged as a promising intervention. Evidence from clinical trials and literature reviews suggests that CBT can reduce gaming time, alleviate core symptoms, and address associated conditions, particularly anxiety and depression. CBT targets predisposing, precipitating, and maintaining factors by identifying dysfunctional beliefs and maladaptive emotional responses, and by promoting healthier coping strategies. It employs techniques such as psychoeducation, motivational interviewing, cognitive restructuring, behavioural activation, problem-solving, strengthening of support networks, and relapse prevention.

Despite promising results, the current evidence base is limited by methodological challenges. These include the lack of standardised diagnostic criteria, limited availability of validated psychometric tools, heterogeneity in treatment protocols, and a scarcity of longitudinal studies. The underrepresentation of female participants and the absence of age-specific adaptations may also hinder treatment personalisation. Future research should better address the impact of psychiatric comorbidities on treatment outcomes, as these may influence response to CBT and require specific adaptations. Moreover, the potential of specialised CBT modalities—such as third-wave therapies and mindfulness-based interventions—warrants further exploration. Thus, the development of CBT programs tailored to gaming disorder could provide a cost-effective solution by integrating strategies targeted at this condition into existing programs. The creation of clinical manuals and validated protocols, customized to the specificities of the disorder, would be essential for standardizing and optimizing interventions, facilitating their application in clinical practice, including in specialized institutions such as the Portuguese Institute for Addictive Behaviours and Dependencies (ICAD).