Graduation Year


Document Type




Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Child and Family Studies

Major Professor

Oliver T. Massey, Ph.D.

Committee Member

Tammy Jorgensen Smith, Ph.D., CRC

Committee Member

Kyaien Conner, Ph.D., M.P.H., L.S.W.

Committee Member

Dinorah Martinez Tyson, Ph.D., M.P.H.


Gaming disorder, community-based practice, behavioral health, behavioral health addictions


Due to the evolution of technology and increased use of video games, the need to understand how gaming affects individuals is imperative to assisting with those who struggle with problematic gaming behaviors. Video gaming has shown to have significant benefits including an increase in cognitive abilities, a way to relieve stress, and mood enhancement. However, problematic gaming behaviors (PGB) (i.e., uncontrollable gaming behaviors that impair functioning) may cause significant short and long-term problems that impact gamers throughout the lifespan if left untreated. There are critical gaps in the literature regarding how gaming impacts player functioning and how clinicians are managing their clients with problematic gaming behaviors. There is a need for more research assessing player perspectives on their gaming behaviors as well as clinician perspectives on how to best target and treat PGB. The purpose of this dissertation research was to explore gamers’ perceptions of the impact of their gaming behaviors on specific functioning (i.e., employment), while examining clinical perspectives on their ability to recognize, diagnose, and treat PGB and Gaming Disorder (GD) without proper guidelines and treatment manuals available in the United States.

This dissertation began with gamers’ perspectives to highlight how they perceived their gaming behaviors, both positively and negatively, on obtaining and maintaining employment. This served to provide insight into how players are impacted by their gaming behaviors as well as whether they perceive their gaming as problematic. This study also examined differences in how gamers with and without disabilities vary in their perceptions on their gaming behavior, a concept that has not been thoroughly explored within the literature. This manuscript provides recommendations for rehabilitation counseling professionals (i.e., helping professionals who assist individuals to gain meaningful employment) to provide informed, competent services for gamers who may seek professional assistance. In addition, this manuscript was the impetus for the second and third manuscripts that explore the perceived knowledge and skills of clinicians in the field when serving clients with PGBs and GD. There is a significant lack of research conducted in the United States exploring clinical competency and ability to provide treatment to those in the gaming community and this study addresses these gaps.

An exploratory sequential research design was utilized to examine clinician perceptions on their ability to recognize, diagnose, and treat problematic gaming behaviors and Gaming Disorder in the United States. Qualitative and quantitative phases were used to explore these perceptions. In the qualitative phase of the study which informed the second manuscript, semi-structured interviews were used to conduct a comprehensive assessment from a purposeful sample of behavioral health providers working in the United States (N=16) on their ability to accurately diagnose and treat PGB and GD when presented with vignettes. Clinicians were asked to diagnose each vignette, explain their rationale for selecting the given diagnosis, and then were assessed on what factors influenced their clinical decision-making when diagnosing and choosing treatment modalities. Clinicians were also asked to provide insight into barriers and recommendations to improving clinical practice for PGB/GD in the communities that they serve.

Results showed that clinicians had low accuracy scores when diagnosing PGB/GD. Clinicians also reported multiple factors that influenced their decision-making when choosing treatment interventions which included previous clinical experience, client specific factors such as motivation and engagement in treatment, and perceived familial involvement. Barriers included significant issues with finding trainings and education for learning more about PGB/GD and evidence-based treatment modalities. Recommendations from clinicians included creating a resource system for clinicians to be able to access needed information about PGB/GD and treatment interventions, and providing psychoeducation to communities to enhance understanding of PGB/GD for clients and families, and generate more interest in learning more about PGB/GD among professionals.

The final manuscript was informed by the quantitative phase of the study, consisting of online self-report surveys administered to a total of 118 clinicians in the United States. The surveys allowed for a wider understanding of clinician competence and what clinicians are facing when seeing clients with PGB/GD. This study examined the types of behaviors commonly observed in clients with PGB, perceived severity of the clients that are served, prevalence of PGB/GD in their caseloads, and perceived effectiveness of treatment interventions posed from the interviews and from global PGB clinical literature. Results revealed respondents reporting differences in competency levels based on age groups with young providers reporting higher perceived competence in diagnosing and treating PGB/GD despite the lack of education reported by most clinicians. Cognitive Behavioral Therapy (CBT) was the most frequently used treatment with high perceived effectiveness compared to other treatments.

Furthermore, this dissertation provides multiple implications and discussions focused on improving both research and practice. Incorporating both gamers and clinicians’ feedback can generate a more well-rounded understanding of PGB/GD in communities as well as how gaming can both positively and negatively impact functioning. By understanding gamer and clinicians’ perceptions on PGB/GD and how clinicians target these behaviors using their clinical expertise and factors that influence their decision-making, research and policy can assist with addressing significant barriers that are faced in communities.