Problematic video game use as an emotional coping strategy: Evidence from a sample of MMORPG gamers

Abstract

Background:
A positive relationship between problematic gaming and escapism motivation to play video games has been well established, suggesting that problematic gaming may result from attempts to deal with negative emotions. However, to date, no study has examined how emotion dysregulation affects both escapism motives and problematic gaming patterns.

Methods:
Difficulties in emotion regulation, escapism, and problematic involvement with video games were assessed in a sample of 390 World of Warcraft players. A structural equation modeling framework was used to test the hypothesis that escapism mediates the relationship between emotion dysregulation and problematic gaming.

Results:
Statistical analyses showed that difficulties in emotion regulation predicted both escapism motives and problematic gaming, and that escapism partially mediated this relationship.

Conclusion:
Our findings support the view that problematic players are likely to escape in online games as a maladaptive coping strategy for dealing with adverse emotional experiences.

Full text

Problematic video game use as an emotional coping strategy: Evidence from a
sample of MMORPG gamers
MARIA DI BLASI
1
*, ALESSANDRO GIARDINA
1
, CECILIA GIORDANO
1
, GIANLUCA LO COCO
1
, CRISPINO TOSTO
2
,
JOEL BILLIEUX
3
and ADRIANO SCHIMMENTI
4
1
Department of Psychological and Educational Sciences, University of Palermo, Palermo, Italy
2
Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, Palermo, Italy
3
Addictive and Compulsive Behaviours Laboratory, Institute for Health and Behaviours, University of Luxembourg,
Esch-sur-Alzette, Luxembourg
4
Faculty of Human and Social Sciences, UKE –Kore University of Enna, Enna, Italy
(Received: September 2, 2018; revised manuscript received: November 20, 2018; accepted: December 23, 2018)
Background: A positive relationship between problematic gaming and escapism motivation to play video games has
been well established, suggesting that problematic gaming may result from attempts to deal with negative emotions.
However, to date, no study has examined how emotion dysregulation affects both escapism motives and problematic
gaming patterns. Methods: Difficulties in emotion regulation, escapism, and problematic involvement with video
games were assessed in a sample of 390 World of Warcraft players. A structural equation modeling framework was
used to test the hypothesis that escapism mediates the relationship between emotion dysregulation and problematic
gaming. Results: Statistical analyses showed that difficulties in emotion regulation predicted both escapism motives
and problematic gaming, and that escapism partially mediated this relationship. Conclusion: Our findings support the
view that problematic players are likely to escape in online games as a maladaptive coping strategy for dealing with
adverse emotional experiences.
Keywords: problematic gaming, emotion regulation, Internet gaming disorder, escapism, MMORPG, gaming
disorder
INTRODUCTION
Massively multiplayer online role-playing games
(MMORPGs) are virtual environments in which players
can interact with each other through customizable avatars,
co-operating, role-playing, and competing with millions of
players around the world. Previous literature on problem-
atic gaming (PG) has largely focused on MMORPGs. PG is
currently considered a potential disorder, listed within
“Emerging Measures and Models”(Section III) in the
most recent edition of the Diagnostic and Statistical
Manual of Mental Disorders (DSM-5; American Psychi-
atric Association, 2013) under the label Internet gaming
disorder (IGD). Furthermore, the International Classifica-
tion of Diseases (World Health Organization, 2018)
includes Gaming Disorder in its section devoted to dis-
orders resulting from addictive behaviors. Nevertheless,
what exactly constitutes PG is still a topic of debate (King
et al., 2018;Van Rooij et al., 2018). One concern arises
from the risk of pathologizing healthy, “highly engaged”
gamers who could fit the diagnostic criteria for IGD
without experiencing significant life impairment (Deleuze,
Long, Liu, Maurage, & Billieux, 2018). Moreover, it
remains unclear whether there is a causal relationship
between life impairments and addictive-like gaming
behavior (Kardefelt-Winther, 2014a,2014b;Snodgrass
et al., 2014;Van Rooij et al., 2018).
Although PG has often been conceptualized within a
biomedical model of addiction (Petry et al., 2014), alternative
etiological hypotheses have emerged. These include PG
resulting from maladaptive coping strategies displayed to
deal with negative affect states (Maroney, Williams, Thomas,
Skues, & Moulding, 2018;Reinecke, 2009;Schimmenti &
Caretti, 2010;Snodgrass et al., 2018). In this respect,
Kardefelt-Winther (2014b) proposed that some individuals
might use the online environment to alleviate negative
feelings arising from stressful or adverse life situations,
potentially leading to problematic use and addictive-like
symptoms. Therefore, PG may represent a maladaptive cop-
ing strategy for individuals with limited self-regulation skills.
Emotion dysregulation (ED) and problematic gaming (PG)
In the past two decades, the construct of ED has received
growing interest in psychology and psychopathology. ED
* Corresponding author: Maria Di Blasi; Department of Psycholog-
ical and Educational Sciences, University of Palermo, Viale delle
Scienze, Edificio 15, Palermo 90100, Italy; Phone: +39 091 238
97717; Fax: +39 091 651 3825; E-mail: maria.diblasi@unipa.it
This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License,
which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and
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ISSN 2062-5871 © 2019 The Author(s)
FULL-LENGTH REPORT Journal of Behavioral Addictions 8(1), pp. 25–34 (2019)
DOI: 10.1556/2006.8.2019.02
First published online February 11, 2019

has been related to several types of psychopathological and
relational problems (D’Agostino, Covanti, Monti, &
Starcevic, 2017;Dimaggio et al., 2017;Gross & Jazaieri,
2014), leading some authors to consider it a hallmark of
psychopathology (Beauchaine, Gatzke-Kopp, & Mead,
2007). Emotion regulation is generally referred to as a set
of psychological processes aimed at differentiating,
recognizing, and modulating feelings with flexibility and
according to environmental and relational stimuli (David,
2016;Fonagy, Gergely, Jurist, & Target, 2002;Gross &
Thompson, 2007).
Emotional processing and emotion regulation have been
widely analyzed in previous studies of smartphone, social
networks, and general Internet use, showing both a positive
effect on well-being (Elhai et al., 2018;Hoffner & Lee,
2015;Kardefelt-Winther, 2014a) and a link to problematic
Internet use (Casale, Caplan, & Fioravanti, 2016;Hormes,
Kearns, & Timko, 2014;Schimmenti, Starcevic, Gervasi,
Deleuze, & Billieux, 2018;Yildiz, 2017). In the context of
online gaming, many studies have reported a higher use of
video games for emotion regulation purposes (Gaetan,
Bréjard, & Bonnet, 2016;Hemenover & Bowman, 2018;
Hussain & Griffiths, 2009;Villani et al., 2018). For
example, Villani et al. (2018) suggested that some video
game features, such as interactivity, the sense of mastery,
and the ability to deal safely with failure and experiment
with identity, may play a part in facilitating emotion
regulation.
Despite the conflicting evidence, few studies have
addressed the role of ED in PG (Billieux et al., 2011;
Estévez, Jáuregui, Sánchez-Marcos, L´opez-González, &
Griffiths, 2017;Yen et al., 2018). Billieux et al. (2011)
found that a tendency to act rashly when experiencing
intense negative feelings was the main impulsivity dimen-
sion promoting problematic involvement in World of War-
craft (WoW) in a sample of gamers. Similarly, Estévez et al.
(2017) showed that a lack of emotional clarity and control
over emotional responses predicted problematic video game
involvement in their sample. Therefore, it might be hypoth-
esized that some people with emotion regulation difficulties
use video game environments to deal with negative affec-
tivity, thus increasing the risk of negative consequences
(Kardefelt-Winther, 2014b). Clearly, there is a need to
address the paucity of research on the role of ED among
problematic gamers.
Escapism motivations to play and emotional coping
The construct of motivations to play (Yee, 2006) could be
critical in explaining the relationship between ED and
PG. For example, Billieux et al. (2013) found that motiva-
tions to play have specific, meaningful associations with
in-game behaviors, suggesting that psychological motives
are reliable indices of players’interests and needs.
Among the various motivations to play, escapism has
been studied extensively. Escapism refers to the involve-
ment in video games to relax or to distract oneself from
real-life problems (Yee, 2006). It may represent one of the
main features contributing to the enjoyment of online games
and is not necessarily related to negative outcomes
(Bowditch, Chapman, & Naweed, 2018;Hussain &
Griffiths, 2009;Kardefelt-Winther, 2014c). Indeed, Kuo,
Lutz, and Hiler (2016) conceived escapism as an “active,”
emotion-focused, coping mechanism that brings relief from
stress and a sense of efficacy and empowerment to players’
lives. However, several studies have shown escapism moti-
vation to be one of the strongest predictors of PG with
regard to its avoidant, passive, and disengaging nature
(Ballabio et al., 2017;Billieux et al., 2013;Bowditch
et al., 2018;Kuss, Louws, & Wiers, 2012;Schimmenti,
Infanti, Badoud, Laloyaux, & Billieux, 2017;Zanetta-
Dauriat et al., 2011).
To account for this contradiction, some authors have
argued that the negative potential of escapism is related to
its interactions with other vulnerability factors, such as
psychological distress, poor psychosocial well-being, or
poor coping resources (Ballabio et al., 2017;Bowditch
et al., 2018;Demetrovics et al., 2011;Kardefelt-Winther,
2014b,2014c). Moreover, some studies have suggested
that an interaction between negative affect and escapism is
likely to play a pivotal role in PG (Billieux et al., 2015;
Bowditch et al., 2018;Chang, Hsieh, & Lin, 2018;
Kardefelt-Winther, 2014a;Maroney et al., 2018). For
example, Kardefelt-Winther (2014a) showed that escapism
mediated the relationship between distress and problematic
use of WoW. Another study (Király et al., 2015)
suggested that psychiatric symptoms were both directly
and indirectly (via escapism and competition motives,
respectively) negatively associated with PG in a sample
of online gamers. In addition, Billieux et al. (2015)
postulated that among participants characterized by in-
creased negative affect in their sample of 1,057 WoW
players, PG was probably the result of a maladaptive
coping strategy to overcome negative affect and negative
life events. Finally, Maroney et al. (2018) recently found
that escapism motivations partially mediated the
significant effects of depression, loneliness, and social
anxiety on PG among first-person shooter and MMORPG
players. However, to date, no studies have explored the
link between ED and escapism motivations in problematic
MMORPGs use.
The present study
The aim of this study was to test the relationships between
ED, escapism motivations, and PG. More specifically, we
hypothesized that WoW players with higher levels of ED
use video games to escape negative affect, and that this
greater need to escape into virtual reality in turn triggers PG.
Hence, the present investigation has the potential to shed
light on the underlying mechanisms of PG and thus to
inform clinical practice. According to the theoretical frame-
work of the study, three operational hypotheses can be
formulated:
H1: Emotion dysregulation statistically predicts prob-
lematic gaming.
H2: Emotion dysregulation statistically predicts
escapism.
H3: Emotion dysregulation statistically predicts prob-
lematic gaming via escapism.
26 |Journal of Behavioral Addictions 8(1), pp. 25–34 (2019)
Blasi et al.

METHODS
Participants and procedure
Since every game genre has specific features and structural
characteristics that are likely to have confounding effects on
findings, we contacted players of the MMORPG WoW only.
WoW is the most popular title in the MMORPGs genre and
still counts millions of players around the world today. The
game has in fact been the subject of several previous studies
designed to assess motivations to play MMORPG and
potential psychological factors associated with problematic
gaming (Billieux et al., 2013;Bowditch et al., 2018;
Yee, 2006). In WoW, players interact with each other
through customizable avatars within the heroic-fantasy
world of Azeroth. Much of the gameplay revolves around
co-operation (player vs. environment) or competition
(player vs. player) with other players (often via virtual
social networks called “guilds”), in order to complete
quests, improve character skills and items, and achieve a
better in-game ranking.
Participants were recruited through an advertisement
posted on official WoW forums, Facebook groups and
pages, and general video game forums. The advertisement
briefly explained the aim of the study and invited players to
participate through an online survey. The survey started in
May 2017 and ended June 2018. Inclusion criteria were
being fluent Italian speakers, active WoW players, and aged
18 years or older. Anonymity was assured (no data on the
gamers’identification, including their Internet Protocol
address, were collected). Information on sociodemographic
variables including sex, age, and ethnicity, as well as game-
related variables, such as participants’character’s race
(e.g., elf, human, orc), faction (horde or alliance), character
level, self-reported weekly hours spent playing, and the
number of months played, were collected through a struc-
tured questionnaire administered along with standardized
self-reports. Self-reported weekly hours spent playing
was measured as the number of hours of online gaming
in a week reported by the participant. Respondents took
approximately 25 min to complete the survey.
In total, 827 participants started the survey. Four hundred
and fourteen (50.06% of the initial sample) completed the
entire survey. Of these, 24 were excluded from analyses for
the following reasons: no age reported (n=8), anomalous
hours of play (n=1), inconsistent matches between item
level and character level (n=10), and impossible matches
between character faction and character race (n=5). The
final sample consisted of 390 players. Participants’ages
ranged from 18 to 67 years (M=28.28, SD =8.24), and the
sample was predominantly composed of men (n=289,
74.10%).
Measures
Difficulties in Emotion Regulation Scale (DERS-18). The
DERS is a widely used self-report measure of emotion
regulation difficulties. Items are rated on a scale from 1
(almost never)to5(almost always). Scores for each
subscale and the total score are sums of the relevant items
(with three items reverse-coded). Higher DERS scores
reflect greater emotion regulation difficulties. In this study,
we used the Italian translation (Sighinolfi, Norcini Pala, &
Chiri, 2010) of the 18-item version by Victor and Klonsky
(2016). The DERS-18 includes six factor analytically de-
rived subscales: lack of emotional awareness (Awareness;
e.g., “I pay attention to how I feel,”reverse scored; Cron-
bach’sα=.68); lack of emotional clarity (Clarity; e.g., “I
am confused about how I feel;”Cronbach’sα=.83); lack of
acceptance of one’s emotions when distressed (Non-
acceptance; e.g., “When I am upset, I feel ashamed with
myself for feeling that way;”Cronbach’sα=.83); lack of
ability to engage in goal-directed cognition and behavior
when distressed (Goals; e.g., “When I am upset, I have
difficulty focusing on other things;”Cronbach’sα=.88);
lack of ability to manage one’s impulses when distressed
(Impulse; e.g., “When I am upset, I lose control of my
behavior;”Cronbach’sα=.88); and lack of access to
effective strategies for feeling better when distressed (Strat-
egies; e.g., “When I am upset, I believe that I will remain
that way for a long time;”Cronbach’sα=.84). Cronbach’s
αs for the subscales in this study were similar to those found
in other studies (Estévez et al., 2017).
Internet Addiction Test –WoW Version (IAT-WoW). The
IAT-WoW scale was used for assessing PG. The Italian
translation of the IAT (Ferraro, Caci, D’Amico, & Blasi,
2007) was adapted specifically for WoW rather than the
Internet in general, in accordance with Billieux et al.’s
(2013,2015) suggestion. This adapted IAT comprised
20 items scored on a 5-point Likert scale measuring addic-
tive use of WoW and related negative consequences on
various aspects of everyday life (e.g., “Did you ever play
WoW longer than you had intended?”). For each item,
respondents can choose from five response options scored
1–5(never, rarely, occasionally, often, and always). Higher
IAT-WoW scores indicate higher levels of problematic
involvement in WoW. Cronbach’sαfor IAT-WoW in this
study was .88, similar to that reported in other studies
(Billieux et al., 2013,2015).
Motivation to Play in Online Games Questionnaire
(MPOGQ-WoW version). The MPOGQ, developed by Yee
(2006), measures the reasons why players engage in
MMORPG. In this study, we adapted the original version
to apply only to WoW, in accordance with a procedure
used by Billieux et al. (2013). The questionnaire measures
three broad motivations divided into 10 specificmotives:
Achievement (advancement, competition, and mechan-
ics), Social (socializing, relationship, and teamwork), and
Immersion (customization, escapism, discovery, and role-
play). In accordance with the hypotheses of this study,
only the escapism items were used. The escapism scale
measures involvement in the video game to relax and/or to
escape from real-life problems (e.g., “How often do
you play WoW so that you can avoid thinking about
some of your real-life problems or worries?”). Participants
rate each statement using a 5-point Likert scale, with
higher scores indicating higher escapism motives. Cron-
bach’sαof the escapism scale in this study was .69,
similar to that found in other studies (Billieux et al., 2013,
2015).
Journal of Behavioral Addictions 8(1), pp. 25–34 (2019) |27
Problematic gaming and emotional dysregulation

Measurement model
We used a structural equation modeling (SEM) framework
to test the hypothesis that escapism would mediate the
relationship between ED and PG. This model is based on
the notion that the six DERS subscales (Non-acceptance,
Goal, Impulse, Awareness, Strategies, and Clarity) form the
latent variable of ED. The three items comprising
the escapism subscale of the MMOPGQ-WoW formed the
latent variable of escapism. Since the IAT measure has
shown inconsistent factor structures in previous research
(Faraci, Craparo, Messina, & Severino, 2013), we first ran
an exploratory factor analysis on the IAT-WoW to identify a
clear factor structure for our measurement model. Five
factors had eigenvalues above 1 (the eigenvalues being
6.50, 1.47, 1.13, 1.12, and 1.07), but only the first factor
explained more than 5% of the variance of the IAT-WoW
(29.77% of variance); moreover, solutions with more than
one factor displayed significant and inconsistent loadings
across factors. Therefore, we decided to use the five items
with the highest loading on the general factor of the IAT-
WoW to determine an appropriate measurement of PG and
thus to form its latent factor. The five items selected to
measure the IAT-WoW latent factor (items 2, 5, 12, 15, and
20; Cronbach’sα=.76) represent core symptoms of PG
(neglecting household chores to spend more time online;
others complaining about the amount of time spent on
WoW; fears that life without WoW would be joyless; being
preoccupied with WoW when offline and fantasizing
about playing it; and feelings of depression or nervousness
when not playing WoW, which go away when going back to
playing it). Moreover, these items with the highest
loadings on the IAT-WoW general factor are relevant for
understanding PG patterns according to both the compen-
satory hypothesis of PG as a coping strategy to deal with
current stressors (Kardefelt-Winther, 2014b) and to the
symptom-based model of behavioral addictions (Brown,
1993;Griffiths, 2005). The measurement model and its
predicted relationships between variables are depicted in
Figure 1.
Statistical analysis
Descriptive statistics were calculated for all the variables in
the study. Gender differences were examined using inde-
pendent t-tests. Pearson’srcorrelations between weekly
hours of play and the psychological variables were also
considered. SEM analysis of the measurement model was
performed using the lavaan package (Rosseel, 2012) for R
software. Multiple goodness-of-fit indices were assessed.
Assessment of the absolute indices included the following:
the χ
2
/df ratio, for which values ≤2 indicate a good fit; the
root mean square error of approximation (RMSEA), for
which values ≤0.05 indicate a good fit; and the standardized
root mean square residual (SRMR), for which a value ≤0.08
is recommended for accepting a model. Assessment of
incremental fit indices included the non-normed fit index
(NNFI) and the comparative fit index (CFI), with
values >.95 indicating a good fit for both (Brown, 2006;
Hu & Bentler, 1999). The χ
2
test of difference was further
used to determine whether the model presented in Figure 1
provided a better fit than did a non-mediated model in which
ED independently predicted escapism and PG, without
escapism mediating PG.
Ethics
The study was conducted in accordance with the Declaration
of Helsinki and ethical guidelines for psychological research
laid down by the Italian Psychological Association. All
subjects were informed of the anonymity of the study and
all gave their informed consent.
RESULTS
Descriptive statistics for the full sample and differentiated
by gender are presented in Table 1.
The majority of the players (92.8%) had been playing
WoW for more than 12 months, showing high game expe-
rience in terms of number of months played (M=71.33,
Figure 1. Measurement model
28 |Journal of Behavioral Addictions 8(1), pp. 25–34 (2019)
Blasi et al.

SD =42.97). On average, participants did not report high
ED scores (M=38.51, SD =13.07) with respect to other
samples (Sighinolfiet al., 2010), although there was a
slightly higher tendency to play to escape from reality
(M=10.00, SD =2.64) with respect to other studies
(e.g., Kaczmarek & Drążkowski, 2014). Moderate symp-
toms of PG were reported on the IAT-WOW (M=46.97,
SD =11.89), similar to those found in other studies
(Schimmenti, Infanti, et al., 2017;Wang et al., 2017).
The results of the ttests examining gender differences
showed that males did not differ significantly from females
with regard to PG [M=47.56, SD =11.84 vs. M=45.28,
SD =11.91, t(388) =1.661, p=.098], ED [M=38.21,
SD =12.47 vs. M=39.36, SD =2.73, t(388) =−0.70,
p=.48], or escapism [M=9.95, SD =2.61 vs. M=10.12,
SD =4.68, t(388) =−0.56, p=.57]. Nor did they differ in
terms of weekly time spent playing WoW [M=23.26,
SD =15.32 vs. M=22.89, SD =15.19, t(388) =0.21,
p=.83] or months since they had started to play [M=73.47,
SD =42.42 vs. M=65.21, SD =44.16, t(388) =1.66,
p=.096]. Pearson’srcorrelations between age, weekly
time spent playing WoW, and all the psychological mea-
sures are presented in Table 2.
ED was significantly and positively related to both PG
and escapism, with relations being of moderate size. Nota-
bly, weekly hours spent playing was significantly, yet
weakly, associated with escapism and PG but not with ED.
Moreover, all the DERS subscales were significantly related
to both PG and escapism motivations. Specifically, the
strategies scale was the one mostly related to escapism
motivations (r=.40) and PG (r=.33).
After examining the intercorrelations between variables,
the model presented in Figure 1was tested via SEM using
maximum likelihood estimation. The model yielded a sig-
nificant χ
2
value [χ
2
(74) =126.16, p<.001]; however, the
χ
2
/df ratio was 1.70, suggesting a good fit. Further exami-
nation of fit indices confirmed that the mediation model
fitted very well (RMSEA =0.043 [90% CI: 0.029–0.055],
SRMR =0.038, NNFI =0.96, CFI =0.97). All the esti-
mates, intercepts, and variances in this model were signifi-
cant at p<.01. The mediation model explained 31% of
the escapism variance and 53% of the PG variance.
Table 1. Psychosocial and game-related variables: Descriptive statistics and gender differences
Overall
Gender differences
Range t(388) p
Males (N=289) Females (N=101)
M(±SD)orN(%) M(±SD)M(±SD)
DERS 38.51 (±13.07) 38.21 (±12.47) 39.36 (±2.73) 18–90 −0.706 .481
Awareness 7.44 (±2.78) 7.41 (±2.59) 7.50 (±3.24) 3–15 −0.241 .810
Clarity 5.92 (±2.89) 5.84 (±2.67) 6.15 (±3.44) 3–15 −0.842 .401
Goals 7.81 (±13.61) 7.87 (±3.71) 7.63 (±3.33) 3–15 0.600 .549
Impulse 5.22 (2.88) 5.16 (±2.78) 5.38 (±3.14) 3–15 −0.660 .510
Non-acceptance 5.89 (±3.19) 5.80 (±3.15) 6.12 (±3.29) 3–15 −0.883 .378
Strategies 6.23 (±3.38) 6.11 (±3.34) 6.55 (±3.49) 3–15 −1.135 .268
IAT-WOW 46.97 (±11.89) 47.56 (±11.84) 45.28 (±11.91) 20–100 1.661 .098
Escapism 10 (±2.64) 9.95 (±2.61) 10.12 (±14.68) 3–15 −0.568 .570
Weekly hours of play 23.26 (±15.32) 23.26 (±15.32) 22.89 (±15.19) 1–105 0.214 .830
Months of play 71.33 (±42.97) 73.47 (±42.42) 65.21 (±44.16) 1–168 1.666 .096
Note.M: mean; SD: standard deviation; DERS: Difficulties in Emotion Regulation Scale; IAT-WOW: Internet Addiction Test –World of
Warcraft version.
Table 2. Correlations between problematic involvement in WoW, escapism motives, and difficulties in emotion regulation
with its dimensions
Measures 1 2 3 4 5678910
1. Age –
2. Hours a week −.02 –
3. Escapism −.18*** .17*** –
4. IAT-WOW −.17*** .21*** .47*** –
5. DERS total score −.30*** .03 .43*** .39*** –
6. Awareness −.02 .07 .11** .12*** .40*** –
7. Clarity −.27*** −.03 .35*** .31*** .73*** .30*** –
8. Goals −.27*** .00 .34*** .30*** .76*** .05 .41*** –
9. Impulse −.21*** .08* .30*** .30*** .73*** .20*** .41*** .55*** –
10. Acceptance −.19*** −.03 .29*** .25*** .70*** .15*** .40*** .46*** .37*** –
11. Strategies −.27*** .06 .40*** .33*** .80*** .12*** .54*** .57*** .52*** .50***
Note. WoW: World of Warcraft; DERS: Difficulties in Emotion Regulation Scale; IAT-WOW: Internet Addiction Test –WoW version.
*p<.05. **p<.01. ***p<.001.
Journal of Behavioral Addictions 8(1), pp. 25–34 (2019) |29
Problematic gaming and emotional dysregulation

The non-mediated model, in which ED predicted both
escapism and PG with no relationship between these two
latter variables, displayed only acceptable fit indices
(RMSEA =0.055 [90% CI: 0.044–0.067], SRMR =0.060,
NNFI =0.96, CFI =0.93), and explained 37% of the
escapism variance but only 36% of the PG variance. As
expected, the mediation model was superior to the non-
mediated model in which escapism did not mediate the
predictive association between ED and PG [Δχ
2
(1) =38.89,
p<.001]. Notably, the effect of ED on PG decreased
from a standardized estimate of 0.55 (p<.001) in the
non-mediated model to one of 0.26 (p=.008), thus showing
partial mediation of escapism in the relationship between
ED and PG. The standardized total effect of the model
was 0.51 (p<.001); the standardized indirect effect of
ED on PG via escapism was 0.26 (p<.001). The standard-
ized estimates of the mediation model are presented in
Figure 2.
DISCUSSION
All our hypotheses were confirmed in our sample. Analyses
conducted within an SEM framework showed that ED
predicted both escapism motives and PG, and that escapism
partially mediated this relationship. The fit indices of the
mediation model were excellent and support the view that
ED directly and indirectly affects levels of PG.
Consistent with H1, individuals reporting higher ED were
more likely to show problematic involvement in WoW. This
finding supports the view that ED is related to PG (Billieux
et al., 2011;Estévez et al., 2017;Gaetan et al., 2016).
Moreover, our results are consistent with other research
showing that difficulties in emotion regulation are a part of,
or give a rise to, psychological symptoms such as depression
and social anxiety (Klemanski, Curtiss, McLaughlin, &
Nolen-Hoeksema, 2017;Paulus, Vanwoerden, Norton, &
Sharp, 2016), which have been established as risk factors
for PG (Maroney et al., 2018;Yen et al., 2018).
Our findings are also well aligned with recent literature
suggesting that video game environments are particularly
suited to experimenting and coping with negative affect
(Gaetan et al., 2016;Hemenover & Bowman, 2018;Villani
et al., 2018). For example, Gaetan et al. (2016, p. 347)
suggested that video games may function as a means of
rendering emotions psychologically meaningful and to
“curb alexithymic dynamic;”that is, they can help gamers
to reduce difficulties in identifying, describing, and proces-
sing their feelings (Schimmenti, Passanisi, et al., 2017).
Nevertheless, for individuals who display difficulties in
emotion regulation, the video game environment may be
the main domain in which they can approach the regulation
of their emotions without negative consequences (Billieux
et al, 2015;Chang et al., 2018;Gaetan et al., 2016;
Kardefelt-Winther, 2014b;Maroney et al. 2018;
Schimmenti & Caretti, 2010).
In accordance with our second hypothesis, our
results showed higher ED to be associated with escapism.
Previous studies have found an association between escap-
ism motivation to play and negative emotions, as well as
stressful life events (Hussain & Griffiths, 2009;Kardefelt-
Winter, 2014a,2014c;Kuo et al., 2016). However, to our
knowledge, this is the first study to focus on a potential
underlying process, namely ED. As such, our findings are
consistent with the results of Kuo et al. (2016) highlighting
that escapism can act as a coping mechanism for WoW
players motivated by the need to regulate their negative
affect linked to external stressors. It could be argued that
escapism in online games acts as an emotion-focused coping
strategy aimed at better managing negative emotions and
feelings. This strategy may paradoxically have the function
of helping individuals to cope with the inefficacy or unavail-
ability of other emotion regulation processes, thus allowing
them temporarily to escape from negative mood states
experienced in their offline lives through their immersion
into alternative and more comfortable environments.
With regard to H3, we found that escapism partially
mediated the relationship between ED and PG. This
Figure 2. Mediation model. χ
2
=126.16*** (df =74); RMSEA =0.043 [90% CI: 0.029–0.055]; SRMR =0.038; NNFI =0.96;
CFI =0.97. ***p<.001
30 |Journal of Behavioral Addictions 8(1), pp. 25–34 (2019)
Blasi et al.

observed mediating effect of escapism is also meaningful at
the theoretical level, in which it shows that ED may lead
individuals to use video games as either a “psychic retreat”
from current and past problems (Schimmenti & Caretti,
2010;Schimmenti, Guglielmucci, Barbasio, & Granieri,
2012) and/or a coping strategy to escape from psychosocial
stressors (Kardefelt-Winther, 2014b). However, the use of
video games as a preferred strategy for coping with or
escaping from psychological difficulties might foster exces-
sive involvement in video games, and might eventually lead
to clinically impairing gaming patterns. Similarly, a recent
study (Maroney et al., 2018) found that escapism mediated
the relationship between psychosocial distress and PG in a
sample of online gamers. The results from this study suggest
that, for gamers with higher ED, escapism might temporari-
ly serve as an emotion-focused coping strategy for seeking
temporary relief from disturbing affect states, while
simultaneously exercising a “push”effect (Chang et al.,
2018) that presses players into gaming to achieve short-term
well-being, thus increasing the risk of PG.
Therefore, these results raise some relevant questions
concerning the distinction between healthy and maladaptive
escapism that need to be fleshed out. Indeed, many authors
have shown that escapism motivations can be related to
problematic gaming as well as highly engaged gaming, and
that different psychological factors can interact with
escapism to influence its functionality (Bowditch et al.,
2018;Deleuze et al., 2018;Kardefelt-Winther, 2014c;Kuo
et al., 2016). For example, Kuo et al. (2016) pointed out that
while passive escapism provides relief from stressful
emotions by simply refocusing attention on the fantastic
narratives provided by the medium, active escapism may
allow the gamer to directly confront specific psychological
threats (e.g., low self-esteem) by redirecting awareness into
an interactive fantasy world that can provide us with
experiences of self-affirmation and empowerment. Accord-
ingly, in our SEM, clear differences in the magnitude of
loadings of the escapism items into their latent factor could
be observed, suggesting that the escapism construct is
multidimensional. Therefore, clarifying the nature of escap-
ism as reflecting avoidant or active coping processes should
be seen as a crucial task for future research on this topic.
Overall, these findings call for the development of new
measurement tools able to distinguish between adaptive
versus maladaptive escapism in the context of video game
playing.
LIMITATIONS
This study comes with some limitations that need to be
acknowledged. First, it is a cross-sectional study, and
therefore no causality can be inferred. Second, it relies on
self-report measures, which can result in bias effects and
under- or overreporting of behaviors. Third, the self-selected
nature of the sample limits the ability to generalize our
findings to other video game players (Khazaal et al., 2014).
Fourth, partial attrition was high, with only 50% of initial
participants completing the whole survey. Many respon-
dents probably felt that the survey was too long, and as such
a shorter survey may have counteracted this attrition. Final-
ly, other psychosocial factors, such as social anxiety, de-
pression, and social isolation, as well as other gaming
motives that could play a role in PG, were not assessed.
Therefore, future research using longitudinal designs and
more representative samples of gamers are needed.
CONCLUSIONS
The findings of this study provide new information to
support a better understanding of the psychological factors
behind the development and maintenance of PG among
WoW players. They suggest that escapism motivation in
emotionally dysregulated individuals may strengthen PG. In
line with a compensatory framework of PG (Kardefelt-
Winther, 2014b;Schimmenti & Caretti, 2010;Snodgrass
et al., 2018), the findings also show the interplay between
difficulties in emotion regulation, escapism, and problem-
atic involvement in WoW. Furthermore, they provide
evidence that gamers characterized by emotion regulation
difficulties may rely on game experiences in order to regu-
late their emotional experiences, which can ultimately
translate into a maladaptive coping strategy. While the
deeply immersive nature of gaming experience can promote
regulation of, and relief from, negative mood states, this
maladaptive, emotionally focused coping strategy increases
the risk of problematic involvement in video games. It is
worth noting that this study also has some clinical implica-
tions. Problematic players, pushed by overwhelming
emotions to escape into the video game, may benefit from
interventions focused on enhancing their emotion regulation
strategies and processes, such as those aimed at promoting
interception and emotional awareness (Murphy, Brewer,
Catmur, & Bird, 2017) in order to reduce affect-laden
impulsivity (Billieux, Gay, Rochat, & Van der Linden,
2010) and strengthen mentalized affectivity (Schimmenti
& Caretti, 2010).
Funding sources: No financial support was received for this
study.
Authors’contribution: All authors contributed equally to
this work. They had full access to all data in the study and
take responsibility for the integrity of the data and the
accuracy of the data analysis.
Conflict of interest: The authors declare no conflict of
interest.
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