The Role of Avoidance Coping and Escape Motives in Problematic Online Gaming: A Systematic Literature Review

The captivation of videogames appears to lie in their potential to fulfill various psychological needs that can be conceptualized as motives to play. Demetrovics et al. (2011) identified seven motivational dimensions for online gaming: social motivation, escape, competition, skill development, coping, fantasy, and recreation. Escape and coping, especially avoidance coping strategies, have been studied extensively (Deleuze et al. 2019; Brand et al. 2014; Brand et al. 2014; Laconi et al. 2017). Although separate constructs, escape and avoidant coping are highly correlated with each other. While escapism emphasizes leaving reality, avoidance strategies emphasize the game’s capability to help cope with real problems (stress, aggression, anxiety), by helping individuals manage unpleasant moods and unwanted impulses. In the context of addictions, many studies report a higher use of avoidance strategies to cope with life problems and the seeking of a temporary escape from reality, in the same way that individuals use of substances like alcohol (Bacharach et al. 2008), or behaviors like gambling (Bergevin et al. 2006; Blaszczynski and Nower 2002) and online gaming (Hussain and Griffiths 2009; Demetrovics et al. 2011; Przybylski et al. 2010; Hemenover and Bowman 2018).

Coping is a multifaceted and complex construct. When individuals face a stressful event, they can implement a series of emotional, cognitive, and/or behavioral responses. These responses depend on the subjective evaluation of the stressful event and on the perception of control on it. Lazarus and Folkman (1984) defined coping as “persistently changing cognitive and behavioral efforts in order to manage specific external and/or internal demands that are seen as taxing or exceeding the resources of the person” (p.141). The outcomes of this process can be adaptive or maladaptive depending on whether the individual has been able to cope with the stressors adequately. The transactional model proposed by Lazarus and Folkman (1984) emphasizes two types of coping: problem-focused coping includes the active search of information, solutions to the problem, and behaviors aimed at modifying the circumstances at the origin of the stressful event, so it is used in situations perceived as more easily controlled; emotion focused coping is aimed at regulating emotions through their expression and modulation and can be considered less adaptive. Emotion focused coping includes ventilation of feelings or avoiding problems, such as self-blame, anger, self-distraction, withdrawal, and/or use of drugs. It is known that dysfunctional coping strategies, especially emotion focused and avoidant coping strategies predict risky behaviors among adolescents (Cooper et al. 2003) and play a role in the relationship between stressful life events and the etiology of psychiatric disorders (Lazarus and Folkman 1984; Rohde et al. 1990) such as anxiety and depression (Ebata and Moos 1991; Donovon and Spence 2000), whereas problem-focused coping promotes healthier behaviors (Stein and Nyamathi 1998). Coping strategies change during adolescent development and the development of characteristic ways of coping in childhood and adolescence may be precursors to patterns of coping in adulthood (Compas et al. 2001).

The escape motive refers to the intentional involvement in playing videogames to detach from the real world, to immerse into a fantasy world, and/or avoid real-life problems (Caplan et al. 2009). Escapism offers momentary fulfillment and gratification through the use of fanciful scenarios, whether through active participation (e.g., playing online games) or passive observation (e.g., watching movies or series) (Ebata and Moos 1991). Additionally, Evans (2001) suggest that escapism is a construct encompassing both psychological immersion and engagement of fantasy.

Yee (2006) developed a 10-factor model of motivation for MMORPG players that were grouped into three main headings: achievement, which encompasses advancement, mechanics, and competition; social which includes socializing, relationships, and teamwork; and immersion, which includes discovery, role-playing, customization, and escapism. Online videogames, and in particular MMORPGs, offer highly immersive experiences, allowing the player to experience a strong sense of presence in the imaginative game world. Therefore, escapism expands beyond simple psychological immersion, encompassing a believable absorption into the persistent, three-dimensional world (Warmelink et al. 2009). In order to develop prevention programs aimed at promoting moderate and responsible gaming, practitioners and research need to have a good knowledge of the motives as to why people participate in gaming.

The aim of the present study was to review and synthesize empirical research examining the role that escapism and avoidant coping motives play in problematic online gaming. Although escapism and avoidant coping are separate constructs, they are highly correlated with each other and researchers tend to offer no uniform definition in literature when investigating escapism as a motivation for online gaming. Scholars have generally not provided a clear distinction between escapism and avoidance, and the terms escapism and avoidance are often used interchangeably. This conceptual inconsistency makes it difficult to interpret findings if the researcher is unclear in communicating the meaning of these constructs in the first place. Therefore, clarifying the nature of escapism as an avoidant coping strategy should be seen as the basis for further research on this topic. Given the importance of this motive, the present literature review synthesizes the available research that has examined the role of avoidance coping strategies or escape in developing of problematic online gaming, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

The review was conducted utilizing the PRISMA guidelines (Moher et al. 2009). In February 2020, a literature search was carried out via the following database: PubMed, ProQuest, Web of Science, Google Scholar and EBSCO that included Academic Search Complete, PsycARTICLES, and PsycINFO. The researches were conducted using the following search terms: gam* AND (addict* OR compuls* OR depend* OR problem* OR disorder) AND coping strategies OR avoidan* OR escape. Additionally, references reported in relevant studies identified were hand-searched to see if there were additional papers for inclusion in the review. Due to the inconsistent definition of “internet gaming addiction”, papers which had “internet addiction” in their titles or in the abstract were considered, but only studies that assessed gaming addiction, gaming disorder, or problematic gaming use were included in the review. The inclusion criteria for the studies in the present review were: (i) being an empirical study comprising primary data (ii) published in a peer-reviewed paper from 2010 to 2020, (iii) citing avoidance coping strategies, or escape as a motive for gaming, and (iv) having a sample size with more than 500 participants. Additionally, studies were excluded if they (i) had less than 500 participants, (ii) were qualitative studies, reviews, theoretical papers, or psychometric validation studies, (iv) were not published in the English language, and (iv) assessed escape as a symptom according to problematic gaming criteria (e.g., the DSM-5 escape criterion).

The database search parameters (full text, being published from 2010 to 2020 and in English language) yielded a total of 1859 hits, and 26 papers, reported in references lists, were hand-searched. The full study selection process is described in the PRISMA flow diagram (Fig. 1). The title and abstract of each study was examined. A total of 1764 publications were excluded because of unsuitability for the present review based on the inclusion and exclusion criteria. Consequently, 121 full texts of the papers were deemed suitable, for further examination to determine whether they could be included in the review. From 121 papers, 95 studies were excluded due to escape being assessed as a symptom according to DSM-5 (n = 2), no specific assessment of avoidance coping strategies or escape motives (n = 12), and no specifically referring to gaming (n = 20). Additionally, qualitative studies (n = 2), psychometric validation studies (n = 11), reviews (n = 2), and theoretical studies (n = 2) were excluded. Finally, studies with less than 500 participants (n = 44) were excluded. Following this process, a total of 26 studies were identified for inclusion in the present review. Table 1 provides a summary regarding detailed characteristics of included studies.

Concerning the country where the data of the included studies were collected, eight were cross-cultural studies. These eight studies collected data from (i) Australia, Europe, USA, Brazil, and smaller cohorts from a number of other countries (Loton et al. 2016), (ii) North and South America, Europe, Africa, and Australasia (Maroney et al. 2019), (iii, iv) Belgium, Switzerland, and France (Billieux et al. 2013, 2015), (v) Hungary, UK, Italy, Norway, Slovenia, France, Romania, and Korea (Kim et al. 2016), (vi) France, Italy and UK (Dauriat et al. 2011), (vii) Hungary, Romania, and Slovakia (Bányai et al. 2019) and the last study collected data from 45 countries (the majority of participants were from the UK) (Kirby et al. 2014). Data from the remaining studies were collected from Hungary (n = 2; Király et al. 2015, 2017), Germany (n = 3; Von Der Heiden et al. 2019; Rosenkranz et al. 2017; Dreier et al. 2017), China (n = 2; Li et al. 2016; Zhengchuan Xu et al. 2012), Sweden (n = 2; Hellström et al. 2012, 2015), UK (n = 2; Kardefelt-Winther 2014a, b), Australia (Schneider et al. 2018), Croatia (Šporčić and Glavak-Tkalić 2018), Italy (Milani et al. 2018), Canada (Biegun et al. 2020), Poland (Kaczmarek and Drążkowski 2014), Korea (Kwon et al. 2011), and Perù (Ramos-Diaz et al. 2018).

The studies reviewed comprised a total of 48,573 participants. Concerning the age of the samples, ten studies comprised both adolescent and adult samples (Király et al. 2015; Bányai et al. 2019; Maroney et al. 2019; von der Heiden et al. 2019; Kardefelt-Winther 2014a, b; Kaczmarek and Drążkowski 2014; Dauriat et al. 2011; Ramos-Diaz et al. 2018; Király et al. 2017), six only adult samples (Loton et al. 2016; Šporčić and Glavak-Tkalić 2018; Billieux et al. 2013, 2015; Kim et al. 2016; Kirby et al. 2014), eight studies comprised school students from nine to 19 years old (Milani et al. 2018; Schneider et al. 2018; Rosenkranz et al. 2017; Kwon et al. 2011; Dreier et al. 2017; Hellström et al. 2012, 2015; Xu et al. 2012), and two studies comprised university students (Biegun et al. 2020; Li et al. 2016). Eleven studies comprised gamers without specifying the type of videogame played (Milani et al. 2018; Loton et al. 2016; Schneider et al. 2018; von der Heiden et al. 2019; Biegun et al. 2020; Rosenkranz et al. 2017; Kwon et al. 2011; Dreier et al. 2017; Kim et al. 2016; Király et al. 2017; Xu et al. 2012), five studies comprised World of Warcraft players (Kardefelt-Winther 2014a, b; Billieux et al. 2013, 2015; Kirby et al. 2014), two studies comprised MMORPG players (Kaczmarek and Drążkowski 2014; Dauriat et al. 2011), two studies comprised MMOPRG and FPS players (Király et al. 2015; Maroney et al. 2019), and two studies comprised general gamers and MMORPG players (Hellström et al. 2012, 2015). Samples of the four remaining studies comprised recreational and esport gamers (Bányai et al. 2019), FPS, role-playing, adventures, MOBA and MMORPG players (Šporčić and Glavak-Tkalić 2018), addicted and non-addicted general online gamers (Li et al. 2016), and general gamers and MOBA players (Ramos-Diaz et al. 2018). Among 26 studies, 16 studies collected data online (Király et al. 2015; Bányai et al. 2019; Šporčić and Glavak-Tkalić 2018; Loton et al. 2016; Maroney et al. 2019; von der Heiden et al. 2019; Kardefelt-Winther 2014a, b; Kaczmarek and Drążkowski 2014; Billieux et al. 2013, 2015; Kim et al. 2016; Ramos-Diaz et al. 2018; Dauriat et al. 2011; Király et al. 2017; Kirby et al. 2014) and ten collected data offline (Schneider et al. 2018; Milani et al. 2018; Li et al. 2016; Biegun et al. 2020; Rosenkranz et al. 2017; Dreier et al. 2017; Kwon et al. 2011; Hellström et al. 2012, 2015; Xu et al. 2012).

To assess problematic gaming, the measures utilized by the studies comprised the following: Ten-item Internet Gaming Disorder Test (n = 3; Király et al. 2017; Bányai et al. 2019; Ramos-Diaz et al. 2018), Scale for Assessment of Internet and Computer Game Addiction (n = 3; Rosenkranz et al. 2017; Dreier et al. 2017; von der Heiden et al., 2019), Internet Addiction Test (n = 3; Billieux et al. 2013, 2015; Kwon et al. 2011), and Addiction Engagement Questionnaire (n = 2; Loton et al. 2016; Xu et al. 2012). Two studies did not refer to any screening measures because they did not assess problematic online gaming (Kaczmarek and Drążkowski 2014; Hellström et al. 2015). In two studies, problematic gaming was assessed using five negative gaming outcomes adapted for WoW players (Kardefelt-Winther 2014a, b). Two studies utilized a combination of two different measurements: Video Game Addiction Questionnaire and Internet Addiction Test (Milani et al. 2018) and Online Game Cognitive Addiction Scale and Internet Addiction Test (Li et al. 2016). The nine remaining studies utilized the Problematic Online Gaming Addiction (Király et al. 2015), Internet Gaming Disorder Checklist (Schneider et al. 2018), Internet Gaming Disorder Scale (Šporčić and Glavak-Tkalić 2018), Video Gaming Test (Biegun et al. 2019), the DSM-5 IGD criteria (Kim et al. 2016), MMORPG Addiction Scale (Dauriat et al. 2011), Problematic Video Game Playing Test (Maroney et al. 2019), WoW Specific Problematic Usage/Engagement Questionnaire (Kirby et al. 2014), and seven-item screening measure (Hellström et al. 2012).

Among the 26 studies, 19 assessed escapism and seven assessed avoidance coping. For those that assessed escapism, the measures utilized by the studies comprised the following: Motives for Online Gaming Questionnaire (n = 7; Király et al. 2015; Bányai et al. 2019; Šporčić and Glavak-Tkalić 2018; Biegun et al. 2019; Kim et al. 2016; Király et al. 2017; Ramos-Diaz et al. 2018), five items from Yee’s Gaming Motivations Inventory (2007) (n = 2; Kardefelt-Winther 2014a, 2014b), Motivations to Play in Online Games Questionnaire (n = 3; Billieux et al. 2013, 2015; Kirby et al. 2014), Video Game Motivation Scale-Escapism subscale and Video Game Uses and Gratification Instrument (n = 1; Maroney et al. 2019), Motivations of Play in MMORPGs Scale (n = 1; Kaczmarek & Drazkowski, 2014), Escape From Self Scale (n = 1; Kwon et al. 2011), and a 17-item questionnaire assessing four motivation types based on the functional needs of online game playing from previous research (they mainly used Yee’s 2006 motivations) (n = 1; Xu et al. 2012). Finally, three studies assessed escapism with specific bespoke questions rather than a psychometric measure (Dauriat et al. 2011; Hellström et al. 2012, 2015). For those that assessed avoidance coping, the measures utilized by the studies comprised the following: Brief Coping Orientation to Problems Experienced (n = 4; Rosenkranz et al. 2017; von der Heiden et al. 2019; Schneider et al. 2018; Dreier et al. 2017), Children’s Coping Strategies Checklist-Revised-1 (Milani et al. 2018), Brief Approach-Avoidance Questionnaire (Loton et al. 2016), and Coping Style Questionnaire (Li et al. 2016).

Table 2 summarizes the risks of bias assessed in each study. All studies (i) had cross-sectional designs that do not allow conclusions to be made about the causal relationships among variables, (ii) utilized self-report survey methodologies and therefore subject to well-known biases (e.g., social desirability, memory recall), and (iii) reported cutoff criteria based upon self-reporting that might not be reliable enough for diagnosis. Moreover, all studies, apart from two (Li et al. 2016; Dreier et al. 2017), utilized non-probability (self-selecting) sampling (e.g., no representative samples). There were also other sample biases. For instance, 13 studies had a highly imbalanced gender distribution with heavily male-dominated samples (Király et al. 2015; Bányai et al. 2019; Maroney et al. 2019; von der Heiden et al., 2019; Kardefelt-Winther 2014a, b; Billieux et al. 2013, 2015; Kaczmarek and Drążkowski 2014; Dauriat et al. 2011; Király et al. 2017; Ramos-Diaz et al. 2018; Kirby et al. 2014), and one study only collected data from urban dense areas (Milani et al. 2018). With regard to measurement bias, four studies lacked rigorous or psychometrically validated measures (Kardefelt-Winther 2014a, b; Dauriat et al. 2011; Király et al. 2017) and four have limitations due to using BriefCOPE because some of its subscales have poor internal reliability and there is a tendency to report specific strategies rather than adopting different coping styles more dynamically to deal with different problems (Schneider et al. 2018; Dreier et al. 2017; Rosenkranz et al. 2017; von der Heiden et al. 2019).

Table 2 also shows the main findings of each study. Among the studies reviewed, each suggested the existence of a significant relationship between escapism or avoidance coping strategies and problematic online gaming. Billieux et al. (2015) found out that the problematic online gaming is highly heterogeneous and depends on a wide range of psychological factors. One of the main factor involved factor was escapism motive. It characterized two, of the three clusters of problematic gamers that authors classified. Members of the first cluster were named “unregulated escapers” and for them, excessive use can be conceptualized as a maladaptive coping strategy serving to overcome negative effects and/or negative life events. The second cluster included individuals mainly motivated by achievement and escapism with high level of self-esteem. For them, the “virtual” self has overwhelmed the “real” self, implying a potential denial of real life and an over-involvement in virtual life. Those who played for escape motives showed high risk of depressive, musculoskeletal and psychosomatic symptoms (Hellström et al. 2015), and having several negative consequences such as troubles with parents, less sleep due to gaming, forgetting to eat, and not spending time with friends (Hellström et al. 2012). Ten studies reported that escapism was associated with (and might be a predictor of) IGD and increased time spent gaming (Király et al. 2017; Kwon et al. 2011; Xu et al. 2012; Kim et al. 2016; Kaczmarek and Drążkowski 2014; Bányai et al. 2019; Šporčić and Glavak-Tkalić 2018; Biegun et al. 2019; Ramos-Diaz et al. 2018), social anxiety, and loneliness (Kardefelt-Winther 2014b). These results were also found among MMOPRG and FPS players (Billieux et al. 2013; Dauriat et al. 2011; Maroney et al. 2019). High escapism score was associated with stronger beliefs that the virtual world is as realistic as the real world (individuals think/believe the virtual world is as real as the real world), leading to decreased offline support for real world problems and reduced levels of well-being (Kaczmarek & Drazkowski, 2014). Moreover, escapism appears to mediate the relationships between (i) self-esteem, stress, and negative outcomes (Kardefelt-Winther 2014a, b), (ii) problematic online gaming and self-concept (Šporčić and Glavak-Tkalić 2018), (iii) problematic online gaming and loneliness, depression, and social anxiety (Maroney et al. 2019), and (iv) playing time spent and the its negative impact on psychological well-being (Kirby et al. 2014). Some avoidance coping strategies appear to be significant factors in problematic online gamers: self-distraction was associated with low self-esteem and life satisfaction, shyness, poor achievement at school, loneliness, and lack of self-efficacy and social support (von der Heiden et al., 2019); behavioral disengagement and denial were significant predictors of IGD (Schneider et al. 2018; Dreier et al. 2017) and were adopted by problematic gamers more frequently than non-problematic gamers (Rosenkranz et al. 2017). In addition, avoidance coping strategies mediated the relationship between IGD and negative consequences, such as level of distress, thwarted goal attainment, burnout, and negative emotion (Loton et al. 2016), and between IGD and stressful events (Li et al. 2016). Dysfunctional coping strategies, such as avoidance, might represent a risk factor for pre-clinical and clinical levels of IGD (Milani et al. 2018). Only Kiraly et al. (2015) reported that, despite MMORPG players scoring higher on escape, psychiatric symptoms (somatization, obsession compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism) were both directly and indirectly, via escape, negatively associated with problematic online gaming. The authors argued gaming can also be used as an adaptive coping strategy for stress relief or tension reduction for a short time, without necessarily leading to problematic use (i.e., playing games to escape everyday difficulties appears to be a motivating behavior that can ease psychiatric distress).

Overall, problematic life events or stressful situations can motivate individuals to go online and use specific applications, such as videogames, to fulfill unsatisfied needs or relieve dysphoric mood states (Kiraly et al. 2015). It is worth noting that this can lead to both positive and negative outcomes, that is, positive when the compensation is successful (feeling better and where applications have been used for short time) and negative when this mechanism becomes persistent and the intensity of the use compromises other areas of an individual’s life. Furthermore, these are not necessarily mutually exclusive.

Therefore, the question that arises is when or for whom such motivations may be harmful. Parents, educators, and health professionals should not necessarily be worried about online gaming as a way for individuals to cope with daily stressors. However, for small minority, excessive gaming can become a problematic behavior because such motives might result in compulsive engagement in the game and result in negative real-life consequences (Young 2009). From a practical standpoint, if motivations play an important role in excessive and problematic gaming, a better understanding of how individuals attempt to cope with real-life problems and negative feelings should suggest more effective prevention and intervention measures. Studies have shown that reducing the time spent online gaming alone does not appear to be an effective intervention (Šporčić and Glavak-Tkalić 2018). In most cases, prevention programs include psycho-education interventions and tools that have the development of healthier coping strategies as the main outcome so that individuals can better manage daily life stressors (Kuss and Griffiths 2012).

The present review suggests that coping style might be a useful mechanism for the clinical formulations of problematic online gaming, leading to the development of more adaptive, problem-focused coping strategies and redirecting gaming activities toward the search for new meaningful and productive opportunities. The main goals of assisting problematic gamers should be developing awareness of the negative influences of gaming and recognizing cognitive pitfalls that lead to denial or minimizing the distress they experience in their lives (King and Delfabbro 2016). With the promulgation of prevention programs at an early age and underpinned by empirical knowledge concerning the risk factors as motivations for gaming, the greater the possibility that children and adolescents will be protected from the dangers and consequences of excessive online gaming.