Clinical and Personality Correlates of MMO Gaming: Anxiety and Absorption in Problematic Internet Use

Article Clinical and Personality Correlates of MMO Gaming: Anxiety and Absorption in Problematic Internet Use Social Science Computer Review 31(4) 424-436 ª The Author(s) 2013 Reprints and permission: sagepub.com/journalspermissions.nav DOI: 10.1177/0894439312475280 ssc.sagepub.com Sadie H. Cole 1 and Jill M. Hooley 1 Abstract Massively-multiplayer online games (MMOs) are increasingly popular worldwide. MMO gaming can result in problematic Internet use (PIU; or Internet addiction), which is characterized by dysfunction in areas such as work or relationships. Because PIU in online gaming is increasingly seen in clinical populations, we explored PIU in the context of MMO gaming. Using a cross-sectional design, we sought to identify clinical and personality factors, as well as motivations for gaming, that differentiated between people who scored high or low on a measure of problematic Internet use. Subjects completed all study procedures via an online survey. Participants were 163 MMO users recruited from the community, from gaming websites, and from online forums. Subjects completed a series of demographic, mood, anxiety, and personality questionnaires. The study found that individuals in the high PIU group (n ¼ 79) were more likely to have higher levels of social phobia (p ¼.000), state (p ¼.000) and trait (p ¼.000) anxiety, introversion (p ¼.000), neuroticism (p ¼.000) and absorption (p ¼.019) than individuals in the low-piu group (n ¼ 84). Different reasons for gaming also characterized the group with more problematic Internet use. Our findings provide support for the idea that high anxiety and absorption may be risk factors for problematic Internet use within the MMO gaming environment and suggest that gamers who endorse problematic Internet use identify different motivations for online gaming than gamers who do not. Keywords Internet addiction, anxiety, personality, online gaming Introduction Background One area of Internet use that is growing in popularity involves massively multiplayer online games (MMOs). Although such games provide entertainment for many people, there is evidence that MMO gaming can lead to problematic Internet use (PIU; Morrison & Gore, 2010), also referred to as 1 Harvard University, Cambridge, MA, USA Corresponding Author: Sadie H. Cole, William James Hall 1254, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA. Email: scole@fas.harvard.edu

Cole and Hooley 425 Internet addiction, and cause significant problems in functioning (Hsu, Wen, & Wu, 2009; Lo, Wang, & Fang, 2005; Mitchell, Becker-Blease, & Finkelhor, 2005; Young, 2009). Addicted online gamers likely represent a very small proportion of the online gaming community (van Rooij, Schoenmakers, Vermulst, van den Eijnden, & van de Mheen, 2010). Nonetheless, identifying individuals who are at risk of addiction in this particular context is clinically important for focusing prevention and treatment efforts. Smyth (2007) noted that MMO players reported worse health, worse sleep quality, and worse interference in socializing after 1 month compared to those who played arcade, console, or solo computer games. Messias, Castro, Saini, Usman, and Peeples (2011) reported a link between Internet use/ video games and suicidal ideation and planning in adolescents. These findings raise questions about the factors that place people at risk of Internet addiction in online gaming. It bears mention that the concept of Internet addiction is evolving, given the ubiquity of the Internet in modern life. The Diagnostic and Statistical Manuel of Mental Disorders-5 (DSM-5) work group (American Psychiatric Association, www.dsm5.org, accessed October 21, 2012) has proposed Internet Usage Disorder as a nonsubstance-related addiction for Section III (Disorders Requiring Further Study). Interestingly, the criteria for the proposed disorder specify preoccupation with Internet gaming and fail to address other types of Internet use. This highlights the fact that Internet gaming has been the focus of much Internet addiction research, but the term Internet addiction implies a broader application than Internet gaming alone. There has been a proliferation of studies examining Internet addiction, compulsive Internet use, Internet addiction disorder, and so on (e.g., King, Delfabbro, Griffiths, & Gradisar, 2011; Ko et al., 2009; Lee et al., 2012; Lin et al., 2012; van Rooij, Schoenmakers, van de Eijnden, & van de Mheen, 2010; van Rooij, Schoenmakers, Vermulst, et al., 2010), which use a variety of measures (e.g., Young s Internet Addiction Test [Young, 1998]) to assess Internet use. Many of these studies focus on online gaming, based on the fact that problems with Internet use are often associated with gaming (e.g., van Rooij, Schoenmakers, van de Eijnden, et al., 2010), although other types of Internet use may also result in excessive use. The focus of these Internet addiction studies ranges from prevalence (van Rooij, Schoenmakers, Vermulst, et al., 2010) to pathology (e.g., Ko et al., 2009; Lin et al., 2012; Pawlikowski & Brand, 2011), to pharmacological intervention (e.g., with a Selective Serotonin Reuptake Inhibitor [SSRI]-antipsychotic combination, Atmaca, 2007; with escitalopram, Del Osso et al., 2008; and with bupropion, Han, Hwang, & Renshaw, 2010). Further study is needed to determine whether and how different types of excessive Internet use manifest, which is beyond the scope of this article. However, an important theoretical distinction can be made between specific and generalized PIU (Davis, 2001), where specific PIU consists of activities that, absent the Internet, would manifest in other ways (e.g., gambling, which can be conducted offline) and generalized PIU is characterized by dependence on the unique social context of the Internet. In this way, it is possible to think of generalized PIU as separate from but related to gaming addiction. Gaming addiction could develop absent the Internet, but online gaming addiction would be one outcome for generalized PIU. In other words, one might consider gaming addiction as separate from generalized PIU that manifests in the context of online gaming. This will be discussed in more detail below. The distinction between specific and generalized PIU relates directly to the study of MMOs. Unlike some forms of Internet use such as online gambling, which are often conducted in relative social isolation (Griffiths, 2003; Griffiths, Wardle, Orford, Sproston, & Erens, 2011), MMOs rely on interpersonal relationships between players (Caplan, Williams, & Yee, 2009). In the popular game World of Warcraft, users, through their online avatars, can develop cooperative guilds and work together toward common goals. Real-time communication often occurs during game play, and online and offline relationships develop between players. This is important because one view of PIU is that the social potential of the Internet contributes to the development of excessive use (e.g., Caplan, 2002). The idea that there is a close relationship between socializing and Internet use has been proposed by several Internet addiction researchers. Davis s (2001) cognitive behavioral model of PIU predicts that individuals who have problems with real-life interpersonal skills and

426 Social Science Computer Review 31(4) relationships will be more likely to develop PIU. Caplan (2002, 2005) has also suggested that individuals who lack self-presentation skills are likely to prefer online interactions to face-to-face communication, which fosters excessive Internet use. In support of this idea, Caplan (2003) has reported that preference for online social interaction, lack of self-presentational skill, and compulsive Internet use together accounted for 10% of the variance in negative outcomes resulting from Internet use. A unique function of Internet communication in gaming is that it allows users to fulfill a need for belonging (Baumeister & Leary, 1995) without risking face-to-face, real-life ridicule or rejection. It is therefore likely that certain psychological traits, such as deficient social skills, might predispose individuals to PIU. Existing psychopathology may also contribute to excessive Internet use. Past research has found a direct correlation between social anxiety and time spent playing online games (Lo et al., 2005) as well as an association between impulse-control problems and PIU (Cao, Su, Liu, & Gao, 2007). Recent work further highlights the importance of deficient psychosocial functioning in PIU. In a study of Dutch adolescents, low social competence, low self-esteem, and loneliness were all predictors of pathological gaming (Lemmens, Valkenburg, & Peter, 2011). Use of the Internet for gaming was also correlated with lower perceived social support in college students (Mitchell, Lebow, Uribe, Grathouse, & Shoger, 2011). Moreover, after controlling for depression and generalized anxiety, Lee and Stapinski (2011) found that social anxiety was still a significant predictor of PIU. Taken together, the literature to date suggests that an MMO environment that requires people to rely on interaction with others for maximum success in-game but that also allows social exchange to occur at a distance and with anonymity may be especially appealing for people with specific psychological profiles, such as low self-esteem and depression (Stetina, Kothgassner, Lehenbauer, & Kryspin-Exner, 2011) or overall higher psychiatric symptomatology (Pawlikowski & Brand, 2011). This is consistent with Davis (2001) conceptualization of PIU as developing from the unique communication functions of the Internet. This social motivation for play may be particularly true for those who experience heightened anxiety in social situations, such as individuals with social anxiety disorder. In the current study, we sought to extend prior research by examining the association between social anxiety, generalized anxiety, and PIU in a sample of gamers. We also sought to identify personality variables associated with PIU. Accordingly, we explored the extent to which major personality domains (neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness; Costa & McCrae, 2009) differentiated between gamers with higher versus lower levels of PIU. Neuroticism is strongly related to anxiety disorders (Kotov, Gamez, Schmidt, & Watson, 2010). Mehroof and Griffiths (2010) found a correlation between state and trait anxiety, neuroticism, and PIU. It is possible that higher neuroticism underlies risk of PIU as well as of anxiety. Therefore, we predicted that online gamers with high PIU scores would exhibit higher levels of neuroticism. Because low levels of extraversion have been shown to predict a preference for computer-mediated communication (Orchard & Fullwood, 2010), we further hypothesized that high-piu scorers would also exhibit less extraversion. We also sought to identify factors other than psychopathology variables that might potentially increase a person s enjoyment of MMO gaming. MMOs are gaming platforms that are unlike traditional console video games, or non-mmo games such as Words with Friends that occur within relatively stable environments. In contrast to console games, MMOs contain a variety of avatars and environments, limited only by the imagination of their creators and available server space. These environments are also periodically increased to add new material, including new geographic areas and combat scenarios, to the existing MMO, increasing their complexity, variety, and visual appeal. It is reasonable to believe that people who are fantasy-prone and who find it easy to immerse themselves in imagery, would be particularly likely to find such games attractive. Accordingly, we examined the hypothesis that people who scored high on a measure of absorption a construct that indexes an individual s capacity for imaginative involvement, fantasy proneness, and imagery ability (Kremen & Block, 2002; Tellegen & Waller, 2008) would be more likely to report higher levels

Cole and Hooley 427 of PIU in the context of MMO games. The motivation for this research was to identify factors that may place certain people at risk of more PIU than others, given the fact that relatively few people can be identified as Internet addicts. This led us to examine absorption, which was originally identified as a personality trait by Tellegen and Atkinson (1974) and which was included in the Multidimensional Personality Questionnaire (Tellegen & Waller, 2008). The authors describe absorption as follows: Absorption is interpreted as a disposition for having episodes of total attention that fully engage one s representational (i.e., perceptual, enactive, imaginative, and ideational) resources. This kind of attentional functioning is believed to result in a heightened sense of the reality of the attentional object, imperviousness to distracting events, and an altered sense of reality in general. It is reasonable to test the presence of this type of attentional functioning in a sample of people who become highly engaged in MMO environments. To our knowledge, absorption is a personality characteristic that has not been examined in previous research. Finally, using an exploratory approach, we sought to learn more about players motivations for gaming by asking why they liked to play MMOs. Considering the above discussion of personality, psychopathology, and PIU, we predicted that individuals who played online games and who had high-piu scores would be more likely than low-piu scorers to endorse playing MMOs for reasons related to social communication. Identifying Differences Between Low- and High-PIU Gamers We sought to replicate and extend earlier research by examining the clinical and personality characteristics of people who regularly engaged in MMO games, such as World of Warcraft, using a cross-sectional survey approach. At a general level, we sought to identify psychosocial and behavioral factors that distinguished people with high scores on a measure of PIU from those with low scores on the same measure. The goal of this study was to confirm earlier findings relating anxiety to PIU in gamers, and also to expand such work by examining other factors, such as personality traits and motivations for gaming, that might be relevant in predicting PIU in MMO users. Hypotheses We tested several hypotheses about the role of clinical and personality factors in problematic MMO gaming. Specifically, we predicted that (1) higher scores on measures of PIU would be correlated with higher scores on measures of state, trait, and social anxiety. This is because anxious people in general and socially anxious people in particular might be expected to experience MMO game-based social interactions as less threatening and more rewarding than less anxious people. We further predicted that (2) high absorption, which reflects fantasy proneness, would predispose individuals to experience online games as more enjoyable. For these reasons, we therefore expected that people in the high-piu group would have higher absorption scores than people in the low-piu group. We also expected that (3) high-piu gamers would exhibit low extraversion and high neuroticism. Finally, we predicted that (4) high-piu gamers would identify reasons for gaming related to social communication more often than low-piu gamers. Method Participants Participants were recruited by posting an invitation to complete a study survey, and a link to the survey, on Craigslist.org and on online gaming forums. The study was anonymous, and no

428 Social Science Computer Review 31(4) identifiable data were collected from subjects. The website PsychData.com was used to survey participants. Internet protocol (IP) addresses ensured that no subject completed the survey twice. The study advertisement sought out adult current or past players of MMO games who played more days than not or played for more than 2 hr at a time on days they did play. We collected data on a total of 163 participants (65 female, 92 male, 6 unreported), with a mean age of 27.3 years (SD ¼ 9.1). Procedure Participants provided informed consent via the web survey, then completed the measures described below and were asked about their reasons for gaming. Finally, participants provided estimates of the amount of time they had been playing (total number of months) as well as the number of hours they spent playing in a typical session. Mean daily gaming time in the sample was 3.5 hr (SD ¼ 1.33); mean time since starting gaming was 31.56 months (SD ¼ 17.78). Measures We first administered a demographic questionnaire that asked participants to report their age, sex, number of months playing MMOs, daily time spent gaming, and other relevant characteristics. To test our hypotheses about personality and clinical traits that would distinguish low- and high-piu gamers, we used a series of well-validated measures of these traits. To divide the sample of MMO gamers into low- and high-piu groups for comparison, we used a median split based on the scores from the Generalized Pathological Internet Use scale (GPIUS; see below). GPIUS The GPIUS (Caplan, 2002) is a 29-item scale that was developed to operationalize Davis s (2001) model of generalized PIU as a person s experience of particular combinations of cognitions, behaviors, and outcomes associated with PIU. The scale contains items rated on a 5-point Likert-type scale, from 1 ¼ strongly disagree to 5 ¼ strongly agree, where the strength of agreement indicates the degree to which the subject feels the item reflects his or her Internet-related experiences. The items are designed to address cognitions (e.g., I am worthless offline, but online I am someone ), behaviors, (e.g., I spend more time online than I expect to ), and outcomes (e.g., I have missed school or work because of online activities ), which together characterize PIU as a consequence, rather than a cause, of related pathology (Caplan, 2002). The GPIUS contains seven factors. These are correlated with each other and with psychosocial well-being variables in a way that is consistent with Davis s original theory and that provides support for the construct validity of the scale. Analyses of internal consistency show high a coefficients (.92 in the present study), demonstrating that the scale has good reliability. The GPIUS has been used by several authors to assess PIU. Spielberger State-Trait Anxiety Inventory (STAI) The Spielberger STAI (Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1970) is a measure of both state and trait anxiety. It is based on a model in which state anxiety, or the fluctuating experience of arousal to threatening stimuli, is distinguished from trait anxiety, a more stable dispositional trait. The STAI is a brief self-report measure that consists of 40 items on two separate 20-item forms (STAI-Y1 and STAI-Y2). State items assess how the person feels in the moment (e.g., I am tense, or the reverse-scored I feel calm ). Trait items assess how the person generally feels (e.g., I lack self-confidence ). The STAI is a well-validated and frequently used measure. The scale has good construct validity, correlating with other known measures of anxiety (Spielberger et al., 1970).

Cole and Hooley 429 Test retest reliability over a period of 3 weeks has been reported at.97 for Trait anxiety and.45 for State anxiety (Metzger, 1976). Internal consistency of the measure is high, with Cronbach s a coefficients of.92 for both forms (Ramanaiah, Franzen, & Schill, 1983). Tellegen Absorption Scale (TAS) The TAS (Tellegen & Atkinson, 1974) was constructed as part of a larger personality scale and measures the construct of absorption. The TAS is a 34-item self-report scale that is widely used in personality research and has been demonstrated to be reliable and valid. Responses are given in a 4-point Likert-type scale from 0 to 3 (0 ¼ never; 3¼ always). Questions address aspects of an individual s experience of the world and contain items such as While watching a movie, a TV show, or a play, I may become so involved that I may forget about myself and my surroundings and experience the story as if it were real and as if I were taking part in it. NEO-Five Factor Inventory (NEO-FFI) This is a shortened version of the NEO Personality Inventory Revised (Costa & McCrae, 1992) and is based on the five-factor model of personality classification. The NEO-FFI consists of 60 statements rated on a 5-point scale from strongly agree to strongly disagree. It taps the five major dimensions of personality (Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness) and has good reliability and validity (Costa & McCrae, 1992). Social Phobia Scale (SPS) The SPS (Mattick & Clarke, 1998) is a self-report measure that assesses fears of being scrutinized by others. It contains 20 items, rated on a 0 4 Likert-type scale. Respondents indicate the degree to which they feel each statement is characteristic of them (0 ¼ not at all and 4 ¼ extremely). In the original development of the measure, the SPS item-total correlations were high. The scale showed good internal consistency and test retest reliability, as well as showing good discriminant and construct validity. That is, the scale discriminated social phobia from agoraphobia and scores on the measure correlated with scores from the Spielberger STAI and the Fear of Negative Evaluation scale (Mattick & Clarke, 1998; Watson & Friend, 1969). Results Low- Versus High-PIU Groups Independent sample t-tests were used to compare people with low versus high PIU on the variables of interest. No cutoff score has been published for the GPIUS, given the author s goal of exploring relationships among variables rather than assigning users to diagnostic categories (Caplan, 2003). Therefore, to create groups for the purpose of comparison, we assigned participants to the low (n ¼ 84) and high (n ¼ 79) PIU groups using a median split based on the GPIUS score. The mean GPIUS score of the low-piu group was 54.5 (SD ¼ 10.0) and the mean GPIUS score of the high-piu group was 87.2 (SD ¼ 13.4), t(161) ¼ 17.803, p <.001, r ¼.81.The high-piu (57.9% male) and low- PIU (59.3% male) groups did not differ in gender composition, w 2 (1) ¼.0.03, p ¼.86, or in age, t(161) ¼.851, p ¼.396, r ¼.07. Note that this method of comparing groups does not imply that the high-piu group represents an addicted group of gamers; rather, that they have higher scores on what is in fact a continuous measure. Furthermore, because the mean of the high-piu group is 87.2 (on a scale ranging from 29 to 145), the reader may question whether the high-piu group actually has objectively high scores.

430 Social Science Computer Review 31(4) Table 1. Differences Between Low- and High-PIU Groups on Measures of Anxiety, Creativity, and Absorption. Low-PIU Group Mean (SD), n ¼ 84 High-PIU Group Mean (SD), n ¼ 79 t df p r STAI-state 32.52 (9.09) 35.15 (11.19) 4.162 161.000.31 STAI-trait 35.27 (10.16) 46.66 (11.18) 6.812 161.000.47 SPS 32.05 (12.24) 44.11 (7.84) 5.005 137.07 a.000.37 TAS 67.12 (18.11) 73.89 (18.19) 2.379 161.019.18 Note. SPS ¼ Social Phobia scale; STAI ¼ state-trait anxiety inventory; TAS ¼ Tellegen Absorption scale. a Levene s test for equality of variances was significant at p ¼.000; therefore, the value presented represents equal variances not assumed. Table 2. Personality Characteristics of Low- Versus High-PIU Scorers. Low-PIU Group Mean (SD) High-PIU Group Mean (SD) t df p r Neuroticism 18.48 (9.39) 27.35 (9.79) 5.901 161.000 *.42 Extraversion 26.38 (7.10) 21.87 (7.18) 4.031 161.000 *.30 Openness to experience 33.00 (5.73) 32.18 (7.03).821 161.413.06 Agreeableness 30.09 (6.80) 28.32 (6.76) 1.661 161.099.13 Conscientiousness 30.03 (8.08) 26.39 (7.69) 2.946 161.004 **.23 * Significant at p <.001. ** Significant at p <.01. Taking into account the fact that the GPIUS measures outcomes of Internet use in addition to cognitions and behaviors associated with use, higher scores by definition indicate more problematic use. Anxiety, Absorption, and PIU Consistent with prediction, gamers reporting more PIU also endorsed significantly higher levels of state anxiety, trait anxiety, and social phobia than people in the low-piu group (see Table 1 for means and statistics). Also as expected, those in the high-piu group scored higher on the TAS than did those in the low-piu group. This represents the first finding that the personality trait of absorption is related to PIU in online gaming, and supports the idea that fantasy proneness may predispose individuals to find online games rewarding. Together, these findings suggest that high-piu scorers were more anxious in a variety of ways and were more inclined to be drawn into fantasy and imaginative involvement. NEO-FFI Personality Traits In a series of additional analyses, we also examined the personality traits of high- and low-piu scorers using the NEO-FFI (see Table 2). The two groups did not differ significantly on Openness to Experience or Agreeableness. However, consistent with prediction and with prior research, high- PIU participants were more neurotic and less extraverted than their low-piu counterparts. They also scored lower on the trait of conscientiousness. Motivations for Gaming As predicted, there were significant differences between the two groups of gamers with respect to their reasons for playing MMOs. Gamers in the high-piu group were significantly more likely to

Cole and Hooley 431 Table 3. Reasons for Gaming Endorsed by Participants in Low- Versus High-PIU Groups. Item Low-PIU Group High-PIU Group w 2 Sig To socialize n 43 57 7.544.006 * % 26.4 35.0 Just for fun n 73 65.671.413 % 44.8 39.9 To meet new people n 10 13.696.404 % 6.1 8.0 To get away from real life n 31 52 13.62.000 ** % 19 31.9 Decrease stress n 42 52 4.175.041 * % 25.8 31.9 Decrease anxiety n 16 22 1.764.184 % 9.8 13.5 To feel happier n 19 43 17.480.000 ** % 11.7 26.4 Prefer to other games/entertainment n 43 42.064.801 % 26.4 25.8 Other n 17 16.000.998 % 10.4 9.8 * Significant at p <.01. ** Significant at p <.001. endorse the items to socialize, to get away from real life, to decrease stress, and to feel happier. These results are consistent with the idea that individuals who play MMOs to excess desire social interaction and may also have some degree of psychosocial impairment. These data are presented in Table 3. Identifying Predictor Variables for PIU in Gamers Finally, we used stepwise regression to identify the factors that were most strongly associated with PIU in our sample. Past research, in addition to the results of the t-tests reported above, indicates that anxiety may be a risk factor for PIU. However, no study to date has examined the potential contribution played by the construct of absorption, or the contribution made by anxiety when absorption is also considered. Therefore, the TAS and all three anxiety measures (STAI-State, STAI-Trait, and SPS) were added into the model using backward entry to test their contribution to the variance in PIU scores (measured by the GPIUS). In Step 1, TAS, STAI-State, STAI-Trait, and SPS together accounted for 35.5% of the variance in GPIUS score. In Step 2, removal of STAI-State did not result in a significant change in the predictive value of the model. In Step 3, the removal of TAS also did not significantly change the predictive value of the model. There was no evidence of multicollinearity or heteroscedasticity in the results. These data suggest that trait anxiety and social phobia are most predictive of PIU, even when absorption is taken into account. The results of this regression analysis are reported in Table 4. Because neuroticism is highly correlated with anxiety, it is also informative to know whether anxiety still predicts PIU score after controlling for neuroticism. To examine this, we used hierarchical regression, entering neuroticism in the first step and then entering trait anxiety and social anxiety in the second step (see Table 5). Even with neuroticism already in the model, entry of the anxiety variables led to a significant change in the F value and explained additional variance. These findings indicate that although anxiety and neuroticism are highly correlated, it is anxiety, rather than neuroticism that is most important in understanding PIU.

432 Social Science Computer Review 31(4) Table 4. Anxiety and Absorption Measures as Predictors of GPIUS Score. B SE B b Step 1 Constant 29.08 6.13 TAS.02.08.02 STAI-State.03.17.01 STAI-Trait.68.17.41 * SPS.29.10.24 ** Step 2 Constant 28.38 5.81 TAS.02.08.02 STAI-Trait.69.14.42 * SPS.29.10.24 ** Step 3 Constant 30.43 4.54 STAI-Trait.70.13.42 * SPS.30.10.24 ** Note. SPS ¼ Social Phobia scale; STAI ¼ state-trait anxiety inventory; TAS ¼ Tellegen Absorption scale. R 2 ¼.36 for Step 1 (p ¼.000); DR 2 ¼.00 for Step 2 (p ¼.87); DR 2 ¼.00 for Step 3 (p ¼.77). * Significant at p <.001. ** Significant at p <.01. Table 5. Neuroticism and Anxiety Variables as Predictors of GPIUS Score. B SE B b Step 1 Constant 47.41 4.54 Neuroticism 1.01.13.51 * Step 2 Constant 30.69 5.34 Neuroticism.03.29.01 STAI-Trait.68.25.41 ** SPS.30.10.10 ** Note. SPS ¼ Social Phobia scale; STAI ¼ state-trait anxiety inventory. R 2 ¼.28 for Step 1 (p ¼.000); DR 2 ¼.08 for Step 2 (p ¼.000). * Significant at p <.001. ** Significant at p <.01 Discussion Anxiety and PIU in Gaming The purpose of this study was to provide data on the clinical and personality characteristics of online gamers who report PIU. Based on earlier research, we predicted that state anxiety, trait anxiety, and social phobia would be associated with more PIU in this sample. Consistent with prediction, high- PIU scorers experienced more difficulties in all of these areas. Regression analysis further indicated that the best predictors of higher scores on a measure of PIU were trait anxiety and social phobia. Additional analyses confirmed the importance of anxiety as a predictor of higher PIU score, even after accounting for neuroticism. This means that individuals who are more generally anxious and who have difficulties in social situations are the people most likely to have problems using online games in moderation. These results replicate and extend recent findings (e.g., Mehroof & Griffiths, 2010).

Cole and Hooley 433 Of course, these data do not mean that anxiety causes PIU. Not only are higher scores on the measure not diagnostic, it may be the case that using the Internet to excess leads to more anxiety over time. Longitudinal investigations are needed to clarify this issue. Nonetheless, high trait anxiety may constitute a risk factor for PIU in gaming. Absorption and PIU in Gaming We also expected that levels of absorption would be higher in gamers with higher PIU scores, a relationship that has not previously been explored. Absorption was correlated with higher PIU, suggesting that people who are fantasy-prone find online games more engaging than people who are not; this may represent a particular vulnerability to PIU in online gaming. Taken together, our findings suggest that the highly immersive online environment offered by MMO games may be especially appealing to anxious and imaginative individuals. The opportunity to interact with others in a safe yet stimulating environment may contribute to excessive gaming. Of course, because of their cross-sectional nature, no inferences about causal directions can be made. However, our data do provide a possible explanation for why a small minority of people might develop highly problematic or excessive use when exposed to MMOs. Reasons for Gaming We also found that high-piu subjects were more likely than low-piu subjects to endorse socializing and escaping real life as reasons for gaming. Within the high-piu group, trait anxiety was associated with greater likelihood of using gaming to decrease stress and to escape real life. When combined with the personality data from the NEO-FFI, which indicated that high-piu participants were less conscientious, more introverted and more neurotic (Chen, Tu, & Wang, 2008; Mehroof & Griffiths, 2010; Peters & Malesky, 2008), the emerging picture is therefore one of a socially anxious, fantasyprone individual who desires social interaction yet finds such interaction challenging. Together, these findings replicate earlier research associating PIU and anxiety and provide new information about the role of absorption and other personality traits, as well as motivations for play in online gaming. Limitations and Future Directions Although the predicted differences between low- and high-piu individuals were supported by the data, the study is limited by the fact that it is cross-sectional. As a result, we know nothing about factors that may have preceded PIU or that may have developed or been exacerbated over the course of game play. It is possible that highly anxious people are drawn to online gaming, or find it more appealing than low-anxious people. However, it is also possible that gaming results in increased anxiety or changes in personality over time (e.g., perhaps due to neglect of work or other obligations). Furthermore, the median split for creating groups based on a continuous variable should be cautiously interpreted by the reader. The author of the GPIUS (Caplan, personal communication with S. Cole, December 03, 2012) has stated that the GPIUS is not intended as a diagnostic tool. Therefore, when interpreting these data, which compare low and high scorers on the GPIUS, it should be understood that this does not imply that everyone in the high-piu group is a game addict. Understanding whether clinical and personality factors change over time with increased gaming is an important next step for research. Longitudinal studies will further our understanding of who is at increased risk of PIU and help us learn moreabout the consequences of excessive online gaming.

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