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429369APH
Asia-Pacific Journal of Public Health
XX(X) 1 –9
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DOI: 10.1177/1010539511429369
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XXX10.1177/1010539511429369
Liau et al.
1Nanyang Technological University, Singapore
2Singapore Armed Forces Counselling Centre, Singapore
3Iowa State University, Ames, IA, USA
4National University of Singapore, Singapore
5Hong Kong Polytechnic University, Hong Kong, SAR
Corresponding Author:
Albert Kienfie Liau, Psychological Studies Academic Group, National Institute of Education,
Nanyang Technological University, 1 Nanyang Walk, Singapore 637616, Singapore
Email: albertliau@yahoo.com
Impulsivity, Self-Regulation,
and Pathological Video
Gaming Among Youth:
Testing a Mediation Model
Albert Kienfie Liau1, Eng Chuan Neo2, Douglas Gentile3,
Hyekyung Choo4, Timothy Sim5, Dongdong Li1,
and Angeline Khoo1 [AQ: 1][AQ: 2]
Abstract
Given the potential negative mental health consequences of pathological video gaming, under-
standing its etiology may lead to useful treatment developments. The purpose of the study was
to examine the influence of impulsive and regulatory processes on pathological video gaming.
Study 1 involved 2154 students from 6 primary and 4 secondary schools in Singapore. Study 2
involved 191 students from 2 secondary schools. The results of study 1 and study 2 supported
the hypothesis that self-regulation is a mediator between impulsivity and pathological video
gaming. Specifically, higher levels of impulsivity was related to lower levels of self-regulation,
which in turn was related to higher levels of pathological video gaming. The use of impulsivity
and self-regulation in predicting pathological video gaming supports the dual-system model of
incorporating both impulsive and reflective systems in the prediction of self-control outcomes.
The study highlights the development of self-regulatory resources as a possible avenue for
future prevention and treatment research.
Keywords
adolescent health, child health, psychological/behavioral medicine, smoking/tobacco/drug abuse,
population health
Video gaming has become a pervasive part of the lives of children and teenagers today. US,
South Korean, and Singaporean teenagers spend about 13.2,1 23,2 and 23.1 h/wk3 playing video
games, respectively. Although the positive effects of video games and Internet use have been
documented,4,5 psychologists, educators, parents, and researchers have become concerned about
2 Asia-Pacific Journal of Public Health XX(X)
the possible negative effects of extensive video gaming among children and teenagers. In par-
ticular, there has been concern about pathological patterns of behavior with video games and
other computer- and Internet-related technologies. Longitudinal research has shown that patho-
logical video gaming can lead to negative mental health consequences such as depression, anxi-
ety, and social phobia;6 pathological Internet use has been linked to later depression.7
Although pathological video gaming has received research interest, there is not yet a medical
definition of the phenomenon.8 Most researchers define pathological video game use similar to
the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for pathological gam-
bling as both are considered behavioral addictions.9 Hence, pathological video game use has
been defined by modifying DSM-IV-TR10 criteria for pathological gambling, as indicated by at
least 5 out of a list of 10 symptoms of damage to family, social, school, and psychological func-
tioning.3 This definition includes Brown’s core facets of addiction11: salience (activity domi-
nates the person’s life), euphoria/relief (activity provides a “high”), tolerance (greater activity is
needed to achieve the same “high”), withdrawal symptoms (experience of unpleasant effects
when unable to engage in the activity), conflict (activity leads to conflict with others, work, obli-
gations, or self), and relapse and reinstatement (activity is continued despite attempts to abstain
from it), and it has shown reasonable reliability, construct validity, as well as convergent and
divergent validity.1,3
In the DSM-IV-TR, pathological gambling is classified as an impulse-control disorder (ICD).
Similarly, researchers have argued that pathological video game use, or the more general patho-
logical Internet use, should be classified as an ICD.9 The essential feature of ICDs is the “failure
to resist an impulse, drive, or temptation to perform an act that is harmful to the person or to
others.10(p663) Recent research has uncovered neurobiological and genetic predispositions that
emphasize the role of impulsivity in ICDs and other addictions.12 Although impulsivity has been
linked to substance use disorders and other disorders,13 researchers have just started exploring
the link between impulsivity with pathological video gaming and Internet use. For instance,
impulsivity has been identified as a correlate of pathological video gaming,1,3 as well as a predic-
tor of frequent chat room use14 and problematic Internet use.15
In trying to understand the influence of impulsivity on a problematic behavior such as patho-
logical video gaming, Hofmann et al16 have argued that it is necessary to adopt a dual-system
perspective where researchers examine both the impulsive system and the reflective system to
predict behaviors. The reflective system “serves regulatory goals that complement the functions
of the impulsive system.”16(p165) This dual-system perspective is consistent with neurocognitive
research suggesting that different brain areas underlie these 2 systems17 and social–cognitive
theories,18 which portray individuals as proactive, self-organizing, and self-reflecting agents.
The notion of agency is predicated on the idea that people have the capacity to make assessments
about when and whether they are in control. Central to this “agentic self” is the concept of self-
regulation, the ability of an individual to manage his or her own behavior through processes such
as observation, evaluation, and reflection.18 Seay and Kraut19 found that individuals high in self-
regulation reported significantly lower levels of problematic video game use compared with their
counterparts. In addition, self-regulation was the largest and most robust of all the predictors of
problematic video game use in their study.
Given the potential negative mental health consequences of pathological video gaming,
understanding its etiology may lead to useful treatment developments. Hence, the objective of
the present study was to take a preliminary step in understanding the etiology of pathological
video gaming by examining the intricate role of impulsive and regulatory processes in predicting
pathological video gaming. We hypothesized a mediation model in linking these 3 concepts (see
Figure 1). It is hypothesized that self-regulation would mediate the relationship between impul-
sivity and pathological video gaming. Specifically, higher levels of impulsivity would be related
Liau et al. 3
to lower levels of self-regulation, which in turn would be related to higher levels of pathological
video gaming. Impulsivity is considered the more distal predictor of pathological video gaming
compared with self-regulation, as impulsivity is often considered a personality trait.20 On the
other hand, although self-regulation involves a trait-like dispositional capacity, it can also be
conceptualized as an adaptive resource that resembles a muscle.21 It becomes tired after exertion,
resulting in diminished capacity. However, regular exercise can produce improvements in self-
regulation, similar to the strengthening of muscles.21
Study 1
Method
Participants. The participants were 2712 students (1950 males and 762 females) from 6 primary
and 4 secondary schools, 4 of which were boys’ schools. Of these participants, 2155 (1510 males
and 645 females) completed all scales entering the final analysis. The overall average age of the
participants was 10.93 years (SD = 2.04; primary students N = 1182, M = 9.21, SD = 0.7; second-
ary students N = 973, M = 13.02, SD = 0.82). For primary schools, 588 students were from grade
3, and 594 students were from grade 4. For secondary schools, 560 students were from grade 7,
and 413 were from grade 8. The racial makeup was 72.5% Chinese, 14.8% Malay, 8.5% Indian,
4.2% other races. This racial composition is representative of the general population of that age-
group in Singapore. All levels of socioeconomic status were represented, as assessed by housing
type, with 19.1% living in 3-room or smaller public housing, 27.6% living in 4-room public
housing, 27.2% living in 5-room public housing or government-built executive flats, and 25.9%
living in private housing. Housing type, which is classified by the size of residence (eg, 1-2 room
public housing, 3 room public housing, etc), is a major demographic characteristic in studies on
Singaporean youth22 as a proxy indicator of socioeconomic status in the Singaporean context.
Procedures. About 20 primary and secondary schools were short-listed based on the principals’
attendance at a cyber issues workshop. The principals were duly informed about the scope of the
study and were then invited to participate in the study. After considering school zones, type of
school (public or private), and students’ background to ensure the representativeness of the
diversity of Singaporean primary and secondary students, we selected 12 short-listed schools
that were most keen on understanding video gaming behavior of their students. To have at least
500 students at each level, 4 classes from each level of third, fourth, seventh, and eighth grades
were requested from each of the participating schools. Schools were requested to select classes
of different academic abilities, but the final choice was left to them. Ten of the 12 schools were
part of study 1, and the other 2 schools were part of study 2. Informed consents were sought from
Figure 1. The mediation model linking impulsivity and self-regulation to pathological video gaming
4 Asia-Pacific Journal of Public Health XX(X)
the parents through the schools. A liaison teacher from each school collated the information and
excluded students from the study whose parents refused consent. Participation rate was 99%.
Assent was obtained from the students through informing them that participation in the survey
was voluntary and they could withdraw at any time. Privacy of the students’ responses was
ensured by requiring the teachers to seal collected questionnaires in the envelopes provided in
the presence of the students. It was highlighted on the questionnaires that the students’ responses
would be read only by the researchers.
Measures
Demographics and video gaming habits. Besides the usual demographic questions such as gen-
der, age, socioeconomic status measured by housing type, and academic performance, the survey
included several items assessing children’s video game habits adapted from the General Media
Habits Questionnaire (GMHQ) and the Adult Involvement in Media Scale.3 All the scales in
study 1 have been validated for Singaporean youth.3
Impulsivity. The students’ level of impulsivity (IMP) was measured using 10 items adapted
from the Barratt Impulsiveness Scale used by Patton et al.23 Students rated each item on a 4-point
scale ranging from 1 (strongly disagree) to 4 (strongly agree). A higher score indicated a higher
level of impulsivity. This scale yielded a Cronbach’s α of .69.
Emotional regulation. In this study, we focused on emotional regulation (ER) as a measure of
self-regulation. ER represents the use of self-regulatory strategies as a means of coping amid
distressing emotions. ER was measured using a 4-item scale, which is part of the Personal
Strengths Inventory–2.24 Participants rated each item on a 4-point scale, where 1 = strongly dis-
agree, 2 = disagree, 3 = agree, and 4 = strongly agree. Cronbach’s α for ER was .70.
Pathological video gaming. Pathological video gaming (PVG) was measured with a 10-item
instrument derived from the pathological gambling items of the DSM-IV. This scale had been
used previously in a national study of American youth1 and has been validated with Singaporean
youth.3 Participants could respond “no,” “sometimes,” or “yes” to each of the 10 symptoms, and
each item was scored 0, 0.5, or 1, respectively. A total score for the scale was used, and higher
score indicated higher levels of pathological video gaming. Cronbach’s α for PVG was .78.
Data Analyses. The SPSS Macro INDIRECT25 was used to test the mediation model illustrated
in Figure 1. INDIRECT uses a product-of-coefficients strategy to test the significance of indirect
effects. The indirect effect was estimated by first regressing self-regulation (mediator) on impul-
sivity (independent variable; IV) and then regressing pathological video gaming (dependent
variable; DV) on self-regulation (mediator) and impulsivity (IV). The indirect effect was the
product of the sample estimates of the regression coefficients (“Mediator on IV” × “DV on
mediator controlling for IV”). This strategy is considered a more powerful approach compared
with the Baron and Kenny multiple regression approach and the Sobel test.25 Bootstrapped con-
fidence intervals were estimated to avoid power problems introduced by asymmetric and other
nonnormal sampling distributions of an indirect effect. Bias-corrected bootstrapping was used,
as it produces more accurate confidence intervals; 5000 bootstrapped samples were used as
recommended.25
Results
Descriptive Statistics, Correlational Analyses, and Gender Differences. The descriptive
statistics and correlations among the main variables in the study can be found in Table 1. All
3 main variables, IMP, ER, and PVG, were significantly related to each other. Males (M = 2.45)
Liau et al. 5
scored significantly higher than females (M = 1.73) on PVG, t(2153) = 8.85, P < .001. There
were no gender differences for IMP and ER.
Mediation Analyses. In the mediation analysis, PVG was specified as the DV, ER was speci-
fied as the mediator, and IMP was specified as the IV. ER and IMP were centered at the mean.
Gender was specified as a covariate.
The results of the direct effects in the mediation analysis can be found in Figure 2. Controlling
for gender, there was a significant direct effect between IMP and PVG (B = 1.06, P < .001).
There was also a significant indirect effect between IMP and PVG with ER as a mediator (boot-
strap mean = 0.08, 95% confidence interval [CI] = 0.04-.13). Hence, as hypothesized, ER medi-
ated the association between IMP and PVG. Specifically, higher levels of impulsivity would be
related to lower levels of emotional regulation, which in turn would be related to higher levels of
pathological video gaming.
Study 2
In Study 1, self-regulation was measured in terms of emotional regulation. The objective of
study 2 was to supplement study 1 by using a measure of self-regulation that was more specific
Table 1. Descriptive Statistics and Correlations Among the Main Variables of Study 1 and Study 2
Study 1 (N = 2155) Study 2 (N = 191)
IMP ER PVG IMP VGSR P VG
Mean 2.26 2.84 2.23 2.39 2.61 2.57
SD 0.44 0.59 1.74 0.41 0.74 2.12
IMP −.27a.29aIMP −.28a.33a
ER −.15aVGSR −.31a
Abbreviations: IMP, impulsivity; ER = emotional regulation; PVG, pathological video gaming; VGSR, video game self-
regulation.
aP < .001.
Figure 2. Results of direct effects of the mediation model for study 1 and study 2 (in parentheses),
controlling for gender (*P < .001)
6 Asia-Pacific Journal of Public Health XX(X)
to video gaming. Hence, in study 2, self-regulation was measured in terms of video game self-
regulation in a different sample of youth.
Method
Participants. Participants were 301 students (229 males, 55 females, and 17 not reported)
recruited from 2 secondary schools in Singapore, 1 of which was a boys’ school. Of them, 191
(140 males and 51 females) completed all scales entering the final analysis. The overall average
age of the participants was 12.88 (SD = 0.80). A total of 132 students were from seventh grade,
and 58 students were from eighth grade (1 student did not report grade). The racial makeup was
86.7% Chinese, 5.3% Malay, 4.8% ethnic Indian, and 3.2% other ethnicities.
Procedures. The procedures were the same as study 1. However, the 2 schools in study 2
received an additional survey on video game self-regulation.
Measures
Video game self-regulation. A 10-item video game self-regulation (VGSR) scale was developed
for the purpose of this study.26 The construction of items in the scale was based on key constructs
of self-regulation such as metacognition, personal agency, and self-efficacy. A sample item was
as follows: “I believe I can stop playing videogames.” The responses were measured on a 4-point
Likert-type scale (1 = being not true of me; 2 = being somewhat true of me; 3 = being quite true
of me; and 4 = being very true of me). Cronbach’s α for VGSR was .92.
Impulsivity and pathological video gaming. The same measures of IMP and PVG were used as in
study 1. Cronbach’s αs for the IMP and PVG scales were .70, and .93, respectively.
Results
Descriptive Statistics, Correlational Analyses, and Gender Differences. The descriptive
statistics and correlations among the main variables in the study can be found in Table 1. All 3
main variables, IMP, VGSR, and PVG, were significantly related to each other. As in study 1,
males (M = 2.86) scored significantly higher than females (M = 1.75) on PVG, t(189) = 3.29,
P < .01, and there were no gender differences for IMP and VGSR.
Mediation Analyses. In the mediation analyses, PVG was specified as the DV, VGSR was
specified as the mediator, and IMP was specified as the IV. IMP and VGSR were centered at the
mean. Gender was specified as a covariate.
The results of the direct effects in the mediation analysis can be found in Figure 2. Controlling
for gender, there was a significant direct effect between IMP and PVG (B = 1.34, P < .001).
There was also a significant indirect effect between IMP and PVG with VGSR as a mediator
(bootstrap mean = 0.34, 95% CI = 0.10-0.71). Hence, as hypothesized, VGSR mediated the asso-
ciation between IMP and PVG. Specifically, higher levels of impulsivity would be related to
lower levels of video game self-regulation, which in turn would be related to higher levels of
pathological video gaming.
Comment
Both study 1 and study 2 supported the hypothesis that self-regulation is a mediator between
impulsivity and pathological video gaming. The study highlighted the role of 2 kinds of self-
regulation—emotional regulation and a more specific type of regulation related to video gam-
ing. The role of self-regulation had been highlighted by Seay and Kraut19 who found that
Liau et al. 7
self-regulation was more important than motivational factors in predicting problematic use of
online gaming. The authors stated that self-regulatory processes are essential in allowing video
gaming to be a harmless and enjoyable pastime rather than being a destructive preoccupation.
One debate in the field of media or technology addiction is whether pathological use can be
explained by an addictive personality,27 a learning model where operant conditioning leads to
escalating behaviors, or a social–cognitive model, a theory that extends classical learning theory
to include complex human cognitions.28 The findings of our study are consistent with the argu-
ment of LaRose et al28 that deficient self-regulation is a critical risk factor for media or technol-
ogy addictions. Hence, the findings support the utility of a social–cognitive model for
understanding the etiology of pathological video game use and developing treatments for it.28
The investigation of the role of self-regulation and impulsivity helps shift the focus on the
harmful or “addictive” characteristics of video games to the study of the internal processes taking
place within the individual. This mediating role of self-regulation provides at least 2 important
implications. First, the use of both impulsivity and self-regulation in predicting pathological
video gaming supports the call by various researchers for the need to examine both impulsive
and reflective systems in enabling a more precise prediction of self-control outcomes.16 Recent
evidence suggests that different brain areas may underlie these 2 systems.17 Second, the findings
have implications for mental health providers who are working with pathological video gamers.
In particular, the results suggest that developing self-regulatory skills could be a useful strategy
in working with pathological gamers. Baumeister et al21 have argued that it is possible to improve
self-regulation through exercise. As an individual performs exercises to improve self-regulation
in one sphere, he or she becomes better at self-regulating in other spheres. In fact, the develop-
ment of self-regulation is one component of cognitive–behavioral treatment that has been found
to be useful in helping adolescents with pathological Internet use.29
Even though mediation models imply causality, the findings in the study are limited by the
cross-sectional nature of the data. It is possible that the relations examined in this study are recip-
rocal in nature. Hence, longitudinal or experimental studies are needed to establish the temporal
order of a causal process. Although most of the instruments used in the study have been validated
in the Singaporean context, the exception is the VGSR scale. Hence, more work needs to be done
to provide evidence for the validity of this scale.
Future research can move beyond just examining the impulsive and reflective systems in
predicting pathological video gaming, as there are still many factors that were not taken into
account in the model. Other research has suggested that there are various situational and dispo-
sitional moderators that can influence reflective and impulsive processes.16 For instance, future
studies can examine how the influence of peers may impact on these impulsive and reflective
processes. The influence of peers has been found to be an important risk factor for various other
problem behaviors.30 Although much is still unknown about the etiology of pathological video
gaming, the present study has made an important preliminary step in understanding the internal
processes that lead to such behaviors. Consistent with neurocognitive and social–cognitive mod-
els, the present study has helped establish the important role of self-regulation in mediating the
relations between impulsivity and pathological video gaming and highlight the development of
self-regulatory resources as a possible avenue for future prevention and treatment research with
pathological video gamers.
Authors’ Note
Study 2 of this article was based on the second author’s master’s dissertation submitted to Nanyang
Technological University, Singapore. A version of this article was presented at the ASEAN Regional
Union of Psychological Societies Third Congress at Kuala Lumpur, Malaysia in October 2010.
8 Asia-Pacific Journal of Public Health XX(X)
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interests with respect to the research, authorship, and/or
publication of this article. [AQ: 3]
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or pub-
lication of this article: [AQ: 4]
The authors would like to thank the Ministry of Education, Singapore, and the Media Development
Authority for jointly funding the research project (Project #EPI/06AK).
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