Red Box, Green Box: Psychometric evaluation of a self-report behavioral frequency measurement approach for behavioral addictions research

Aims: The behavioral addictions field lacks clinically useful behavior frequency measures. This study evaluated the psychometric performance of the new ‘Red Box, Green Box’ method for measuring gaming behavior with a focus on its utility for gaming disorder (GD) screening. 

Design, setting and participants: A prospective, cross-sectional survey study was conducted using an online crowdsourcing platform. Participants were 1149 male gamers aged 18–35 years from Australia, Canada, United States, United Kingdom and Asia, reporting ≥12 hours of weekly gaming. 

Measurements: Gaming time was measured using a conventional weekly hours item, Red Box hours (gaming instead of fulfilling responsibilities) and Green Box hours (gaming during free or leisure time). GD was assessed by the Internet Gaming Disorder Test (IGDT-10), with International Classification of Diseases, 11th Revision (ICD-11) and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) scoring approaches. Psychological distress [Depression, Anxiety and Stress Scale - 21 Items (DASS-21)] and impulsivity [Barratt Impulsiveness Scale–short form (BIS-15)] were measured. 

Findings: Gamers with GD reported higher Red Box hours [mean (M) = 21.1, standard deviation (SD) = 11.3] than those without (M = 8.7, SD = 8.4; P < 0.001), and greater Red Box proportion (41.9% vs. 26.8%; P < 0.001). Red Box hours demonstrated superior diagnostic accuracy for GD [area under the curve (AUC) = 0.86, sensitivity = 0.94, specificity = 0.63] and Internet gaming disorder (IGD) (AUC = 0.76, sensitivity = 0.88, specificity = 0.56), outperforming comparative measures. A Red Box response of ≥ 9.5 hours had a 94% likelihood of indicating ICD-11 GD. 

Conclusions: The ‘Red Box, Green Box’ method appears to effectively identify International Classification of Diseases, 11th Revision, gaming disorder risk among males. Red Box hours demonstrated greater classification validity than the conventional weekly hours approach. This method provides a simple tool for epidemiological research, routine screening (e.g. outpatient consultation) and clinical assessment and treatment planning. Further validation in clinical populations and longitudinal studies is needed.