THE ADVANTAGES AND DISADVANTAGES OF VIDEO GAME PLAYING

Transcription

1 THE ADVANTAGES AND DISADVANTAGES OF VIDEO GAME PLAYING Dr. Mark Griffiths Distinguished Professor of Behavioural Addiction International Gaming Research Unit Psychology Department Nottingham Trent University United Kingdom

2 OVERVIEW OF PRESENTATION Positive benefits of videogames Therapeutic uses of videogames Videogames as distractors Videogames in educative healthcare/psychotherapy Behavioural indicators of excessive video gaming Medical consequences of excessive video gaming Gaming addiction [Internet] gaming disorder Conclusions

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4 VIDEOGAMES: POSITIVE BENEFITS (Griffiths, 2005; 2010; Griffiths et al., 2012, 2017) Educational benefits Simulation/practice benefits Perceptual-motor skills/hand-eye co-ordination Social benefits Pain management, physiotherapy, mental distraction Cognitive rehabilitation (strokes and attention difficulties) Psychotherapy/behaviour management in children

5 THERAPEUTIC USES OF VIDEO GAMES (1) (Weimeyer, 2010) VGs as a therapeutic setting: VGs allow participants to simulate novelty and challenge without real life consequences VGs as a therapeutic or intervention tool: VGs make it easier to achieve/maintain a person s undivided attention for long periods of time

6 THERAPEUTIC USES OF VIDEO GAMES (2) (Weimeyer, 2010) VGs as a measurement tool: VGs can allow measuring of performance on a very wide variety of tasks VGs as a motivating tool: VGs are stimulating, so can be used to assist patients in goalsetting, goal rehearsal, providing feedback, reinforcement, and maintaining records of behavioural change.

7 THERAPEUTIC, MEDICAL AND HEALTH USES OF VIDEOGAMES (Griffiths, 2004; 2005; 2009; 2018; Griffiths et al., 2017) VGs as painkillers VGs in psychotherapeutic settings VGs in cognitive rehabilitation VGs in educative health care VGs for the learning disabled VGs for exergaming VG therapy for ADD/impulsivity VG therapy for anxiety (VRET) VG therapy for the elderly

8 VIDEOGAMES AS DISTRACTORS Studies show cognitive distraction may block the perception of pain. Distractor tasks consume some degree of the attentional capacity otherwise devoted to pain perception. VGs likely to engage a person s active attention because of the cognitive and motor activity required. VGs allow possibility of sustained achievement due to level of difficulty (challenge) during extended play.

9 Many studies demonstrate that VGs can provide cognitive distraction during cancer chemotherapy in children and adolescents (e.g., Kato et al, 2008; Reichlin et al, 2011) All studies report patients report less nausea prior to chemotherapy and lower systolic pressure after treatment (when compared with controls). Distraction tasks also reduce amount of painkillers needed. This pain management technique utilizing videogames has also been applied successfully to children undergoing treatment for sickle cell disease (Pegelow, 1992)

10 ANALGESIC EFFECT OF VIDEOGAMES (Griffiths, Kuss & Ortiz de Gortari, 2011; 2017) VGs have been used as a form of physiotherapy/occupational therapy in many different groups: Increase strength in arm, hand and finger injuries/rheumatology Respiratory muscle training aid for young patients with Duchenne Muscular Dystrophy Movement aid for cerebral palsy Postural stability and balance Increase strength for wheelchair users Upper-limb physiotherapy for burns victims Sitting tolerance for lower back pain Scratch prevention for neurodermatitis

11 VIDEOGAMES IN EDUCATIVE HEALTH CARE In randomized clinical trials, children and adolescents improved their self-care Significant reduction in use of emergency clinical services after playing health education and disease management videogames Bronkie the Bronchiasaurus (asthma self-management) Packy & Marlon (diabetes self-management) Rex Ronan (smoking prevention)

12 Other issues tackled using videogames include: HIV/AIDS prevention Cystic fibrosis Drug use Alcohol use Marijuana use Sexual behaviour Anti-social behaviour However, these videogames were specially designed Raises questions about commercial videogames

13 VIDEOGAMES IN PSYCHOTHERAPEUTIC SETTINGS Therapists working with children have long used games in therapy Therapists claim VGs are an excellent ice-breaker and rapport builder Therapists claim use of VGs in his psychotherapy sessions provide excellent behavioural observation and development opportunities:

14 (1) Child's repertoire of problem solving strategies (2) Measure of achievement to raise self-esteem (3) Eye-hand co-ordination (4) Release of aggression and control (5) Develop social skills and cooperation using videogames to provide basis of a therapeutic relationship (6) Satisfaction of cognitive activity in the involvement of the recall of bits of basic information (7) Child s motivation by using videogames as bargaining counters to get children to do things

15 VIDEO GAMES AND THE ELDERLY (Griffiths, Kuss & Ortiz de Gortari, 2011; 2017) VGs can increase reaction times among the elderly after an 11-week period of VG playing VGs can raise self-esteem, and positive sense of well-being, as a result of playing VGs for five hours a week for five weeks VGs can help both short-term and long-term memory Computers and videogames can be used to assess cognitive functions.

16 BEHAVIOURAL INDICATORS OF EXCESSIVE VIDEO GAMING Stealing money to play arcade games (Klein, 1984; Keepers, 1990) Stealing money to buy new games (Griffiths & Hunt, 1995;1998) Truanting from school/college or sacrificing work to play (Keepers, 1990; Griffiths & Hunt, 1995; 1998; Grusser et al, 2007; Rehbein et al, 2010) Not doing academic work/getting poor grades (Griffiths & Hunt, 1993; Phillips et al, 1995; Chiu et al, 2004; Ng & Weimar-Hastings, 2005; Smyth, 2007; Hart et al, 2008; Rehbein et al, 2010)

17 Sacrificing of social activities to play (Egli & Meyers, 1984; Griffiths & Hunt, 1995; 1998; Smyth, 2007; Grusser et al, 2007; Hart et al, 2008; Rehbein et al, 2008) Irritability and annoyance if unable to play (Griffiths & Hunt, 1995; 1998; Rutkowska & Carlton, 1994; Grusser et al, 2007) Playing longer than intended (Griffiths & Hunt, 1995; 1998; Phillips et al, 1995) Increased social anxiety (Lo et al, 2005; Hart et al, 2008) Decreased interpersonal relationships (Lo et al, 2005; Ng & Weimar-Hastings, 2005; Smyth, 2007) Poor sleep (Smyth, 2007; Grusser et al, 2007; Rehbein et al, 2010) Increased (Anderson et al, 2011) aggression

18 MEDICAL CONSEQUENCES OF EXCESSIVE VIDEO GAMING Photosensitive epilepsy (e.g. Maeda et al, 1990; Graf et al, 1994; Harding & Jeavons, 1994; Quirk et al, 1995; Millett et al, 1997). Auditory and visual hallucinations (Spence, 1993; Ortiz & Griffiths, 2014a; 2014b; 2016) Enuresis (Schink, 1991) Encoprisis (Corkery, 1990)

19 Skin, joint and muscle problems, blisters, calluses, hand and finger numbness (Loftus & Loftus, 1983) RSI ( Nintendonitis ) (Reinstein, 1983; Brasington, 1990; Casanova & Casanova, 1991; Siegal, 1991) Wrist, neck and elbow pain (McCowan, 1981; Miller, 1991) Hand-arm vibration syndrome (Cleary, McKendrick & Sills, 2002) Obesity (Shimai et al, 1993; Deheger et al, 1997 Johnson & Hackett, 1997)

20 KEY ADDICTION QUESTIONS (Griffiths, 1998) What is addiction? Does gaming addiction exist? If gaming addiction exists what are people actually addicted to?

21 "Certain individuals use certain substances in certain ways, thought at certain times to be unacceptable by certain other individuals for reasons both certain and uncertain" (Burglass & Shaffer, 1984)

22 ADDICTION: A DEFINITION Addictive behaviour is a repetitive habit pattern that increases the risk of disease and/or associated personal and social problems...often experienced subjectively as 'loss of control'...these habit patterns are typically characterized by immediate gratification (short term reward), often coupled with delayed, deleterious effects (long term costs)...attempts to change an addictive behaviour (via treatment or by self-initiation) are typically marked by high relapse rates (Marlatt, Baer, Donovan & Kivlahan, 1988)

23 GAMBLING ADDICTION HAS CHANGED THE THINKING ABOUT THE NATURE OF ADDICTION Gambling addiction is the breakthrough addiction Now accepted in psychiatric and medical texts Pathological gambling has been re-classified as an impulse control disorder to a behavioural addiction No theoretical reason why other behavioural addictions cannot exist

24 VIDEO GAME ADDICTION According to Soper and Miller (1983) "video game addiction" is like any other behavioural addiction and consists of: A compulsive behavioural involvement A lack of interest in other activities Association mainly with other addicts Physical and mental symptoms when attempting to stop the behaviour (e.g., the shakes) Way of determining whether video game addiction is addictive in a non metaphorical sense - compare it against clinical criteria for other addictions.

25 ADDICTION COMPONENTS IN GAMING ADDICTION (Griffiths, 1995; 1996; 2005; 2009) Salience Mood modification Tolerance Withdrawal Conflict Relapse

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27 ADDICTION COMPONENTS MODEL (Griffiths, 1995; 1996; 2005; 2009) Salience Mood modification Tolerance Withdrawal Conflict Relapse 01/11/

28 INFLUENCES ON ADDICTIVE BEHAVIOUR (Griffiths & Delfabbro, 2001) Individual Characteristics Structural Characteristics Addictive Behaviour Situational Characteristics

29 INTERNET ADDICTION: THE DEBATES (Griffiths, King & Demetrovics, 2014; Pontes, Kuss & Griffiths, 2015) Prior to the publication of the latest DSM-5 by the American Psychiatric Association, there had been debate as to whether internet addiction should be introduced into the text as a separate disorder Also been debate as to whether those researching in the IA field should be researching generalized internet use and/or the potentially addictive activities that can be engaged on the internet (e.g., gambling, video gaming, sex, shopping, etc.)

30 Substance Use Disorder Work Group recommended that the DSM-5 include a subtype of problematic internet use i.e., Internet Gaming Disorder in Section 3 ( Emerging Measures and Models ) Is an area that needed future research before being included in future editions of the DSM.

31 INTERNET GAMING DISORDER CRITERIA (DSM-5; APA 2013; Griffiths et al, 2014) (1) Preoccupation with internet games [salience] (2) Withdrawal symptoms when internet gaming is taken away [withdrawal] (3) The need to spend increasing amounts of time engaged in internet gaming [tolerance] (4) Unsuccessful attempts to control participation in internet gaming [relapse/loss of control] (5) Loss of interest in hobbies and entertainment as a result of, and with the exception of, internet gaming [conflict]

32 (6) continued excessive use of internet games despite knowledge of psychosocial problems [conflict] (7) deception of family members, therapists, or others regarding the amount of internet gaming [conflict] (8) use of the internet gaming to escape or relieve a negative mood [mood modification] (9) loss of a significant relationship, job, or educational or career opportunity because of participation in internet games [conflict]

33 GAMING DISORDER (World Health Organization, ICD-11, 2018) Gaming disorder is defined as a pattern of gaming behaviour ( digital-gaming or videogaming ) characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences.

34 A decision on inclusion of gaming disorder in ICD-11 is based on reviews of available evidence The inclusion reflects a consensus of experts from different disciplines and geographical regions that were involved in the process of technical consultations undertaken by WHO in the process of ICD-11 development.

35 GENERIC RISK FACTORS THAT MAY FACILITATE ONLINE ADDICTIONS (Griffiths, 2003) Access Affordability Anonymity Convenience Disinhibition Escape Social acceptability

36 INTERNET ADDICTION TYPOLOGY (Young 1999) Cybersexual addiction: Compulsive use of adult websites for cybersex and cyberporn Cyber-relationship addiction: Over-involvement in online relationships Net compulsions: Obsessive online gambling, shopping Information overload: Compulsive web surfing or database searches Computer addiction: Obsessive computer game playing (e.g. Solitaire etc.)

37 Many of these excessive users are not "Internet addicts Just use the Internet excessively as a medium to fuel other addictions (Griffiths, 1999, 2000) The Internet is just the place where they engage in the behaviour There are case study reports of individuals who appear to be addicted to the Internet itself (Griffiths, 2000b; Young, 1998)

38 These are usually people who use Internet chat rooms or play fantasy role playing games (activities that they would not engage in except on the Internet itself) Engaged in text-based virtual realities and take on other personas and social identities as a way of raising self-esteem Internet may provide an alternative reality to the user and allow them feelings of immersion and anonymity

39 ONLINE GAMING ADDICTION (Kuss & Griffiths, 2012a; 2012b; Pontes & Griffiths, 2015) Reviewed over 100 empirical studies on internet gaming addiction Argued that gaming addiction follows a continuum Antecedents in etiology and risk factors, through to the development of an addiction Gaming addiction associated with various personality traits (e.g., introversion, sensationseeking, neuroticism, state/trait anxiety, low emotional intelligence, social inhibition)

40 Terminologies and assessment of addiction was variable (e.g., problem video game playing, problematic online game use, video game addiction, online gaming addiction) Excessive (problematic) engagement found in approx. 8-12% of young persons, whereas addiction seems to be present in 2-5% of children, teenagers and students.

41 NATIONAL GAMING ADDICTION SURVEYS Nationally representative samples have reported IGD rates: 8.5% in American youth aged 8-18 years (Gentile, 2009) 1.2% in German adolescents aged years (Rehbein et al, 2015) 5.5% in Dutch adolescents aged years and 5.4% in Dutch adults (Lemmens et al, 2015) 4.3% in Hungarian adolescents aged years (Kiraly et al, 2014) 1.4% in Norwegian gamers (Wittek et al, 2016) 1.6% in youth from seven European countries aged years (Muller et al, 2015) 2.5% in Slovenian adolescents aged years (Pontes et al, 2016) 5.9% in South Korean adolescents aged 13 to 15 years (Yu et al, 2016) 4% in South Korean adults (Park et al, 2017) 1.3% Dutch adolescents aged 14 years (Carras et al, 2017) 3.6% in German adolescents aged years (Rosenkranz et al, 2015)

42 GAMING ADDICTION SCREENS (King, Haagsma, Delfabbro, Gradisar & Griffiths, 2013) A review of instruments assessing problematic, pathological and/or addictive gaming reported that 18 different screening instruments had been developed These had been used in 63 quantitative studies comprising 58,415 participants. This comprehensive review identified both strengths and weaknesses of these instruments.

43 Main strengths of the instrumentation included: Brevity and ease of scoring Excellent psychometric properties such as convergent validity and internal consistency Robust data that will aid the development of standardized norms for adolescent populations

44 Main weaknesses identified in the instrumentation: Core addiction indicators being inconsistent across studies A general lack of any temporal dimension Inconsistent cut-off scores relating to clinical status Poor and/or inadequate inter-rater reliability and predictive validity

45 NEUROBIOLOGY OF GAMING ADDICTION In systematic reviews of neuroimaging studies examining internet addiction (Kuss & Griffiths, 2012; Pontes. Kuss & Griffiths, 2017) noted: These studies provide compelling evidence for the similarities between different types of addictions, notably substance-related addictions and Internet and gaming addiction, on a variety of levels. On the level of neural circuitry, Internet and gaming addiction lead to neuroadaptation and structural changes that occur as a consequence of prolonged increased activity in brain areas associated with addiction. On a behavioral level, Internet and gaming addicts appear to be constricted with regards to their cognitive functioning in various domains (p.347).

46 CONCLUSIONS (THE POSITIVES) In the right context, VGs can have therapeutic benefit to: Children chemotherapy Children psychotherapy undergoing undergoing Children with particular emotional and behavioural problems (ADD, impulsivity, autism) Individuals with medical and health problems (Erb s palsy, muscular dystrophy, burns, strokes, movement impaired) And groups such as the elderly

47 CONCLUSIONS (THE NEGATIVES) Gaming addiction appears to exist (depending upon addiction criteria used) Even if VG addiction is not accepted by some, there is lots of evidence that it can be problematic Although time spent online correlates with VG addiction, excessive VG use can be non-problematic Assessing VG addiction can be problematic The medium may be more harmful for susceptible individuals (e.g., youth)

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