Author Archives: drmarkgriffiths

A night on the tiles: A brief look at addiction to ‘Scrabble’

In previous blogs I have covered some arguably frivolous (and alleged) addictions including addictions to cryptic crosswords and Sudoku. Today’s blog looks at an equally frivolous topic in the same vein – Scrabble addiction. I have to be honest and say that I love playing Scrabble and have been playing a lot against the computer over the last few weeks (and is one of the reasons I decided to write an article on the topic). According to a 2004 article ‘Scrabble addicts’ in The Independent by John Walsh, there are numerous celebrity Scrabble lovers including Robbie Williams, Kylie Minogue, Nigella Lawson, Christina Aguilera, Sting, Avril Lavigne and Alison Steadman. He also  asserted that the secret of Scrabble’s success is threefold.

“First, it’s a game of skill (like chess) that depends on the luck of the tiles you get (like cards). Second, it deploys a commodity common to every human being, namely words. Third, anyone can play it”.

Back in 2000, I published a paper on the psychology of games in Psychology Review and what makes a good game. These are all applicable to Scrabble. I noted in that article that:

  • All good games are relatively easy to play but can take a lifetime to become truly adept. In short, there will always room for improvement.
  • For games of any complexity there must be a bibliography that people can reference and consult. Without books and magazines to instruct and provide information there will be no development and the activity will die.
  • There needs to be competitions and tournaments. Without somewhere to play (and likeminded people to play with) there will be little development within the field over long periods of time.
  • Finally – and very much a sign of the times – no leisure activity can succeed today without corporate sponsorship of some kind.

But is there any evidence to suggest Scrabble can be addictive? Jan Kern published a book in 2009 called Eyes on Line: Eyes on Life – A Journey Out of Online Addictions. She noted the case of Tom who started out his story by saying: “Hi, my name is Tom, and I’m an addict. I don’t have a problem with the bottle or with any kind of pharmaceutical product, legal or illegal. No, my problem is with games. I’m addicted to them…And now the Internet has made this potential to get hooked all too easy. My particular poison these days is online Scrabble”. I then came across these examples:

  • Extract 1: “[I] have struggled with Scrabble addiction. When I play Scrabble on the Internet, I lose all track of time. I promise myself I’ll just play one game, and the next thing I know, the sun is coming up and my eyes are a shade of crimson. I’m just glad to know that I’m not the only one” (Raphael Pope-Sussman, New York Times, 2007).
  • Extract 2: “I read ‘Addicted to L-U-V’ while I was in the midst of a Scrabble game…Whenever I encounter a new word, I calculate the number of letters, roots, prefixes and suffixes. I’ve got it bad. My Scrabble buddies both live out of state…When we are together, we have cut-throat marathon games…When we’re apart, we practice our addiction online” (Cheryl Beatty, New York Times, 2007).
  • Extract 3: “Phew! I am not the only one! Scrabble with my friends and daughter was my addiction for years. These days I play it on my computer when I take a break from work…O.K., that’s enough writing; time to get back to another game of Scrabble” (Beth Rosen, New York Times, 2007).

These extracts were all published in response to American journalist and film director Nora Ephron’s 2007 article ‘Addicted to L-U-V’ in the New York Times about her addiction to the word game Scrabble. In her article, Ephron admitted that:

“I stumbled onto something called Scrabble Blitz. It was a four-minute version of Scrabble solitaire, on a Web site called Games.com, and I began playing it without a clue that within 24 hours – I am not exaggerating – it would fry my brain…I began having Scrabble dreams in which people turned into letter tiles that danced madly about. I tuned out on conversations and instead thought about how many letters there were in the name of the person I wasn’t listening to. I fell asleep memorizing the two- and three-letter words that distinguish those of us who are hooked on Scrabble from those of you who aren’t…My brain turned to cheese. I could feel it happening. It was clear that I was becoming more and more scattered, more distracted, more unfocused…I instantly became an expert on how the Internet could alter your brain in a permanent way”.

Ephron went on to report comments from other people in the online Scrabble games (“I’m an addict, lol”, “I can’t stop playing this, ha ha”). Ephron concluded she was no different from the other players. She then went onto say:

“The game of Scrabble Blitz eventually became too much for the Web site. Lag was a huge problem. From time to time, the Scrabble Blitz area would shut down for days, and when it returned, so did all the addicts, full of comments about how they had barely withstood life without the game. I began to get carpal tunnel syndrome from playing. I’m not kidding. I realized I was going to have to kick the habit…I was saved by what’s known in the insurance business as an act of God: Games.com shut down Scrabble Blitz. And that was that. It was gone”.

Obviously I’m sceptical about whether there are genuine cases of addiction to Scrabble (particularly as there is nothing in the psychological literature whatsoever). There have also been other lengthy first-person journalistic accounts of Scrabble addiction such as the 2011 article by James Brown in the Sabotage Times (who also did some interesting background research for his article). According to Brown, the recent upsurge in Scrabble began in 2007 when Indian brothers Rajat and Jayant Agarwalla developed a Scrabble application for Facebook (‘Scrabulous’). It quickly became the most popular game on Facebook (but was then removed due to a legal dispute with the original developers of Scrabble – Hasbro and Mattel. The game later returned as Lexulous). Brown then confessed:

Hello, my name’s James and I am a Scrabble addict. I have been playing it all day everyday from last Christmas until my summer holiday when two weeks without a computer allowed me to crack the habit. I am not alone, there are over a hundred thousand Scrabble players on Facebook. We play each other at any time of day or night because we are situated all over the world and timezones are helpful like that. We decide how long we will allow for each move to take, how many people can play, and what standard we play at…On an hourly basis day after day I played people in Australia, Britain, South Africa, India, the West Indies and pretty much anywhere else where the Scrabble application could work. Eventually I spent more time talking and playing with these new Scrabble partners than I did the people I lived with. It was madness. A genuine obsession, I would go as far as to say addiction. I was late to pick my son up from school, late to sports matches I was playing in, I ignored writing work I had to do, I took the computer to bed with me and played last thing at night until my eyes hurt and then started again as soon as I woke up… For me it eventually became too much. One day I looked at the 18 consecutive games I had going on at once, many of them with just two minutes at a time to play my word, and realised what that would look like if I actually had 18 people with 18 boards in the room with me. This moment of clarity gave me some perspective on how it had consumed my life”.

I have to admit that this case account is quite compelling and does at least suggest Scrabble could be potentially addictive. Finally, as a Professor of Gambling Studies I was also interested in Brown’s analogy between Scrabble and gambling as he noted:

“Not knowing what letters would appear next had that random appeal that watching a horse race has.  The excitement at using all seven letters and scoring a bingo, or taking a game to the very last tile to reach a conclusion was immense, there was always just one more game, one more opponent, maybe the same one you’d already played five times that day and you wanted to take another victory from or avenge an earlier defeat. The international 24 hour pull of the game is relentless, for some it over-comes loneliness for others it fuels addictive personalities”.

Playing with what you get given is almost an outlook on life itself. However, unlike life, I seriously doubt whether excessive and/or addictive playing of Scrabble will ever become the topic of scientific study.

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Brown, J. (2011). Scrabble addict. Sabotage Times, May 16. Located at: http://sabotagetimes.com/life/scrabble-addict/

Ephron, N. (2007). Addicted to L-U-V. New York Times, May 13. Located at: http://www.nytimes.com/2007/05/13/opinion/13ephron.html

Griffiths, M.D. (2000). The psychology of games. Psychology Review, 7(2), 24-26.

Hayward, A. (2014). Can New Words With Friends reignite your competitive pseudo-Scrabble addiction? MacWorld, October 14. Located at: http://www.macworld.com/article/2825932/can-new-words-with-friends-reignite-your-competitive-pseudo-scrabble-addiction.html

Kern, J. (2009). Eyes on Line: Eyes on Life – A Journey Out of Online Addictions. Accessible Publishing Systems PTY, Ltd.

Walsh, J. (2004). Scrabble addicts. The Independent, October 9. Located at: http://www.independent.co.uk/news/uk/this-britain/scrabble-addicts-535160.html

Feline purrversions: A beginner’s guide to aelurophilia

In a previous blog on a hoax form of zoophilia (emysphilia – sexual arousal from turtles), I briefly mentioned other various specific sub-types of zoophilia including aelurophilia. In 2006, Dr. Lisa Shaffer and Dr. Julie Penn developed a comprehensive paraphilia classification system and published it as a book chapter in Dr. William Hickey’s book Sex Crimes and Paraphilia. In that chapter they defined aelurophilia deriving sexual gratification from cats. The same definition was also provided by Dr. Anil Aggrawal in his new 2011 classification of zoophilia in the Journal of Forensic and Legal Medicine. Before I take a closer academic look at the clinical literature on aelurophilia, I’d like to share this story reported in the Russian newspaper Pravda from March 2004:

 “Two women attempted to experience sexual pleasure from an intimate contact with a cat. The weird endeavor ended rather sad for one of the women [Svetlana]: she was hospitalized with severe genital injuries. Doctors arrived to hospitalize a woman, who had suffered from unexpected bleeding…They saw a woman lying on the sofa. …Streaks of blood could be seen on her legs. The woman’s friend was speechless to explain what happened. The woman was taken to the gynecological department of the local hospital, where doctors determined the unusual character of the genital injuries…When the woman recovered, she confessed that she had been injured during her love act with a cat…Svetlana was bored and she decided to visit her friend, Vera. The two women had some wine and started talking about intimate matters. Vera was the first, who suggested trying something totally unusual…Vera brought in a cat [called Timka]…Vera took her clothes off, put the light out and played an adult movie on the video recorder. She lied down, took a bottle of valerian and poured some on her most intimate body part. When the cat smelled valerian, he started licking it away, putting Vera in the state of ecstasy. Vera told Svetlana…there is nothing better than the cat’s little tongue. When the cat started licking valerian off from Svetlana, something happened to the animal. Timka probably took too much of the medication: he started licking the liquid away but all of a sudden he seized the genitals of the poor woman with his claws and teeth. Svetlana screamed and tried to push the fierce pet lover away from her, but the cat wouldn’t let go. Vera hurried to help her friend: she emptied a bucket of water on the cat and threw the animal out of the house. When she saw that Svetlana was bleeding, she called an ambulance. Boris [Svetlana’s husband] could not take the fact that his wife preferred having oral sex with a cat [and] kicked Svetlana out of the house…It is noteworthy that lonely women often use their pets (cats or dogs, regardless of sex) to satisfy their sexual needs. Such pet adventures often lead to lamentable consequences – not for pets, but for orgasm-craving women, as a rule. An overdose of valerian can make the loveliest cat become a fierce and aggressive animal”.

I did an academic literature search on aelurophilia and thought I had found an article in the Journal of Feline Medicine and Surgery but the editorial by Margie Scherk used the term ‘aelurophilia’ in it most literal sense to refer to introduce a special issue of the journal that had brought together the aelurophilic veterinary community” (i.e., vets who love cats but not in any sexual sense). I also thought I had located a relevant conference paper by Dr. A Franklin about people who go looking for big wild cats in the country. He noted that:

For some reason it appears that people now believe [wild cats] to be there but more than that, they want them to be there, they have become the focus for a new form of aelurophilia, or the love of (wild) cats”.

Again, like the editorial in the Journal of Feline Medicine and Surgery, the term ‘aelurophilia’ is used in its’ most literal sense. Thankfully, there are a few references in the more general zoophilia literature to people who have had sexual relationships with cats (although none of these authors mention the word ‘aelurophilia’). For instance, the Kinsey Reports (of 1948 and 1953) reported that 8% of males and 4% females had at least one sexual experience with an animal. The most frequent sexual acts engaged in with animals comprised calves, sheep, donkeys, large fowl (ducks, geese), dogs and cats. It probably won’t surprise you to learn that the internet has plenty of websites where people have confessed sexual relationships with cats such as those at the Is It Normal?, Zoklet, Zoo Destiny and Tribal War websites. There are also a number of dedicated websites with advice on engaging in human-cat sex such as the Beast Forum’s ‘The ultimate guide: How to make love to big cats’ and Zoophile.Net’s “How to make love to felines’.

In a 2001 issue of the Journal of Small Animal Practice, Dr. H. Munro and Dr. M. Thrusfield (2001) reported that they had collected data on animal abuse from over 400 British vets. They reported that 6% of their cases involved sexual abuse based on their observations of injuries in the animals’ genital and anal areas. Of these, 21 cases referred to dogs and three to cats.

Dr Andrea Beetz carried out a study comprising 32 male zoophiles. She reported that sex had occurred with dogs (78%), horses (53%), cats (13%) and farm animals (19%). She also reported that many of the zoophiles (including the cat lovers) had a very close emotional attachment to their animals and reported that they love their animal partner as others love their human partner (and are devastated when their animal partner dies). In a later paper in a 2004 issue of the Journal of Forensic Psychology Practice, she also wrote:

“Besides the whole range of sexual practices with more or less common mammals of a suitable size and anatomy, including deer, tapirs, antelopes, and camels (Massen, 1994), sexual contacts with more unusual species were mentioned in the literature. Insertion of fish – eels seem to be preferred – and snakes into the vagina and sexual stimulation through the movements of the animal (Dekkers, 1994), masturbation of male or female cats and letting cats lick the human genitalia or eat food from the penis or the vagina (Miletski, 2002) are further practices”.

Dr. Hani Miletski (2002) conducted one of the largest studies in this area examining 93 zoophiles (82 men and 11 women). Her study found that most of her sample had sexual contact with dogs (90%). However, she also reported that 19.5% of her participants admitted to having had sexual contact with female felines (large cats or domestic cats) and 17% with male felines (large cats or domestic cats).

Although there are only a few studies that have examined aelurophilia, the data quite clearly show that minorities of both men and women have engaged in human-feline sex although compared to other animals that people have had sex with cats are much lower in the zoophilic preference league.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Aggrawal, A. (2011). A new classification of zoophilia. Journal of Forensic and Legal Medicine, 18, 73-78.

Beetz, A.M. (2000, June). Human sexual contact with animals: New insights from current research. Paper presented at the 5th Congress of the European Federation of Sexology, Berlin.

Beetz, A. (2004): Bestiality/zoophilia: A scarcely investigated phenomenon between crime, paraphilia, and love. Journal of Forensic Psychology Practice, 4(2), 1-36.

Dekkers, M. (1994). Dearest pet: On bestiality. New York: Verso.

Franklin, A, (2011, November). Imagined big cats in the English countryside. Proceedings of 2011 TASA Conference: Local Lives/Global Networks. Newcastle, Australia.

Kinsey, A. C., Pomeroy, W. B., Martin, C.E., Gebhard, P.H. (1953). Sexual Behavior in the Human Female. Philadelphia, PA: W.B. Saunders Company.

Kinsey, A. C., Pomeroy, W. B., Martin, C.E., (1948). Sexual Behavior in the Human Male. Philadelphia, PA: W.B. Saunders Company.

Massen, J. (1994). Zoophilie. Die sexuelle Liebe zu Tieren. Koln: Pinto Press.

Miletski, H. (2002). Understanding bestiality-zoophilia. Bethesda, MD: Author.

Munro, H.M.C., & Thrusfield, M.V. (2001). “Battered pets”: Sexual abuse. Journal of Small Animal Practice, 42, 333-337.

Pravda (2004). Cat rapes woman after performing oral sex on her. November 10. Located at: http://english.pravda.ru/news/society/sex/10-11-2004/60215-0/

Shaffer L, & Penn J. A comprehensive paraphilia classification system. In: E.W. Hickey (Editor). Sex crimes and paraphilia. New Jersey: Pearson Prentice Hall.

Scherk, M.A. (2009). FIP – A disease full of curiosities. Journal of Feline Medicine and Surgery, 11, 223.

Hooked on pain: Inside the world of the Corn Tryb Rituals

“Devotees at Kerala’s Aaryyankavu Bhagwathi Temple have devised a new way of performing the banned ancient Thookkam, or body-piercing ritual. In the original Thookam ritual, the back of the person willing to perform the ritual is pierced with sharp hooks and lifted up to a height of over 30 feet on a scaffold, before the bleeding victim is brought down and hooks taken out. However, the new method doesn’t require the devotee to be hung or lifted. ‘After a court put a ban on the ancient ritual of multiple body-piercing and hanging from rope, now only single piercing is done in the body and the person just stands still and does not hang. The devotees also fast for 41 days’ said Shiv Raman, a temple committee member. In 2004 – following a widespread protest by social activists and even Hindu priests – the practice was banned by a court. The legend behind the ritual goes back to the ancient days. Legend has it that even after slaying the demon Darika, the Goddess Kali remained bloodthirsty. Hindu god Lord Vishnu then sent his mount, the giant bird Garuda, to Kali. Garuda gave the goddess some drops of blood, which pacified her thirst. The ritual is performed based on this belief” (News Track India, March 31, 2010).

Last year I was the resident psychologist on a 12-episode series for the Discovery Channel called Forbidden (which is now airing in the UK). Each episode examined four cases of extreme human behaviour from around the world (in fact, when I started filming, the series was called Extreme Worlds and only changed names at the eleventh hour). One of the stories we covered featured people that hung and suspended themselves from hooks that were pierced into their flesh. Although some people appear to carry out the practice as part of sexually sadomasochistic practices, the opening story highlights that some people carry out such ritualistic behaviour for religious and/or spiritual reasons.

In Forbidden, the story concentrated on what were called the ‘Corn Tryb Rituals’ (CTRs). These originated in St. Louis (Missouri, USA) when a small group of friends formed a group that would meet to engage in bloodletting rituals and ‘flesh pulls’. These practices then evolved into regular ritualised ‘suspensions’ that strove to connect to ancient ways. As one CTR participant interviewed said: “We give back to the earth and universe parts of us. Usually blood, sometimes flesh…We burn sage and sing songs to the gods. We send out positive energies”.

In researching CTRs, the documentary makers found out that there were strong Mayan threads running through the group in St. Louis, the foremost theme being the myth of creation, i.e., the Mayans first created man out of mud, then wood, and then finally corn (and where the CTR name derives). All the St. Louis CTR members had a scarification or tattoo of day glyph, a symbol of the Mayan calendar. (A glyph is an element of writing – an individual mark on a written medium – that contributes to the meaning of what is written).

The CTR’s founder is Ricardo H. (a professional piercer by trade) who formed the group with 12 ‘core’ members comprising seven men and five women (although there are more individuals on the periphery). The members claimed that the female members had a higher pain threshold (although there was little evidence to back up this claim). The documentary’s production notes reported that:

“[The St. Louis CTR group] is one of few crews is the US that does suspension the tribal and ceremonial way. Other groups are more hardcore and punk, kind of like ‘F the World’, Ricardo says. CTR members say for them it’s about loving the world and forging a connection to Mother Earth. There are a few people in the Tryb that practice Druidism and several Wiccans, even a Catholic guy who believes that doing suspensions (especially things like the crucifixion suspensions) help him become closer to God. Then there are the atheists who just like to suspend because it gives them a high that tops any drug they’ve ever touched. Even for those who have never done drugs, it’s still a high for them. Being safe is their No. 1 priority. It took nearly three years before they had all the necessary equipment, especially considering mountain equipment is very expensive. In general, most suspension groups work with the same materials that are used by climbers and professional riggers. If people think they sloppily insert hooks and try dangerous procedures on a whim, they would be wrong. The procedures behind the suspensions are specific and everything is well planned out. The hooks are specialized for suspension and can cost from $15 to $75 each. And they are sanitized in a similar way as for piercing tools: cold sanitation scrub, soak, scrub, autoclave”.

During CTRs, the hooks are usually placed into parts of the body where the skin is soft and stretches easily (so called ‘sweet spots’). This includes hook placements in the upper to middle back, chest, hips, calves, forearms, and knees. Even for those that have participated in many suspensions, the initial piercing hurts (“the hooks sting”) like any other piercing but the pain lasts longer because the needles and hooks are longer and bigger than those involved in typical ‘everyday’ body piercings. As one of the female group members said:

“Getting pierced sucks…But once you’re off the ground it’s just a big endorphin rush like how marathoners get runner’s high. Once the pulling starts though it’s not so bad, just pressure. I can deal with pressure pain better than stingy pain. When it gets too intense, I just zone out, but I try not to because I like to be able to selectively ‘zone,’ which is something I’m working on with scarification”.

Each time the group carries out a ritual suspension there are between five and eight people present all with a specific job they have to do to make the process as safe as possible for the person undergoing the actual suspension. According to the show’s production notes, the different roles include:

  • The ‘rigger’ that installs and monitors all the suspension equipment such as cable and ropes.
  • The piercer (in charge of ‘hook placement’) who also monitors the person for flesh ripping.
  • The ‘bio’ (short for ‘biohazard’) who keeps an eye on the hooks throughout the suspension, and removes bubbles and/or patches up any holes that form. They also make sure that not a single drop of blood hits the ground.
  • The ‘rope director’ that hoists the suspended person up and controls the slackness of the rope. There are also one or two others that control the rope line going up and down (a ‘puller’ and/or ‘holder’).
  • The ‘anchor points’ that oversee where the cables and chains are stationed and anchored and oversee the pulley system.

The ceremonial aspect is fundamental to the whole process with spiritual and fasting components. One interviewee reported:

“When you are suspended you are in a state of meditation. You feel connected to everything, all the energy of nature, my Tryb, the love that’s there. We often fast, offer offerings, play drums and other things. It’s pretty amazing”.

At the time of filming, the CTR members were about to have their ‘End of the World’ party (December 21). The date is significant as this is when the ancient Mayans marked the end of an era that would reset the date to zero and signal the end of humanity. The CTR members don’t see this as the literal ‘end of time’ but as the end of the cycle, with the re-alignment of planets and the beginning of a new, exciting cycle. I’m sure most of you reading this can’t imagine being subjected to such a extreme bodily experience (I certainly can’t) but the CTR members stress that the experience for them is not abnormal. Ultimately, they claim the ritual is a way of coping and understanding pain. They also stress that no-one in the groups is a masochist. They do it because it’s a challenge and a way to test the boundaries of their bodies.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

News Track India (2010). Body-piercing ritual at Kochi Temple. March 31. Located at: http://newstrackindia.com/newsdetails/156577

Hook Life (2011). Corn Tryb Ritual. Suspension.org, September 28. Located at: http://www.suspension.org/hooklife/corn-tryb-ritual/

I love view: Can Google Glass be addictive?

Last week, The Guardian (and news media all over the world) reported the story of a man being treated for internet addiction disorder brought on by his excessive use of Google Glass. According to The Guardian’s report:

“The man had been using the technology for around 18 hours a day – removing it only to sleep and wash – and complained of feeling irritable and argumentative without the device. In the two months since he bought the device, he had also begun experiencing his dreams as if viewed through the device’s small grey window…[The patient] had checked into the Sarp [Substance Addiction Recovery Program] in September 2013 for alcoholism treatment. The facility requires patients to steer clear of addictive behaviours for 35 days – no alcohol, drugs, or cigarettes – but it also takes away all electronic devices. Doctors noticed the patient repeatedly tapped his right temple with his index finger. He said the movement was an involuntary mimic of the motion regularly used to switch on the heads-up display on his Google Glass”.

The story was based on a case study that has just been published in the journal Addictive Behaviors by Dr. Kathryn Yung and her colleagues from the Department of Mental Health, Naval Medical Center in San Diego (United States). The authors claim that the paper (i) reported the first ever case of internet addiction disorder involving the problematic use of Google Glass, (ii) showed that excessive and problematic uses of Google Glass can be associated with involuntary movements to the temple area and short-term memory problems, and (iii) highlighted that the man in their case study displayed frustration and irritability that were related to withdrawal symptoms from excessive use of Google Glass. For those reading this who have not yet come across what Google Glass is, the authors provided a brief description: 

Google Glass™ was named as one of the best inventions of the year by Time Magazine in 2012. The device is a wearable mobile computing device with Bluetooth connectivity to internet-ready devices. Google Glass™ has an optical head-mounted display, resembling eyeglasses; it displays information in a Smartphone-like, but hands-free format that is controlled via voice commands and touch”.

The man that came in for treatment was a 31-year old enlisted service member who had served seven months in Afghanistan. Although he did not suffer any kind of post-traumatic stress disorder (PTSD) he was reported by the authors as having a mood disorder, most consistent with a substance-induced hypomania overlaying a depressive disorder, anxiety disorder with characteristics of social phobia, obsessive–compulsive disorder, and severe alcohol and tobacco use disorders”. His referral to the substance use program was because he had resumed problematic alcohol drinking following a previous eight-week intensive outpatient treatment. It was only after re-entering the program that staff noticed other behaviours that were nothing to do with his alcohol problem. More specifically, they reported that:

“The patient had been wearing the Google Glass™ device each day for up to 18 h for two months prior to admission, removing the device during sleep and bathing. He was given permission by his superiors to use the device at work, as the device allowed him to function at a high level by accessing detailed and complicated information quickly. The patient shared that the Google Glass™ increased his confidence with social situations, as the device frequently became an initial topic of discussion. All electronic devices and mobile computing devices are customarily removed from patients during substance rehabilitation treatment. The patient noted significant frustration and irritability related to not being able to use the device during treatment. He stated, ‘The withdrawal from this is much worse than the withdrawal I went through from alcohol’, He noted that when he dreamed during his residential treatment, he envisioned the dream through the device. He would experience the dream through a small gray window, which was consistent with what he saw when wearing the device while awake. He reported that if he had been prevented from wearing the device while at work, he would become extremely irritable and argumentative. When asked questions by the examiner, the patient was noted on exam to reach his right hand up to his temple area and tap it with his forefinger. He explained that this felt almost involuntary, in that it was the familiar motion he would make in order to turn on the device in order to access information and answer questions. He found that he almost ‘craved’ using the device, especially when trying to recall information”.

Even though my primary area of research interest in behavioural addictions, the thing that caught my attention in the description above was the observation that his dreams were experienced in the way he viewed things through Google Glass while he was awake. On first reading this I thought this sounding very much like some research I have been doing with my colleague Angelica Ortiz de Gortari on Game Transfer Phenomena (GTP) in which gamers transfer aspects of their game playing into real life situations. Our work is an extension of the so-called Tetris Effect where Tetris players see falling blocks before their eyes even when they are not playing the game. It appears the authors of this case study has also made the same connection as they reported:

The patient’s experiences of viewing his dreams through the device appear to be best explained solely by his heavy use of the device and may be consistent with what is referred to as the ‘Tetris Effect’. When individuals play the game Tetris for long periods of time, they report seeing invasive imagery of the game in their sleep (Stickgold, Malia, Maguire, Roddenberry, & O’Connor, 2000). Interestingly, Stickgold et al. noted that patients with amnesia due to traumatic brain injury, who had trouble with short-term memory recall, reported invasive imagery of the game during sleep even though they did not recall playing the game (Stickgold et al., 2000). Technology-assisted learning devices and video gaming appear to be powerful methods to aid in the acquisition of new information. Further studies in the field of traumatic brain injury utilizing gaming and technology-assisted learning are needed”.

At the end of the 35-day inpatient stay, the outcome was reported as being good. The patient reported he felt less irritable, and he was making far fewer compulsive movements to his temple. However, no further follow-up was reported by Yung and her colleagues. There are, of course, wider questions about whether addiction to the internet even exists although the article in The Guardian did provide a link to a comprehensive and systematic review of internet addiction that I co-authored with Dr. Kuss and others in the journal Current Pharmaceutical Design. As regular readers of my blog will be aware, I believe that there is a fundamental difference between addictions on the internet and addictions to the internet. The vast majority of people appear to have addictions on the internet (such as gambling addiction, gaming addiction, sex addiction, shopping addiction, etc.) where the internet facilitates other addictive behaviours. However, there is growing evidence of internet-only addictive behaviour (with social networking addiction being the most common).

In relation to this case study, there have been some that have said that the study doesn’t have face validity because the battery life of Google Glass is so small that it is impossible to spend up to 18 hours a day wearing it. (For instance, check out an interesting article written by Taylor Hatmaker published by the Daily Dot). I ought to add that one of the study’s co-authors, Dr. Andrew Doan did say to various news outlets that:

“A wearable device is constantly there – so the neurological reward associated with using it is constantly accessible. There’s nothing inherently bad about Google Glass. It’s just that there is very little time between these rushes. So for an individual who’s looking to escape, for an individual who has underlying mental dysregulation, for people with a predisposition for addiction, technology provides a very convenient way to access these rushes. And the danger with wearable technology is that you’re allowed to be almost constantly in the closet, while appearing like you’re present in the moment”.

Based on the two-page paper that was published, I don’t think there was enough evidence presented to say whether the man in question was addicted to the internet via Google Glass. There were certainly elements associated with addiction but that doesn’t mean somebody is genuinely addicted. Furthermore, most addictive behaviours have to have been present for at least six months before being diagnosed as a genuine addiction. In this case, the man had only been using Google Glass for two months before entering the treatment program.

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Ghorayshi, A. (2014). Google glass user treated for internet addiction caused by device. The Guardian, October 14. Located at: http://www.theguardian.com/science/2014/oct/14/google-glass-user-treated-addiction-withdrawal-symptoms

Griffiths, M.D. (2000). Internet addiction – Time to be taken seriously? Addiction Research, 8, 413-418.

Griffiths, M.D. (2010). Internet abuse and internet addiction in the workplace. Journal of Worplace Learning, 7, 463-472.

Hatmaker, T. (2014). There is no such thing as Google Glass addiction. The Daily Dot, October 15. Located at: https://www.dailydot.com/technology/google-glass-internet-addiction/

Kuss, D.J., Griffiths, M.D. & Binder, J. (2013). Internet addiction in students: Prevalence and risk factors. Computers in Human Behavior, 29, 959-966.

Kuss, D.J., Griffiths, M.D., Karila, L. & Billieux, J. (2014).  Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, 20, 4026-4052.

Kuss, D.J., Shorter, G.W., van Rooij, A.J., Griffiths, M.D., & Schoenmakers, T.M. (2014). Assessing Internet addiction using the parsimonious Internet addiction components model – A preliminary study. International Journal of Mental Health and Addiction, 12, 351-366.

Kuss, D.J., van Rooij, A.J., Shorter, G.W., Griffiths, M.D. & van de Mheen, D. (2013). Internet addiction in adolescents: Prevalence and risk factors. Computers in Human Behavior, 29, 1987-1996.

Ortiz de Gotari, A., Aronnson, K. & Griffiths, M.D. (2011). Game Transfer Phenomena in video game playing: A qualitative interview study. International Journal of Cyber Behavior, Psychology and Learning, 1(3), 15-33.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2012). An introduction to Game Transfer Phenomena in video game playing. In J. Gackenbach (Ed.), Video Game Play and Consciousness (pp.223-250). Hauppauge, NY: Nova Science.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Altered visual perception in Game Transfer Phenomena: An empirical self-report study. International Journal of Human-Computer Interaction, 30, 95-105.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Auditory experiences in Game Transfer Phenomena: An empirical self-report study. International Journal of Cyber Behavior, Psychology and Learning, 4(1), 59-75.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Automatic mental processes, automatic actions and behaviours in Game Transfer Phenomena: An empirical self-report study using online forum data. International Journal of Mental Health and Addiction, 12, 432-452.

Stickgold, R., Malia, A., Maguire, D., Roddenberry, D., & O’Connor, M. (2000). Replaying the game: Hypnagogic images in normals and amnesics. Science, 290, 350–353.

Widyanto, L. & Griffiths, M.D. (2006). Internet addiction: A critical review. International Journal of Mental Health and Addiction, 4, 31-51.

Yung, K., Eickhoff, E., Davis, D. L., Klam, W. P., & Doan, A. P. (2014). Internet Addiction Disorder and problematic use of Google Glass™ in patient treated at a residential substance abuse treatment program. Addictive Behaviors, http://dx.doi.org/10.1016/j.addbeh.2014.09.024.

Joystick junkies: A brief overview of online gaming addiction

Over the last 15 years, research into various online addictions have greatly increased. Prior to the 2013 publication of the American Psychiatric Association’s fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there had been some debate as to whether ‘internet addiction’ should be introduced into the text as a separate disorder. Alongside this, there has also been debate as to whether those researching in the online addiction 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.).

It should also be noted that given the lack of consensus as to whether video game addiction exists and/or whether the term ‘addiction’ is the most appropriate to use, some researchers have instead used terminology such as ‘excessive’ or ‘problematic’ to denote the harmful use of video games. Terminology for what appears to be for the same disorder and/or its consequences include problem video game playing, problematic online game use, video game addiction, online gaming addiction, internet gaming addiction, and compulsive Internet use.

Following these debates, the Substance Use Disorder Work Group (SUDWG) recommended that the DSM-5 include a sub-type of problematic internet use (i.e., internet gaming disorder [IGD]) in Section 3 (‘Emerging Measures and Models’) as an area that needed future research before being included in future editions of the DSM. According to Dr. Nancy Petry and Dr. Charles O’Brien, IGD will not be included as a separate mental disorder until the (i) defining features of IGD have been identified, (ii) reliability and validity of specific IGD criteria have been obtained cross-culturally, (iii) prevalence rates have been determined in representative epidemiological samples across the world, and (iv) etiology and associated biological features have been evaluated.

Although there is now a rapidly growing literature on pathological video gaming, one of the key reasons that IGD was not included in the main text of the DSM-5 was that the SUDWG concluded that no standard diagnostic criteria were used to assess gaming addiction across these many studies. In 2013, some of my colleagues and I published a paper in Clinical Psychology Review examining all instruments assessing problematic, pathological and/or addictive gaming. We reported that 18 different screening instruments had been developed, and that these had been used in 63 quantitative studies comprising 58,415 participants. The prevalence rates for problematic gaming were highly variable depending on age (e.g., children, adolescents, young adults, older adults) and sample (e.g., college students, internet users, gamers, etc.). Most studies’ prevalence rates of problematic gaming ranged between 1% and 10% but higher figures have been reported (particularly amongst self-selected samples of video gamers). In our review, we also identified both strengths and weaknesses of these instruments.

The main strengths of the instrumentation included the: (i) the brevity and ease of scoring, (ii) excellent psychometric properties such as convergent validity and internal consistency, and (iii) robust data that will aid the development of standardized norms for adolescent populations. However, the main weaknesses identified in the instrumentation included: (i) core addiction indicators being inconsistent across studies, (iii) a general lack of any temporal dimension, (iii) inconsistent cut-off scores relating to clinical status, (iv) poor and/or inadequate inter-rater reliability and predictive validity, and (v) inconsistent and/or dimensionality.

It has also been noted by many researchers (including me) that the criteria for IGD assessment tools are theoretically based on a variety of different potentially problematic activities including substance use disorders, pathological gambling, and/or other behavioural addiction criteria. There are also issues surrounding the settings in which diagnostic screens are used as those used in clinical practice settings may require a different emphasis that those used in epidemiological, experimental, and neurobiological research settings.

Video gaming that is problematic, pathological and/or addictive lacks a widely accepted definition. Some researchers in the field consider video games as the starting point for examining the characteristics of this specific disorder, while others consider the internet as the main platform that unites different addictive internet activities, including online games. My colleagues and I have begun to make an effort to integrate both approaches, i.e., classifying online gaming addiction as a sub-type of video game addiction but acknowledging that some situational and structural characteristics of the internet may facilitate addictive tendencies (e.g., accessibility, anonymity, affordability, disinhibition, etc.).

Throughout my career I have argued that although all addictions have particular and idiosyncratic characteristics, they share more commonalities than differences (i.e., salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse), and likely reflects a common etiology of addictive behaviour. When I started research internet addiction in the mid-1990s, I came to the view that there is a fundamental difference between addiction to the internet, and addictions on the internet. However many online games (such as Massively Multiplayer Online Role Playing Games) differ from traditional stand-alone video games as there are social and/or role-playing dimension that allow interaction with other gamers.

Irrespective of approach or model, the components and dimensions that comprise online gaming addiction outlined above are very similar to the IGD criteria in Section 3 of the DSM-5. For instance, my six addiction components directly map onto the nine proposed criteria for IGD (of which five or more need to be endorsed and resulting in clinically significant impairment). More specifically: (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]; (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];  and (9) loss of a significant relationship, job, or educational or career opportunity because of participation in internet games [conflict].

The fact that IGD was included in Section 3 of the DSM-5 appears to have been well received by researchers and clinicians in the gaming addiction field (and by those individuals that have sought treatment for such disorders and had their experiences psychiatrically validated and feel less stigmatized). However, for IGD to be included in the section on ‘Substance-Related and Addictive Disorders’ along with ‘Gambling Disorder’, the gaming addiction field must unite and start using the same assessment measures so that comparisons can be made across different demographic groups and different cultures.

For epidemiological purposes, my research colleagues and I have asserted that the most appropriate measures in assessing problematic online use (including internet gaming) should meet six requirements. Such an instrument should have: (i) brevity (to make surveys as short as possible and help overcome question fatigue); (ii) comprehensiveness (to examine all core aspects of problematic gaming as possible); (iii) reliability and validity across age groups (e.g., adolescents vs. adults); (iv) reliability and validity across data collection methods (e.g., online, face-to-face interview, paper-and-pencil); (v) cross-cultural reliability and validity; and (vi) clinical validation. We aso reached the conclusion that an ideal assessment instrument should serve as the basis for defining adequate cut-off scores in terms of both specificity and sensitivity.

The good news is that research in the gaming addiction field does appear to be reaching an emerging consensus. There have also been over 20 studies using neuroimaging techniques (such as functional magnetic resonance imaging) indicating that generalized internet addiction and online gaming addiction share neurobiological similarities with more traditional addictions. However, it is critical that a unified approach to assessment of IGD is urgently needed as this is the only way that there will be a strong empirical and scientific basis for IGD to be included in the next DSM.

Note: A version of this article was first published on Rehabs.com

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders – Text Revision (Fifth Edition). Washington, D.C.: Author.

Demetrovics, Z., Urbán, R., Nagygyörgy, K., Farkas, J., Griffiths, M. D., Pápay, O., . . . Oláh, A. (2012). The development of the Problematic Online Gaming Questionnaire (POGQ). PLoS ONE, 7(5), e36417.

Griffiths, M.D. (2000). Internet addiction – Time to be taken seriously? Addiction Research, 8, 413-418.

Griffiths, M. D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10(4), 191-197.

Griffiths, M.D., King, D.L. & Demetrovics, Z. (2014). DSM-5 Internet Gaming Disorder needs a unified approach to assessment. Neuropsychiatry, under review.

Griffiths, M.D., Kuss, D.J. & King, D.L. (2012). Video game addiction: Past, present and future. Current Psychiatry Reviews, 8, 308-318.

Kim, M. G., & Kim, J. (2010). Cross-validation of reliability, convergent and discriminant validity for the problematic online game use scale. Computers in Human Behavior, 26(3), 389-398.

King, D. L., Delfabbro, P. H., Griffiths, M. D., & Gradisar, M. (2011). Assessing clinical trials of Internet addiction treatment: A systematic review and CONSORT evaluation. Clinical Psychology Review, 31, 1110-1116.

King, D. L., Delfabbro, P. H., & Griffiths, M. D. (2012). Cognitive-behavioral approaches to outpatient treatment of Internet addiction in children and adolescents. Journal of Clinical Psychology, 68, 1185-1195.

King, D.L., Haagsma, M.C., Delfabbro, P.H., Gradisar, M.S., Griffiths, M.D. (2013). Toward a consensus definition of pathological video-gaming: A systematic review of psychometric assessment tools. Clinical Psychology Review, 33, 331-342.

Koronczai, B., Urban, R., Kokonyei, G., Paksi, B., Papp, K., Kun, B., . . . Demetrovics, Z. (2011). Confirmation of the three-factor model of problematic internet use on off-line adolescent and adult samples. Cyberpsychology, Behavior and Social Networking, 14, 657–664.

Kuss, D.J. & Griffiths, M.D. (2012). Internet and gaming addiction: A systematic literature review of neuroimaging studies. Brain Sciences, 2, 347-374.

Kuss, D.J., Griffiths, M.D., Karila, L. & Billieux, J. (2013).  Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, in press.

Pápay, O., Nagygyörgy, K., Griffiths, M.D. & Demetrovics, Z. (2014). Problematic online gaming. In K. Rosenberg & L. Feder (Eds.), Behavioral Addictions: Criteria, Evidence and Treatment. New York: Elsevier.

Petry, N.M., & O’Brien, C.P. (2013). Internet gaming disorder and the DSM-5. Addiction, 108, 1186–1187.

Porter, G., Starcevic, V., Berle, D., & Fenech, P. (2010). Recognizing problem video game use. The Australian and New Zealand Journal of Psychiatry, 44, 120-128.

Young, K. S. (1998). Internet addiction: The emergence of a new clinical disorder. Cyberpsychology and Behavior, 1, 237-244.

Palm minimization: An unusual case of Alien Hand Syndrome

In a previous blog I briefly overviewed Alien Hand Syndrome. Since writing that blog I came across an interesting case of alien hand syndrome published in a 2000 issue of the American Journal of Physical Medicine and Rehabilitation by Dr. B. Hai and Dr. I. Odderson. They reported an unusual case in which their patient had a right hemispheric stroke and subsequently experienced what the authors described as embarrassing manifestations of Alien Hand Syndrome in the form of involuntary masturbation. The case involved a 73-year old man who was brought into a hospital emergency ward by his wife because of a sudden loss of movement in the left-hand side of his body (including a slight droop on the left-hand side of his face), slurred speech and poor balance. Furthermore, he could stand if helped but was unable to walk unaided. The man had obviously had a stroke but four days later he started to experience involuntary movements of his left arm and claimed his left hand “has a mind of his own”. The paper reported that:

“He developed a tonic grasp reflex with inability to release. He also had a tendency to reach and grasp onto objects with the left hand, such as the telephone cord or the remote control for the television, and was unable to release despite verbal commands. He would persistently grab his comb or fix the collar of his shirt. He also demonstrated difficulty performing bimanual activities, such as eating

Most worryingly, the man’s wife expressed extreme concern when her husband’s left hand would expose his genitals and start to masturbate in public. The involuntary masturbation happened on numerous occasions when talking with the nurses and doctors in the hospital, and only ever occurred with his left hand (even though the man was right-handed). The man denied that he had any history of “excessive self-stimulation, sexual dysfunction, or exhibitionism. While in hospital, the man was dismayed and frustrated that he was unable to stop his left hand stimulating his genitals in front of other people. The authors reported that:

“A clinical impression of [Alien Hand Syndrome] was made, and magnetic resonance imaging of the brain showed an acute infarct [dead tissue] in the medial right frontal lobe [of his brain] in the anterior cerebral artery distribution involving the right anterior cingulate gyrus and the corpus callosum. After [three weeks] of acute inpatient rehabilitation, the patient was able to walk with a standard walker and negotiate stairs with rails with contact guard assist. He also began to use his left hand for bimanual activities. He was subsequently discharged to home with his family”.

After a month of treatment, the man was able to walk again unassisted but his left hand was still not under his own control (and telling the medical staff that his hand “still has a mind of his own and won’t turn things loose”). However, the good news was that the involuntary masturbation in public subsided and eventually ceased. The authors of the paper claim this is a very rare case because their patient displayed “an unusual and disturbing manifestation of uncontrolled involuntary genital fondling with the nondominant, apraxic hand and with mirroring hand movements during eating”. The authors also noted that the involuntary movements of the man’s left hand never occurred while they were carrying out medical tests and suggested that their findings indicate “the possibility of the presence of a dexterous ‘alien’ mode of control that can be distinguished from a more clumsy and slow ‘voluntary’ mode of control”. Although there is no known treatment for AHS, as I noted in my previous blog on the topic, the symptoms can be minimized and managed to some extent by keeping the affected hand occupied and involved in a task (e.g., by giving it an object to hold in its grasp). This would seem to explain why the man never masturbated while undergoing medical tests (i.e., his hands were being occupied). The authors also noted that:

“So far, at least two types of [Alien Hand Syndrome] have been described. The callosal type, as seen in our patient (lesion involving the corpus callosum with or without frontal damage), is characterized by frequent intermanual conflict and apraxia of the affected limb. The frontal type (lesion involving the left mediofrontal and callosal) is associated with dominant hand grasp reflex, compulsive movements (such as groping), restraining actions, and compulsive manipulation of tool [Feinberg, Schindler & Flanagan, 1992]”.

As I noted in my previous blog on AHS, research indicates that AHS sufferers often personify the alien hand and may believe the hand is ‘possessed’ by some other spirit or alien life form. Their hands may even appear to act in opposition to each other (such as when AHS sufferers who are also cigarette smokers put a cigarette in their mouth to set it alight, only for the alien hand to pull it out and throw the cigarette away). Such behaviour is an example of ‘intermanual conflict’ and has been given the name ‘diagnostic ideomotor apraxia’.

A number of published papers have reported that involuntary masturbation can be associated with other conditions. For instance, it has been associated with temporal lobe epilepsy. Dr. M. Cherian reported the case of excessive masturbation in a young girl in a 1997 issue of the European Journal of Pediatrics. However, until the publication of this case of AHS, it had not ever been associated with having a stroke. Dr. Hai and Dr. Odderson conclude:

Although [Alien Hand Syndrome] is a rare phenomenon, this condition should be considered in patients who present with a feeling of alienation of one or both upper limbs accompanied by complex purposeful involuntary movement. It must be differentiated from limb neglect and anosognosia, which present with dissociation from the limb as perceived object (i.e., where the limb is not perceived as a part of the “self”), but without involuntary movement and without dissociation from control over purposeful complex action of the affected limb (i.e., where the actions of the limb are perceived as self-generated). Further studies are required to elucidate a definite anatomical explanation that can lead to accurate diagnosis, specific treatment, and rehabilitation of these patients”

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK 

Further reading

Biran, I. & Chatterjee, A. (2004). Alien Hand Syndrome. Archives of Neurology, 61, 292-294.

Cherian, M.P. (1997). Excessive masturbation in a young girl: A rare presentation of temporal lobe epilepsy. European Journal of Pediatrics, 156, 249.

Doody, R.S. & Jankovic, J. (1992). The alien hand and related signs. Journal of Neurology, Neurosurgery and Psychiatry, 55, 806-810.

Feinberg, T.E., Schindler, R.J. & Flanagan, N.G. (1992). Two alien hand syndromes. Neurology, 42, 19-24.

Hai, B.G.O., & Odderson, I.R. (2000). Involuntary masturbation as a manifestation of stroke-related alien hand syndrome. American Journal of Physical Medicine & Rehabilitation, 79, 395-398.

Jacome, D.E. & Risko, M.S. (1983). Absence status manifested by compulsive masturbation. Archives of Neurology, 40, 523-524.

Scepkowski, L.A. & Cronin-Golomb, A. (2003). The alien hand: Cases, categorizations, and anatomical correlates. Behavioral and Cognitive Neuroscience Reviews, 2, 261-277.

The weighting game: Gambling with the nation’s health (revisited)

A couple of weeks ago I wrote a blog on why problem gambling should be considered a health issue. Earlier this week, I came across an interesting study carried out by jackpot.co.uk who surveyed 2,131 online gamblers (58% males and 42% female) about their health. After the self-reported data had been collected, the gamblers were classed into one of nine categories based on the casino game type that the gambler played most often (i.e., slot machines, video poker, blackjack, roulette, dice/craps, baccarat, poker, pai gow, and ‘other’). The data were then tabulated so that all the health variables (including obesity) corresponded to the gambler’s preferred casino game.

I was interested in the findings not only because I am a Professor of Gambling Studies, but also because I was a member of the Department of Health’s Expert Working Group on Sedentary Behaviour, Screen Time and Obesity’ (a reference to our final report to the British government can be found in the ‘Further Reading’ section below). The study took an objective measurement of physical condition by asking each gambler their height (centimetres) and their weight (kilograms) to calculate each person’s Body Mass Index (BMI) by dividing the gamblers’ weight by height (metres) and dividing by height again (for example, someone who weighs 80kg and is 180cm tall, the BMI is 24.1 as this is 80/1.80)/1.80). The survey then asked s few general health and lifestyle questions (similar to ones that we have used in the last few British Gambling Prevalence Surveys:

  • Do you normally drink more than the recommended limit for weekly alcohol consumption (21 units of alcohol for men and 14 for women)? (Yes/No)
  • Do you smoke regularly? (Yes/No)
  • Do you normally engage in at least 30 minutes of physical activity, 5 times per week? (Yes/No)

Overall, the survey found that British casino gamblers as a group were no less healthy than the rest of the British population, with an average Body Mass index (BMI) of 27 (which is the same as the UK national average). However, the survey also reported that the average BMIs, health, and lifestyle choices (such as smoking cigarettes, engaging in exercise, and drinking alcohol varied considerably depending on the casino games that the respondents played. Here are some of the main findings:

  • Slots players were the least healthy. They took less exercise and had an average BMI of 31, pushing them into the category of obese (which is linked to increased chance of developing illnesses such as Type 2 diabetes and reduced life expectancy)
  • Roulette, blackjack, video poker and craps/dice players were not far behind slots players, each having BMI levels higher than the national average.
  • Those that played poker, baccarat and Pai Gow had an average BMI of 25 or under (well within the normal range recommended by the World Health Organisation.
  • Whilst drinking levels might be reasonably high among poker players, they were very exercise conscious, with 58% engaging in physical activity for at least 30 minutes, five times a week. For slots players the figure was 27% meeting this government recommended target.
  • Overall slots players drink the most, with 24.1% drinking over the recommended weekly limit. Poker players are not far behind on 23%. Female slots players were the biggest drinking subgroup, closely followed by male poker players.
  • Slots players also smoked more, with 24% being regular smokers (compared to the UK national average of 20%). Blackjack and roulette players smoked slightly more than average, on 21% and 22% respectively, while poker players smoked slightly less than average, on 19.5%.

None of these results is overly surprising as there are many studies (including my own) showing comorbidity between gambling and other potentially addictive behaviours. However, very few academic studies have ever looked at these health variables by game type. Although this was not an academic study, the results will likely be of interest to those in the gambling studies field.

The survey also examined the most common platform on which the gamblers played casino games. The most common was the desktop computer (65%), followed by mobiles and tablets (20%) and land-based casinos (14%). This is not surprising given the survey was completed by online gamblers. Interestingly, desktop use was linked to higher levels of obesity, drinking and smoking. This is something that I would expect given that online gambling is the most sedentary of these activities.

There are (of course) some limitations with the data collected particularly as it comprised a self-selected sample of online gamblers that played via jackpot.co.uk websites. We have no idea as to whether the sample is representative of all online gamblers but as I noted above, it is no surprise that online gamblers preferred playing casino games online compared to offline (i.e., land-based casinos). The data were also self-report and are therefore open to any number of individual biases including recall biases and social desirability biases. Also, we have no geographical breakdown of the sample as the internet (by definition) is global. However, the sample size is good in comparison to many published studies on gambling and the sample included individuals that were actually gamblers (as opposed to university undergraduates or members of the general public). According to Sam Marsden (editor of jackpot.co.uk and author of the report):

“There’s an undeniable link connecting passive games like slots and video poker to unhealthy, sedentary lifestyles. On the other hand, games that require concentration, strategy and some physical stamina like poker and blackjack seem to fare much better in the health stakes. It seems it’s less a case of ‘you are what you eat’ and more ‘you are what you play’.”  

Although such a conclusion could be argued to be PR spin on the findings, the results suggest that more rigorous studies could be carried out in the area including secondary analyses of the robust datasets that already exist including the British Gambling Prevalence Surveys, the English Health Surveys, and the Scottish health Surveys.

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Biddle, S., Cavill, N., Ekelund, U., Gorely, T., Griffiths, M.D., Jago, R., et al. (2010). Sedentary Behaviour and Obesity: Review of the Current Scientific Evidence. London: Department of Health/Department For Children, Schools and Families (126pp).

Griffiths, M.D. (2001). Gambling – An emerging area of concern for health psychologists. Journal of Health Psychology, 6, 477-479.

Griffiths, M.D. (2004). Betting your life on it: Problem gambling has clear health related consequences. British Medical Journal, 329, 1055-1056.

Griffiths, M.D. (2007). Gambling Addiction and its Treatment Within the NHS. London: British Medical Association (ISBN 1-905545-11-8).

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2010). Gambling, alcohol consumption, cigarette smoking and health: findings from the 2007 British Gambling Prevalence Survey. Addiction Research and Theory, 18, 208-223.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2011). Internet gambling, health. Smoking and alcohol use: Findings from the 2007 British Gambling Prevalence Survey. International Journal of Mental Health and Addiction, 9, 1-11.

Marsden, S. (2014). Booze, bets, and BMI. Jackpot.co.uk, October 6. Located at: http://www.jackpot.co.uk/online-casino-articles/booze-bets-bmi

Rigbye, J. & Griffiths, M.D. (2011). Problem gambling treatment within the British National Health Service. International Journal of Mental Health and Addiction, 9, 276-281.

Wardle, H., Griffiths, M.D., Orford, J., Moody, A. & Volberg, R. (2012). Gambling in Britain: A time of change? Health implications from the British Gambling Prevalence Survey 2010. International Journal of Mental Health and Addiction, 10, 273-277.

Wardle, H., Moody. A., Spence, S., Orford, J., Volberg, R., Jotangia, D., Griffiths, M.D., Hussey, D. & Dobbie, F. (2011). British Gambling Prevalence Survey 2010. London: The Stationery Office.

Wardle, H., Seabury, C., Ahmed, H., Payne, C., Byron, C., Corbett, J. & Sutton, R. (2014). Gambling behaviour in England and Scotland: Findings from the Health Survey for England 2012 and Scottish Health Survey 2012. London: NatCen.

Wardle, H., Sproston, K., Orford, J., Erens, B., Griffiths, M. D., Constantine, R., & Pigott, S. (2007). The British Gambling Prevalence Survey 2007. London: National Centre for Social Research.

Method factors: The cognitive psychology of gambling (revisited)

One of the proudest moments of my academic career was when my 1994 study on the role of cognitive bias in slot machine gambling published in the British Journal of Psychology was introduced as a compulsory study that all ‘A’ Level students on the OCR syllabus have to learn about here in the UK. Today’s blog looks at that 1994 study in context.

I began a PhD on the psychology of slot machines back in 1987 and spent the first three or four months reading everything I could about how psychological research methods had been used to study this relatively new area of research. As a PhD student, the paper that really inspired me was a pioneering study by George Anderson and Iain Brown (also published in the British Journal of Psychology in 1984). Up until the mid-1980s almost all of the experimental work on the psychology of gambling had been done in laboratory settings and the question of ecological validity was something that I had great concerns about. I didn’t want to study gamblers in a psychology laboratory, I wanted to examine them in the gambling environments themselves. Anderson and Brown studied the role of arousal in gambling and used heart rate measures as an indicator of arousal. They found that regular gamblers’ heart rates increased significantly by around 23 beats per minute (compared to baseline resting levels) when they were gambling in a casino but when doing the same activity in a laboratory setting there was no significant increase in heart rate. To me, this perhaps explained why previous studies on arousal during laboratory gambling had failed to find significant heart rate increases above baseline levels.

Anderson and Brown claimed that Skinnerian reinforcement theory couldn’t account for the phenomenology of addictive gambling (especially relapse after abstinence). As a result of their ecologically valid experimental study, Anderson and Brown postulated a theoretical model centred upon individual differences in cortical and autonomic arousal in combination with irregular reinforcement schedules. They argued for a neo-Pavlovian model in which arousal played a central role in the addiction process. According to Anderson and Brown this model accounts for reinstatement after abstinence and allows for the maintenance of the behaviour by internal mood/state/arousal cues in addition to external situation cues. I found this theoretical perspective too restrictive and believed that gambling addiction was a more complex process and was the consequence of a combination of a person’s biological/genetic predisposition, their psychological make-up (personality, attitudes, beliefs, expectations, etc.), and the environment they were brought up in. This is what most people would now recognize as a biopsychosocial perspective that runs through much of my subsequent writing and research. Added to this, I passionately believed there were other important factors at play including the situational factors of where the activity took place such as the design of the gambling environment, and the structural features of the activity itself such as the speed of play and ambient factors like lights, colour, noise and music.

My 1994 study found that regular gamblers produced significantly more irrational verbalisations that non-regular gamblers. (The ethics committee wouldn’t let me use non-gamblers as they didn’t want participants to be introduced to gambling via a university research study!). One of the most observations in my study was that regular gamblers personified the machine and often treated the machine as if it was a person. They attributed thought processes to it and would talk to it as if it could actually hear them. Another of the more interesting observations concerned ‘the psychology of the near miss’ (or more accurately. ‘the near win’). I noticed that when I used the ‘thinking aloud method’ as a way of gaining direct cognitive access to what gamblers were thinking as they played a slot machine, regular gamblers often explained away their losses and changed clear losing situations into near winning ones. On a cognitive level gamblers weren’t constantly losing, they were constantly nearly winning, and this, I argued, was both psychologically and physiologically rewarding for them. (I also did a study where I measured gamblers’ heart rates in an amusement arcade where, like Anderson and Brown I found regular gamblers had significantly increased heart rates when compared to baseline resting levels).

Anyone reading my 1994 paper will instantly spot what appears to be a major limitation of the study – the fact that there was no inter-rater reliability in the coding of the verbalisations that I transcribed. Could this be (as some have argued) the Achilles Heel of the study? I have argued that in the context of this study having a second rater might have added a confounding variable in itself. Another rater wouldn’t have had the time with the data that I had and wouldn’t have been there at the time of the experiment. In short, ‘not being there’ would have been a great disadvantage to a second coder as they would not have understood the context in which various verbalizations were made. I transcribed each tape straight after each trial so that I could remember the context of everything that was said by each player. I would also add that this was one study that was done in conjunction with lots of others simultaneously (the details of which are provided below).

The work of Dr. Paul Delfabbro in Australia built on my idea of analysing gamblers within session and postulated that gambling is maintained by winning and losing sequences within the operant conditioning paradigm (i.e., that the only rewards and reinforcers in gambling are purely monetary). I then argued in response to that paper (in a 1999 issue of the British Journal of Psychology) that Delfabbro’s contribution was too narrow in its focus in that they had taken no account of the ‘near miss’ in relation to operant conditioning theory and that there may be other reinforcers that play a role in the maintenance process (such as physiological rewards, psychological rewards, and social rewards). I also argued that gambling was biopsychosocial behaviour and should therefore be explained by a biopsychosocial account.

My 1994 study showed that gamblers could be studied in real-life contexts and that useful data could be collected. It also showed the complexity of gambling and that gamblers could turn apparently objective outcomes (i.e., losing) into ones that were highly subjective (i.e., near winning ones). I also showed that this had implications for treatment and that maybe these cognitive biases could be used by psychologists as a way of ‘re-educating’ gamblers through some kind of ‘cognitive correction’ technique. I should also point out that this one experimental study was one small part of a much bigger jigsaw. What I mean by this is that my 1994 shouldn’t be seen in isolation but read along with my simultaneous observational studies of arcade gamblers, my other experimental studies, my semi-structured interview studies, surveys, and my case studies. All of these studies as a whole were featured in my first book (Adolescent Gambling, published in1995).

My work into the role of cognitive bias in gambling and gambling addiction also led to me studying behavioural addictions more generally. Since I finished my PhD I have branched out and carried out research into videogame addiction, Internet addiction, sex addiction, work addiction, and exercise addiction. Many psychologists don’t view excessive behaviour as an addiction, but for me gambling is the ‘breakthrough’ addiction. I have argued that when gambling is taken to excess it can be comparable to other more recognised addictions like alcoholism. If you accept that gambling can be a genuine addiction, there is no theoretical reason why other behaviours when taken to excess cannot be considered potentially addictive if ‘gambling addiction’ exists.

A key difference between excessive use and addiction is the detrimental effects (or lack of) that arise as a result of that behaviour. When people are addicted to a behaviour that becomes the single most important thing in their life, they compromise everything else in their life to do it. A person’s job/work, personal relationships and hobbies are severely compromised. The basic difference between an excessive healthy enthusiasm and an addiction is that healthy enthusiasms add to life – addictions take away from it. This is very much a (non-psychological) lay view, but there is a lot of truth in it.

I am the first to admit that my 1994 study when taken in isolation is hardly up there with the ‘classic’ studies of Freud, Watson, Skinner or Milgram. However, as part of two decades of other research into gambling and other potentially excessive behaviours I would like to think I have had an influence in my field. Only time will tell.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Allegre, B., Souville, M., Therme, P. & Griffiths, M.D. (2006). Definitions and measures of exercise dependence, Addiction Research and Theory,14, 631-646.

Anderson, G. and Brown, R.I.F. (1984). Real and laboratory gambling, sensation seeking and arousal. British Journal of Psychology, 75, 401-410.

Delfabbro, P. & Winefield, A.H. (1999). Poker machine gambling: An analysis of within-session characteristics. British Journal of Psychology, 90, 425-439.

Griffiths, M.D. (1990). The acquisition, development and maintenance of fruit machine gambling. Journal of Gambling Studies, 6, 193-204.

Griffiths, M.D. (1991a). The observational study of adolescent gambling in UK amusement arcades. Journal of Community and Applied Social Psychology, 1, 309-320.

Griffiths, M.D. (1991b). Fruit machine addiction: Two brief case studies. British Journal of Addiction, 85, 465.

Griffiths, M.D. (1993a). Fruit machine gambling: The importance of structural characteristics. Journal of Gambling Studies, 9, 101-120.

Griffiths, M.D. (1993b). Tolerance in gambling: An objective measure using the psychophysiological analysis of male fruit machine gamblers. Addictive Behaviors, 18, 365-372.

Griffiths, M.D. (1993c). Pathological gambling: Possible treatment using an audio playback technique. Journal of Gambling Studies, 9, 295-297.

Griffiths, M.D. (1993d). Factors in problem adolescent fruit machine gambling: Results of a small postal survey. Journal of Gambling Studies, 9, 31-45.

Griffiths, M.D. (1993e). Fruit machine addiction in adolescence: A case study. Journal of Gambling Studies, 9, 387-399.

Griffiths, M.D. (1994). The role of cognitive bias and skill in fruit machine gambling. British Journal of Psychology, 85, 351-369.

Griffiths, M.D. (1995a). The role of subjective mood states in the maintenence of gambling behaviour, Journal of Gambling Studies, 11, 123-135.

Griffiths, M.D. (1995b). Adolescent gambling. London: Routledge.

Griffiths, M.D. (1999). The psychology of the near miss (revisited): A comment on Delfabbro and Winefield. British Journal of Psychology, 90, 441-445.

Griffiths, M.D. (2005). A “components” model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.

Griffiths, M.D. (2008). Diagnosis and management of video game addiction. New Directions in Addiction Treatment and Prevention, 12, 27-41.

Griffiths, M.D. & Delfabbro, P. (2001). The biopsychosocial approach to gambling: Contextual factors in research and clinical interventions. Journal of Gambling Issues, 5, 1-33.

Griffiths, M.D. & Parke, J. (2003). The environmental psychology of gambling. In G. Reith (Ed.), Gambling: Who wins? Who Loses? pp. 277-292. New York: Prometheus Books.

Parke, J. & Griffiths, M.D. (2006). The psychology of the fruit machine: The role of structural characteristics (revisited). International Journal of Mental Health and Addiction, 4, 151-179.

Parke, J. & Griffiths, M.D. (2007). The role of structural characteristics in gambling. In G. Smith, D. Hodgins & R. Williams (Eds.), Research and Measurement Issues in Gambling Studies. pp.211-243. New York: Elsevier.

Widyanto, L. & Griffiths, M.D. (2006). Internet addiction: A critical review. International Journal of Mental Health and Addiction, 4, 31-51.

Ginger rogerers: A very brief look at figging‬

While researching various other blogs (most notably one on urtication and sexual arousal from stinging nettles), I came across the sexual practice of figging. For the uninitiated, figging in the broadest sense refers the act of inserting something (typically ginger) into the body (typically a bodily orifice such as the anus, vagina and/or urethra) that subsequently causes a stinging and/or burning sensation for sexual pleasure and arousal. Figging would appear to be a relatively rare sexual activity, as it doesn’t appear in either Dr. Anil Aggrawal’s Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices or Dr. Brenda Love’s Encyclopedia of Unusual Sex Practices. Furthermore, there is not a single reference to figging in any academic article or book that I am aware of. According to an online article at the London Fetish Scene website:

“The word [figging] is likely to be a derivative of ‘feague’, the practice during Victorian times of putting a piece of peeled ginger into a horse’s anus to make it appear more sprightly and hold its tail up (for shows and selling). Mostly, figging is still used to mean putting a peeled, shaped piece of ginger root into an anus, but in a BDSM context the anus would be that of a [submissive]. Sometimes ‘figging’ is used to refer to a pervertable other than ginger (for example nettles) and also to cover the insertion into the vagina, athough it may be incorrect to consider these as figging…The ginger root is skinned and may also be carved into the shape of a butt plug. Inserting ginger into a healthy anus for even quite lengthy periods should cause no physical damage…Apart from, or together with, figging, ginger pieces or juice from crushed ginger can be inserted in the vagina or applied to the clitoris or male genitals. Care should be taken here, especially with juice, as the genitals are much more sensitive…Victorian texts on the proper treatment of recalcitrant wives included the instructions for figging as it was considered that a spanking should be received on relaxed buttocks and this was seen as one way to train them to receive the spanking properly. It may be from this practice that the phrase who gives a fig?’ originated”.

(By the way, I had never come across the word ‘pervertible’ but in another article on the London Fetish Scene website, pervertibles are defined as “ordinary non-sexual objects, especially everyday household objects, that can be used sexually, particularly in BDSM play”). The (very short) Wikipedia entry on figging also makes reference to the practice of inserting ginger into the anuses of horses (although they describe this practice as ‘gingering’ rather than figging).

As with other types of pain, sexual masochists can find the painful sensations of figging an erotic experience. In sadomasochistic sexual activity, the dominant partner may use figging as a punishment on their submissive partner. The London Fetish Scene article claims:

“If the sub is made to tighten his/her buttocks with a fig inside the anus, the sensation becomes more intense: thus they will usually try to relax those muscles. This provides a good target for caning or spanking, which will often cause the sub to clench his/her backside, which will immediately increase the feeling of heat and pain, thus causing them to want to un-clench”.

There is also the very similar practice called ‘rhapanidosis’ which refers to the insertion of horseradish into bodily orifices (usually the anus), and was allegedly a punishment given to adulterous wives in ancient Athens. According to Wikipedia:

“There is some doubt as to whether the punishment was ever enforced or whether the references to it in comic plays (such as the debate between Right and Wrong in The Clouds of Aritophanes) should be understood as signifying public humiliation in general. In order to be allowed to apply rhaphanidosis to an adulteror, one must catch the man in the act of adultery with one’s own wife, in one’s own house. Rhaphanidosis was not the only penalty available; sodomy by mulletfish was common as well, or the man could simply be killed on the spot. Following this, the adulterous wife would have to be divorced”.

In my research for this blog I came across more than a few websites that espouse the joys of figging. The Figging (Anal Discipline) website has a surprisingly diverse set of articles (such as one on ‘Why figging enhances sex’) and there are a number of websites that provide a ‘how to’ guide for figging. For instance, one detailed guide on the Live Journal by a BDSM practitioner provides the ‘theory and practice of ginger figging’ and asserts:

“Figging is a fairly rare practice that seems to have declined in popularity recently, which I think is a shame because it’s so easy and the effects are so interesting. It’s a lot of fun, and I encourage people to experiment with it”.

There’s also an interesting first person account by Elizabeth Black on the Sex is Social website who describes in detail the first time she tried it (and liked it). Other first hand accounts didn’t (such as those on A Kinkster’s Guide concluding “Stick to sex toys – don’t try this!”). Although there are many academic articles on sadomasochism and sadomasochistic practices, not one of them mentions figging. Therefore, we know absolutely nothing about the prevalence of the practice (but as I said earlier, it is likely to be very rare).

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Black, E. (2010). The fine art of figging Sex is Social, January 2. Located at: http://www.edenfantasys.com/sexis/sex/figging-0102101/

Figging: Anal Discipline (2005). Why figging enhances sex. November 19. Located at: http://www.figging.com/2005/11/19/why-figging-enhances-sex/

Live Journal (2007). BDSM: Theory and practice of figging. Located at: http://tacit.livejournal.com/225189.html

Wikipedia (2013). Figging. Located at: http://en.wikipedia.org/wiki/Figging

Wikipedia (2013). Rhaphanidosis. Located at: http://en.wikipedia.org/wiki/Rhaphanidosis

Wipi (2013). Figging. Located at: http://www.londonfetishscene.com/wipi/index.php/Figging

Wipi (2013). Pervertible. Located at: http://www.londonfetishscene.com/wipi/index.php/Pervertable

Blocked-in syndrome: Another look at Game Transfer Phenomena

Back in the early 1990s, I used to play the video game Tetris on my handheld Nintendo Game Boy. Although I say so myself, I was a really good player and I used to play for hours every day. When I went to bed I would see falling blocks as I closed my eyes. I often experienced the same thing when waking up. What I didn’t realise was that many other gamers experienced this too and that it had a name – ‘The Tetris Effect’. According to Wikipedia,the Tetris effect occurs when people devote so much time and attention to an activity that it begins to pattern their thoughts, mental images, and dreams.”

In the late 1980s I started researching into the area of video game addiction. One of the papers I cited a lot in my early research concerning the side effects of excessive playing was a 1993 case study published in the Irish Journal of Psychological Medicine by Dr. Sean Spence. Dr. Spence reported the case of a female video game player who was diagnosed as suffering from persecutory delusions, exhibiting violent behaviour, and experiencing constant imaginary auditory hallucinations triggered by the music of the Super Mario Brothers video game. This case study and the Tetris effect are both examples of what I and my research colleague Angelica Ortiz de Gortari call ‘game transfer phenomena’ (GTP).

These phenomena tend to occur when video game players become so immersed in their gaming that when they stop playing, they sometimes transfer some of their virtual gaming experiences to the real world. These phenomena can occur both visually and aurally as well is in the form of unconscious bodily movements.

We have been researching GTP for a number of years and our first published study in 2011 made worldwide news. Some of the press coverage was both sensationalist (“Gamers can’t tell real world from fantasy, say researchers) and misleading (“How video games blur real life boundaries and prompt thoughts of violent solutions to players’ problems) and angered some of the gaming community. Our first published study in the International Journal of Cyber Behavior, Psychology and Learning was an exploratory study in which 42 gamers were interviewed. Although the sample was small, we reported that all our participants had, at some point, experienced some type of involuntary sensations, thoughts, actions and/or reflexes in relation to videogames when not playing them. For instance, one gamer reported witnessing a mathematics equation appearing in a bubble above his teacher’s head while another reported health bars hovering over football players from a rival team. However, this didn’t stop some of the press coverage being derogatory (Unscientific survey of 42 gamers concludes video games interfere with perceptions of reality).

Since then we have published three more studies from a self-selected dataset of over 1,600 gamers’ experiences (all of who had experienced some form of GTP) in various academic journals (International Journal of Human Computer Interaction; International Journal of Mental Health and Addiction; International Journal of Cyber Behavior, Psychology and Learning). Our findings have shown that some gamers (i) are unable to stop thinking about the game, (ii) expect that something from the game will happen in real life, (iii) display confusion between video game events and real life events, (iv) have impulses to perform something as in the video game, (v) have verbal outbursts, and (vi) experience voluntary and involuntary behaviours.

While some gamers qualify their experiences as funny, amusing, or even normal, others said they got surprised, felt worried, embarrassed and their experiences were a reason to quit playing. Based on our research so far, Game Transfer Phenomena appear to be commonplace among excessive gamers but the good news is that most of these phenomena are short-lasting, temporary, and appear to resolve of their own accord.

Despite instances of GTP elsewhere in the psychological and medical literature, we argue that there are important reasons for not using the ‘Tetris effect’ concept when studying game transfer effects. Among the most important are that: (i) the Tetris effect definition is very broad and does not emphasize the importance of the association between real life stimulus and video game elements as a trigger of some of the transfer experiences, (ii) it does not make a clear distinction between sensorial modalities in the game transfer experiences or talk about players’ experiences across sensorial modalities (e.g., hearing a sound and visualizing a video game element), and (iii) the name itself is inspired by a one specific stereotypical puzzle game (i.e., Tetris). This simple name indicates that it is repetition that triggers the transfer effects but there are other factors involved in game transfer experiences. Furthermore, modern video games use more than abstract shapes and offer more flexible scenarios compared to Tetris and similar games.

Our latest study that surveyed over 2,500 gamers is currently being analysed but preliminary results indicate that game transfer phenomena appear to be common among players – especially those that play heavily. It could be that some gamers are more susceptible than others to experience GTP. Although for many gamers the effects of these experiences appear to be short lived, our research also shows that some gamers experience them recurrently. More research is needed to understand the cognitive and psychological implications of GTP. Our studies to date show there is a need to investigate neural adaptations and after-effects induced by video game playing as a way of encouraging healthy and safe video game playing.

Note: This blog is an extended version of an article first published in The Conversation

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK 

Further reading

Gackenbach, J.I (2008). Video game play and consciouness development: A transpersonal perspective. Journal of Transpersonal Psychology, 40(1), 60-87.

Griffiths, M. D., Kuss, D.J., & Ortiz de Gortari, A. (2013). Videogames as therapy: A review of the medical and psychological literature. In I. M. Miranda & M. M. Cruz-Cunha (Eds.), Handbook of research on ICTs for healthcare and social services: Developments and applications (pp.43-68). Pennsylvania: IGI Global.

Ortiz de Gotari, A., Aronnson, K. & Griffiths, M.D. (2011). Game Transfer Phenomena in video game playing: A qualitative interview study. International Journal of Cyber Behavior, Psychology and Learning, 1(3), 15-33.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2012). An introduction to Game Transfer Phenomena in video game playing. In J. Gackenbach (Ed.), Video Game Play and Consciousness (pp.223-250). Nova Science

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Altered visual perception in Game Transfer Phenomena: An empirical self-report study. International Journal of Human-Computer Interaction, 30, 95-105.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Auditory experiences in Game Transfer Phenomena: An empirical self-report study. International Journal of Cyber Behavior, Psychology and Learning, 4(1), 59-75.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Automatic mental processes, automatic actions and behaviours in Game Transfer Phenomena: An empirical self-report study using online forum data. International Journal of Mental Health and Addiction, 12, 432-452.

Parfitt, B. (2011). Metro “can’t tell real world from fantasy”. MCV. September 21. Located at: http://www.mcvuk.com/news/read/metro-can-t-tell-real-world-from-fantasy/085065

Purchase, R. (2011). Prof clarifies Game Transfer Phenomena. Eurogamer.net. September 21. Located at: http://www.eurogamer.net/articles/2011-09-21-game-transfer-phenomena-authors-defence

Spence, S.A. (1993). Nintendo hallucinations: A new phenomenological entity. Irish Journal of Psychological Medicine, 10, 98-99.

The Tetris Effect. Located at: http://en.wikipedia.org/wiki/Tetris_effect

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