Aid and a bet: Can personalised feedback help online gamblers play more responsibly?

In recent years, online gambling has become a more common leisure time activity. Research around the world suggests around 8-16% of adults have gambled online during the past year. Research has also demonstrated that there are a number of situational and structural characteristics that make online gambling potentially risky for susceptible and vulnerable individuals. Such factors include increased accessibility, affordability, anonymity and specific structural features of online games such as high event frequency. In addition, some forms of online gambling may be more problematic than others (e.g., online poker, online casino games).

A number of scientific studies have also shown that there are typically more problematic gamblers among those that gamble on the internet compared to those that only gamble in land-based venues. However, problem gambling severity is associated with overall engagement and that when the volume of gambling is controlled for, Internet gambling is not predictive of problems. Furthermore, most online gamblers are also offline gamblers and gamble on many different activities and across different gambling platforms.

Given the increasing number of people gambling online and issues surrounding problem gambling, many of the more socially responsible gambling companies around the world have started to use responsible gambling tools to help their clientele gamble more safely (such as the option to set time and money spending limits or to temporarily self-exclude from gambling for a day, week, month, or longer). In fact, one of our own studies recently demonstrated that the use of both time and money spending limits are most effective among gamblers that play most frequently, and that the effects are differential. For instance, time spending limits were most useful for online poker players and monetary spending limits were most useful for online casino players.

In addition, gamblers can now access and/or are given general advice on healthy and responsible gambling, as well as information about common misbeliefs and erroneous perceptions concerning gambling. However, findings on the effectiveness of providing gamblers with information in correcting or changing erroneous beliefs have been mixed. Some outcomes support the display of information, while other studies have reported non-significant results.

Studies have also shown that the way information is presented can significantly influence behaviour and thinking. Several studies have investigated the effects of interactive versus static pop-up messages during gambling sessions. Static messages do not appear to be effective, whereas interactive pop-up messages and animated information have been shown to change both irrational belief patterns and behaviour of gamblers. It has also been suggested that informational warning signs should promote the application of self-appraisal and self-regulation skills rather than the simple provision of information.

In one of our more recent studies, we investigated the effect of a pop-up message that appeared after 1,000 consecutive online slot machine games had been played during a single gambling session using behavioural tracking data. Our study analysed 400,000 gambling sessions (200,000 sessions before the pop-up had been introduced and 200,000 after the pop-up had been introduced). We found that the pop-up message had a limited effect on a small percentage of players. Although the study reported nine times as many gamblers stopped after 1000 consecutive plays compared to those gamblers before the introduction of the pop-up message, the number of gamblers that actually stopped after viewing the pop-up message was less than 1%.

In a follow-up study, we investigated the effects of normative and self-appraisal feedback in a slot machine pop-up message compared to a simple (non-enhanced) pop-up message. The study compared two representative random samples of 800,000 gambling sessions (i.e., 1.6 million sessions in total) across two conditions (i.e., simple pop-up message versus an enhanced pop-up message). The results indicated that the additional normative and self-appraisal content doubled the number of gamblers who stopped playing after they received the enhanced pop-up message (1.39%) compared to the simple pop-up message (0.67%). Like our previous study, the findings suggested that pop-up messages influence only a small number of gamblers to cease long playing sessions but that enhanced messages are slightly more effective in helping gamblers to stop playing within-session. Our two studies evaluating pop-up messages are the only published studies that examine the impact of messaging on actual gamblers in a real world online gambling environment.

In order to make individuals gamble more responsibly using behavioural tracking data, we believe that player feedback should also be presented in a motivational way. In practical terms, this means presenting messages in a non-judgmental way alongside normative data so that gamblers can evaluate their actions compared to other like-minded individuals. One of our most recent studies examined personalised feedback and information given to players during real world gambling sessions. We hypothesized that gamblers receiving tailored feedback about their online gambling behaviour would be more likely to change their behaviour (as measured by the amount of time and money spent) compared to those who did not receive tailored feedback.

We were given access to the behavioural tracking data of 1,358 gamblers at a European online gambling website that had voluntarily signed up to a behavioural feedback system that we developed (called mentor) that is offered to all customers on the website. The system is an opt-in system (i.e., gamblers can voluntarily choose to use it and the system is not mandatory). Once gamblers have enrolled to use the system, they can retrieve detailed visual and numerical feedback about their gambling behaviour via a button on the website. Player feedback is displayed in a number of ways (numerical, graphical, and textual) and provides information about wins and losses, playing duration, number of playing days, and games played. The system can also display personal gambling behaviour over time. For instance, Figure 1 shows the playing time information for a hypothetical player in the form of a graph over time.

At the top of the screen, players receive information about playing time over the previous 4-week and 24-week period. The white line in Figure 1 indicates that the player shows an upward trend and is steadily increasing the amount of time spent gambling. During the previous 4-week period, the player spent 25.75 hours gambling online. The upper line in Figure 1 is the average playing time for all other comparable online players (depending upon what types of game are typically played) and provides the gambler both normative and comparative feedback. Such feedback has been emphasized as an important aspect in facilitating behavioural change. Players are either assigned to ‘lottery’ type players or ‘casino’ type players based on their playing patterns.

Of the daily active players, 10% (n=1,358) opted into the system. Players could opt-in via a clearly visible button on the post-login website page which appeared immediately after they logged into their account. The personalised information appeared in a new pop-up window. This typically led to a break in play, as gamblers who viewed the information are unlikely to play and view information simultaneously. The system tracks those players who sign up and therefore the opt-in date is known and can also be used for analytical purposes.

All the visual, numerical, and textual information can be accessed by the gambler via a user-friendly on-screen dashboard. Responsiveness means that interactive content automatically adapts to technical environments. The player front end thus looks similar on different devices such as desktops, laptops, mobile phones, or tablets and also across different browsers and operating systems such as Windows, Android or iOS.

We investigated whether players’ behaviour changed after they have registered for the mentor system and saw the personalised feedback for the first time. We then compared their gambling behaviour with over 15,000 online gamblers displaying the same types of gambling behaviour (i.e., matched controls). Our results indicated that the personalised feedback system achieved the hypothesised effect and that the time and money spent gambling was significantly reduced compared to the online gambler control group that did not utilize the mentor system. The results suggest that responsible gambling tools such as mentor may help the clientele of gambling companies gamble more responsibly, and may be of help those who gamble excessively.

To our knowledge, this study was the first real world study investigating the effects of behavioural feedback on actual gambling behaviour within a real online gambling website. However, there were a number of limitations. For instance, all of the players in the target population had voluntarily registered to use the mentor system and were therefore not selected randomly from the population of players (but we tried to overcome this by using a control group of matched pairs). In addition, the reliability of our findings is limited because our data were only collected from one online gambling environment. It may also the case that players who voluntarily signed up to receive personalised messages about their gambling were different in other ways from controls (i.e., gamblers who voluntarily signed up to receive personalised messages may have already been interested in reducing their gambling and would be likely to gamble less).

Another limitation is that we did not know whether any of the gamblers who voluntarily opted to use the mentor system were problem gamblers. Therefore we do not know whether the system captures gamblers most in need of such interventions. Based on the findings, one explanation may be that the tool may simply be curtailing gambling in those who already play responsibly. Although our study was performed in a real world setting utilising objective behavioural data, it is limited because the motivations and thoughts of the players were unknown and can only be inferred.

Online gambling operators have the technical capabilities to introduce behavioural feedback systems such as the one we described in our paper, and our findings suggest that a system like mentor can help players limit the amount of time and money spent gambling can be achieved. However, the findings are preliminary and future research should focus on investigating at which point in time players should receive personalised messages to optimize behavioural change.

Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Auer, M. & Griffiths, M. D. (2013). Voluntary limit setting and player choice in most intense online gamblers: An empirical study of gambling behaviour. Journal of Gambling Studies, 29, 647-660.

Auer, M. & Griffiths, M. D. (2014). Personalised feedback in the promotion of responsible gambling: A brief overview. Responsible Gambling Review, 1, 27-36.

Auer, M. & Griffiths, M. D. (2015). Testing normative and self-appraisal feedback in an online slot-machine pop-up message in a real-world setting. Frontiers in Psychology, 6, 339. doi: 10.3389/fpsyg.2015.00339.

Auer, M. & Griffiths, M. D. (2015). The use of personalized behavioral feedback for problematic online gamblers: An empirical study. Frontiers in Psychology, 6, 1406. doi: 10.3389/fpsyg.2015.01406.

Auer, M. & Griffiths, M.D. (2016). Personalized behavioral feedback for online gamblers: A real world empirical study. Frontiers in Psychology, 7, 1875. doi: 10.3389/fpsyg.2016.01875. 

Auer, M., Littler, A. & Griffiths, M.D. (2015). Legal aspects of responsible gaming pre-commitment and personal feedback initiatives. Gaming Law Review and Economics, 6, 444-456.

Auer, M., Malischnig, D. & Griffiths, M.D. (2014). Is ‘pop-up’ messaging in online slot machine gambling effective? An empirical research note. Journal of Gambling Issues, 29, 1-10.

Leisure pleasure treasure: A brief look at gambling within videogames

Over the last decade, gambling and gaming technologies have begun to converge with video games featuring gambling-like elements, and gambling games featuring video gaming-like elements. Many of the newer convergent gambling-gaming convergent forms include such activities as online penny auctions and gambling-type activities on social networking sites, so-called ‘social gaming’. With regard to video gaming including gambling-like elements, a paper that I co-wrote in 2012 with Dr. Daniel King in the journal International Gambling Studies noted that simulated gambling activities and gambling themes have a substantial presence in many modern video games. We noted that gambling content in video games can be categorized according to the following three categories:

• Standard gambling simulation, a digitally simulated interactive gambling activity that is structurally identical to the standard format of an established gambling activity, such as blackjack or roulette;
• Non-standard gambling simulation, an interactive gambling activity that involves the intentional wagering of in-game credits or other items on an uncertain outcome, in an activity that may be partially modelled on a standard gambling activity but which contains distinct player rules or other structural components that differ from established gambling games;
• Gambling references, the appearance of non-interactive gambling material or gambling-related paraphernalia/materials within the context of the video game.

In regard to the second of these categories, it could be argued that some online video games feature mini-games that are non-standard gambling simulations. For instance, in February 2014, the mini-game Treasure Hunter (TH) was introduced into the online video game Runescape. To get in-game prizes, players have to get keys to open chests. Originally, to participate in TH, players had to play in a members’ world. Players that tried to play TH in a free world are given the message: “As a member, you are eligible for improved prizes, so please play Treasure Hunter on a members’ world instead.” However, in April 2014, TH was reformulated and for the first time, members’ prizes could be claimed by those playing in a free world also.

In TH, five chests can be opened, each containing one of five different gems (going from most common to least common – white, yellow, orange, red, or purple gem – with white being the most common and purple being the rarest). After obtaining a key, players select a chest (not knowing what gem is inside the chest), and open it. The player is then given the option of storing the prize in the bank, discarding the prize, collecting the prize later, or cashing out for a small number of coins. There are a number of different ways to gain TH keys (free daily keys, keys obtained through skilful gameplay, and buying keys). Members get two free keys a day and those playing in free worlds only get one free key a day. Those players paying to be in the silver or gold Premier Club get three free keys a day.

It should also be noted that (i) TH is reset every night at midnight, (ii) free keys have to be used on the day, (iii) one monthly free key can be earned by playing ‘Troll Invasion’, (iv) players can buy bonds for gold coins or money, and (v) a random number generator is used to determine the winners. After completing any daily challenge, players receive an extra key, and after completing any in-game quest, players receive two additional keys. Keys can be bought in bundles of 15 (€3.99), 35 (€8.00), 75 (€16.00), 200 (€39.99) or 450 keys (€79.99). The maximum number of keys that could be bought is $200 (US) a day and $500 (US) a week. Keys can also be earned by watching advertisements, buying products, and completing surveys (and accessed via the ‘Earn keys’ option). TH prizes include in-game skilling items, weapons, bonus experience stars, etc. or can be converted to coins.

The legal definition of gambling in Great Britain is contained in the Gambling Act 2005. It notes that gambling includes “gaming”, “betting” or “participating in lottery”. Gaming is defined in the 2005 Act as “playing a game of a chance for a prize” while betting involves the process of placing or accepting a bet on anything other than financial services that remains uncertain to at least one party of the transaction at the time of the bet. By this definition alone, it would appear that Treasure Hunter is a form of gambling if purchases to participate are made (rather than being given free spins or keys, or earning them through skilful gameplay).

In 2015, the UK Gambling Commission highlighted that they believe the mini-games within Runescape to be ‘social gaming’ and not a game of chance and therefore out of their jurisdiction in relation to the regulation of the game. They have also claim that RuneScape bonds have no intrinsic value outside of Runescape under the terms of the British Gambling Act and therefore is not gambling. The Gambling Commission also note on their website that:

“We are not saying there are no risks in social gaming, nor are we saying that this ends our interest in the issue. We are simply saying that our current assessment of the available evidence is that there is no persuasive reason for us to take regulatory action, in effect to change from maintaining a watching brief. We will continue to monitor emerging evidence, and we are prepared to change this position if the evidence warrants it”.

However, there are instances when the bonds and prizes won do have value outside of the game. Bonds that are purchased with real life currency can be sold to another player for an in-game sum of money. Bonds and prizes can also be redeemed within the game for real-life services. These services are not just limited to the buying of game-related merchandise, such as the buying of card games like Top Trumps, but also includes attendance at offline RuneScape events, such as RuneFest, hotel rooms, and even plane tickets. The bonds can also be used to pay for postage and packing of items bought outside the game. Players can also donate the bonds to charity (in which Jagex contributes the full value of the bond to the charity chosen by the player). These examples clearly demonstrate that the bonds do have specific financial value outside the game in some circumstances, and an impact on real-world activities. More specifically, they demonstrate that the financial value of the bonds and prizes can be used outside the game itself.

Mini-games like Treasure Hunter within the online game RuneScape are not uncommon and are another example of convergence between gambling and video gaming. These games appear to meet the criteria for gambling found in the gambling studies literature and should be regulated as such.

Dr. Mark Griffiths, Professor of Behavioural Addictions, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Gambling Commission (2015). Explaining our approach to social gaming. Located at: http://www.gamblingcommission.gov.uk/Gambling-data-analysis/Social-media/Explaining-our-approach-to-social-gaming.aspx

Griffiths, M.D. (2003). Internet gambling: Issues, concerns and recommendations. CyberPsychology and Behavior, 6, 557-568.

Griffiths, M.D. (2015). Adolescent gambling and gambling-type games on social networking sites: Issues, concerns, and recommendations. Aloma: Revista de Psicologia, Ciències de l’Educació i de l’Esport, 33(2), 31-37.

Griffiths, M.D. & Carran, M. (2015). Are online penny auctions a form of gambling? Gaming Law Review and Economics, 19, 190-196.

Griffiths, M.D., King, D.L. & Delfabbro, P.H. (2009). Adolescent gambling-like experiences: Are they a cause for concern? Education and Health, 27, 27-30.

Griffiths, M.D., King, D.L. & Delfabbro, P.H. (2014). The technological convergence of gambling and gaming practices. In Richard, D.C.S., Blaszczynski, A. & Nower, L. (Eds.). The Wiley-Blackwell Handbook of Disordered Gambling (pp. 327-346). Chichester: Wiley.

Griffiths, M.D. & King, R. (2015). Are mini-games within RuneScape gambling or gaming? Gaming Law Review and Economics, 19, 64-643.

King, D.L., Delfabbro, P.H., Derevensky, J. & Griffiths, M.D. (2012). A review of Australian classification practices for commercial video games featuring simulated gambling. International Gambling Studies, 12, 231-242.

Stairing at the rude boys: A brief look at climacophilia

In a number of my previous blogs, I have mentioned sexual paraphilias that appear to have been derived from the opposite phobic behaviours. Some examples include defecaloesiophilia (sexual arousal from painful bowel movements), lockiophilia (sexual arousal from childbirth), categelophilia (sexual arousal from being ridiculed), and rupophilia (sexual arousal from dirt). Another one that I could add to this list is climacophilia (sexual arousal from falling down stairs). This particular paraphilia got a lot of media publicity a few years ago when Dr. Jesse Baring was plugging his 2013 book Perv: The Sexual Deviant In All Of Us. (which I will return to below; I ought to confess that I love reading Baring’s populist articles and Professor Paul Bloom [of Yale University] went as far as to describe him as the “Hunter S. Thompson of science writing.”). Climacophilia appears to be the opposite of climacophobia. The Wikipedia entry notes that:

“Climacophobia is the fear of climbing, especially using stairs. It is a type of specific phobia. Climacophobia is distinct from bathmophobia the fear of stairs themselves. Climacophobia is usually traced back to a negative experience, like falling down the stairs or having difficult time to climb stairs. The fear is also triggered by others, like witnessing somebody falling down stairs (either in real visualization or through media) or the other people he/she knows is suffering from climacophobia. Sufferers of climacophobia, if left untreated, end up limiting their activities and avoiding occupations that require the use of stairs or ladders. Sufferers tend to rely on elevators or disability-access ramps rather than stairs…Climacophobes tend to suffer from dizziness resembling vertigo when looking down stairs…Climacophobia can be treated using cognitive behavioural therapy [CBT], either independently or in tandem with other techniques. CBT can help sufferers stop negative thoughts about climbing while changing behaviors. Other treatment options include relaxation techniques, talk therapy, and medication for people who suffer severely from climacophobia”.

In Dr. Anil Aggrawal’s 2009 book Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices, climacophilia makes a seven-word entry between ‘clinical vampirism’ (arousal by drinking human or animal blood) and ‘coitobalnism’ (having sex in the bath), and is simply defined as deriving pleasure from falling down stairs. There was no mention of it all in Dr. Brenda Love’s Encyclopedia of Unusual Sex Practices. Various websites provide definitions including the Pro Boner website (“Climacophilia is an intriguing paraphilia characterised by sexual arousal to falling down the stairs. Climacophiles have their best orgasms when they’re falling down the stairs”) and the Buzz IO website (“Climacophilia is being sexually stimulated by seeing someone fall down a flight of stairs”). When reviewing Baring’s book, the New York Times defined it as “the erotic compulsion to tumble down stairs”. Wikipedia also has a short entry and simply states:

“Climacophilia is a rare sexual paraphilia, or fetish in which the subject experiences erotic gratification when falling down the stairs. There hasn’t been a wide body of research conducted on people affected with this particular sexual preference and/or fetish”.

All of these definitions and snippets imply slightly different things relating to the same alleged behaviour. While all involve some kind of sexual arousal from falling down stairs, the New York Times says the behaviour is an “erotic compulsion” whereas most others describe the behaviour as arousing, stimulating, and pleasurable (without being compulsive). One definition involves ‘orgasm’ being involved while the rest do not. The Wikipedia entry seems to imply that the paraphilia exists (it says “rare” rather than non-existent). The entry also says there “hasn’t been a wide body of research” suggesting there is some (perhaps a narrow body of research) – but that clearly isn’t the case. There’s none.

The journalist David DiSalvo interviewed Dr. Baring for Forbes magazine in relation to his book Perv, which covers 46 different paraphilias (all of which are listed in an article in the Huffington Post) – with paraphilias being defined by Baring as being “primary attraction to a target or activity outside of the statistical norm”. Although I agree that paraphilias tend to be non-normative, I’m not whether I’d ever use the phrase “outside of the statistical norm” as there are some paraphilic behaviours that the majority of sexually active individuals are likely to have engaged in at least peripherally (such as bondage and other milder forms of sadomasochistic behaviour). In relation to the paraphilias outlined in his book, baring told DiSalvo that:

“These included both exceptionally rare paraphilias (such as ‘climacophilia’ in which a person can only get off while tumbling down a flight of stairs) and the more run-of-the-mill ones that are detailed in the DSM-V, such as voyeurism, sadism, and frotteurism (which is gratification by touching people in crowded public places, such as subways). But that’s just a small sampling. The most authoritative list, cobbled together by an Indian psychiatrist named Anil Aggrawal, includes a total of 547 distinct paraphilias”.

If you type in Baring’s name and his book into Google, many articles appear which mention ‘climacophilia’. For instance, in an interview with Vice magazine, the journalist (Nadja Sayej) began her article by saying:

“You may have recently seen the soft-spoken Jesse Baring on Conan recalling the strangest of sexual fetishes. Be it arousal from falling down the stairs (Climacophilia) or feeling steamy from rolling around in stones and gravel (Lithophilia), nothing surprises the Western New York author and psychologist”.

Baring was asked by Sayej what the weirdest fetish he had come across but there was no mention of climacophilia (probably because no-one has ever come across it):

“According to a recent forensic resource by the psychiatrist Anil Aggrawal, there are 547 documented paraphilias. Some of them – actually, most of them – are quite carnival-like. But it’s important to remember that these more exotic manifestations of sexuality might be represented by just one lone figure in the universe: a single, sad, lascivious soul who can only, just to give two random examples, have an orgasm while fondling a mouse (“musophilia”) or while rolling around in ferns (“pteridomania”). It’s virtually impossible for me to pick the weirdest, since so many of them would fit the bill for truly bizarre. I’m reminded of one of my favorite quotes in this literature, from a sex research pioneer named Wilhelm Stekel – who, incidentally, coined the word ‘paraphilia‘ in the 1920s. “Variatio delectat! How innumerable are the variations which Eros creates in order to make the monotonous simplicity of the natural sex organ interesting to the sexologist”.

I have spent hours online trying to track down any evidence that climacophilia exists and I have drawn a complete blank. Yes, there are lots of mentions of it (particularly in the articles on Baring’s book) but no dedicated articles (except a satirical one that I came across on the Dumb Buzz Feed website which you can read here). There are no online forums where like-minded climacophiles congregate and there are no climacophiles that have written so much as a one-sentence confession of being sexually aroused either by falling down stairs or watching others fall down stairs. In an academic review of Baring’s book, in the journal Sexual and Relationship Therapy, Dr. David Ribner made a specific reference about Baring’s inclusion of climacophilia and said it was “incredulous…is there really someone out there who can only achieve orgasm by falling down a flight of stairs?”

Based on my own research I think I can answer that question in two letters. No.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Aggrawal A. (2009). Forensic and Medico-legal Aspects of Sexual Crimes and Unusual Sexual Practices. Boca Raton: CRC Press.

Baring, J. (2013). Perv: The Sexual Deviant In All Of Us. New York: Scientific American/Farrar, Strauss & Giroux.

Bergner, D. (2013). Acquired tastes. ‘Perv’, by Jesse Baring. New York Times, October 4. Located at: http://www.nytimes.com/2013/10/06/books/review/perv-by-jesse-bering.html

DiSalvo, D. (2013). Getting in touch with your inner sexual deviant. Forbes, October 24. Located at: http://www.forbes.com/sites/daviddisalvo/2013/10/24/getting-in-touch-with-your-inner-sexual-deviant/#6f0f5548568e

Dumb Buzz Feed (2015). 7 problems only people with climacophilia will understand. May 3. Located at: https://dumbuzzfeed.wordpress.com/2015/03/05/7-problems-only-people-with-climacophilia-will-understand/

Huffington Post (2013). 46 sexual fetishes you’ve never heard of. October 23. Located at: http://www.huffingtonpost.com/2013/10/23/sexual-fetish_n_4144418.html

Love, B. (2001). Encyclopedia of Unusual Sex Practices. London: Greenwich Editions.

Ribner, D.S. (2013). A review of ‘Perv: The sexual deviant in all of us’, by Jesse Baring. Sexual and Relationship Therapy, 30, 297-300.

Gore-ist information: A brief look at virtual reality horror games

“I recently played ‘The Visitor’ in VR. In front of an audience of drunken friends egging on my high pitch outbursts. I lasted seven out of the ten minutes, finally succumbing after a close encounter with a pixelated pillow. The Visitor’s story is about an unexpected guest calling to your house in the middle of the night. Developed by ‘NostalgicBear VR’ for the ‘Oculus Rift’ and ‘HTC Vive’ it relies on atmosphere to unsettle players, using visual cues in the form of intermittent flickering lights to inform the player where to look. Paralysed and lying in bed, you can only wait and watch as the strange occurrences culminate in one of the biggest jump scares I’ve ever experienced. As virtual reality goes, this particular experience has a high creep factor. It’s one of those new VR ‘games’ that really should come with a free pair of pants…In the wake of the PlayStation VR release, headed up by the dark and psychological Here They Lie, pretty much every major gaming outlet slashed their prices on horror games and gamers all over the world have been celebrating Halloween with their first exposure to a virtual reality freak out…VR grips the gamer with such a suspension of disbelief; when the headset is on there is seemingly no escape. Do developers take into account the psychological differences between previous gaming horror experiences and that of VR?”

The opening quote in today’s blog is from an article by Gareth May published last month for the Wareable website (‘Could VR horror be too…horrifying?’). I was interviewed by May for the story and is one of a number of media stories that I have been interviewed over the last year concerning virtual reality. Regular readers of my blog will know that I have a personal interest in horror films and a professional interest in excessive use of virtual reality so it was an interview I enjoyed doing (in fact, May interviewed me for two stories simultaneously, the other being on mechanophilia – sexual arousal from machines – which also was published last month in an article in the Daily Telegraph).

In his article on VR horror, May wanted to know about whether the playing of VR horror games could be problematic in any way (or as May asked me, ‘Is it possible that VR is just a bit too ‘real’?’). I pointed out that there had been little empirical research on the topic and that almost everything that I said was speculative. I noted that while VR is certainly more immersive than usual, we should remember that immersion can occur even without being in an VR environment. For instance, a lot of my research into video gaming demonstrates that gaming can be immersive (particularly the research I have been carrying out with Dr. Angelica Ortiz de Gortari on game transfer phenomena and some research I co-authored in the mid-2000s on time loss in video game play). I did point out to May that for most people, there’s not going to be a problem with playing VR horror games. Those that already enjoy watching horror films, the vast majority will probably love it even more in VR and it’s not going to have a negative impact on them. I told May that I loved gore in horror films and said that I would probably be fine playing an immersive horror VR game and that seeing somebody being disembowelled in front of me would have little effect on me psychologically. (However, I ought to point out that my few experiences of VR have left me feeling sick as I suffer from motion sickness). However, you can never rule out a small minority of individuals that it may negatively affect either psychologically or traumatically. In short, I don’t have many concerns about this until scientific evidence proves otherwise.

May also interviewed Professor Tanya Krzywinska, Director of the Games Academy at Falmouth University who thinks that VR and horror video games are a good match:

“VR is the next natural step for one of gaming’s most popular genres. Horror made its way into video games very early on [such as] the 1995 point and click ‘Phantasmagoria’ [was] an early breakthrough game due to its use of video snippets to show a ‘real’ actress reacting to the horrific events as they unfolded around her…’Silent Hill’ [was also] a game-changer for its use of sound and its surreal ‘Twin Peak-ish twist’ on survival horror. Both these games utilise a particular emotional palette that I regard as central to games: a sense of claustrophobia and the sense of being unable to act effectively on a situation…VR can make very good use of this palette because of its immersive nature and I think horror is one of the few genres that VR really suits…Horror is very inclined to want to take advantage of new formats to refresh the palette and work with the cache that the novelty provides. Without that novelty, repetition occurs and you then only manage to engage younger audiences who haven’t been around the horror block. Horror is a very suitable place to take a good, long, critical look at ethics and I hope that some game designers see that”.

So is the introduction of VR for the horror genre a game-changer? May also interviewed the independent games developer Sergio Hidalgo, creator of the creepy dungeon game Dreadhalls. He was quoted as saying:

“VR can work as an immersion multiplier, and given that the horror genre is built on immersion, it simply opens more opportunities to create experiences that take advantage of that sense of physicality it can provide. Simply being in a scary environment can be a very engaging experience in VR on its own. This was already true when I started ‘Dreadhalls’ but the technology keeps moving forward and improving with new developments such as room scale or motion tracked controllers…In ‘Dreadhalls’ there are monsters that react to the player’s gaze direction, forcing the player to either not look at them directly or the opposite. This is a much richer interaction when the player is performing it herself rather than via a mouse or controller. ‘Dreadhalls would never have gathered such attention if it weren’t for the new types of interactions and features made possible by VR tech…The main ethical recommendation I have in this regard is that of not betraying the player’s trust. When the player enters a VR experience and surrenders control over their senses to the developer, it’s important that [the players are] aware of exactly what to expect, and that this promise isn’t broken by the developer”.

In an interview that May had with Ben Tester, the games developer of VR horror game Don’t Knock Twice, Tester noted:

“Developers are in a strange predicament where it’s now possible to make a game that’s too scary. For that reason, ‘Don’t Knock Twice’ includes traditional adventure gameplay elements, such as puzzle solving and environmental props, to aid storytelling and remind the player every once in a while that they are still playing a game. We want to make a great horror game that people will remember for sure but we don’t want to make it so uncomfortable that it makes it unplayable. In ‘Don’t Knock Twice’, we want to avoid the player going through a constant stream of scares one after another and instead, create an interesting and atmospheric environment which will creep out any horror enthusiast. It’s about finding the right balance between having a solid gaming experience and immersing the player in a terrifying horror situation…In the VR demo of ‘Don’t Knock Twice’, players can break down a door with an axe. [This often leads to players] leaning their heads forward and triggering the classic ‘Here’s Johnny’ moment [from ‘The Shining’], which only amplifies the jump scare which follows. A scare that wouldn’t have been half as effective if it was in traditional gaming style”.

Finally, May asked me for some advice for those who were scared witless by playing VR horror games. My quoted response? “Just shut your eyes”.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Ashcroft, S. (2015). VR revenue to hit $21.8 billion by 2020. Wareable, July 29. Located at: http://www.wareable.com/vr/vr-revenues-could-reach-dollar-218-billion-by-2020-1451

Griffiths, M.D. (2016). Can virtual reality be addictive? Virtual Reality News, June 28. Located at: http://www.virtualreality-news.net/news/2016/jun/28/can-virtual-reality-really-be-addictive/

Juniper Research (2016). White paper: The rise of virtual reality. Available from: http://www.juniperresearch.com/document-library/white-papers/the-rise-of-virtual-reality

May, G. (2016). Could VR horror be too…horrifying? Wareable, November 3. Located at: http://www.wareable.com/vr/virtual-reality-horror-experiences-too-real-ethics-55

Ortiz de Gortari, A.B. & Griffiths, M.D. (2015). Game Transfer Phenomena and its associated factors: An exploratory empirical online survey study. Computers in Human Behavior, 51, 195-202.

Ortiz de Gortari, A.B., Oldfield, B. & Griffiths, M.D. (2016). An empirical examination of factors associated with Game Transfer Phenomena severity. Computers in Human Behavior, 64, 274-284.

Ortiz de Gortari, A.B., Pontes, H.M. & Griffiths, M.D. (2015). The Game Transfer Phenomena Scale: An instrument for investigating the non-volitional effects of video game playing. Cyberpsychology, Behavior and Social Networking, 18, 588-594.

Stables, J. (2016).  Gambling, gaming and porn: Research says VR is set to blast off. Wareable, September 15. Located at: http://www.wareable.com/vr/gaming-gambling-and-porn-research-says-vr-is-set-to-blast-off-1682

Sung, D. (2015). VR and vice: Are we heading for mass addiction to virtual reality fantasies? Wareable, October 15. Located at: http://www.wareable.com/vr/vr-and-vice-9232

Tractica (2015). Virtual reality for consumer markets. Available at: https://www.tractica.com/research/virtual-reality-for-consumer-markets/

Wood, R.T.A. & Griffiths, M.D. (2007). Time loss whilst playing video games: Is there a relationship to addictive behaviours? International Journal of Mental Health and Addiction, 5, 141-149.

Wood, R.T.A., Griffiths, M.D. & Parke, A. (2007). Experiences of time loss among videogame players: An empirical study. CyberPsychology and Behavior, 10, 45-56.

More mass debating: Compulsive sexual behaviour and the internet

The issue of sex addiction as a behavioural addiction has been hotly debated over the last decade. A recent contribution to this debate is a review by Shane Kraus and his colleagues in the latest issue of the journal Addiction that examined the empirical evidence base for classifying compulsive sexual behaviour (CSB) as a behavioural (i.e., non-substance) addiction. The review raised many important issues and highlighted many of the problems in the area including the problems in defining CSB, and the lack of robust data from many different perspectives (epidemiological, longitudinal, neuropsychological, neurobiological, genetic, etc.).

As my regular blog readers will know, I have carried out empirical research into a wide variety of different behavioural addictions (gambling, video gaming, internet use, exercise, sex, work, etc.) and have argued that some types of problematic sexual behaviour can be classed as sex addiction depending upon the definition of addiction used. I was invited by the editors of Addiction to write a commentary on the review and this has just been published in the same issue as the paper by Kraus and colleagues. This blog briefly looks at the issues in that review that I highlighted in my commentary.

For instance, there are a number of areas in Kraus et al.’s paper that were briefly mentioned without any critical evaluation. For instance, in the short section on co-occurring psychopathology and CSB, reference was made to studies claiming that 4%-20% of those with CSB also display disordered gambling behaviour. I pointed out that a very comprehensive review that I published with Dr. Steve Sussman and Nadra Lisha (in the journal Evaluation and the Health Professions) examining 11 different potentially addictive behaviours also highlighted studies claiming that sex addiction could co-occur with exercise addiction (8%-12%), work addiction (28%-34%), and shopping addiction (5%-31%). While it is entirely possible for an individual to be addicted to (say) cocaine and sex concurrently (because both behaviours can be carried out simultaneously), there is little face validity that an individual could have two or more co-occurring behavioural addictions because genuine behavioural addictions consume large amounts of time every single day. My own view is that it is almost impossible for someone to be genuinely addicted to (for example) both work and sex (unless the person’s work was as an actor/actress in the pornographic film industry).

The paper by Kraus et al also made a number of references to “excessive/problematic sexual behavior” and appeared to make the assumption that ‘excessive’ behaviour is bad (i.e., problematic).  While I agree that CSB is typically excessive, excessive sex in itself is not necessarily problematic. Preoccupation with any behaviour in relation to addiction obviously needs to take into account the context of the behaviour, as the context is far more important in defining addictive behaviour than the amount of the activity undertaken. As I have constantly argued, the fundamental difference between a healthy excessive enthusiasms and addictions is that healthy excessive enthusiasms add to life whereas addictions take away from them.

The paper also appeared to have an underlying assumption that empirical research from a neurobiological and genetic perspective should be treated more seriously than that from a psychological perspective. Whether problematic sexual behaviour is described as CSB, sex addiction and/or hypersexual disorder, there are thousands of psychological therapists around the world that treat such disorders. Consequently, clinical evidence from those that help and treat such individuals should be given greater credence by the psychiatric community.

Arguably the most important development in the field of CSB and sex addiction is how the internet is changing and facilitating CSB. This was not even mentioned until the concluding paragraph yet research into online sex addiction (while comprising a small empirical base) has existed since the late 1990s including sample sizes of up to almost 10,000 individuals. In fact, there have been a number of recent reviews of the empirical data concerning online sex addiction including its treatment including ones by myself in journals such as Addiction Research and Theory (in 2012) and Current Addiction Reports (in 2015). My review papers specifically outlined the many specific features of the Internet that may facilitate and stimulate addictive tendencies in relation to sexual behaviour (accessibility, affordability, anonymity, convenience, escape, disinhibition, etc.). The internet may also be facilitating behaviours that an individual would never imagine doing offline such as cybersexual stalking.

Finally, there is also the issue of why Internet Gaming Disorder was included in the DSM-5 (in Section 3 – ‘Emerging measures and models’) but sex addiction/hypersexual disorder was not, even though the empirical base for sex addiction is arguably on a par with IGD. One of the reasons might be that the term ‘sex addiction’ is often used (and arguably misused) by high profile celebrities as an excuse to justify their infidelity (e.g., Tiger Woods, Michael Douglas, David Duchovny, Russell Brand), and is little more than a ‘functional attribution’. For instance, the golfer Tiger Woods claimed an addiction to sex after his wife found out that he had many sexual relationships during their marriage. If his wife had never found out, I doubt whether Woods would have claimed he was addicted to sex. I would argue that many celebrities are in a position where they are bombarded with sexual advances from other individuals and have succumbed. But how many people would not do the same thing if they had the opportunity? Sex only becomes a problem (and is pathologised) when the person is found to have been unfaithful. Such examples arguably give sex addiction a ‘bad name’, and provides a good reason for those not wanting to include such behaviour in diagnostic psychiatry texts.

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Bocij, P., Griffiths, M.D., McFarlane, L. (2002). Cyberstalking: A new challenge for criminal law. Criminal Lawyer, 122, 3-5.

Cooper, A., Delmonico, D.L., & Burg, R. (2000). Cybersex users, abusers, and compulsives: New findings and implications. Sexual Addiction and Compulsivity, 6, 79-104.

Cooper, A., Delmonico, D.L., Griffin-Shelley, E., & Mathy, R.M. (2004). Online sexual activity: An examination of potentially problematic behaviors. Sexual Addiction and Compulsivity, 11, 129-143.

Cooper, A., Galbreath, N., Becker, M.A. (2004). Sex on the Internet: Furthering our understanding of men with online sexual problems. Psychology of Addictive Behaviors, 18, 223-230.

Cooper, A., Griffin-Shelley, E., Delmonico, D.L., Mathy, R.M. (2001). Online sexual problems: Assessment and predictive variables. Sexual Addiction and Compulsivity, 8, 267-285.

Dhuffar, M. & Griffiths, M.D. (2015). A systematic review of online sex addiction and clinical treatments using CONSORT evaluation. Current Addiction Reports, 2, 163-174.

Griffiths, M.D. (2000).  Excessive internet use: Implications for sexual behavior. CyberPsychology and Behavior, 3, 537-552.

Griffiths, M.D.  (2001).  Sex on the internet: Observations and implications for sex addiction. Journal of Sex Research, 38, 333-342.

Griffiths, M.D. (2004). Sex addiction on the Internet. Janus Head: Journal of Interdisciplinary Studies in Literature, Continental Philosophy, Phenomenological Psychology and the Arts, 7(2), 188-217.

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

Griffiths, M.D. (2012). Internet sex addiction: A review of empirical research. Addiction Research and Theory, 20, 111-124.

Griffiths, M.D. (2016). Compulsive sexual behaviour as a behavioural addiction: The impact of the Internet and other issues. Addiction, 111, 2107-2109.

Griffiths, M.D. & Dhuffar, M. (2014). Treatment of sexual addiction within the British National Health Service. International Journal of Mental Health and Addiction, 12, 561-571.

Kraus, S., Voon, V., & Potenza, M. (2016). Should compulsive sexual behavior be considered an addiction? Addiction 111, 2097-2106.

Orzack M.H., & Ross C.J. (2000). Should virtual sex be treated like other sex addictions? Sexual Addiction and Compulsivity, 7, 113-125.

Sussman, S., Lisha, N. & Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.

Van Gordon, W., Shonin, E., & Griffiths, M.D. (2016). Meditation Awareness Training for the treatment of sex addiction: A case study. Journal of Behavioral Addictions, 5, 363–372.

 

More of the write stuff: Why do people write blogs?

Given the large number of blogs I have published, I consider being a ‘blogger’ one of my core identities (although admittedly this is subsumed within my identity as a ‘writer’). I am often asked why I blog and why I blog so much (some would say excessively) which prompted me putting together the article you are now reading.

Academically, there have been a number of studies that have carried out research into why people blog. For instance, Dr. Bonnie Nardi and colleagues published a paper in Communications of the ACM, (2004) and concluded that bloggers are “driven to document their lives, provide commentary and opinions, express deeply felt emotions, articulate ideas through writing, and form and maintain community forums”. In 2008, Dr. Chin-Lung Hsu and Dr. Judy Lin published the results of a small survey of 212 bloggers in the journal Information and Management. Using the theory of reasoned action (a theory I have also used in relation to some of my gambling attitude research – see ‘Further reading’), they found that “ease of use and enjoyment, and knowledge sharing (altruism and reputation) were positively related to attitude toward blogging…[and that] social factors (community identification) and attitude toward blogging significantly influenced a blog participant’s intention to continue to use blogs”.

A 2007 paper by Dr. Su-Houn Liu and colleagues in the journal Issues in Information Systems surveyed 177 bloggers following a qualitative study where they interviewed five bloggers about their motivation for blogging. From the interviews they generated ten motivations to blog – five that were intrinsic (killing time; having space to store data and files; enjoying sharing life with others; pouring out feelings; gaining achievement) and five that were extrinsic (looking forward to others’ responses; finding good topics after talking with others; constantly connecting with known people; making new friends; understanding others’ feelings and opinions). Using these motivations they hypothesized that blogging motivation would be positively related to blogging intention and that a blogger’s intention would be positively related to the amount of blogging. In the survey results, they found that the two most important motivations for blogging were (i) pouring out feelings and (ii) connecting with people. The results also showed that bloggers who had (i) both high intrinsic and extrinsic motivation for rewards had higher levels of blogging intention, and (ii) higher blogging intention were willing to take more time to maintain their blog and post more articles.

A study by Dr. Chris Fullwood and colleagues in a 2009 issue of CyberPsychology and Behavior carried out a content analysis of MySpace blogs and concluded that “most blogs were written in a positive tone, and the main motivations for blogging appeared to be writing a diary and as an emotional outlet”. They found no significant gender differences but reported that the blog’s purpose and style differed across age groups. For instance, bloggers aged over 50 years were more likely to use their blog as “an emotional outlet with a negative tone”. Those aged between 18 and 29 years “used a semiformal language style” on their blog. A 2007 paper by Dr. Rong-An Shang and colleagues published in the PACIS Proceedings examined why people blog by investigating the impacts of task and technology characteristics on user evaluation of blogs and blog usage. They found that self-presentation, need for sociality, and the perception of social presence best explained why people blogged.

Despite the academic research into why people blog, the topic has been covered in dozens of online articles often with much longer lists of motivations as to why people blog and the benefits that can be got from blogging. (I include my own online article on this topic as to why I blog, and I would also draw you attention to the published articles I have had on the benefits of blogging – see ‘Further reading’ below). So here is a more definitive list that I have compiled from many different websites:

• To express thoughts and opinions – Blogs provide one of the easiest ways to write things for a potentially global audience. I often use my blogs to establish initial thoughts and ideas that can then be finessed and built upon more rigorously in more formal later published work. The best thing about blogs is that they are free, easy to set up, and you can publish something within seconds of finishing what you write.
• To connect and network with like-minded people – Blogs on specific topics can help in making contact with individuals that have similar thoughts and opinions. In short, blogs can be an aid to online networking. If you run a business, blogs can also be used to connect with your customers.
• To be free and creative – Writing blogs should be fun to do but they can also be an exercise in creativity and freedom. Similarly, blogs can be an extra creative outlet in which you can put into words thoughts and ideas that are hard to put into use elsewhere in your life.
• To become a more organized and better communicator, thinker and writer – Blog writing is a skill that can be developed and they can be used to become a better communicator. How you write something can sometimes be more important than what you want to say. Increased writing can also help you to become more organized in your thinking.
• To help focus thinking – Not only can blog writing make thinking become more organized, it can help making thinking more focused. Once I have chosen a topic to write about, my thinking becomes very focused and while writing everything else is in the periphery. I would also argue that your mindset becomes more objective and ‘well rounded’ the more blogs that you write.
• To help and inspire other people – Blogs can provide informative help to almost anything you can think of. Although a small amount of the feedback I get about my blog is negative the overwhelming majority is supportive and celebratory. It’s even better if someone says that your blog inspired that person to do something positive.
• To advertise and promote something – Blogs can be used to promote or market a product, a business and/or even yourself. Blogs can be an excellent vehicle for self-promotion and personal branding. Good blogs get you noticed and could be good for your career. Your next employer might even be one of your regular blog readers. I have also realized that blogs can be a great way to attract potential clients for consultancy opportunities.
• To establish expertise and create awareness – Blogs are a great way to help individuals establish themselves as an expert in a specific topic or area and can help in creating awareness of specific issues. One of the side benefits is that you also become more expert in researching a topic. Reading your old blogs can also help you in becoming more reflective and critical about your thinking.
• To make a difference (to oneself and/or others) – Blogs that are specific and issue-based can be used to educate and/or change opinion in someone else. Your writing might help make a difference in their lives (such as learning about something they didn’t know before reading your blog). Writing can be therapeutic and some people write blogs as a journal or diary. Sometimes ‘making a difference’ can be to the bloggers themselves. For instance, my blogs on survivor guilt and the death of David Bowie were primarily to help myself rather than anyone else reading.
• To keep up to date with a specific interest or topic and gain knowledge – Being a regular blogger means that you have to keep up-to-date with what’s going on in the area being written about. At the same time it increases your knowledge base.
• To make money – Making money from blogs may not be at the top of people’s lists but good bloggers can get paid for some of their efforts.
• To help time management and other life skills – Writing a regular blog takes time and dedication but can also help you become better in time management. My blogs complement the other things I do in my life (both professionally and personally) and I plan my blog writing around other areas of my life. Why watch a dull TV show when I could be bettering myself writing a blog? In short, it could lead to some healthier life habits.
• To boost self-esteem and ego needs – The one thing I love about blogging is that I have a running record of how many people have accessed my blog, which articles they are reading, where they were referred from, and who has re-blogged my writing. This all contributes to my overall sense of self-worth and helps raise my self-esteem. Positive feedback makes you feel good. In short, blog ‘success’ is measurable.

Many of the reasons I’ve listed above form part of my own motivations for blogging but the main reason I write my blogs is that I love writing them because others seem to like reading them. In short I have a passion for it. 

Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Becker, J. (2016). 15 reasons I think you should blog. Becoming Minimalist, January 14. Located at: http://www.becomingminimalist.com/15-reasons-i-think-you-should-blog/

Bullas, J. (2010). 12 reasons why people blog. jeffbullas.com. Located at: http://www.jeffbullas.com/2010/07/23/12-reasons-why-people-blog/

Fullwood, C., Sheehan, N., & Nicholls, W. (2009). Blog function revisited: A content analysis of MySpace blogs. CyberPsychology and Behavior, 12(6), 685-689.

Griffiths, M.D. (2013). How writing blogs can help your academic career. Psy-PAG Quarterly, 87, 39-40.

Griffiths, M.D. (2014). Top tips on…Writing blogs. Psy-PAG Quarterly, 90, 13-14.

Gunnellus, S. (2014). Top 10 reasons to start  blog. About Tech, December 16. Located at: http://weblogs.about.com/od/startingablog/tp/Top-Ten-Reasons-to-Blog.htm

Hsu, C.L., & Lin, J.C.C. (2008). Acceptance of blog usage: The roles of technology acceptance, social influence and knowledge sharing motivation. Information and Management, 45(1), 65-74.

Kim, H.N. (2008). The phenomenon of blogs and theoretical model of blog use in educational contexts. Computers and Education, 51(3), 1342-1352.

Li, J., & Chignell, M. (2010). Birds of a feather: How personality influences blog writing and reading. International Journal of Human-Computer Studies, 68(9), 589-602.

Liu, S.H., Liao, H.L., & Zeng, Y.T. (2007). Why people blog: an expectancy theory analysis. Issues in Information Systems, 8(2), 232-237.

Nardi, B.A., Schiano, D. J., & Gumbrecht, M. (2004). Blogging as social activity, or, would you let 900 million people read your diary? In Proceedings of the 2004 ACM conference on Computer supported cooperative work (pp. 222-231). ACM.

Reich, D. (2011). 9 reasons you should blog. Forbes, October 15. Located at: http://www.forbes.com/sites/danreich/2011/10/15/9-reasons-you-should-blog/#616c4f2a5ab0

Shang, R.A., Chen, Y.C., & Chen, C.M. (2007). Why people blog? An empirical investigation of the task technology fit model. PACIS 2007 Proceedings, 5. PACIS.

Suyeoka, B. (2016). 6 things that blogging can do for you. Huffington Post, September 25. Located at: http://www.huffingtonpost.com/brandon-suyeoka/6-things-that-blogging-ca_b_3973092.html

Thacker, N. (2011). 10 reasons why you need a blog. Life Hack, October 15. Located at: http://www.forbes.com/sites/danreich/2011/10/15/9-reasons-you-should-blog/#616c4f2a5ab0

Websudasa (2015). Top 10 reasons why people blog. Shout Me Loud, July 16. Located at: http://www.shoutmeloud.com/top-10-reasons-why-people-blog.html

Wood, R.T.A. & Griffiths, M.D. (2004). Adolescent lottery and scratchcard players: Do their attitudes influence their gambling behaviour? Journal of Adolescence, 27, 467-475.