Doctor, doctor: What can British GPs do about problem gambling?

A study published in the British Journal of General Practice in March 2017 reported that of 1,058 individuals surveyed in GP waiting rooms in Bristol (UK), 0.9% were problem gamblers and that a further 4.3% reported gambling problems that “were low to medium severity”. This is in line with other British studies carried out over the last decade which have reported problem gambling prevalence rates of between 0.5% and 0.9%.

I have long argued that problem gambling is a health issue and that GPs should routinely screen for gambling problems. Back in 2004, I published an article in the British Medical Journal about why problem gambling is a health issue. I argued that the social and health costs of problem gambling were (and still are) large at both individual and societal levels.

Personal costs can include irritability, extreme moodiness, problems with personal relationships (including divorce), absenteeism from work, neglect of family, and bankruptcy. Adverse health consequences for problem gamblers and their partners include depression, insomnia, intestinal disorders, migraine, and other stress related disorders. In my BMJ article I also noted that analysis of calls to the GamCare national gambling helpline indicated that a small minority of callers reported health-related consequences as a result of their problematic gambling. These included depression, anxiety, stomach problems, and suicidal ideation. Obviously many of these medical problems arise through the stress of financial problems but that doesn’t make it any less of a health issue for those suffering from severe gambling problems.

Research published in the American Journal of Addictions has also shown that health-related problems can occur as a result of withdrawal effects. For instance, one study by Dr. Richard Rosenthal and Dr. Henry Lesieur found that at least 65% of pathological gamblers reported at least one physical side effect during withdrawal, including insomnia, headaches, loss of appetite, physical weakness, heart racing, muscle aches, breathing difficulty, and chills.

Based on these findings, problem gambling is very much a health issue that needs to be taken seriously by all in the medical profession. GPs routinely ask patients about smoking cigarettes and drinking, but gambling is something that is not generally discussed. Problem gambling may be perceived as a grey area in the field of health, and it is therefore very easy for those in the medical profession not to have the issue on their wellbeing radar. If the main aim of GPs is to ensure the health of their patients, then an awareness of gambling and the issues surrounding it should be an important part of basic knowledge and should be taught in the curriculum while prospective doctors are at medical school. One of the reasons that GPs don’t routinely screen for problem gambling is because they are not taught about it during their medical training and therefore do not even think about screening for it in the first place. As I recommended in a report commissioned by the British Medical Association, the need for education and training in the diagnosis, appropriate referral and effective treatment of gambling problems must be addressed within GP training. More specifically, GPs should be aware of the types of gambling and problem gambling, demographic and cultural differences, and the problems and common co-morbidities associated with problem gambling. GPs should also understand the importance of screening patients perceived to be at increased risk of gambling addiction, and should be aware of the referral and support services available locally.

I also recommended that treatment for problem gambling should be provided under the NHS (either as standalone services or alongside drug and alcohol addiction services) and funded by gambling-derived profit revenue.

Back in 2011, Dr. Jane Rigbye and myself published a study using Freedom of Information requests to ask NHS trusts if they had ever treated pathological gamblers. Only 3% of the trusts had ever treated a problem gambler and only one trust said they offered dedicated help and support. I’m sure if we repeated the study today, little will have changed.

It is evident that problem gambling is not, as yet, on the public health agenda in the UK. NHS services – including GP surgeries – need to be encouraged to see gambling problems as a primary reason for referral and a valid treatment option. Information about gambling addiction services, in particular services in the local area, should be readily available to gamblers and GP surgeries are a good outlet to advertise such services. Although some gambling services (such as GamCare, the gambling charity I co-founded) provide information to problem gamblers about local services, such information is provided to problem gamblers who have already been proactive in seeking gambling help and/or information. Given that very few GPs could probably treat a problem gambler, what they must have is the knowledge of who they can refer their patients to.

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

Further reading

Calado, F. & Griffiths, M.D. (2016). Problem gambling worldwide: An update of empirical research (2000-2015). Journal of Behavioral Addictions, 5, 592–613.

Cowlishaw, S., Gale, L., Gregory, A., McCambridge, J., & Kessler, D. (2017). Gambling problems among patients in primary care: a cross-sectional study of general practices. British Journal of General Practice, doi: bjgp17X689905

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. & Smeaton, M. (2002). Withdrawal in pathological gamblers: A small qualitative study. Social Psychology Review, 4, 4-13.

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.

Rosenthal, R., & Lesieur, H. (1992). Self-reported withdrawal symptoms and pathological gambling. American Journal of the Addictions, 1, 150–154.

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., Sproston, K., Orford, J., Erens, B., Griffiths, M.D., Constantine, R. & Pigott, S. (2007). The British Gambling Prevalence Survey. London: The Stationery Office.

It takes all sports: A brief look at sport-related betting

Over the past year I have been carrying out research with my Spanish colleague – Dr. Hibai Lopez-Gonzalez – into problematic sports betting and sports betting advertising which has already produced a number of papers (see ‘Further reading’ below) and with many more to come. One of the issues we have faced in contextualising our work is that there is no such concept as sport-related problem gambling in prevalence surveys because problem gambling is assessed on the totality of gambling experiences rather than a single activity. For instance, in the three British Gambling Prevalence Surveys (BGPSs) conducted since 1999, sport-related gambling is subsumed within a number of different gambling forms: ‘football pools and fixed odds coupons’, ‘private betting’, and ‘other events with a bookmaker’. The 2010 BGPS (which I co-authored) included ‘sports betting’ as a category, along with ‘football pools’ (no coupons), ‘private betting’, ‘spread betting’ (which can include both sports or financial trading). In addition, the 2010 BGPS added a new category under online gambling activities to include ‘any online betting’. More recently, the Health Survey for England also introduced a new category: ‘gambling on sports events (not online)’.

Despite these limitations, some evidence can be inferred from gambling activity by gambling type. In 2014, Heather Wardle and her colleagues combined the gambling data from the Health Survey for England and the Scottish Health Survey. They reported that among adult males aged 16 years and over during a 12-month period, 5% participated in offline football pools, 8% engaged in online betting (although no indication was made about whether this only involved sport), and 8% engaged in sports events (not online). The categories were not mutually exclusive so an overlapping of respondents across categories was very likely. A similar rate was found in South Australia in a 2013 report the Social Research Centre with those betting on sports over the past year accounting for 6.1% of the adult population, an increase from the 4.2% reported in 2005.

In Spain, the Spanish Gambling Commission (Direccion General de Ordenacion del Juego [DGOJ] reported that 1.5% of the adult (male and female) population had gambled online on sports in 2015. This is a significantly lower proportion compared with the British data, although the methodological variations cannot be underestimated. Spanish data also shows that, among those who have gambled online on a single gambling type only, betting on sports is the more prevalent form with up to 66% of those adults.

In France, the data on the topic only focuses on those who gamble rather than examining the general population of gamblers and non-gamblers. Among online gamblers, Dr. Jean-Michel Costes and colleagues reported in a 2011 issue of the journal Tendances that 35.1% had bet on sports during the last 12 months. In another French study by Costes and colleagues published in a 2016 issue of the Journal of Gambling Studies, sports betting represented 16.4% of the gambling cohort, although again, the representativeness of sports betting behaviour among the general gambling and non-gambling population could not be determined.

Due to the aforementioned shortcomings in the definition of sport-related gambling, there is only fragmented empirical evidence concerning the impact of sports-related problem gambling behaviour. For instance, in 2014, Dr. Nerilee Hing noted that clinical reports indicate that treatment seeking for sports-related problem gambling had grown in Australia. In British Columbia (Canada), a 2014 survey by Malatests & Associates for the Ministry of Finance reported that 23.6% of at-risk or problem gamblers had gambled on sports either offline or online. A smaller proportion (16.2%) was found in the Spanish population screened in the national gambling DGOJ survey, except this subgroup was entirely composed of online bettors.

In a 2011 study published in International Gambling Studies with patients from a pathological gambling unit within a community hospital in Barcelona, Dr. Susana Jiménez-Murcia and her colleagues found that among those who had developed the disorder gambling online only (as opposed to those who gamble both online/offline or offline only), just over half (50.8%) were sport bettors. Those who gambled online only (on any activity) and those that only gambled online on sports events represented a small minority of the total number of problem gamblers. Overall, there is relatively little research on this sub-group of gamblers therefore I and others will be monitoring the evolution of this trend as the online gambling population grows.

(Note: This blog was co-written with input from Dr. Hibai Lopez-Gonzalez).

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

Further reading

Costes, J-M, Kairouz, S., Eroukmanoff, V., et al. (2016) Gambling patterns and problems of gamblers on licensed and unlicensed sites in France. Journal of Gambling Studies 32(1), 79–91.

Costes, J., Pousset, M., Eroukmanoff, V., et al. (2010). Gambling prevalence and practices in France in 2010. Tendances, 77, 1–8.

DGOJ (2016a) Análisis del perfil del jugador online. Madrid: Ministerio de Hacienda y Administraciones Públicas.

DGOJ (2016b) Estudio sobre prevalencia, comportamiento y características de los usuarios de juegos de azar en España 2015. Madrid: Ministerio de Hacienda y Administraciones Públicas.

Hing, N. (2014) Sports betting and advertising (AGRC Discussion Paper No. 4). Melbourne: Australian Gambling Research Centre.

Jiménez-Murcia S, Stinchfield R, Fernández-Aranda F, et al. (2011) Are online pathological gamblers different from non-online pathological gamblers on demographics, gambling problem severity, psychopathology and personality characteristics? International Gambling Studies 11(3), 325–337.

Lopez-Gonzalez, H., Estevez, A. & Griffiths, M.D. (2017). Marketing and advertising online sports betting: A problem gambling perspective. Journal of Sport and Social Issues, in press.

Lopez-Gonzalez, H. & Griffiths, M.D. (2016). Is European online gambling regulation adequately addressing in-play betting advertising? Gaming Law Review and Economics, 20, 495-503.

Lopez-Gonzalez, H. & Griffiths, M.D. (2017). Understanding the convergence of online sports betting markets. International Review for the Sociology of Sport, in press.

Lopez-Gonzalez, H. & Griffiths, M.D. (2017). ‘Cashing out’ in sports betting: Implications for problem gambling and regulation. Gaming Law Review and Economics, in press.

Malatests & Associates Ltd (2014). 2014 British Columbia Problem Gambling Prevalence Study. Victoria, Canada: Gaming policy and enforcement branch, Ministry of Finance.

The Social Research Centre (2013) Gambling prevalence in South Australia. Adelaide, Australia: Office for problem gambling. Available from: http://phys.org/news/2012-03-lung-doctors-respiratory-diseases-worsen.html.

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, et al. (2014) Gambling behaviour in England & Scotland. Findings from the health survey for England 2012 and Scottish health survey 2012. London: NatCen Social Research.

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

Games without frontiers: A brief look at the psychology of play

In a previous blog I examined my favourite board game (Scrabble) and the extent to which someone could become addicted to it. Today’s blog takes a broader look at the psychology of play more generally. Arguably, many of the topics that I research involve the psychology of playing games with video games and gambling games being my two most obvious areas of interest.

It’s been argued by myself (and others) that the ritualized play of several childhood games provides ‘training’ in the acquisition of gambling behaviour and that some games are pre-cursors to actual gambling (e.g., playing marbles, card flipping, etc.). Some authors (such as Igor Kusyszyn) hold the view that gambling is in itself ‘adult play’. Unsurprisingly, Freud was one of the first people to concentrate on the ‘functions’ of play and concluded that play in all its varieties (a) provides a wish-fulfilment, (b) leads to conflict reduction, (c) provides temporary leave of absence from reality, and (d) brings about a change from the passive to the active.

Since Freud, most psychologists have concentrated on the idea of ‘conflict reduction’ and in doing so have ignored his other three postulations. A more modern approach in the 1970s by Mihalyi Czikszentmihalyi asserted that during play a person can “concentrate on a limited stimulus field, in which he or she can use skills to meet clear demands, thereby forgetting his or her own problems and separate identity” (and provides one of the reasons that a small minority of people can develop problems playing games). Seminal research on the sociology of play by Roger Caillois states notes that play is a “free and voluntary activity”, “a source of joy and amusement” and “bounded by precise limits of time and space” whereas Erving Goffman views it as a “world building activity”.

Games provide the opportunity to prove one’s superiority, the desire to challenge and overcome an obstacle, and a medium by which to test one’s skill, endurance and ingenuity. Games, unlike some activities (including life itself!), tell us whether we have won or lost. As observed by James Smith and Vicki Abt in the 1980s:

“…in the context of a competitive and materialistic culture that has become increasingly regimented and standardized with little room for individual creativity and personal achievement, games (including gambling) offer the illusion of control over destiny and circumstance”.

Perhaps the best categorisation of game types was formulated by Roger Caillois who listed four classifications – agon (competition), alea (chance), mimicry (simulation), and ilinx (vertigo). In the context of games involving gambling, alea and agon are crucial in that they offer a combination of skill, chance and luck. As was previously asserted, most people desire opportunities to test their strength and skill against an adversary, and those games which offer a component of skill or talent combined with luck and chance provide the most favourable conditions. This is particularly prevalent in males who are deemed ‘masculine’ if during the socialization process they show (socially) important traits such as courage, independence, and bravery.

According to Caillois, play is “an occasion of pure waste: waste of time, energy, ingenuity, skill, and often of money” and is a “free and voluntary activity that occurs in a pure space, isolated and protected from the rest of life”. According to Caillois, play is best described by six core characteristics:

• It is free, or not obligatory.
• It is separate (from the routine of life) occupying its own time and space.
• It is uncertain, so that the results of play cannot be pre-determined and so that the player’s initiative is involved.
• It is unproductive in that it creates no wealth and ends as it begins.
• It is governed by rules that suspend ordinary laws and behaviours and that must be followed by players.
• It involves make-believe that confirms for players the existence of imagined realities that may be set against ‘real life’.

Back in 2000, I published an article on the psychology of games in Psychology Review and what makes a good game. I noted 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.

I was recently interviewed by Lucy Orr for an article on board games for The Register – particularly about the psychology of winning. For instance, why is winning so important? I responded to Orr by pointing out that winning makes us feel good both psychologically and physiologically. Winning something – especially if it is a result of something skilful rather than by chance – can feel even better (unless the chance winning is something life changing like winning the lottery). Winning something using your own skill can demand respect from other competitors and brings about esteem (that can feed into one’s own self-esteem). Winning can be a validation that what you are doing is worthwhile. Other parts of my interview were not used.

I was asked whether beating other people makes winning more rewarding? Of course it does. Any time we engage in a behaviour that feels good we want to do it again (and again). Winning can be reinforcing on many different levels. There may be financial rewards, social rewards (peer praise, admiration and respect from others), psychological rewards (feeling better about oneself and feeling that the activity is a life-affirming and life-enhancing activity that feeds into self-esteem), and physiological rewards (increases in adrenaline and serotonin that trigger dopamine and makes us feel happy).

For some people, winning can become addictive. You can’t become addicted to something unless you are constantly reinforced and rewarded for engaging in the behaviour, and (as mentioned above) there are many different types of rewards (e.g., financial, social, psychological and physiological). Any (or all of these) could lead to repetitive and habitual behaviour and in a small minority of cases be addictive. However, as I have noted in a number of my papers, doing something to excess is not addiction. The difference between a healthy excessive enthusiasm and an addiction is that excessive enthusiasms add to life and addictions take away from it. For most people, winning behaviour – particularly in the context of playing board games – will be highly rewarding without being in any way problematic

Dr. Mark Griffiths, Professor of Behavioural Addiction, 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/

Caillois, R. (1961). Man, play and games. Paris: Simon and Schuster.

Csikszentmihalyi, M. (1976). Play and intrinsic rewards. Journal of Humanistic Psychology, 16, 41-63.

Goffman, E. (1967). Interaction Ritual: Essays on face-to-face behavior. Garden City, New York: Doubleday Anchor.

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

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

Griffiths, M.D. (2010). The role of context in online gaming excess and addiction: Some case study evidence. International Journal of Mental Health and Addiction, 8, 119-125.

Kusyszyn, I. (1984). The psychology of gambling. Annals of American Academy of Political and Social Sciences, 474, 133-145.

Orr, L. (2016). Winner! Crush your loved ones at Connect Four this Christmas. The Register, December 16. Located at: http://www.theregister.co.uk/2016/12/15/beating_your_family_and_winning_this_christmas/

Smith, J. F. & Abt, V. (1984). Gambling as play Annals of the American Academy of Political and Social Sciences, 474, 122-132.

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

A diction for addiction: A brief overview of our papers at the 2017 International Conference on Behavioral Addictions

This week I attended (and gave one of the keynote papers at) the fourth International Conference on Behavioral Addictions in Haifa (Israel). It was a great conference and I was accompanied by five of my colleagues from Nottingham Trent University all of who were also giving papers. All of the conference abstracts have just been published in the latest issue of the Journal of Behavioral Addictions (reprinted below in today’s blog) and if you would like copies of the presentations then do get in touch with me.

Griffiths, M.D. (2017). Behavioural tracking in gambling: Implications for responsible gambling, player protection, and harm minimization. Journal of Behavioral Addictions, 6 (Supplement 1), 2.

• Social responsibility, responsible gambling, player protection, and harm minimization in gambling have become major issues for both researchers in the gambling studies field and the gaming industry. This has been coupled with the rise of behavioural tracking technologies that allow companies to track every behavioural decision and action made by gamblers on online gambling sites, slot machines, and/or any type of gambling that utilizes player cards. This paper has a number of distinct but related aims including: (i) a brief overview of behavioural tracking technologies accompanied by a critique of both advantages and disadvantages of such technologies for both the gaming industry and researchers; (ii) results from a series of studies carried out using behavioural tracking (particularly in relation to data concerning the use of social responsibility initiatives such as limit setting, pop-up messaging, and behavioural feedback); and (c) a brief overview of the behavioural tracking tool mentor that provides detailed help and feedback to players based on their actual gambling behaviour.

Calado, F., Alexandre, J. & Griffiths, M.D. (2017). Youth problem gambling: A cross-cultural study between Portuguese and English youth. Journal of Behavioral Addictions, 6 (Supplement 1), 7.

• Background and aims: In spite of age prohibitions, most re- search suggests that a large proportion of adolescents engage in gambling, with a rate of problem gambling significantly higher than adults. There is some evidence suggesting that there are some cultural variables that might explain the development of gambling behaviours among this age group. However, cross­cultural studies on this field are generally lacking. This study aimed to test a model in which individual and family variables are integrated into a single perspective as predictors of youth gambling behaviour, in two different contexts (i.e., Portugal and England). Methods: A total of 1,137 adolescents and young adults (552 Portuguese and 585 English) were surveyed on the measures of problem gambling, gambling frequency, sensation seeking, parental attachment, and cognitive distortions. Results: The results of this study revealed that in both Portuguese and English youth, the most played gambling activities were scratch cards, sports betting, and lotteries. With regard to problem gambling prevalence, English youth showed a higher prevalence of problem gambling. The findings of this study also revealed that sensation seeking was a common predictor in both samples. However, there were some differences on the other predictors be- tween the two samples. Conclusions: The findings of this study suggest that youth problem gambling and its risk factors appear to be influenced by the cultural context and highlights the need to conduct more cross-cultural studies on this field.

Demetrovics, Z., Richman, M., Hende, B., Blum, K., Griffiths,
M.D, Magi, A., Király, O., Barta, C. & Urbán, R. (2017). Reward Deficiency Syndrome Questionnaire (RDSQ):
A new tool to assess the psychological features of reward deficiency. Journal of Behavioral Addictions, 6 (Supplement 1), 11.

• ‘Reward Deficiency Syndrome’ (RDS) is a theory assuming that specific individuals do not reach a satisfactory state of reward due to the functioning of their hypodopaminergic reward system. For this reason, these people search for further rewarding stimuli in order to stimulate their central reward system (i.e., extreme sports, hypersexuality, substance use and/or other addictive behaviors such as gambling, gaming, etc.). Beside the growing genetic and neurobiological evidence regarding the existence of RDS little re- search has been done over the past two decades on the psychological processes behind this phenomenon. The aim of the present paper is to provide a psychological description of RDS as well as to present the development of the Reward Deficiency Syndrome Questionnaire (developed using a sample of 1,726 participants), a new four-factor instrument assessing the different aspects of reward deficiency. The results indicate that four specific factors contribute to RDS comprise “lack of satisfaction”, “risk seeking behaviors”, “need for being in action”, and “search for overstimulation”. The paper also provides psychological evidence of the association between reward deficiency and addictive disorders. The findings demonstrate that the concept of RDS provides a meaningful and theoretical useful context to the understanding of behavioral addictions.

Demetrovics, Z., Bothe, B., Diaz, J.R., Rahimi­Movaghar, A., Lukavska, K., Hrabec, O., Miovsky, M., Billieux, J., Deleuze,
J., Nuyens, P. Karila, L., Nagygyörgy, K., Griffiths, M.D. & Király, O. (2017). Ten-Item Internet Gaming Disorder Test (IGDT-10): Psychometric properties across seven language-based samples. Journal of Behavioral Addictions, 6 (Supplement 1), 11.

• Background and aims: The Ten-Item Internet Gaming Disorder Test (IGDT-10) is a brief instrument developed to assess Internet Gaming Disorder as proposed in the DSM­5. The first psychometric analyses carried out among a large sample of Hungarian online gamers demonstrated that the IGDT-10 is a valid and reliable instrument. The present study aimed to test the psychometric properties in a large cross-cultural sample. Methods: Data were collected among Hungarian (n = 5222), Iranian (n = 791), Norwegian (n = 195), Czech (n = 503), Peruvian (n = 804), French­speaking (n = 425) and English­ speaking (n = 769) online gamers through gaming­related websites and gaming-related social networking site groups. Results: Confirmatory factor analysis was applied to test the dimensionality of the IGDT-10. Results showed that the theoretically chosen one-factor structure yielded appropriate to the data in all language­based subsamples. In addition, results indicated measurement invariance across all language-based subgroups and across gen- der in the total sample. Reliability indicators (i.e., Cronbach’s alpha, Guttman’s Lambda-2, and composite reliability) were acceptable in all subgroups. The IGDT- 10 had a strong positive association with the Problematic Online Gaming Questionnaire and was positively and moderately related to psychopathological symptoms, impulsivity and weekly game time supporting the construct validity of the instrument. Conclusions: Due to its satisfactory psychometric characteristics, the IGDT-10 appears to be an adequate tool for the assessment of internet gam- ing disorder as proposed in the DSM-5.

Throuvala, M.A., Kuss, D.J., Rennoldson, M. & Griffiths, M.D. (2017). Delivering school-based prevention regarding digital use for adolescents: A systematic review in the UK. Journal of Behavioral Addictions, 6 (Supplement 1), 54.

• Background: To date, the evidence base for school-delivered prevention programs for positive digital citizenship for adolescents is limited to internet safety programs. Despite the inclusion of Internet Gaming Disorder (IGD) as a pro- visional disorder in the DSM-5, with arguable worrying prevalence rates for problematic gaming across countries, and a growing societal concern over adolescents’ digital use, no scientifically designed digital citizenship programs have been delivered yet, addressing positive internet use among adolescents. Methods: A systematic database search of quantitative and qualitative research evidence followed by a search for governmental initiatives and policies, as well as, non­profit organizations’ websites and reports was conducted to evaluate if any systematic needs assessment and/or evidence-based, school delivered prevention or intervention programs have been conducted in the UK, targeting positive internet use in adolescent populations. Results: Limited evidence was found for school-based digital citizenship awareness programs and those that were identified mainly focused on the areas of internet safety and cyber bullying. To the authors’ knowledge, no systematic needs assessment has been conducted to assess the needs of relevant stakeholders (e.g., students, parents, schools), and no prevention program has taken place within UK school context to address mindful and positive digital consumption, with the exception of few nascent efforts by non­profit organizations that require systematic evaluation. Conclusions: There is a lack of systematic research in the design and delivery of school-delivered, evidence-based prevention and intervention programs in the UK that endorse more mindful, reflective attitudes that will aid adolescents in adopting healthier internet use habits across their lifetime. Research suggests that adolescence is the highest risk group for the development of internet addictions, with the highest internet usage rates of all age groups. Additionally, the inclusion of IGD in the DSM-5 as provisional disorder, the debatable alarming prevalence rates for problematic gaming and the growing societal focus on adolescents’ internet misuse, renders the review of relevant grey and published research timely, contributing to the development of digital citizenship programs that might effectively promote healthy internet use amongst adolescents.

Bányai, F., Zsila, A., Király, O., Maraz, A., Elekes, Z., Griffiths, M.D., Andreassen, C.S. & Demetrovics, Z. (2017). Problematic social networking sites use among adolescents: A national representative study. Journal of Behavioral Addictions, 6 (Supplement 1), 62.

• Despite being one of the most popular activities among adolescents nowadays, robust measures of Social Media use and representative prevalence estimates are lacking in the field. N = 5961 adolescents (49.2% male; mean age 16.6 years) completed our survey. Results showed that the one-factor Bergen Social Media Addiction Scale (BSMAS) has appropriate psychometric properties. Based on latent pro le analysis, 4.5% of the adolescents belonged to the at-risk group, who reported low self-esteem, high level of depression and the elevated social media use (34+ hours a week). Conclusively, BSMAS is an adequate measure to identify those adolescents who are at risk of problematic Social Media use and should therefore be targeted by school-based prevention and intervention programs.

Bothe, B., Toth-Király, I. Zsila, A., Griffiths, M.D., Demetrovics, Z. & Orosz, G. (2017). The six-component problematic pornography consumption scale. Journal of Behavioral Addictions, 6 (Supplement 1), 62.

• Background and aims: To our best knowledge, no scale ex- ists with strong psychometric properties assessing problematic pornography consumption which is based on an over- arching theoretical background. The goal of the present study was to develop a short scale (Problematic Pornography Consumption Scale; PPCS) on the basis of Griffiths` (2005) six-component addiction model that can assess problematic pornography consumption. Methods: The sample comprised 772 respondents (390 females; Mage = 22.56, SD = 4.98 years). Items creation was based on the definitions of the components of Griffiths’ model. Results: A confirmatory factor analysis was carried out leading to an 18­item second­order factor structure. The reliability of the PPCS was good and measurement invariance was established. Considering the sensitivity and specificity values, we identified an optimal cut­off to distinguish between problematic and non-problematic pornography users. In the present sample, 3.6% of the pornography consumers be- longed to the at-risk group. Discussion and Conclusion: The PPCS is a multidimensional scale of problematic pornography consumption with strong theoretical background that also has strong psychometric properties.

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

Don’t blame the game: Parents, videogame content, and age ratings

Back in March 2015, BBC News reported that parents of children in 16 Cheshire county schools had been sent a letter saying that head teachers would report them to the authorities if they allowed their children to play videogames that are rated for adults (i.e., games that have an ‘18’ rating). The teachers claimed that popular games like Grand Theft Auto and Call of Duty are too violent to be played by those under the age of 18 years. They also stated that such games increased sexualised behaviour and left children vulnerable to sexual grooming. The schools also threatened to report parents who let their children play such games because it was a form of parental neglect. The author of the letter, Mary Hennessy Jones, was quoted as saying that:

“We are trying to help parents to keep their children as safe as possible in this digital era. It is so easy for children to end up in the wrong place and parents find it helpful to have some very clear guidelines”.

I’m sure the letter to parents was written with the best of intentions but as a parent of three ‘screenagers’ and someone that has spent almost three decades researching the effects of video games on human behaviour, this appears to be a very heavy-handed way to deal with the issue. Although it is illegal for any retailer to sell ‘18’ rated games to minors, it is not illegal for children to play such games, or illegal for parents to allow their children to play such games. Many parents need to be educated about the positives and negatives of playing video games but reporting them to the “authorities” is not the right way forward.

Back in the early 1990s I was probably the only academic in the UK carrying out scientific research on children’s video game playing. In fact, I was proud of my role in getting age ratings onto all video games in the first place, and for writing the text for educational information leaflets for parents (outlining the effects of excessive playing of such games) sponsored by the National Council for Educational Technology. There are many positive benefits of playing video games (something that I wrote about in a previous article for The Conversation).

I know from first-hand experience that children often play games that are age-inappropriate. Two years ago, my (then) 13-year old son said he was the only boy in his class that did not play or own the Call of Duty video game. This is also borne out by research evidence. One study that I was involved in found that almost two-thirds of children aged 11- to 13-years of age (63%) had played an 18+ video game. Unsurprisingly, boys (76%) were more likely than girls (49%) to have played an 18+ video game. Children were also asked about how often they played 18+ video games. Of the two-thirds who had played them, 8% reported playing them “all the time”, 22% reported playing them “most of the time”, 50% reported playing them “sometimes”, 18% reported playing them “hardly ever”. Again, boys were more likely than girls to play 18+ video games more frequently. Children were asked how they got access to 18+ plus video games. The majority had the games bought for them by family or friends (58%), played them at a friend’s house (35%), swapped them with friends (27%), or bought games themselves (5%). This research certainly appears to suggest that parents and siblings are complicit in the playing of age-inappropriate games.

There is a growing amount of scientific literature that has examined the content of video games designed for adults. For instance, a study led by Dr. Kimberley Thompson and published in the Archives of Pediatric and Adolescent Medicine attempted to quantify the depiction of violence, blood, sexual themes, profanity, substances, and gambling in adult (18+) video games and to assess whether the actual game content matched the content descriptor on the packaging. Although content descriptors for violence and blood provided a good indication of content in the 36 games examined, the authors concluded that 81% of the games studied (n=29) lacked content descriptors of other adult content. Other studies carried out by the same research team have found that adult content can be found in lots of games aimed at young children and teenagers.

Another study led by Dr. David Walsh published in Minerva Pediatrica tested the validity of media rating systems (including video games). Results showed that when the entertainment industry rated a product as inappropriate for children, parents also agreed that it was inappropriate. However, parents disagreed with many industry ratings that were designated as containing material as suitable for children. The products rated as appropriate for adolescents by the industry were of the greatest concern to parents.

The issue of children and adolescents playing 18+ games is no different from the debates about children and adolescents watching 18+ films. However, based on anecdotal evidence appears that parents are more likely to adhere to age ratings on films than they are on video games. This is one area that both media researchers and media educators need to inform parents to be more socially responsible in how they monitor their children’s leisure activity. A school sending out a threatening letter to parents is unlikely to change parental behaviour. Education and informed debate is likely to have a much greater effect in protecting our children from the potential harms of video game playing.

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

 Further reading

Anderson, C.A., Gentile, D.A., & Dill, K.E. (2012). Prosocial, antisocial and other effects of recreational video games. In D.G. Singer, & J.L. Singer (Eds), Handbook of Children and the Media, Second Edition, (pp. 249-272). Thousand Oaks, CA: Sage.

Anderson, C. A., Shibuya, A., Ihori, N., Swing, E. L., Bushman, B.J., Sakamoto, A., Rothstein, H.R., & Saleem, M. (2010). Violent video game effects on aggression, empathy, and prosocial behavior in eastern and western countries: a meta-analytic review. Psychological Bulletin, 136, 151-173.

Bartlett, C. P., Anderson, C.A. & Swing, E.L. (2009). Video game effects confirmed, suspected and speculative: A review of the evidence. Simulation and Gaming, 40, 377-403.

Ferguson, C. J. (2007). Evidence for publication bias in video game violence effects literature: A meta analytic review. Aggression and Violent Behavior, 12, 470-482.

Ferguson, C. J. (2013). Violent video games and the supreme court: Lessons for the scientific community in the wake of Brown v. Entertainment Merchants Association. American Psychologists, 68, 57-74.

Ferguson, C. J., San Miguel, S. & Hartley, T. (2009).  Multivariate analysis of youth violence and aggression: The influence of family, peers, depression and media violence. Journal of Paediatrics, 155, 904-908.

Gentile, D. A. & Stone, W. (2005). Violent video game effects in children and adolescents: A review of the literature. Minerva Pediatrics, 57, 337-358.

Griffiths, M.D. (1998). Video games and aggression: A review of the literature. Aggression and Violent Behavior, 4, 203-212.

Griffiths, M.D. (2000). Video game violence and aggression: Comments on ‘Video game playing and its relations with aggressive and prosocial behaviour’ by O. Weigman and E.G.M. van Schie. British Journal of Social Psychology, 39, 147-149.

Griffiths, M.D. (2010). Age ratings on video games: Are the effective? Education and Health, 28, 65-67.

Griffiths, M.D. & McLean, L. (in press). Content effects: Online and offline games. In P. Roessler (Ed.), International Encyclopedia of Media Effects. Chichester: Wiley.

Grüsser, S.M., Thalemann, R. & Griffiths, M.D. (2007). Excessive computer game playing: Evidence for addiction and aggression?  CyberPsychology and Behavior, 10, 290-292.

Ivory, J.D., Colwell, J., Elson, M., Ferguson, C.J., Griffiths, M.D., Markey, P.M., Savage, J. & Williams, K.D. (2015). Manufacturing consensus in a divided field and blurring the line between the aggression concept and violent crime. Psychology of Popular Media Culture, 4, 222–229.

McLean, L. & Griffiths, M.D. (2013). The psychological effects of videogames on young people. Aloma: Revista de Psicologia, Ciències de l’Educació i de l’Esport, 31(1), 119-133.

McLean, L. & Griffiths, M.D. (2013). Violent video games and attitudes towards victims of crime: An empirical study among youth. International Journal of Cyber Behavior, Psychology and Learning, 2(3), 1-16.

Mehroof, M. & Griffiths, M.D. (2010). Online gaming addiction: The role of sensation seeking, self-control, neuroticism, aggression, state anxiety and trait anxiety. Cyberpsychology, Behavior, and Social Networking, 13, 313-316.

The song and binding mode: Musical hallucinations in video game playing

According to a 2015 review in the journal Frontiers in Psychology by Jan Coebergh and colleagues, musical hallucinations (MHs) “are auditory hallucinations characterized by songs, tunes, melodies, harmonics, rhythms, and/or timbres…and that the mechanisms responsible for the mediation of MH are probably diverse”. While Danilo Vitorovic and Jose Biller reported in a 2013 issue of Frontiers in Neurology that the prevalence rate of MHs among the general population is at present unknown and/or rare, ‘involuntary musical imagery’ (INMI) is thought to be more commonplace. For instance, in a 2012 Finnish study in the journal Psychology of Music, Lassi Liikkanen reported that 89% of the total sample (n=12,519) reported experiencing INMI at least once a week. Music hallucination prevalence rates among various groups have been reported including obsessive-compulsive disorder patients (41%; Journal of Clinical Psychiatry, 2004), elderly people with auditory problems (2.5%; International Journal of Geriatric Psychiatry, 2002), and general hospital setting patients (0.16%; Psychosomatics, 1998).

Although Coebergh and colleagues described MHs, they were not explicitly defined. In a review in a 2014 issue of the Journal of Medical Case Reports, Woo and colleagues defined MHs as “complex auditory perceptions in the absence of an external acoustic stimulus and are often consistent with previous listening experience” whereas the 2013 review by Vitorovic and Biller (see above) noted that MHs “represent a specific form of auditory hallucinations whereby patients experience formed songs, instrumental music, or tunes, without an external musical stimulus”. In a 2015 paper in the journal Psychomusicology: Music, Mind, and Brain, Tim Williams provided a classification of INMI and noted they cover a number of different types of involuntary musical experience (including MHs). Despite the lack of detailed definition, it is known that MHs occur within the context of an individual’s culture and are often viewed by those experiencing them as intrusive and sometimes unpleasant.

In 2015, Dr. Angelica Ortiz de Gortari and I wrote a commentary paper on musical hallucinations in videogame playing in response to the review by Coebergh and colleagues. As far as we were aware, we noted that no review paper examining musical hallucinations had ever included papers referring to musical hallucinations arising from playing video games. The earliest report in the psychological literature is by Sean Spence (published in 1993 in the Irish Journal of Psychological Medicine) who reported the case of a 20-year-old female patient with a family history of psychosis. She presented with persecutory delusions, suicidal ideation, violent behaviour and third-person auditory hallucinations comprising 48 hours of constant MHs from the Mario Brothers videogame that developed into delusional thoughts. No drugs were found in her urinary system and her EEG was normal when MHs occurred. The MHs from the videogame decreased within 48 hours of treatment (using antidepressants and neuroleptics).

More recently, a series of papers by Dr. Ortiz de Gortari and I examined Game Transfer Phenomena (GTP). GTP research has demonstrated how the videogame can keep on playing even after the game has been turned off. GTP are non-volitional phenomena (e.g., altered perceptions, automatic mental processes, and involuntary behaviors). In an analysis of over 1600 gamers’ self-reports, our research has shown that videogame playing can lead to (i) perceptual distortions of physical objects, environments, and/or sounds, (ii) misperceptions of objects and sounds that are similar to those in the videogame, (iii) interpretation of events in real life contexts that utilize the logic of the videogame, (iv) ghost perceptions and sensations of images, sounds, and tactile experiences, and (v) involuntary actions and behaviors based on experiences from the videogame.

One study that we published in a 2014 issue of the International Journal of Cyber Behavior, Psychology and Learning specifically examined auditory GTP experiences. Gamers’ experiences identified as GTP in one or more modalities (e.g., visual, auditory) were collected from 60 online videogame forums over seven months. Of these, there were 192 auditory experiences from 155 gamers collected. The largest numbers of experiences (90%) were identified as involuntary auditory imagery. This manifested as hearing music (n = 73), sound (n = 83), or voices from within the game (n = 12). Some experiences were triggered by external cues associated with the game, while others were not. Experiences with music included hearing high pitch music in addition to calm and classical music.

Music from the videogames was usually experienced persistently, while sound effects or voices appeared to have occurred more episodically. Hearing the music persistently provoked sleep deprivation, annoyance, and uncertainty. When the music was re-experienced very vividly, the gamers attributed them to external sources associated with the videogame. More specifically, when auditory cues were associated with adverse videogame content, they resulted in irrational thoughts, reactions and changes in behaviour. In many cases, the gamers said that they had been playing intensively (i.e., either playing long sessions or playing frequently). Previous studies have linked hearing music in absence of auditory stimuli with the recent or repeated exposure to music (see ‘Further reading’ below including: Gardner, 1985; Gerra et al., 1998; Hyman et al., 2012).

In our study, one gamer said that he heard the sound of music coming out from the speakers so he stood up to check them while another heard music from Pokémon when vacuuming. It also appears that musical hallucinations can cross sensory modalities. For instance, some gamers have reported hearing music while seeing images from the video game. An online survey about GTP with a convenience sample of 2,362 gamers found that hearing music from videogames when not playing were the more prevalent (74%) than hearing sounds (65.0%) or voices (46%) when not playing (Ortiz de Gortari & Griffiths, 2015b).

Based on what is known empirically, our paper concluded that (i) MHs from videogame playing – although not well documented – appear to be relatively commonplace among gamers and prevalence appears to be higher than found in other populations, (ii) individual interpretation of MHs from videogames are influenced by the meanings and uses of auditory cues in the videogames, (iii) MHs can manifest beyond one sensory modality and has been reported across-sensory channels (e.g., hearing music while seeing ghost images from the game), (iv) there is little evidence that MHs among videogame players are linked to other underlying pathology (e.g., epilepsy, psychiatric disorder, etc.), (v) those researching in the field of MHs and INMI appear to have overlooked the literature on these phenomena related to videogame playing, and (vi) better definitions are needed for MHs and a distinction between MHs and INMI is required.

(Please note: This blog is based on material used in the following paper: Griffiths, M.D. & Ortiz de Gortari, A.B. (2015). Musical hallucinations: Review of treatment effects. Frontiers in Psychology, 6, 1885. doi: 10.3389/fpsyg.2015.01885).

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

Further reading

Coebergh, J. A. F., Lauw, R. F., Bots, R., Sommer, I. E. C., & Blom, J. D. (2015) Musical hallucinations: review of treatment effects. Frontiers in Psychology, 6, 814.

Cole M.G., Dowson, L., Dendukuri, N., & Belzile, E. (2002). The prevalence and phenomenology of auditory hallucinations among elderly subjects attending an audiology clinic. International Journal of Geriatric Psychiatry (2002) 17, 444–52.

Fukunishi, I., Horikawa, N., & Onai, H. Prevalence rate of musical hallucinations in a general hospital setting. Psychosomatics (1998) 39, 175.

Hermesh H. (2004). Musical hallucinations: prevalence in psychotic and nonpsychotic outpatients. Journal of Clinical Psychiatry, 65, 191–7. doi:10.4088/JCP.v65n0208

Gardner, M. P. (1985). Mood states and consumer behavior: A critical review. Journal of Consumer Research, 12, 281-300.

Gerra, G., Zaimovic, A., Franchini, D., Palladino, M., Giucastro, G., Reali, N., . . . Brambilla, F. (1998). Neuroendocrine responses of healthy volunteers to `techno-music’: relationships with personality traits and emotional state. International Journal of Psychophysiology, 28(1), 99-111.

Griffiths, M.D. & Ortiz de Gortari, A.B. (2015). Musical hallucinations: Review of treatment effects. Frontiers in Psychology, 6, 1885. doi: 10.3389/fpsyg.2015.01885

Hyman, I. E., Burland, N. K., Duskin, H. M., Cook, M. C., Roy, C. M., McGrath, J. C., & Roundhill, R. F. (2012). Going gaga: Investigating, creating, and manipulating the song stuck in my head. Applied Cognitive Psychology, 27, 204-215.

Liikkanen, L. A. (2012). Musical activities predispose to involuntary musical imagery. Psychology of Music, 40(2), 236-256.

Ortiz de Gortari, A. B, Aronsson, 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. (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). 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). 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.

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., 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, in press.

Ortiz de Gortari, A.B. & Griffiths, M.D (2015b). Prevalence and characteristics of Game Transfer Phenomena: A descriptive survey study. Manuscript under review.

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

Vitorovic, D. & Biller, D. (2013). Musical hallucinations and forgotten tunes – case report and brief literature review. Frontiers in Neurology, 4, 109. doi: 10.3389/fneur.2013.00109

Williams, T. I. (2015). The classification of involuntary musical imagery: The case for earworms. Psychomusicology: Music, Mind, and Brain, 25(1), 5-13.

Woo, P. Y. M. Leung, L. N. Y., Cheng, S. T. M. & Chan, K-Y. (2014). Monoaural musical hallucinations caused by a thalamocortical auditory radiation infarct: a case report. Journal of Medical Case Reports, 8, 400.

Ga(y)ming studies: The importance of sexuality in video gaming

Back in May 2014, hundreds of news outlets reported on Nintendo’s decision not to allow gamers to play as gay characters and form same-sex relationships in the life-simulation game Tomodachi Life. Understandably, there was disquiet and outrage from a number of quarters despite Nintendo’s statement that “Tomodachi Life was intended to be a whimsical and quirky game [and] not trying to provide social commentary”. Their statement at the time appeared to fan the flames rather than silence the critics.

I have been researching video game play for almost three decades and I’ve always found issues surrounding character formation, sexuality, and gender in gaming of great psychological interest. In one of our studies we found that a majority of gamers (57%) had gender-swapped their game character with female gamers (68%) being more likely to gender swap than male gamers (54%). We argued that gender swapping enabled gamers to play around and experiment with various aspects of their in-game character that are not so easy to do in real life. For others it was just fun to see if they felt any different playing a different gendered character. What makes our findings interesting is that in most instances, the gamers had the opportunity to choose the gender of their character and to develop other aspects of their character before they began to play. Choosing to gender swap may have had an effect on the gamers’ styles of play and interaction with other gamers. Whatever the reasons, it was clear from our research that the development of gamers’ online characters and avatars was important to them.

One of the reasons for the importance of online gaming identities may be because it subverts traditional parasocial interaction (PI). PI is a concept used by psychologists that has traditionally described one-sided, parasocial interpersonal relationships in situations where one individual knows a great deal about someone else, but where the other person knows little about the other (the most common being the relationship between celebrities and their fans).

A study led by Nicholas Bowman (and published in a 2012 issue of the journal Cyberpsychology, Behavior and Social Networking [CPBSN]) argued that the playing of video games challenges this concept “as the distance between game players and characters is greatly reduced, if not completely removed, in virtual environments.” The study claimed that online gaming encourages the “psychological merging of a player’s and a character’s mind” and is critical in the development of character attachment. In this context, the sexuality of a character for a player may be of fundamental psychological importance.

This appears to be confirmed in a paper by Melissa Lewis and colleagues (also published in CPBSN) who developed a scale to assess ‘character attachment’ (“the connection felt by a video game player toward a video game character”). They found that character attachment had a significant relationship with self-esteem, addiction, game enjoyment, and time spent playing games.

American researcher Dr. Adrienne Shaw has carried out a number of studies into lesbian, gay, bisexual, and transgender (LGBT) representation in video games from a cultural production perspective. She was one of the first academics in the gaming studies field to note that there was a relative lack of LGBT representation in video games. Other areas of the entertainment media (e.g., music, film, and television) appear to have much greater LGBT representation than in video games so it does beg the question of why the gaming industry appears to be behind in this respect. I recall writing a paper back in 1993 (in The Psychologist) where I argued that most video games at the time were designed by males for other males. This arguably alienated female gamers but eventually led to developers introducing strong female characters into video games (the most notable being Lara Croft in Tomb Raider). Maybe the appearance of LGBT characters and role models within games will increase over time but I’m not holding my breath.

In a more recent paper in a 2012 paper in the journal New Media and Society, Dr. Shaw claimed that the demand for minority representation in video games “often focuses on proving that members of marginalized groups are gamers” and that the gaming industry should focus on appealing to such players via targeted content. However, she argues that an individual’s identity as a gamer will intersect with “other identities like gender, race, and sexuality.” She then goes on to say that the negative connotations about being an online gamer may lead to such marginalized groups not wanting to engage in gaming. She concluded that “those invested in diversity in video games must focus their attention on the construction of the medium, and not the construction of the audience…[This] is necessary to develop arguments for representation in games that do not rely on marking groups as specific kinds of gaming markets via identifiers like gender, race, and sexuality.”

Nintendo’s decision not to allow gay relationships to form within Tomodachi Life was ill-judged, ill-informed, and outdated. Games in which identity content can be generated by its users needs to reflect the world in which the gamers’ live. In short, there should be no compromise when it comes to allowing gamers to choose their sexuality within the game.

(N.B. A version of this article first appeared in The Conversation)

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

Further reading

Bowman, N. D., Schultheiss, D., & Schumann, C. (2012). “I’m attached, and I’m a good guy/gal!”: how character attachment influences pro-and anti-social motivations to play massively multiplayer online role-playing games. Cyberpsychology, Behavior, and Social Networking, 15(3), 169-174

Griffiths, M.D. (1993). Are computer games bad for children? The Psychologist: Bulletin of the British Psychological Society, 6, 401-407.

Griffiths, M.D., Arcelus, J. & Bouman, W.P. (2016). Video gaming and gender dysphoria: Some case study evidence. Aloma: Revista de Psicologia, Ciències de l’Educació i de l’Esport, 34(2), 59-66.

Hussain, Z., & Griffiths, M. D. (2008). Gender swapping and socializing in cyberspace: An exploratory study. CyberPsychology and Behavior, 11(1), 47-53.

Lewis, A. & Griffiths, M.D. (2011). Confronting gender representation: A qualitative study of the experiences and motivations of female casual-gamers. Aloma: Revista de Psicologia, Ciències de l’Educació i de l’Esport, 28, 245-272.

Lewis, M. L., Weber, R., & Bowman, N. D. (2008). “They may be pixels, but they’re MY pixels:” Developing a metric of character attachment in role-playing video games. CyberPsychology and Behavior, 11(4), 515-518.

McLean, L. & Griffiths, M.D. (2013). Female gamers: A thematic analysis of their gaming experience. International Journal of Games-Based Learning, 3(3), 54-71.

Shaw, A. (2009). Putting the gay in games cultural production and GLBT content in video games. Games and Culture, 4(3), 228-253.

Shaw, A. (2012). Do you identify as a gamer? Gender, race, sexuality, and gamer identity. New Media and Society, 14(1), 28-44.

Shaw, A. (2015). Gaming at the edge: Sexuality and gender at the margins of gamer culture. Minnesota: University of Minnesota Press.

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.

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.