Learning, yearning, but not earning: A brief look at student gambling

Last week, the UK Gambling Commission put out a press release relating to student gambling. Having been in the university sector for as long as I have been researching gambling (i.e., 30 years), student gambling is an area that has always been close to my professional heart. I have published dozens of papers on youth gambling and student gambling over the last three decades (see ‘Further reading’ below for a few examples).

With my daughter leaving home to go to university this week there are lots I could potentially worry about and gambling isn’t necessarily my main concern where my daughter is concerned, but gambling is still of concern to me especially because a study I published back in 2012 with Luke Benson and Dr. Christine Norman (in the International Journal of Mental Health and Addiction) found that first year university students gambled more than final year students and were more susceptible to problem gambling compared to final year students.

The Gambling Commission have just published their own research into the topic. They hired Youth Sight who conducted 1,000 online interviews with undergraduate students in August 2017 (the students were part of an online panel recruited from applicants through Universities and Colleges Admission Service). The quotas chosen reflected the UK student population in terms of gender, course year and university group. Here are some of their key findings:

• Two-thirds of students had gambled in the previous month
• Over half of student gamblers (54%) engaged in gambling to make money
• Two-fifths of students said they felt guilty after they had gambled
• One in eight student gamblers had missed lectures due to gambling
• One in four student gamblers (25%) had spent more money gambling than they could afford
• One in 25 student gamblers (4%) were in debt because of their gambling
• One in four students that had a gambling debt, had a debt of over £10,000

The Gambling Commission noted there were are number of limitations with the study. They specifically noted that gambling participation rates may have been higher than if the data had been collected using other methodologies (telephone, face-to-face interviews) due to the self-selecting nature of online surveys. However, online surveys were chosen due to students’ access to technology and the availability of a representative panel via this method. 

On the back of their survey, the Gambling Commission also provided their top ten tips to help students avoid getting into trouble with gambling. I have reproduced them here verbatim.

• Ask yourself why you are gambling: Are you gambling to escape debt or as a way to make quick money? Think carefully about your motivations to gamble. Gambling shouldn’t be seen as the answer to improving your personal finances. If you have concerns about money, speak to a financial adviser or student support services.
• Monitor how often you’re gambling online: Websites must give you access to historic account activity. This means you can see exactly when, how much and what you’ve been gambling on over time and make well-informed choices about what to do next.
• Keep track of how much time you’ve spent gambling: With a reality check, you can set alerts to pop up on screen, which help you to monitor the time spent gambling either online or on gaming machines in a betting shop.
• Limit how much you can spend: If you’re concerned about how much money you’re gambling, you can set a limit on how much you spend across individual gambling products online. You can also set a limit on how much you spend on gaming machines in a betting shop.
• Give yourself a timeout: During a timeout, you can block yourself from gambling online for a set amount of time, of up to 6 weeks, and even bar yourself from gambling during a specific time of day.
• Need a longer break? Self-exclude from gambling firms for a minimum of 6 months: If you think you are spending too much time or money gambling – whether online or in gambling premises – you can ask to be self-excluded. This is when you ask the company to stop you from gambling with them for a period of time. The exclusion will last for a minimum of least six months. Self-exclusion can be used if you think you have a problem with gambling and want help to stop. [The Gambling Commission] are also working with industry representatives to develop a national online self-exclusion scheme.
• Read the terms and conditions: Did you know almost 80% of gamblers haven’t read the terms and conditions on the websites they are gambling on? By taking the time to read the T&Cs, you can ensure you understand exactly what you are gambling on, and what restrictions are attached to promotions and bonus offers (such as a minimum spend level before the bonus is paid) – this will help you make an informed decision.
• Make sure the website you’re gambling with is licensed: Make sure you’re gambling with a Gambling Commission licensed business. This means you’ll be protected by gambling and consumer protection rules in Great Britain. Licensed gambling businesses must display that they are licensed and provide a link to our licence register where you can see what type of activities they are allowed to offer and also if we have taken any regulatory action against them.
• Check how your money is protected: Any gambling business that holds customer funds must explain in their T&Cs how customer funds are protected if the business goes bust – this should help you decide who you want to gamble with.
• Feel it’s getting too much? Talk to someone: There are a number of gambling support groups available if you feel your gambling is getting out of control or too much. More information about the signs of problem gambling can be found on the Gambleaware and Gamcare websites [You can call the National Gambling Helpline on Freephone 0808 8020 133]. They also provide general information about gambling, including how to gamble safely and where to get help if you or someone you know has problems with their gambling.

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

Further reading

Benson, L., Norman, C. & Griffiths, M.D. (2012). The role of impulsivity, sensation seeking, coping, and year of study in student gambling: A pilot study. International Journal of Mental Health and Addiction, 10, 461-473.

Canale, N., Griffiths, M.D., Vieno, A., Siciliano, V. & Molinaro, S. (2016). Impact of internet gambling on problem gambling among adolescents in Italy: Findings from a large-scale nationally representative survey. Computers in Human Behavior, 57, 99-106.

Canale, N., Vieno, A., Lenzi, M., Griffiths, M.D., Borraccino, A., Lazzeri, G., Lemma, P., Scacchi, L., Santinello, M. (2017). Income inequality and adolescent gambling severity: Findings from a large-scale Italian representative survey. Frontiers in Psychology, 8, 1318. doi: 10.3389/fpsyg.2017.01318

Gambling Commision (2017). Commission raises awareness of potential risks for students who gamble. September 12. Located at: http://www.gamblingcommission.gov.uk/news-action-and-statistics/news/2017/Commission-raises-awareness-of-potential-risks-for-students-who-gamble.aspx

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

Griffiths, M.D. (2002). Adolescent gambling: What should teachers and parents know? Education and Health, 20, 31-35.

Griffiths, M.D. (2002). Gambling and Gaming Addictions in Adolescence. Leicester: British Psychological Society/Blackwells.

Griffiths, M.D. (2008). Adolescent gambling in Great Britain. Education Today: Quarterly Journal of the College of Teachers. 58(1), 7-11.

Griffiths, M.D. (2013). Adolescent gambling via social networking sites: A brief overview. Education and Health, 31, 84-87.

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. & Calado, F. (2017). Adolescent gambling. Reference Module in Neuroscience and Biobehavioral Psychology (pp. 1-12). Oxford: Elsevier.

Griffiths, M.D. & Linsey, A. (2006). Adolescent gambling: Still a cause for concern? Education and Health, 24, 9-11.

Griffiths, M.D. & Parke, J. (2010). Adolescent gambling on the Internet: A review. International Journal of Adolescent Medicine and Health, 22, 59-75.

Teaming reign: A brief look at marketing convergence in online sports betting

The marketing cycle of a typical online betting firm aptly illustrates the converging nature of sports and its neighbouring industries. For instance, consider the following football narrative. A betting site buys advertisement space in a national newspaper. The online edition of that newspaper accompanies the advertisement with an active link. If a user clicks on it and access the betting site, the newspaper as an affiliate marketer will get 30% of the money that user has lost betting. In order to boost the number of users clicking on it, the paper publishes next to it a news article featuring Real Madrid on the eve of a match against Manchester United with the following headline: ‘Cristiano Ronaldo scored in 4 of his last 5 visits to Old Trafford’. Now, the journalist shares the link to that piece of news on Twitter, predicting a goal from Ronaldo, with a non-negligible likelihood that he or she is in business with a betting company, according to what was found in a 2014 sample of the ten most followed sports journalists in Spain.

The tweet might be read by someone at home, or even in the stands of a stadium as the game is being played, in which case a betting company might have sponsored the installation of high-speed Wi-Fi connection to facilitate bets. The bet will be preferably made in the proprietary app of the team, who partnered with the betting firm for an amount of money in exchange for adorning the stadium with the brand’s logo, although exclusivity in the electronic banners surrounding the pitch is not possible since the home team must comply with the different betting partners of the league.

Chances are that those at home watching the game on television will hear a litany of statistics about the game delivered by the commentators, provided by a data company like Perform or Dimension Data, who in turn also provide those same data to betting companies, and which are also in a partnership with the league. It is these same data that will inform a fantasy league competition, which also sponsors the league. It might be the case that among the members of the family watching the game at home there are minors who cannot legally gamble for money, for whom a social gaming alternative is also available that can smooth the transition towards real money gambling in the future.

Also, for some demographic groups, sports betting might not be as appealing as eSports, but sport teams have already started sponsoring players in those competitions. When the match has finished, fans can watch further gambling commercials such as ones related to poker, conveniently introduced by sportsmen such as Neymar, Rafael Nadal or Cristiano Ronaldo, or indulge themselves in a little trading in the forex market company Xtrade endorsed by Cristiano Ronaldo himself.

A potential downside of such convergence might be the errors derived by a faulty identification of each product’s category and characteristics. The border between not-for-real-money social gaming on sports and real money gambling might not be obvious, especially when gambling gradually approaches gaming with more gamification attributes being added to the betting experience, and simultaneously, gaming approaches gambling by implementing real or virtual money in-app micro purchases or simulating gambling environments. Blurred lines might impact the understanding of what is information and what is promotion, as has been observed with children having problems distinguishing gambling advertising from non-advertising content (as demonstrated by Helena Sandberg and her colleagues in a 2011 issue of the International Journal of Communication). Another downside could be the transference of positive attributes from sport to other markets (most notably financial trading or poker in the example above), that buy their way into the mental association by, for instance, becoming a named sponsor of a sporting competition.

However, neither the situational and structural characteristics nor the cross-marketing convergence act as singular factors determining online betting behaviour. More likely, they work by aggregation, populating a marketing and advertising ecosystem that far from curtailing other gambling motivating factors – individual factors such as the biological, psychological or social characteristics of the gambler – it facilitates them.

(Please not that this article was co-written with Dr. Hibai Lopez-Gonzalez).

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

Further reading

Deans, E.G., Thomas, S.L,. Derevensky, J. & Daube, M. (2017) The influence of marketing on the sports betting attitudes and consumption behaviours of young men: implications for harm reduction and prevention strategies. Harm Reduction Journal, 14(5). doi:10.1186/s12954-017-0131-8.

Deans, E.G., Thomas, S.L,. Daube, M. & Derevensky J (2016) The role of peer influences on the normalisation of sports wagering: a qualitative study of Australian men. Addiction Research & Theory. doi: 10.1080/16066359.2016.1205042.

Gainsbury, S.M., Delfabbro, P., King, D.L., et al. (2016) An exploratory study of gambling operators’ use of social media and the latent messages conveyed. Journal of Gambling Studies, 32, 125–141.

Gordon, R. & Chapman, M. (2014). Brand community and sports betting in Australia. Victoria, Australia: Victorian Responsible Gambling Foundation.

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

Hing, N., Lamont, M., Vitartas, P., et al. (2015). Sports-embedded gambling promotions: A study of exposure, sports betting intention and problem gambling amongst adults. International Journal of Mental Health and Addiction, 13(1), 115–135..

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., Estevez, A. & Griffiths, M.D. (2017). Marketing and advertising online sports betting: A problem gambling perspective. Journal of Sport and Social Issues, 41, 256-272.

Lopez-Gonzalez, H., Estévez, A. & Griffiths, M.D. (2017). Controlling the illusion of control: A grounded theory of sports betting advertising in the UK. International Gambling Studies, in press.

Lopez-Gonzalez, H. & Griffiths, M.D. (2017). Betting, forex trading, and fantasy gaming sponsorships – A responsible marketing inquiry into the ‘gamblification’ of English football. International Journal of Mental Health and Addiction, in press.

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., Guerrero-Sole, F. & Griffiths, M.D. (2017). A content analysis of how ‘normal’ sports betting behaviour is represented in gambling advertising. Addiction Research and Theory, in press.

Lopez-Gonzalez, H. & Tulloch, C.D. (2015) Enhancing media sport consumption: Online gambling in European football. Media International Australia, 155, 130–139.

Sandberg, H., Gidlof, K. & Holmberg, N. (2011). Children’s exposure to and perceptions of online advertising. International Journal of Communication, 5, 21–50.

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.