Category Archives: I.T.
About a year ago, my colleagues and I published what we believe is the very first study of the helping role that video gaming can play in the lives of transgender individuals. Before I get to that, it’s probably worth noting that there have been studies of how gamers and fans play with sexuality, gender, and the video game Minecraft on YouTube as well as papers discussing whether the gaming industry should cater for marginalized groups and develop games for groups where there is little representation within games (e.g., gay and transgendered characters). For instance, there is now a short autobiographical game by Auntie Pixellante called Dys4ia. This is a WarioWare-style game, played only with the arrow keys, chronicling the experiences of a trans woman rectifying her own gender dysphoria. Such videogames raise interesting questions about how those individuals with gender dysphoria utilize gaming as part of their identity.
In a previous blog I briefly looked at gender swapping in online video games including some of my own research. For instance, in 2003 I published a paper in the journal CyberPsychology and Behavior using secondary poll data from online gaming forums. The paper reported that of 10,350 players at the Everlore fan site, 15% had swapped the gender of their main in-game playing character. We also reported a similar finding among 8,694 players at the Allakhazam fan site with 15.5% reporting that they had gender swapped their main in-game character (and more specifically, 14.5% males and 1% were females who had changed the gender of their lead character). In a 2004 follow-up survey among 540 Everquest gamers (again in the journal CyberPsychology and Behavior) my colleagues and I reported that 60% had swapped their online in-game characters. The prevalence of gender swapping was probably much higher in this study because the question related to the gender swapping of any online game character not just their main playing character.
In a small exploratory study I published in 2008 with Dr. Zaheer Hussain in the International Journal of Mental Health and Addiction, we examined why people engaged in gender swapping in a self-selecting sample of 119 online gamers (mean age of 28.5 years). We reported that 57% of gamers had engaged in gender swapping (any character not just their main character), and that males adopting an online female persona believed there were a number of positive social attributes to becoming female characters in male-oriented gaming environments. The study also reported that significantly more females than males had gender swapped their character – mainly to prevent unsolicited male approaches on their female characters. Some females appeared to gender swap purely out of interest to see what would happen in the game (as a personal experiment), while others claimed that they were treated more favourably by male gamers when they played as a male character. Others reported that gender swapping enabled them to play around with aspects of their identity that would not be possible to explore in real life. Other reasons for gender swapping were that (i) female characters had better in-game statistics, (ii) some specific tools were only available with female characters, (iii) the class of character was sometimes only available in one gender, (iv) they played for fun, and/or (v) they did it to so something that they would not normally do in the game (i.e., they did it for a change in their usual playing behaviour).
Outside of online gaming, a 2002 paper by Hegland and Nelson in the International Journal of Sexuality and Gender Studies noted that the Internet more generally can be used as a tool for expressing gender identity because it allows identities to cross cultural boundaries instantly and without regard for real physical space. They examined 30 cross-dressing websites and argued that for most cross-dressers that visited such websites, the online forum was their primary medium of expression. The users of the website used the Internet to nurture the ability to create a feminine identity, and helped them to pass as a woman in the offline public world. More generally, cross-dressers used the Internet to participate in the larger cultural dialogue of gender.
For an adult to meet current criteria for a diagnosis of transsexualism, the World Health Organisation’s International Classification of Diseases (ICD) reports they must express the desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the desired sex through surgery and cross-sex hormones. This transsexual identity must have been present persistently for a minimum of two years and not be a symptom of another mental disorder or a chromosomal abnormality. The latest (fifth) edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association uses the term gender dysphoria to describe people who are uncomfortable and/or distressed regarding their assigned gender, their physical sex characteristics and/or their associated social roles. Depending upon the intensity of this distress, some individuals may wish to transition from one point on a notional gender scale to another. The most common direction is from a man to a woman (individuals known as trans women), or from a woman to a man (individuals known as trans men). The distress intrinsic to gender dysphoria may be focused around anatomy, physiology, and/or being perceived and treated as someone of a gender with which the person does not identify. However, these diagnostic labels do not apply to all trans individuals for a multitude of reasons because some people will not identify themselves as a man or as a woman
The World Health Organisation working group has recommended that the latest ICD replace the term Transsexualism with Gender Incongruence) and remove it from the mental and behavioural disorders chapter. Gender incongruence denotes the incongruence between a person’s gender identity and their assigned sex and/or congenital primary and secondary sex characteristics. The terminology in this field has changed over the years and the terms ‘transgender’ and ‘trans’ have been used in the literature as umbrella terms to cover a wide variety of atypical gender experiences and expressions which may lead to permanent change of social gender role but does not necessarily involve treatment with cross-sex hormones or surgical intervention. A recent study has reported an prevalence for transsexualism of 4.6 in 100,000 individuals; 6.8 for trans women and 2.6 for trans men, which is primarily based on studies looking at individuals attending clinical services. (However, it should be noted that recent population studies have reported a significantly higher prevalence rate of atypical gender experiences and expressions).
The study we published in the journal Aloma originated from initial observations made by Dr. Jon Arcelus that a number of gender dysphoric clients presenting at the national (UK) gender dysphoria clinic admitted that they gender-swapped while playing online games. After I met with Dr. Arcelus I suggested he revisit his case files and and to write them up as case studies (as no study in the gaming field has ever examined online gaming among those with gender dysphoria). The main objectives of our study were to use exemplar case studies to highlight that gaming – in some circumstances – appears to be a functional way of dealing with gender identity issues, and that gender swapping in gaming may help such individuals to come to terms with their gender dysphoria.
Our paper featured four case studies who attended an assessment at the National Centre for Gender Dysphoria in Nottingham. All four individuals described in our paper were given pseudonyms and the content of their histories were anonymised (and included ‘Mary’ a 26-year old natal male who fully transitioned to the female social role six months prior to our study; ‘Mark’ a 20-year old natal female who first attended for an assessment in the female role; ‘Paul’ a 31-year old natal male who would like to be female, but still living full-time as a male; and ‘Harry’ a 23-year old natal male who presented for an assessment as a male). If you want to read about each case in detail, the paper can be downloaded for free from here).
The four case studies outlined in our paper are only a selected sample of the number of cases attending a national clinic for people with gender dysphoria. However, they were in no way unusual to the other clients that have sought help at the Centre. However, these individual accounts were specifically selected to demonstrate the different ways that video gaming may help people with gender dysphoria come to terms with their gender identity. For example, gaming can be used among trans people as a psychological tool to increase one’s awareness of gender identity and/or as part of the self. Gaming may therefore be a useful way to express one’s experienced gender identity in a safe, non-threatening, non-alienating, non-stigmatizing, and non-critical environment. This appears to mirror other the findings of other studies outside of the online gaming environment.
Articles published in the mass media have reported that online games such as World of Warcraft provide a creative space that allows gamers that might be questioning aspects of their identity to explore their lives as different individuals. Some have even gone as far as to argue that this could help gamers transform their ‘offline’ identity, as is the case with some trans gamers. This was also demonstrated in the case studies described in our study. Other authors have asserted that the online medium offers an infinite space for development and resistance to traditional gender roles, and that online interaction enables a transgression of the dichotomous categories of male and female, constructing trans (or even genderless) social identities and relationships. However, although such anonymous online communities may provide trans individuals with the power to subvert their physical sex.
Our case studies also demonstrated the different functions of gaming in trans people (e.g., the function of “testing out” their gender feelings). For instance, using gaming to ‘come out’ to other people, by initially coming out in the online community, which is perceived as a safe environment, and then gradually coming out in real life. Gaming, as for many non-trans individuals, can derive psychological benefits and a sense of escapism. This is even more relevant among trans people as it may be the only time that they feel they can be themselves, allowing them to feel happy, relaxed, and achieving a sense of completeness. This could develop into a powerful coping skill substituting unhealthy behaviours, such as self-harming behaviour. This is particularly important in this population as research shows a strong association between being trans and mental health problems, particularly depression and self-harm as a way to manage one’s trans feelings. This is not surprising as the discomfort and distress about assigned gender and body dissatisfaction may lead to a sense of hopelessness, which can bring low mood, self-injury and even suicide.
Although gaming appears (at least initially) to be a positive and beneficial activity for many trans people, there is also the risk that staying in the game becomes too much of a secure and safe environment. This can create a vicious circle where the trans person does not wish to move out of the secure online world, and back into reality. Spending an increasing amount of time in online gaming carries the risk of developing a gaming dependence or addiction. This may not only affect one’s personal relationships, work and/or study, but may also impair real life social gender role transition, as in many cases, the individual is expected to socially transition before they can be considered for treatment.
Obviously our paper only included four participants and may be perceived by some researchers as ‘anecdotal’ because the data were not collected for this specific study but were retrospectively collated. However, our findings showed that for a trans individual, the online gaming environment was perceived as “safe” but further research is needed to establish what the distinctive elements of online gaming are that help to raise gender awareness (or not as the case may be). With the rates of gender dysphoria attending clinical services increasing significantly, future research should investigate (i) the rates and severity of gaming among this population as well as its function, and (ii) the rates of gender dysphoria among game addiction as coming out may help their addiction. The game industry may also want to consider how they can use games as a way of helping trans people being more accepted within society by developing game industry may want to co-observe how their games can prepare and assist individuals to socially transition. Online games also provide a safe environment that provides people access to a platform where individuals can discuss and experiment with gender identity.
Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Arcelus, J., Bouman, W. P., Witcomb, G. L., Van den Noortgate, W., Claes, L., & Fernandez-Aranda, F. (2015). Systematic review and meta-analysis of prevalence studies in transsexualism. European Psychiatry, 30, 807-815.
Arcelus, J., Jones, B., Richards, C., Jimenez-Murcia, S., Bouman, W.P. & Griffiths, M.D. (2017). Video gaming and gaming addiction in transgender people: An exploratory study. Journal of Behavioral Addictions, 6, 21–29.
Dale, L. K. (2014, January 23). How World of Warcraft helped me come out as transgender. The Guardian. Retrieved from http://www.theguardian.com/technology/gamesblog/2014/jan/23/how-world-of-warcraft-game-helped-me-come-out-transgender
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.
Griffiths, M. D., Davies, M.N.O. & Chappell, D. (2003). Breaking the stereotype: The case of online gaming. CyberPsychology and Behavior, 6, 81-91.
Griffiths, M.D., Davies, M.N.O. & Chappell, D. (2004). Demographic factors and playing variables in online computer gaming. CyberPsychology and Behavior, 7, 479-487.
Griffiths, M. D., Kiraly, O., M. Pontes, H. M. & and Demetrovics, Z. (2015). An overview of problematic gaming. In Starcevic, V. & Aboujaoude, E. (Eds.), Mental Health in the Digital Age: Grave Dangers, Great Promise (pp.27-55). Oxford: Oxford University Press.
Fahs, B., & Gohr, M. (2012). Superpatriarchy meets cyberfeminism: Facebook, online gaming, and the new social genocide. MP: An Online Feminist Journal, 3(6), 1-40.
Hegland, J. E., & Nelson, N. J. (2002). Cross-dressers in cyber-space: Exploring the Internet as a tool for expressing gendered identity. International Journal of Sexuality and Gender Studies, 7(2-3), 139-161.
Huh, S., & Williams, D. (2010). Dude looks like a lady: Gender swapping in an online game. In Online worlds: Convergence of the real and the virtual (pp. 161-174). London: Springer.
Hussain, Z., & Griffiths, M. D. (2008). Gender swapping and socialising in cyberspace: An exploratory study. CyberPsychology and Behavior, 11, 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, Ciencies de l’Educacio i de l’Esport, 28, 245-272.
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.
Osborne, H. (2012). Performing self, performing character: Exploring gender performativity in online role-playing games. Transformative Works and Cultures, 11. doi:10.3983/twc.2012.0411.
Potts, A. (2015). ‘LOVE YOU GUYS (NO HOMO)’ How gamers and fans play with sexuality, gender, and Minecraft on YouTube. Critical Discourse Studies, 12(2), 163-186.
Shaw, A. (2012). Do you identify as a gamer? Gender, race, sexuality, and gamer identity. New Media and Society, 14(1), 28-44
Taylor, T. L. (2003). Multiple pleasures women and online gaming. Convergence: The International Journal of Research into New Media Technologies, 9(1), 21-46.
Todd, C. (2012). ‘Troubling’ gender in virtual gaming spaces. New Zealand Geographer, 68(2), 101-110.
Unwanted visual intrusions are characteristic of Post-Traumatic Stress Disorder (PTSD). According to Dr. Emily Holmes and her colleagues in a 2009 paper in the journal PLoS ONE, one innovative intervention for inhibiting unwanted intrusions is playing the Tetris videogame, described as a ‘cognitive vaccine’ in preventing intrusions after traumatic events. Playing Tetris consumes heavy visuospatial working memory resources that potentially compete with cognitive resources required for elaboration of visual imagery. Since Holmes and colleagues’ study, other studies have used Tetris to inhibit intrusive imagery including more studies by Holmes and her colleagues and others by Ella James’ research group, as well as some innovative studies using Tetris to reduce drug cravings by Jessica Storka-Brown and her colleagues (see ‘Further reading’ below). However, none of these studies assessed the role of videogame content after playing in relation to Game Transfer Phenomena (GTP), an area that we have carried out a lot of research into (see ‘Further reading’ below).
GTP research has investigated non-volitional experiences (e.g., altered sensorial perceptions and automatic mental processes/behaviours) mostly experienced after gaming. Gamers often report sensorial (visual/auditory) intrusions after playing (e.g., visual and auditory imagery, hallucinations). In a survey of 2,362 gamers that we published in a 2016 issue of the International Journal of Human-Computer Interaction, most (77%) had visualized images from a variety of videogames (including tile-puzzle games) with closed-eyes, and one-third (31%) had visualized images with open-eyes. Other studies have experimentally induced videogame-related visualizations at sleep onset (including studies by Stickgold and colleagues , Wamsley and colleagues , Kusse and colleagues  – see ‘Further reading’).
James and colleagues’ 2015 study in the journal Psychological Science was the first to make explicit reference to GTP (referred to as the ‘Tetris effect’ [TE]). In 2012, we argued the TE term is misleading as it suggests repetition is the core of transfer effects. However, other factors are involved. Research concerning GTP makes the distinction between sensorial modalities facilitating non-volitional phenomena with videogame content that occur along the continuum from mild to severe. Moreover, the descriptive constructs of GTP are empirically based on our analysis of 3,500+ gamers and have been examined via confirmatory factor analysis demonstrating good reliability and validity.
James and her colleagues tested if playing Tetris offered a protective mechanism against re-experiencing traumatic events. Healthy participants (n=56) were randomly assigned to either playing Tetris for 11 minutes, or doing nothing before exposure to a 12-minute traumatic film. Image-base memories about the film were then registered in a one-week dairy. However, playing Tetris as a proactive interference task before watching the film did not show significant results. James and colleagues offered different explanations including: (i) duration of the task in relation to film length, (ii) temporal contingencies between the tasks, (iii) differences between the task types, (iv) videogame types used, and (v) reactivation of gameplay during the film for aided interference. In a commentary paper published in a 2016 issue of Frontiers in Psychology, we discussed these findings and some of its shortcomings in relation to GTP literature.
- Duration of task in relation to film length: Playing Tetris for 11 minutes may not have been long enough to compete with the consolidation of memory of the 12-minute film. GTP are significantly more likely to occur when playing 3-6 hours. Our research reported only 4% of gamers reported GTP when playing sessions shorter than one-hour. Laboratory experiments have taken days of playing to induce game-related visualizations at sleep onset.
- Temporal contingencies between gaming and film watching: The tasks were performed minutes apart from each other. GTP mostly occur soon after stopping playing but our research has found that gamers have also reported GTP days after playing. In most cases, duration of experience is very short (seconds/minutes) but in some cases hours or longer.
- Differences between the tasks: Previous studies have demonstrated that similar tasks aid interference. However, watching a film is a passive activity while gaming is interactive requiring additional perceptual/motor skills. Therefore, it may be expected that gaming is more potent as interference task, particularly because inducing the subjective sense of presence in the virtual world may strengthen the interference.
- Type of videogame used as interference task and emotional content of film: The unrealistic (geometric) Tetris content may have been overwritten by the film’s traumatic images. Visualization of stereotypical games induced at sleep onset are characterized by lack of emotion, assuming that the amygdala and the reward system are not involved. In GTP research, emotions in tile-matching puzzle-games are incomparable to emotions in realistic videogames.
- Reactivation of gameplay during the film for aided interference: The use of cue reminders may have potential in reviving videogame content. In many cases, thoughts and altered perceptions are triggered by game-related cues. Selective attention toward game-related cues has been demonstrated in experiments. GTP have been reported in variety of videogame genres particularly those that have very realistic graphics and settings. Therefore, more realistic games may aid associations between real life stimuli and videogame content, and may be more effective in competing with memories of traumatic events.
In our Frontiers paper, we noted that playing Tetris is not only an effective visuospatial task (overloading working memory resources needed for imagery-formation while playing), but as demonstrated in our GTP studies, videogame content stays active after playing (e.g., mental imagery, sensory perceptions), and may offer additional benefits for managing unwanted intrusions. GTP may potentially strengthen effects of interference tasks but should be used cautiously, because videogame content not only targets unwanted intrusions, but also influences individual cognitions, perceptions, and behaviours in day-to-day contexts (e.g., attention bias, lack of task awareness, control inhibition failures). Moreover, our studies have shown distress and dysfunction have been reported with GTP.
Consequently, further research needs conducting to identify: (i) videogames that are most effective, (ii) playing duration, (iii) factors that reduce intervention efficacy and strategies to control them, and (iv) individuals that may benefit the most from such intervention. While using videogames as intervention tools for preventing unwanted imagery from traumatic experiences has potential, therapeutically it is still at an early stage.
- (Please note: This blog was co-written with Dr. Angelica Ortiz de Gortari and is based on an article we published in Frontiers in Psychology: Ortiz de Gortari, A.B. & Griffiths, M.D. (2016). Playing the computer game Tetris prior to viewing traumatic film material and subsequent intrusive memories: Examining proactive interference. Frontiers in Psychology, 7, 260. doi: 10.3389/fpsyg.2016.00260)
Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Holmes, E. A., James, E. L., Kilford, E. J., & Deeprose, C. (2010). Key steps in developing a cognitive vaccine against traumatic flashbacks: Visuospatial Tetris versus Verbal Pub Quiz. PloS ONE, 5(11), e13706.
James, E. L., Bonsall, M. B., Hoppitt, L., Tunbridge, E. M., Geddes, J. R., Milton, A. L., & Holmes, E. A. (2015a). Computer game play reduces intrusive memories of experimental trauma via reconsolidation-update mechanisms. Psychological Science. doi: 10.1177/0956797615583071
James, E. L., Zhu, A. L., Tickle, H., Horsch, A., & Holmes, E. A. (2015b). Playing the computer game Tetris prior to viewing traumatic film material and subsequent intrusive memories: Examining proactive interference. Journal of Behavior Therapy and Experimental Psychiatry. doi: 10.1016/j.jbtep.2015.11.004
Kusse, C., Shaffii-Le Bourdiec, A., Schrouff, J., Matarazzo, L., & Maquet, P. (2012). Experience-dependent induction of hypnagogic images during daytime naps: A combined behavioural and EEG study. Journal of Sleep Research, 21(1), 10-20.
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. (2012). An introduction to Game Transfer Phenomena in video game playing. In J. I. Gackenbach (Ed.), Video Game Play and Consciousness (pp. 223-250). Hauppauge, NY: Nova Publisher.
Ortiz de Gortari, A. B., & Griffiths, M. D. (2014a). Altered visual perception in Game Transfer Phenomena: An empirical self-report study. International Journal of Human-Computer Interaction, 30(2), 95-105.
Ortiz de Gortari, A. B., & Griffiths, M. D. (2014b). 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. (2014c). 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(4), 1-21.
Ortiz de Gortari, A. B., & Griffiths, M. D. (2015a). 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. & Griffiths, M.D. (2016). Prevalence and characteristics of Game Transfer Phenomena: A descriptive survey study. International Journal of Human-Computer Interaction, 32, 470-480.
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 nonvolitional effects of video game playing. Cyberpsychology, Behavior, and Social Networking 10, 588-594
Skorka-Brown, J., Andrade, J., & May, J. (2014). Playing ‘Tetris’ reduces the strength, frequency and vividness of naturally occurring cravings. Appetite, 76 , 161-165.
Skorka-Brown, J., Andrade, J., Whalley, B., & May, J. (2015). Playing Tetris decreases drug and other cravings in real world settings. Addictive Behaviors, 51, 165-170.
Stickgold, R., Malia, A., Maguire, D., Roddenberry, D., & O’Connor, M. (2000). Replaying the Game: Hypnagogic images in normals and amnesics. Science, 290(5490), 350-353.
Wamsley, E. J., Perry, K., Djonlagic, I., Reaven, L. B., & Stickgold, R. (2010). Cognitive replay of visuomotor learning at sleep onset: Temporal dynamics and relationship to task performance. Sleep, 1(33), 59-68.