Category Archives: Technology

Net gains: A brief overview of our recent papers on Internet addiction

Following my recent blogs where I outlined some of the papers that I and my colleagues have published on mindfulness, I got a couple of emails asking if I could do the same thing on other areas that we have been researching into. So, here it is.

Pontes, H.M., Szabo, A. & Griffiths, M.D. (2015). The impact of Internet-based specific activities on the perceptions of Internet Addiction, Quality of Life, and excessive usage: A cross-sectional study. Addictive Behaviors Reports, 1, 19-25.

  • Introduction: Recent research has examined the context in which preference for specific online activities arises, leading researchers to suggest that excessive Internet users are engaged in specific activities rather than ‘generalized’ Internet use. The present study aimed to partially replicate and expand these findings by addressing four research questions regarding (i) participants’ preferred online activities, (i) possible expected changes in online behavior in light of hypothetical scenarios, (iii) perceived quality of life when access to Internet was not possible, and (iv) how participants with self-diagnosed Internet addiction relate to intensity and frequency of Internet use. Methods: A cross-sectional design was adopted using convenience and snowball sampling to recruit participants. A total of 1057 Internet users with ages ranging from 16 to 70 years (Mean age= 30 years, SD = 10.84) were recruited online via several English-speaking online forums. Results: Most participants indicated that their preferred activities were (i) accessing general information and news, (ii) social networking, and (iii) using e-mail and/or online chatting. Participants also reported that there would be a significant decrease of their Internet use if access to their preferred activities was restricted. The study also found that 51% of the total sample perceived themselves as being addicted to the Internet, while 14.1% reported that without the Internet their life would be improved. Conclusions: The context in which the Internet is used appears to determine the intensity and the lengths that individuals will go to use this tool. The implications of these findings are further discussed.

Pontes, H.M., Kuss, D.J. & Griffiths, M.D. (2015). The clinical psychology of Internet addiction: A review of its conceptualization, prevalence, neuronal processes, and implications for treatment. Neuroscience and Neuroeconomics, 4, 11-23.

  • Research into Internet addiction (IA) has grown rapidly over the last decade. The topic has generated a great deal of debate, particularly in relation to how IA can be defined conceptually as well as the many methodological limitations. The present review aims to further elaborate and clarify issues that are relevant to IA research in a number of areas including: definition and characterization, incidence and prevalence rates, associated neuronal processes, and implications for treatment, prevention, and patient-specific considerations. It is concluded that there is no consensual definition for IA. Prevalence rates among nationally representative samples across several countries vary greatly (from 1% to 18.7%), most likely reflecting the lack of methodological consistency and conceptual rigor of the studies. The overlaps between IA and other more traditional substance-based addictions and the possible neural substrates implicated in IA are also highlighted. In terms of treatment and prevention, both psychological and pharmacological treatments are examined in light of existing evidence alongside particular aspects inherent to the patient perspective. Based on the evidence analyzed, it is concluded that IA may pose a serious health hazard to a minority of people.

Lai, C-L., Mak, K-K., Cheng, C., Watanabe, H., Nomachi, S., Bahar, N., Young, K.S., Ko, H-C., Kim, D. & Griffiths, M.D. (2015). Measurement invariance of Internet Addiction Test among Hong Kong, Japanese, and Malaysian adolescents: An item response analysis. Cyberpsychology, Behavior and Social Networking, 18, 609-617.

  • There has been increased research examining the psychometric properties on the Internet Addiction Test (IAT) in different populations. This population-based study examined the psychometric properties and measurement invariance of the IAT in adolescents from three Asian countries. In the Asian Adolescent Risk Behavior Survey (AARBS), 2,535 secondary school students (55.9% girls) aged 12-18 years from Hong Kong (n=844), Japan (n=744), and Malaysia (n=947) completed a survey in 2012-2013 school year. A nested hierarchy of hypotheses concerning the IAT cross-country invariance was tested using multigroup confirmatory factor analyses. Replicating past findings in Hong Kong adolescents, the construct of the IAT is best represented by a second-order three-factor structure in Malaysian and Japanese adolescents. Configural, metric, scalar, and partial strict factorial invariance was established across the three samples. No cross-country differences on Internet addiction were detected at the latent mean level. This study provided empirical support for the IAT as a reliable and factorially stable instrument, and valid to be used across Asian adolescent populations.

Griffiths, M.D., Kuss, D.J., Billieux J. & Pontes, H.M. (2016). The evolution of internet addiction: A global perspective. Addictive Behaviors, 53, 193–195.

  • Kimberly Young’s initial work on Internet addiction (IA) was pioneering and her early writings on the topic in- spired many others to carry out research in the area. Young’s (2015) recent paper on the ‘evolution of Internet addiction’ featured very little European research, and did not consider the main international evidence that has contributed to our current knowledge about the conceptualization, epidemiology, etiology, and course of Internet-related disorders. This short commentary paper elaborates on important literature omitted by Young that the present authors believe may be of use to researchers. We also address statements made in Young’s (2015) commentary that are incorrect (and therefore misleading) and not systematically substantiated by empirical evidence.

Stavropoulos, V., Kuss, D.K., Griffiths, M.D. & Motti-Stafanidi, F. (2016). A longitudinal study of adolescent internet addiction: The role of conscientiousness and classroom hostility. Journal of Adolescent Research, in press.

  • Over the last decade, research on Internet addiction (IA) has increased. However, almost all studies in the area are cross-sectional and do not examine the context in which Internet use takes place. Therefore, a longitudinal study examined the role of conscientiousness (as a personality trait) and classroom hostility (as a contextual factor) in the development of IA. The participants comprised 648 adolescents and were assessed over a 2-year period (while aged 16-18 years). A three-level hierarchical linear model was carried out on the data collected. Findings revealed that (a) lower conscientiousness was associated with IA and this did not change over time and (b) although being in a more hostile classroom did not initially have a significant effect, it increased girls’ IA vulnerability over time and functioned protectively for boys. Results indicated that the contribution of individual and contextual IA factors may differ across genders and over time. More specifically, although the protective effect of conscientiousness appeared to hold, the over-time effect of classroom hostility increased the risk of IA for girls. These findings are discussed in relation to the psychological literature. The study’s limitations and implications are also discussed.

Ostovar, S., Allahyar, N., Aminpoor, H. Moafian, F., Nor, M. & Griffiths, M.D. (2016). Internet addiction and its psychosocial risks (depression, anxiety, stress and loneliness) among Iranian adolescents and young adults: A structural equation model in a cross-sectional study. International Journal of Mental Health and Addiction, in press.

  • Internet addiction has become an increasingly researched area in many Westernized countries. However, there has been little research in developing countries such as Iran, and when research has been conducted, it has typically utilized small samples. This study investigated the relationship of Internet addiction with stress, depression, anxiety, and loneliness in 1052 Iranian adolescents and young adults. The participants were randomly selected to complete a battery of psychometrically validated instruments including the Internet Addiction Test, Depression Anxiety Stress Scale, and the Loneliness Scale. Structural equation modeling and Pearson correlation coefficients were used to determine the relationship between Internet addiction and psychological impairments (depression, anxiety, stress and loneliness). Pearson correlation, path analysis, multivariate analysis of variance (MANOVA), and t-tests were used to analyze the data. Results showed that Internet addiction is a predictor of stress, depression, anxiety, and loneliness. Findings further indicated that addictive Internet use is gender sensitive and that the risk of Internet addiction is higher in males than in females. The results showed that male Internet addicts differed significantly from females in terms of depression, anxiety, stress, and loneliness. The implications of these results are discussed.

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

Further reading

Billieux, J., Deleuze, J., Griffiths, M.D., & Kuss, D.J. (2015). Internet addiction: The case of massively multiplayer online role playing games. In N. El-Guebaly, M. Galanter, & G. Carra (Eds.), The Textbook of Addiction Treatment: International Perspectives (pp.1516-1525). New York: Springer.

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

Griffiths, M.D. & Pontes, H.M. (2014). Internet addiction disorder and internet gaming disorder are not the same. Journal of Addiction Research and Therapy, 5: e124. doi:10.4172/2155-6105.1000e124.

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

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

Kuss, D.J. & Griffiths, M.D. (2015). Internet Addiction in Psychotherapy. Basingstoke: Palgrave Macmillan.

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

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

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

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

Widyanto, L. & Griffiths, M.D. (2006). Internet addiction: Does it really exist? (Revisited). In J. Gackenbach (Ed.), Psychology and the Internet: Intrapersonal, Interpersonal and Transpersonal Applications (2nd Edition), (pp.141-163). New York: Academic Press.

Widyanto, L. & Griffiths, M.D. (2011). Unravelling the Web: Adolescents and Internet Addiction. In Virtual Communities: Concepts, Methodologies, Tools and Applications (pp. 2433-2453). Hershey, Pennsylvania: Idea Publishing.

Tales of the unexpected: 10 bad habits that sometimes do us good (Part 1)

All of us have bad habits, and all of us from time to time feel guilty about these habits. But there are some bad habits – at least when carried out in moderation – that might actually have benefits for psychological and/or physical wellbeing. Most bad habits help change our mood state and reduce stress (at least in the very short-term) but tend to become less helpful the more they are engaged in. Some of these bad habits turn into addictions where the short-term benefits are outweighed by the long-term costs. However, there are many activities that can sometimes have unexpected benefits and five of these are outlined in this blog. The next five bad habits will be in my next blog.

(1) Fidgeting helps burn calories

While fidgeting might be annoying for individuals and those around them, it is an activity that expends energy and burns calories. Fidgeting is one of a number of activities (along with walking, gardening, typing, tidying up, etc.) that are known as non-exercise activity thermogenesis (NEAT). In basic terms, NEAT is any activity that is not eating, sleeping, or sporting exercise. A number of studies carried out by obesity expert Dr. James Levine at the US Mayo Clinic (Arizona, US) have shown that individuals who fidget burn up about 350kcal a day. This is because fidgeting speeds up an individual’s metabolism by stimulating neurochemicals in the body thus increasing the ability to convert body fat into energy. So, if you are a compulsive foot tapper, an excessive thumb twiddler, or a restless doodler, just remember that all of these activities burn calories.

(2) Chewing gum helps boost thinking and alertness

Watching people chew gum is not a pretty site but if English football managers are anything to go by, chewing gum appears to be a stress relieving activity. In fact, there appear to appear to be many cognitive benefits of chewing gum. Dr. Kin-ya Kubo and colleagues in the book Senescence and Senescence-Related Disorders noted that chewing gum immediately before performing a cognitive task increases blood oxygen levels in the prefrontal cortex and hippocampus (important brain structures involved in learning and memory), thereby improving task performance. Dr. Kubo argues that chewing gum may therefore be a drug-free and simple method of helping those with senile dementia and stress-related disorders that are often associated with cognitive dysfunction. Another study by Dr. Yoshiyuki Hirano and colleagues showed that chewing gum boosts thinking and alertness, and that reaction times among chewers were 10% faster than non-chewers. The research team also reported that up to eight areas of the brain are affected by chewing (most notably the areas concerning attention and movement). As Professor Andy Smith (Cardiff University, UK) neatly summed up: “The effects of chewing on reaction time are profound. Perhaps football managers arrived at the idea of chewing gum by accident, but they seem to be on the right track”. 

(3) Playing video games helps relieve pain

Many individuals that do not play video games view the activity as a complete waste of time and potentially addictive. While excessive video game playing may cause problems in a minority of individuals, there is lots of scientific evidence that playing video games can have many beneficial effects. For instance, a number of studies have shown that children with cancer who play video games after chemotherapy take less pain killing medication. Video games have also been used as pain relieving therapy for other medical conditions such as burns victims and those with back pain. This is because playing video games is an engaging and engrossing activity that means the player cannot think about anything else but playing the game (and is what psychologists refer to as a ‘cognitive distractor task’). Pain has a large psychological component and individuals experience less pain if the person is engaged in an activity that takes up all their cognitive mind space. As well as being a pain reliever, there are also many studies showing that playing video games increase hand-eye co-ordination, increase reaction times, and have educational learning benefits.

(4) Eating snot helps strengthen the immune system (maybe)

How does it make you feel when you see someone picking their nose and then eating what they have found? Disgust? Contempt? Amused? In 2008, Dr Friedrich Bischinger, an Austrian lung specialist, claimed that picking your nose and eating it was good for you. He claimed that people who pick their noses with their fingers were healthy, happier and probably better in tune with their bodies than those who didn’t. Dr. Bischinger believes that eating the dry remains of what you pull out of your nose is a great way of strengthening the body’s immune system. He explained that in terms of the immune system, the nose is a filter in which a great deal of bacteria are collected, and when this mixture arrives in the intestines it works just like a medicine. He said that “people who pick their nose and eat it get a natural boost to their immune system for free. I would recommend a new approach where children are encouraged to pick their nose. It is a completely natural response and medically a good idea as well”. He went on to suggest that if anyone was worried about what other people think, they should pick their noses privately if they want to get the benefits.  This view is also shared by Dr. Scott Napper, a biochemist at the University of Saskatchewan. He theorises that hygiene improvement has led to the increase in allergies and auto-immune disorders and that eating snot may boost the immune system by ingesting small and harmless amounts of germs into the body. The same theory has also been applied to another bad habit – biting fingernails – because again, the act of biting nails introduces germs directly into a person’s orifices.

(5) Daydreaming helps problem solving

Daydreaming is something that can occupy up to one-third of our waking lives and is often viewed as a sign of laziness, inattentiveness and/or procrastination. However, scientific research has shown that the ‘executive network’ in our brain is highly active when we daydream. A study carried out by Professor Kalina Christoff and colleagues and published in the Proceedings of the National Academy of Sciences found activity in numerous brain regions while daydreaming including areas associated with complex problem solving. These brain regions were more active while daydreaming compared to routine tasks. It is believed that when an individual uses conscious thought they can become too rigid and limited in their thinking. The findings suggest that daydreaming is an important cognitive state where individuals turn their attention from immediate tasks to unconsciously think about problems in their lives. Christoff says that “when you daydream, you may not be achieving your immediate goal – say reading a book or paying attention in class – but your mind may be taking that time to address more important questions in your life, such as advancing your career or personal relationships”. In addition to this, Dr. Eric Klinger of the University of Minnesota has argued that daydreaming also serves an evolutionary purpose. When individuals are engaged on one task, daydreaming can trigger reminders of other, concurrent goals so that they do not lose sight of them.

Part 2 of this article will be in the next blog.

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

Further reading

Christoff, K., Gordon, A.M., Smallwood, J., Smith, R., & Schooler, J.W. (2009). Experience sampling during fMRI reveals default network and executive system contributions to mind wandering. Proceedings of the National Academy of Sciences, 106, 8719-872

Fox, K.C., Nijeboer, S., Solomonova, E., Domhoff, G.W., & Christoff, K. (2013). Dreaming as mind wandering: evidence from functional neuroimaging and first-person content reports. Frontiers in Human Neuroscience, 7, 42. doi: 10.3389/fnhum.2013.00412.

Griffiths, M.D. (2005). The therapeutic value of videogames. In J. Goldstein & J. Raessens (Eds.), Handbook of Computer Game Studies (pp. 161-171). Boston: MIT Press.

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

Hirano, Y., Obata, T., Takahashi, H., Tachibana, A., Kuroiwa, D., Takahashi, T., … & Onozuka, M. (2013). Effects of chewing on cognitive processing speed. Brain and Cognition, 81, 376-381.

Kato, P. M., Cole, S. W., Bradlyn, A. S., & Pollock, B. H. (2008). A video game improves behavioral outcomes in adolescents and young adults with cancer: A randomized trial. Pediatrics, 122, E305-E317.

Klinger, E. (2009). Daydreaming and fantasizing: Thought flow and motivation. In Markman, K. D., Klein, W.P., & Suhr, J.A. (Eds.), Handbook of Imagination and Mental Simulation (pp. 225-239). New York: Psychology Press.

Klinger, E., Henning, V. R., & Janssen, J. M. (2009). Fantasy-proneness dimensionalized: Dissociative component is related to psychopathology, daydreaming as such is not. Journal of Research in Personality, 43, 506-510.

Kubo, K. Y., Chen, H., & Onozuka, M. (2013). The relationship between mastication and cognition. In Wang, Z. & Inuzuka (Eds.), Senescence and Senescence-Related Disorders. InTech. Located at: http://www.intechopen.com/books/senescence-and-senescence-related-disorders

Levine, J.A. (2004). Nonexercise activity thermogenesis (NEAT): environment and biology. American Journal of Physiology-Endocrinology And Metabolism, 286, E675-E685.

Levine, J.A., Melanson, E. L., Westerterp, K. R., & Hill, J.O. (2001). Measurement of the components of nonexercise activity thermogenesis. American Journal of Physiology-Endocrinology and Metabolism, 281, E670-E675.

Levine, J.A., Schleusner, S. J., & Jensen, M.D. (2000). Energy expenditure of nonexercise activity. American Journal of Clinical Nutrition, 72, 1451-1454.

Redd, W.H., Jacobsen, P.B., DieTrill, M., Dermatis, H., McEvoy, M., & Holland, J.C. (1987). Cognitive-attentional distraction in the control of conditioned nausea in pediatric cancer patients receiving chemotherapy. Journal of Consulting and Clinical Psychology, 55, 391-395.

Reichlin, L., Mani, N., McArthur, K., Harris, A.M., Rajan, N., & Dacso, C.C. (2011). Assessing the acceptability and usability of an interactive serious game in aiding treatment decisions for patients with localized prostate cancer. Journal of Medical Internet Research, 13, 188-201.

Vasterling, J., Jenkins, R.A., Tope, D.M., & Burish, T.G. (1993). Cognitive distraction and relaxation training for the control of side effects due to cancer chemotherapy. Journal of Behavioral Medicine, 16, 65-80.

Wighton, K. (2013). From biting your nails to burping and even eating in bed: The bad habits that can be GOOD for you! Daily Mail, April 8. Located at: http://www.dailymail.co.uk/health/article-2305953/Bad-habits-From-biting-nails-burping-eating-bed-The-bad-habits-GOOD-you.html

Stick in the Buddhism: Mindfulness in the treatment of addiction and improved psychological wellbeing (Part 1)

Over the last year I’ve been receiving a lot of emails (well, about nine or ten to be honest but it seems like a lot) expressing surprise at the increasing numbers of papers on mindfulness that have been appearing on my Research Gate and Academia.edu webpages. This research program is actually being led by my friends and Nottingham Trent University research colleagues, Dr. Edo Shonin and Willliam Van Gordon. Given this increasing level of interest, I thought I would use my next two blogs to briefly overview some of these publications. My research colleagues and I are happy for anyone interested in these papers to contact us at the email addresses below. We also have a new book on the topic too (Mindfulness and Buddhist-derived Approaches in Mental Health and Addiction).

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Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). Cognitive Behavioral Therapy (CBT) and Meditation Awareness Training (MAT) for the treatment of co-occurring schizophrenia with pathological gambling: A case study. International Journal of Mental Health and Addiction, 12, 806–823.

  • There is a paucity of interventional approaches that are sensitive to the complex needs of individuals with co-occurring schizophrenia and pathological gambling. Utilizing a single-participant design, this study conducted the first clinical evaluation of a novel and integrated non-pharmacological treatment for a participant with dual-diagnosis schizophrenia and pathological gambling. The participant underwent a 20-week treatment course comprising: (i) an initial phase of second-wave cognitive behavioral therapy (CBT), and (ii) a subsequent phase employing a meditation-based recovery model (involving the administering of an intervention known as Meditation Awareness Training). The primary outcome was diagnostic change (based on DSM-IV-TR criteria) for schizophrenia and pathological gambling. Secondary outcomes were: (i) psychiatric symptom severity, (ii) pathological gambling symptom severity, (iii) psychosocial functioning, and (iv) dispositional mindfulness. Findings demonstrated that the participant was successfully treated for both schizophrenia and pathological gambling. Significant improvements were also observed across all other outcome variables and positive outcomes were maintained at three-month follow-up. An initial phase of CBT to improve social coping skills and environmental mastery, followed by a phase of meditation-based therapy to increase perceptual distance from mental urges and intrusive thoughts, may be a diagnostically-syntonic treatment for co-occurring schizophrenia and pathological gambling.

Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). The treatment of workaholism with Meditation Awareness Training: A case study. Explore: Journal of Science and Healing, 10, 193-195.

  • Recent decades have witnessed a marked increase in research investigating the etiology, typology, symptoms, prevalence, and correlates of workaholism. However, despite increasing prevalence rates for workaholism, there is a paucity of workaholism treatment studies. Indeed, guidelines for the treatment of workaholism tend to be based on either theoretical proposals or anecdotal reports elicited during clinical practice. Thus, there is a need to establish dedicated and effective treatments for workaholism. A novel broad-application interventional approach receiving increasing attention by occupational and healthcare stakeholders is that of third-wave cognitive behavioral therapies (CBTs). Third-wave CBTs integrate aspects of Eastern philosophy and typically employ a meditation-based recovery model. A primary treatment mechanism of these techniques involves the regulation of psychological and autonomic arousal by increasing perceptual distance from faulty thoughts and mental urges. A ‘meditative anchor’, such as observing the breath, is typically used to aid concentration and to help maintain an open-awareness of present moment sensory and cognitive-affective experience. The purpose of this case study was to conduct the first evaluation of a treatment employing a meditation-based recovery model for a workaholic.

Shonin, E.S., van Gordon, W. & Griffiths, M.D. (2013). Buddhist philosophy for the treatment of problem gambling. Journal of Behavioral Addictions, 2, 63-71.

  • In the last five years, scientific interest into the potential applications of Buddhist-derived interventions (BDIs) for the treatment of problem gambling has been growing. This paper reviews current directions, proposes conceptual applications, and discusses integration issues relating to the utilisation of BDIs as problem gambling treatments. A literature search and evaluation of the empirical literature for BDIs as problem gambling treatments was undertaken. To date, research has been limited to cross-sectional studies and clinical case studies and findings indicate that Buddhist-derived mindfulness practices have the potential to play an important role in ameliorating problem gambling symptomatology. As an adjunct to mindfulness, other Buddhist-derived practices are also of interest including: (i) insight meditation techniques (e.g., meditation on ‘emptiness’) to overcome avoidance and dissociation strategies, (ii) ‘antidotes’ (e.g., patience, impermanence, etc.) to attenuate impulsivity and salience-related issues, (iii) loving-kindness and compassion meditation to foster positive thinking and reduce conflict, and (iv) ‘middle-way’ principles and ‘bliss-substitution’ to reduce relapse and temper withdrawal symptoms. In addition to an absence of controlled treatment studies, the successful operationalisation of BDIs as effective treatments for problem gambling may be impeded by issues such as a deficiency of suitably experienced BDI clinicians, and the poor provision by service providers of both BDIs and dedicated gambling interventions. Preliminary findings for BDIs as problem gambling treatments are promising, however, further research is required.

Shonin, E.S., van Gordon, W., Slade, K. & Griffiths, M.D. (2013). Mindfulness and other Buddhist-derived interventions in correctional settings: A systematic review. Aggression and Violent Behavior, 18, 365-372.

  • Throughout the last decade, there has been a growth of interest into the rehabilitative utility of Buddhist-derived interventions (BDIs) for incarcerated populations. The purpose of this study was to systematically review the evidence for BDIs in correctional settings. MEDLINE, Science Direct, ISI Web of Knowledge, PsychInfo, and Google Scholar electronic databases were systematically searched. Reference lists of retrieved articles and review papers were also examined for any further studies. Controlled intervention studies of BDIs that utilised incarcerated samples were included. Jaded scoring was used to evaluate methodological quality. PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines were followed. The initial comprehensive literature search yielded 85 papers but only eight studies met all the inclusion criteria. The eight eligible studies comprised two mindfulness studies, four vipassana meditation studies, and two studies utilizing other BDIs. Intervention participants demonstrated significant improvements across five key criminogenic variables: (i) negative affective, (ii) substance use (and related attitudes), (iii) anger and hostility, (iv) relaxation capacity, and (v) self-esteem and optimism. There were a number of major quality issues. It is concluded that BDIs may be feasible and effective rehabilitative interventions for incarcerated populations. However, if the potential suitability and efficacy of BDIs for prisoner populations is to be evaluated in earnest, it is essential that methodological rigour is substantially improved. Studies that can overcome the ethical issues relating to randomisation in correctional settings and employ robust randomised controlled trial designs are favoured.

Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). Mindfulness meditation in American correctional facilities: A ‘what-works’ approach to reducing reoffending. Corrections Today: Journal of the American Correctional Association, March/April, 48-51.

  • Throughout the last decade, there has been a growth of interest into the rehabilitative utility of Buddhist-derived interventions (BDIs) for incarcerated populations. The purpose of this study was to systematically review the evidence for BDIs in correctional settings. MEDLINE, Science Direct, ISI Web of Knowledge, PsychInfo, and Google Scholar electronic databases were systematically searched. Reference lists of retrieved articles and review papers were also examined for any further studies. Controlled intervention studies of BDIs that utilised incarcerated samples were included. Jaded scoring was used to evaluate methodological quality. PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines were followed. The initial comprehensive literature search yielded 85 papers and but only eight studies met all the inclusion criteria. The eight eligible studies comprised two mindfulness studies, four vipassana meditation studies, and two studies utilizing other BDIs. Intervention participants demonstrated significant improvements across five key criminogenic variables: (i) negative affective, (ii) substance use (and related attitudes), (iii) anger and hostility, (iv) relaxation capacity, and (v) self-esteem and optimism. There were a number of major quality issues. It is concluded that BDIs may be feasible and effective rehabilitative interventions for incarcerated populations. However, if the potential suitability and efficacy of BDIs for prisoner populations is to be evaluated in earnest, it is essential that methodological rigour is substantially improved. Studies that can overcome the ethical issues relating to randomisation in correctional settings and employ robust randomised controlled trial designs are favoured.

Contact details

e.shonin@awaketowisdom.co.ukwilliam@awaketowisdom.co.ukmark.griffiths@ntu.ac.uk

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

Additional input by Edo Shonin and William Van Gordon

Further reading

Shonin, E.S., van Gordon, W. & Griffiths, M.D. (2012). The health benefits of mindfulness-based interventions for children and adolescents, Education and Health, 30, 94-97.

Shonin, E.S., van Gordon, W. & Griffiths, M.D. (2013). Mindfulness-based interventions: Towards mindful clinical integration. Frontiers in Psychology, 4, 194, doi: 10.3389/fpsyg.2013.00194.

Shonin, E.S., van Gordon, W. & Griffiths, M.D. (2013). Buddhist philosophy for the treatment of problem gambling. Journal of Behavioral Addictions, 2, 63-71.

Shonin, E.S., van Gordon, W. & Griffiths, M.D. (2013). Meditation as medication: Are attitudes changing? British Journal of General Practice, 617, 654-654.

Shonin, E., Van Gordon, W. & Griffiths, M.D. (2013). Mindfulness and addiction: Sending out an SOS. Addiction Today, March, 18-19.

Shonin, E., Van Gordon, W. & Griffiths, M.D. (2013). Mindfulness-based therapy: A tool for spiritual growth? Thresholds, Summer, 14-18.

Shonin, E.S., van Gordon, W. & Griffiths, M.D. (2014). Practical tips for using mindfulness in general practice. British Journal of General Practice, 624 368-369.

Shonin, E.S., van Gordon, W. & Griffiths, M.D. (2014). Meditation Based Awareness Training (MBAT) for psychological wellbeing: A qualitative examination of participant experiences. Journal of Religion and Health, 53, 849–863.

Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). Mindfulness meditation in American correctional facilities: A ‘what-works’ approach to reducing reoffending. Corrections Today: Journal of the American Correctional Association, March/April, 48-51.

Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). Does mindfulness meditation have a role in the treatment of psychosis? Australian and New Zealand Journal of Psychiatry, 48, 124-127.

Shonin, E., Van Gordon W., & Griffiths M.D. (2014). The emerging role of Buddhism in clinical psychology: Towards effective integration. Psychology of Religion and Spirituality, 6, 123-137.

Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). The treatment of workaholism with Meditation Awareness Training: A case study. Explore: Journal of Science and Healing, 10, 193-195.

Shonin, E.S., Van Gordon, W. & Griffiths, M.D. (2014). Mindfulness and the Social Media, Mass Communication and Journalism, 4: 194. doi: 10.4172/2165-7912.1000194.

Shonin, E., Van Gordon, W., & Griffiths M.D. (2014). Cognitive Behavioral Therapy (CBT) and Meditation Awareness Training (MAT) for the treatment of co-occurring schizophrenia with pathological gambling: A case study. International Journal of Mental Health and Addiction, 12, 181-196.

Shonin, E., Van Gordon, W., & Griffiths, M.D. (2016), Mindfulness and Buddhist-derived Approaches in Mental Health and Addiction. New York: Springer.

Shonin, E.S., van Gordon, W., Slade, K. & Griffiths, M.D. (2013). Mindfulness and other Buddhist-derived interventions in correctional settings: A systematic review. Aggression and Violent Behavior, 18, 365-372.

Shonin, E., Van Gordon W., & Griffiths, M.D. (2014). Are there risks associated with using mindfulness for the treatment of psychopathology? Clinical Practice, 11, 389-392.

Van Gordon, W. Shonin, E.S., Skelton, K. & Griffiths, M.D. (2014). Working mindfully: Can mindfulness improve work-related wellbeing and work? Counselling at Work, 87, 14-19.

Van Gordon, W., Shonin, E., Sumich, A., Sundin, E., & Griffiths, M.D. (2014). Meditation Awareness Training (MAT) for psychological wellbeing in a sub-clinical sample of university students: A controlled pilot study. Mindfulness, 12, 806–823.

Playing the field: Another look at Internet Gaming Disorder

Research into online addictions has grown considerably over the last two decades and much of it has concentrated on problematic gaming, particularly MMORPGs (Massively Multiplayer Online Role-Playing Games). In the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013), Internet Gaming Disorder (IGD) (also commonly referred in the literature as problematic gaming and gaming addiction) was included in Section 3 (‘Emerging Measures and Models’) as a promising area that needed future research before being included in the main section of future editions of the DSM.

The DSM-5 proposed nine criteria for IGD (of which five or more need to be endorsed over the period of 12 months and result in clinically significant impairment to be diagnosed as experiencing IGD). More specifically the criteria include (1) preoccupation with games; (2) withdrawal symptoms when gaming is taken away; (3) the need to spend increasing amounts of time engaged in gaming, (4) unsuccessful attempts to control participation in gaming; (5) loss of interest in hobbies and entertainment as a result of, and with the exception of, gaming; (6) continued excessive use of games despite knowledge of psychosocial problems; (7) deception of family members, therapists, or others regarding the amount of gaming; (8) use of gaming to escape or relieve a negative mood;  and (9) loss of a significant relationship, job, or educational or career opportunity because of participation in games.

There is no agreement on the prevalence of IGD as the vast majority of studies have surveyed non-representative self-selected samples using over 20 different screening instruments. A review of problematic gaming prevalence studies that I published with Orsi Király, Halley Pontes, and Zsolt Demetrovics (in the 2015 book Mental Health in the Digital Age: Grave Dangers, Great Promise) reported a large variation in the prevalence rates (from 0.2% up to 34%). However, we noted that there were many factors that could have accounted for the wide variation in prevalence rates including the type of gaming examined (i.e., some studies just examined online gaming, whereas others examined console gaming or a mixture of both), sample size, participants’ age range, participant type (i.e., some surveyed the general population while others assessed gamers only), and instruments used to assess gaming.

There have been a handful of studies that have reported the prevalence of IGD using nationally representative samples. The prevalence rates reported were 8.5% of American youth aged 8–18 years, 1.2% of German adolescents aged 13-18 years, 5.5% among Dutch adolescents aged 13-20, and 5.4% among Dutch adults, 4.3% of Hungarian adolescents aged 15-16 years, 1.4% of Norwegian gamers, and 1.6% of European youth from seven countries aged 14-17 years.

There are now over 20 different screening instruments including a number of new ones specifically incorporating the IGD criteria (including a number that I have co-developed with Halley Pontes). The multiplicity of problematic gaming screens remains a key challenge in the field and partially reflects the lack of consensus in terms of the assessment of the phenomenon. A comprehensive 2013 review that I published with Daniel King and others in Clinical Psychology Review examined the criteria of 18 problematic gaming screens. The 18 screens had been utilized in 63 quantitative studies (N=58,415 participants). The main weaknesses identified were (i) inconsistency of core addiction indicators across studies, (ii) a general lack of any temporal dimension, (iii) inconsistent cutoff scores relating to clinical status, (iv) poor and/or inadequate inter-rater reliability and predictive validity, and (v) inconsistent and/or untested dimensionality. We also questioned the appropriateness of certain screens for certain settings, because those used in clinical practice may require a different emphasis than those used in epidemiological, experimental, or neurobiological research settings.

Research into IGD is needed from clinical, epidemiological, and neurobiological aspects of IGD. There has been an increasing number of neurobiological studies on IGD and a 2014 meta-analysis by Dr. Y. Meng and colleagues in Addiction Biology of 10 neuroimaging studies investigating the functional brain response to cognitive tasks from IGD using quantitative effect size signed differential mapping meta-analytic methods. found reliable clusters of abnormal activation in IGD within the regions comprising the bilateral medial frontal gyrus/cingulate gyrus, the left middle temporal gyrus and fusiform gyrus when compared to healthy controls. The same review also found that greater amounts of time spent per week playing was associated with hyper-activity in the left medial frontal gyrus and the right cingulate gyrus. Despite the useful findings reported, one of the major limitations of this meta-analysis was that 90% of the studies reviewed were conducted in Asian countries or regions, which might be problematic since prevalence rates of IGD in these populations are usually inflated compared to prevalence rates reported in Western countries. Furthermore, a systematic review of neuroimaging studies examining Internet addiction (IA) and IGD by Daria Kuss and myself in the journal Brain Sciences concluded that:

“These studies provide compelling evidence for the similarities between different types of addictions, notably substance-related addictions and Internet and gaming addiction, on a variety of levels. On the molecular level, Internet addiction is characterized by an overall reward deficiency that entails decreased dopaminergic activity. On the level of neural circuitry, Internet and gaming addiction lead to neuroadaptation and structural changes that occur as a consequence of prolonged increased activity in brain areas associated with addiction. On a behavioral level, Internet and gaming addicts appear to be constricted with regards to their cognitive functioning in various domains”

Over the last decade, a number of studies have investigated the association between IGD (and its derivatives) and various personality and comorbidity factors. Our recent review in the book Mental Health in the Digital Age: Grave Dangers, Great Promise summarized the research examining the relationship between personality traits and IGD. Empirical studies have shown IGD to be associated with (i) neuroticism, (ii) aggression and hostility, (iii) avoidant and schizoid tendencies, loneliness and introversion, (iv) social inhibition, (v) boredom inclination, (vi) sensation-seeking, (vii) diminished agreeableness, (viii) diminished self-control and narcissistic personality traits, (ix) low self-esteem, (x) state and trait anxiety, and (xi) low emotional intelligence. However, we noted that it was difficult to assess the aetiological significance of such associations because these personality factors are not unique to problematic gaming. Our review also reported that IGD had been associated with various comorbid disorders, including (i) attention deficit hyperactivity disorder, (ii) symptoms of generalized anxiety disorder, panic disorder, depression, and social phobia, and (iii) various psychosomatic symptoms.

According to a 2013 editorial in the journal Addiction, Nancy Petry and Charles O’Brien (2013), IGD will not be included as a separate mental disorder in future editions of the DSM until the (i) defining features of IGD have been identified, (ii) reliability and validity of specific IGD criteria have been obtained cross-culturally, (iii) prevalence rates have been determined in representative epidemiological samples across the world, and (iv) aetiology and associated biological features have been evaluated.

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

Please note: Additional input from Daria Kuss and Halley Pontes

Further reading

Gentile, D. (2009). Pathological video-game use among youth ages 8–18: A national study. Psychological Science, 20(5), 594-602. doi: 10.1111/j.1467-9280.2009.02340.x

Griffiths, M.D., Van Rooij, A., Kardefelt-Winther, D., Starcevic, V., Király, O…Demetrovics, Z. (2016). Working towards an international consensus on criteria for assessing Internet Gaming Disorder: A critical commentary on Petry et al (2014). Addiction, 111, 167-175.

Griffiths, M. D., King, D. L., & Demetrovics, Z. (2014). DSM-5 Internet Gaming Disorder needs a unified approach to assessment. Neuropsychiatry, 4(1), 1-4. doi: 10.2217/npy.13.82

Griffiths, M. D., Király, O., Pontes, H. M., & Demetrovics, Z. (2015). An overview of problematic gaming. In E. Aboujaoude & V. Starcevic (Eds.), Mental Health in the Digital Age: Grave Dangers, Great Promise (pp. 27-45). Oxford: Oxford University Press. doi: 10.1093/med/9780199380183.003.0002

Griffiths, M. D., & Pontes, H. M. (2014). Internet Addiction Disorder and Internet Gaming Disorder are not the same. Journal of Addiction Research & Therapy, 5(4), e124. doi: 10.4172/2155-6105.1000e124

Griffiths, M. D., & Szabo, A. (2014). Is excessive online usage a function of medium or activity? An empirical pilot study. Journal of Behavioral Addictions, 3(1), 74-77. doi: 10.1556/JBA.2.2013.016

King, D. L., Haagsma, M. C., Delfabbro, P. H., Gradisar, M. S. & Griffiths, M. D. (2013). Toward a consensus definition of pathological video-gaming: A systematic review of psychometric assessment tools. Clinical Psychology Review, 33(3), 331-342. doi: 10.1016/j.cpr.2013.01.002

Király, O., Griffiths, M. D., & Demetrovics, Z. (2015). Internet Gaming Disorder and the DSM-5: Conceptualization, debates, and controversies. Current Addiction Reports, 2(3), 254-262. doi: 10.1007/s40429-015-0066-7

Király, O., Griffiths, M. D., Urbán, R., Farkas, J., Kökönyei, G., Elekes, Z., Tamás, D., & Demetrovics, Z. (2014). Problematic internet use and problematic online gaming are not the same: Findings from a large nationally representative adolescent sample. Cyberpsychology, Behavior, and Social Networking, 17(12), 749-754. doi: 10.1089/cyber.2014.0475

Király, O., Sleczka, P., Pontes, H. M., Urbán, R., Griffiths, M. D., & Demetrovics, Z. (2016). Validation of the ten-item Internet Gaming Disorder Test (IGDT-10) and evaluation of the nine DSM-5 Internet Gaming Disorder criteria. Addictive Behaviors. doi: 10.1016/j.addbeh.2015.11.005

Kuss, D. J., & Griffiths, M. D. (2015). Internet addiction in psychotherapy. London: Palgrave.

Kuss, D. J., & Griffiths, M. D. (2012). Internet and gaming addiction: A systematic literature review of neuroimaging studies. Brain Sciences, 2(3), 347-374. doi: 10.3390/brainsci2030347

Kuss, D. J., Griffiths, M. D., Karila, L., & Billieux, J. (2014). Internet addiction: A systematic review of epidemiological research for the last decade. Current Pharmaceutical Design, 20(25), 4026-4052. doi: 10.2174/13816128113199990617

Lemmens, J. S., Valkenburg, P. M., & Gentile, D.A. (2015). The Internet Gaming Disorder Scale. Psychological Assessment, 27(2), 567-582. doi: 10.1037/pas0000062

Meng, Y., Deng, W., Wang, H., Guo, W., & Li, T. (2014). The prefrontal dysfunction in individuals with Internet Gaming Disorder: A meta-analysis of functional magnetic resonance imaging studies. Addiction Biology, 20(4), 799-808. doi: 10.1111/adb.12154

Müller, K. W., Janikian, M., Dreier, M., Wölfling, K., Beutel, M. E., Tzavara, C., Richardson, C., & Tsitsika, A. (2015). Regular gaming behavior and internet gaming disorder in European adolescents: results from a cross-national representative survey of prevalence, predictors, and psychopathological correlates. European Child and Adolescent Psychiatry, 24(5), 565-574. doi: 10.1007/s00787-014-0611-2

Petry, N. M., & O’Brien, C. P. (2013). Internet gaming disorder and the DSM-5. Addiction 108(7), 1186–1187. doi: 10.1111/add.12162

Pontes, H. M., & Griffiths, M. D. (2015). New concepts, old known issues: The DSM-5 and Internet Gaming Disorder and its assessment. In J. Bishop (Ed.), Psychological and Social Implications Surrounding Internet and Gaming Addiction (pp. 16-30). Hershey, PA: Information Science Reference. doi: 10.4018/978-1-4666-8595-6.ch002

Pontes, H. & Griffiths, M.D. (2015). Measuring DSM-5 Internet Gaming Disorder: Development and validation of a short psychometric scale. Computers in Human Behavior, 45, 137-143. doi: 10.1016/j.chb.2014.12.006

Pontes, H. M., Szabo, A., & Griffiths, M. D. (2015). The impact of Internet-based specific activities on the perceptions of Internet Addiction, Quality of Life, and excessive usage: A cross-sectional study. Addictive Behaviors Reports, 1, 19-25. doi: 10.1016/j.abrep.2015.03.002

Pontes, H., Király, O. Demetrovics, Z., & Griffiths, M. D. (2014). The conceptualisation and measurement of DSM-5 Internet Gaming Disorder: The development of the IGD-20 Test. PLoS ONE, 9(10): e110137. doi:10.1371/journal.pone.0110137.

Pontes, H. M., Kuss, D. J., & Griffiths, M. D. (2015). Clinical psychology of Internet addiction: a review of its conceptualization, prevalence, neuronal processes, and implications for treatment. Neuroscience and Neuroeconomics, 4, 11-23. doi: 10.2147/NAN.S60982

Rehbein, F., Kliem, S., Baier, D., Mößle, T., & Petry, N. M. (2015). Prevalence of Internet Gaming Disorder in German adolescents: Diagnostic contribution of the nine DSM-5 criteria in a state-wide representative sample. Addiction, 110(5), 842–851. doi: 10.1111/add.12849

Thomas, N., & Martin, F. (2010). Video-arcade game, computer game and Internet activities of Australian students: Participation habits and prevalence of addiction. Australian Journal of Psychology. 62(2), 59-66. doi: 10.1080/00049530902748283

van Rooij, A. J., Schoenmakers, T. M., & van de Mheen, D. (2015). Clinical validation of the C-VAT 2.0 assessment tool for gaming disorder: A sensitivity analysis of the proposed DSM-5 criteria and the clinical characteristics of young patients with ‘video game addiction’. Addictive Behaviors. doi: 10.1016/j.addbeh.2015.10.018

Wittek, C. T., Finserås, T. R., Pallesen, S., Mentzoni, R. A., Hanss, D., Griffiths, M. D., & Molde, H. (2015). Prevalence and predictors of video game addiction: A study based on a national representative sample of gamers. International Journal of Mental Health and Addiction, 1-15. doi: 10.1007/s11469-015-9592-8

Young, K.S. (1999). Internet addiction: Symptoms, evaluation and treatment. Innovations in clinical practice: A source book, (Vol. 17; pp. 19-31). Sarasota, FL: Professional Resource Press.

Bought in the act: How prevalent is compulsive buying?

Although shopping is a necessity in modern life, it is also a leisure activity and a form of entertainment with a rewarding value for some people. However, as I have noted in a number of my previous blogs, when taken to the extreme, shopping (or buying) can be a harmful and destructive activity for a minority of individuals. The consequences of compulsive buying behaviour (CBB) are often underestimated.

For instance, CBB can result in (i) large debts, (ii) inability to meet payments, (iii) criticism from partners, friends and acquaintances, (iv) legal and financial consequences, (v) criminal legal problems, and (vi) guilt. Furthermore, individuals with CBB often describe an increasing level of urge or anxiety that can only be alleviated and lead to a sense of completion when a purchase is made. Research has demonstrated that compulsive buying is a frequent disorder in a small minority of shopping mall visitors and is associated with important and robust indicators of psychopathology such as psychiatric distress, borderline personality disorder, and substance abuse. Compared to non-compulsive buyers, compulsive buyers are over twice as likely to abuse substances, have any mood or anxiety disorder, and three times more likely to develop eating disorder than non-compulsive buyers. However, most of these findings are based on a small number of studies, all of which have sampling limitations.

Despite many studies highlighting the severe negative consequences that compulsive buying can lead to, the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) did not include compulsive buying disorder due to insufficient research in the field. Therefore, individuals with the condition are classified within the residual category of “Unspecified disruptive, impulse-control, and conduct disorders”. Diagnostic criteria elsewhere include (i) maladaptive preoccupation with buying or shopping, or maladaptive buying or shopping impulses; (ii) generation of marked distress by the buying preoccupations, impulses or behaviours, which are time consuming, significantly interfere with social or occupational functioning or result in financial problems; and (iii) lack of restriction of the excessive buying or shopping behaviour to periods of hypomania or mania.

The age of onset for CBB appears to be in the late teens or early twenties, although some studies have reported a later mean age of 30 years. There is also a lack of consensus relating to gender differences. Most clinical studies report that women are much more likely to become compulsive buyers than men, but not all surveys have found significant differences in buying tendencies between men and women. Cultural mechanisms have been proposed to recognize the fact that CBB mainly occurs among individuals living in developed countries. Elements reported as being necessary for the development of CBB include the presence of a market-based economy, the availability of a wide variety of goods, disposable income, and significant leisure time. For these reasons, most working in the area agree that CBB is unlikely to occur in poorly developed countries, except among the wealthy elite.

Given this background, Aniko Maraz, Zsolt Demetrovics and I recently carried out a meta-analytic review that was published in the journal Addiction using all the empirical data concerning the prevalence of compulsive buying in non-clinical populations. We attempted to estimate a pooled prevalence of compulsive buying behaviour (CBB) in different populations across the world where studies have been carried out. We also examined the effect of age, gender, geographical location of the study.

Our initial literature search identified 638 publications. We then excluded case studies (n=23), reviews or theoretical works (n=192), studies involving data from clinical samples (n=244), qualitative studies (n=26), studies that used a compulsive buying scale to determine shopping severity but didn’t report a prevalence rate (n=73), studies written in a foreign language (n=15), dissertations and conference abstracts (n=7), studies written in a foreign language (n=15), small studies with a sample size of below 145 participants (n=16), and studies involving adolescents (n=2). This left 40 studies that met the inclusion criteria for the review. We then extracted sample mean age, proportion of females (in %), the study’s geographical location, and the screening instrument used to assess CBB, and the reported prevalence estimate of CBB.

The 40 relevant studies identified reported 49 different prevalence rate estimates for 32,333 participants. We then divided the data into four sub-samples: adult representative, adult non-representative, university student and shopping-specific. The mean prevalence of compulsive buying was 4.9% in adult representative samples [10,102 participants], 12.3% in adult non-representative samples [3,929 participants], 8.3% in university student samples [14,947 participants] and 16.2% in shopping-specific samples [4,686 participants]. Unsurprisingly, the highest prevalence rates were among shopping-specific samples.

We noted that the heterogeneity in prevalence rates of CBB may be because of the lack of consensus regarding the definition of compulsive buying. Studies used different measures to assess CBB, each having a different conceptual background. Most definitions include cognitive-affective indicators as well as maladaptive behavioural consequences when defining the disorder (e.g., debts). The screening instruments used across studies differed in indicators of financial consequences (e.g., credit card use, debts, loan etc.) and are subject to differences according to countries, sub-cultures and/or age groups.

Another problem we identified was that measures used to assess CBB didn’t explicitly distinguish current and lifetime assessment of CBB. Prevalence rates assessed with an instrument that assessed lifetime prevalence report 1.6 times higher rates on average than those that assessed current prevalence. We also observed that non-representative samples (e.g., adults, university students, shoppers) tended to recruit younger participants who were more likely to be female than representative studies. However, we also noted that the mean age of the sample and the proportion of males and females did not have a reliable effect on the prevalence estimates.

Being of a younger age was predictive of CBB according to individual study results and also according to the regression analysis that we carried out in the representative samples. However, it remains open as to whether compulsive buying tendency decreases with age or this difference reflects generational differences. If the latter was the case, then the prevalence of compulsive buying behaviour is expected to increase in the future. We also found some evidence for increasing rates of CBB in Germany and in Spain, but longitudinal studies are needed to clarify this.

In relation to data collection, estimates from the United States (18 out of 49) were over-represented compared to countries other than the USA, although there was no difference in the reported estimates between the U.S. and non-U.S. countries. However, it is difficult to draw reliable conclusions regarding the cultural variance of CBB given that adult representative estimates are only available from the USA, Spain, Germany and Hungary.

The fact that compulsive buying behaviour is a relatively common disorder with severe consequences for a minority of individuals should not be overlooked. It appears that approximately one in 20 individuals suffer from CBB at some point in their lives and that being young and female are associated with a higher risk of CBB. High heterogeneity is likely to be the result of methodological variability within studies, such as assessment screens with different time frames and conceptual background. We concluded that future studies should therefore think carefully about how to conceptualise the disorder and to clearly separate out current versus lifetime prevalence in the samples used.

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

Please note : This article was co-written with Aniko Maraz and Zsolt Demetrovics (Institute of Psychology, Eötvös Loránd University, Budapest, Hungary)

Further reading

Alemis, M. C., & Yap, K. (2013). The role of negative urgency impulsivity and financial management practices in compulsive buying. Australian Journal of Psychology, 65(4), 224-231.

Andreassen, C.S., Griffiths, M.D., Pallesen, S., Bilder, R.M., Torsheim, T. Aboujaoude, E.N. (2015). The Bergen Shopping Addiction Scale: Reliability and validity of a brief screening test. Frontiers in Psychology, 6:1374. doi: 10.3389/fpsyg.2015.01374.

Basu, B., Basu, S., & Basu, J. (2011). Compulsive buying: an overlooked entity. Journal of the Indian Medical Association, 109(8), 582-585.

Black, D.W., Shaw, M., McCormick, B., Bayless, J.D., Allena, J. (2012). Neuropsychological performance, impulsivity, ADHD symptoms, and novelty seeking in compulsive buying disorder. Psychiatry Research, 200, 581–587.

Black, D. W. (2007). A review of compulsive buying disorder. World Psychiatry, 6, 14-18.

Davenport, K., Houston, J.E., Griffiths, M.D. (2012). Excessive eating and compulsive buying behaviours in women: An empirical pilot study examining reward sensitivity, anxiety, impulsivity, self-esteem and social desirability. International Journal of Mental Health and Addiction, 10, 474–489.

Dittmar, H., Long, K. & Bond, R. (2007). When a better self is only a button click away: Associations between materialistic values, emotional and identity-related buying motives, and compulsive buying tendency online. Journal of Social and Clinical Psychology, 26, 334-361.

Duroy, D., Gorse, P., & Lejoyeux, M. (2014). Characteristics of online compulsive buying in Parisian students. Addictive Behaviors, 39, 1827-1830.

Frost, R.A., Tolin, D.F., Steketee, G., Fitch, K.E., Selbo-Bruns, A. (2009). Excessive acquisition in hoarding, Journal of Anxiety Disorders, 23, 632-639.

Guo, Z., Cai, Y. (2011). Exploring the antecedents of compulsive buying tendency among adolescents in China and Thailand: A consumer socialization perspective. African Journal of Business Management, 5(24), 10198-10209.

Harvanko, A., Lust, K., Odlaug, B. L., Schreiber, L., Derbyshire, K., Christenson, G., & Grant, J. E. (2013). Prevalence and characteristics of compulsive buying in college students. Psychiatry Research, 210(3), 1079-1085.

Jung, J., & Yi, S. (2013). Assessment of heterogeneity of compulsive buyers based on affective antecedents of buying lapses. Addiction Research and Theory, 22, 37-48.

Koran, L.M., Faber, R.J., Aboujaoude, M.A., Large, M.D., Serpe, R.T. (2006). Estimated prevalence of compulsive buying behavior in the United States. American Journal of Psychiatry, 163, 1806-1812.

Kukar-Kinney, M., Ridgway, N. M., & Monroe, K. B. (2012). The role of price in the behavior and purchase decisions of compulsive buyers. Journal of Retailing, 88(1), 63-71.

Lejoyeux, M., Weinstein, A. (2010). Compulsive buying. American Journal of Drug and Alcohol Abuse, 36 (5), 248–253.

Maraz, A., Griffiths, M. D., Demetrovics, Z. (2015). The prevalence of compulsive buying in nonclinical populations: a systematic review and meta-analysis. Addiction, doi:10.1111/add.13223.

Mikołajczak-Degrauwe, K., & Brengman, M. (2014). The influence of advertising on compulsive buying – The role of persuasion knowledge. Journal of Behavioral Addictions3(1), 65–73.

Mueller, A., Mitchell, J. E., Peterson, L. A., Faber, R. J., Steffen, K. J., Crosby, R. D., & Claes, L. (2011). Depression, materialism, and excessive Internet use in relation to compulsive buying. Comprehensive Psychiatry, 52(4), 420-424.

Tommasi, M., & Busonera, A. (2012). Validation of three compulsive buying scales on an Italian sample 1. Psychological Reports, 111(3), 831-844.

Weinstein, A., Maraz, A., Griffiths, M.D., Lejoyeaux, M. & Demetrovics, Z. (in press). Shopping addiction and compulsive buying: Features and characteristics of addiction. In V. Preedy (Ed.), The Neuropathology Of Drug Addictions And Substance Misuse. London: Academic Press.

Tech it or leave it: Excessive email use and how to curb it

If there is a single behaviour in my life that borders on the pathological, it is the urge I feel to log on and check my emails. When I have no email access (such as when I am on a plane or am on holiday staying at a foreign beachside villa with no Wi-Fi) I function perfectly well but as soon as I know there is a Wi-Fi connection, the first thing I typically do is check my emails. It’s like an itch that I have to scratch. Given that the vast majority of my emails are work-related I don’t necessarily see this as problematic (as I love my work) but it does admittedly facilitate my workaholic tendencies. The psychology and psychosocial impact of email use is also an area that I have published a few articles and book chapters on (see ‘Further reading’ below).

The reason I mention all this is that earlier this month, many of the British newspapers featured a story about how turning off automatic emails helps reduce stress levels. The survey study of just under 2,000 individuals was carried out by psychologists at the Future Work Centre (FWC) and examined the impact of ‘email pressure’ on individuals’ work-life balance. The report noted that there were “2.5 billion email users worldwide, and adults spent an average of over an hour of each day on emails, according to Radicati and Ofcom”. The FWC’s main findings (which I have taken verbatim from the report) highlighted:

  • A strong relationship between using ‘push’ email and perceived email pressure. This means that people who automatically receive email on their devices were more likely to report higher perceived email pressure.
  • People who leave their email on all day were much more likely to report perceived email pressure.
  • Checking email earlier in the morning or later at night is associated with higher levels of perceived email pressure.
  • Managers experience significantly higher levels of perceived email pressure when compared to non-managers.
  • Higher email pressure was associated with more examples of work negatively impacting home life and home life negatively impacting performance at work.
  • Perceived email pressure is significantly higher in people with caring responsibilities. This finding is probably less of a surprise, as the work-life balance research literature is full of examples citing the challenges facing carers when it comes to navigating the boundaries between work and home. Interestingly, our data didn’t reveal any significant differences between people with different caring responsibilities. It seems that just having these responsibilities is associated with significantly higher email pressure.
  • Personality appears to moderate the relationship between perceived email pressure and work-life balance. People who rate their own ability and sense of control over their environment lower find that work interferes more with their home life, and vice versa.

Clearly the benefits of email outweigh the disadvantages but as the FWC report noted, emails are a “double-edged sword” in that that they are clearly a useful communication tool but can be a source of stress. The report concluded that:

“[The results of the study] link perceptions of email pressure to actual work-life balance outcomes, not just perceptions of work-life balance. But that’s not the end of the story. Whilst we’ve identified the external factors that affect our perceived email pressure and explored the relationship between perceived email pressure and work-life balance, there’s another variable we should consider in order to increase our understanding of an individual’s experience of email – personality…Personality moderates the relationship between perceived email pressure and all work-life balance outcomes. It shows that people with low core self-evaluation experience more interference, both positive and negative, between their work and home lives – i.e. they are more sensitive to how the two domains – work and home – affect each other. This could be due to how people with low core self-evaluation make sense of their world. People with high core self-evaluation don’t see these things as happening to them – they can take control and set boundaries”.

The report also provided some tips to combat email stress many of which can be found in other articles examining the topic. For instance, back in 2004, I published my own set of tips in the British Medical Journal (not that I follow my own advice based on what I said in the opening paragraph of this article). However, I’ll end this blog with my (hopefully) common-sense and practical advice:

  • Set retrieval limits: Limit email retrieval to a few times per day (say when you first get in, lunchtime, and/or just before you leave work). You will spend less time both reading and responding to each email than if you had read them when they individually came in.
  • Turn off instant messaging system: There is a tendency to look at emails straight away if the instant messaging system is turned on. This is only helpful when you are expecting a message.
  • Get a good spam filter: There is nothing worse than an inbox full of junk mail so invest in a good filter system.
  • Use your ‘auto delete’ button: If there are constant junk emails that you get most days then use the ‘auto delete’ button to avoid them appearing in your inbox.
  • Develop a good filing system: The setting up of a good email filing system is paramount in keeping on top of your emails. This is no different to the desktop management system on your computer. You can put unread messages into appropriate folders to read at a later time and reducing the size of your inbox. A good filing system also aids in retrieving important emails at a later date.
  • Reply and file: Once you have replied to an email either delete it immediately or file it away in a separate email folder.
  • Use your ‘out of office’ assistant facility: This will help reduce the repeated emails from the same people asking “Did you get my earlier email?” Once people know you are unavailable for a given time period they may not send the email in the first place.
  • Print out hard copies of really important e-mails: There is always a chance that emails can get lost or accidentally deleted. If it is really important, print a hard copy straight away and file it.
  • Be selective in who you respond to: When responding to an email sent to a group, don’t necessarily reply to all the group. This will cut down on the number of potential replies.

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

Further reading

Byron, K. (2008). Carrying too heavy a load? The communication and miscommunication of emotion by email. Academy of Management Review, 33, 309-327.

Future Work Centre (2015). You’ve got mail: Research Report 2015. London: Future Work Centre. Located at: http://www.futureworkcentre.com/wp-content/uploads/2015/07/FWC-Youve-got-mail-research-report.pdf

Giumetti, G.W., Hatfield, A.L., Scisco, J. L., Schroeder,
A.N., Muth, E.R., & Kowalski, R. M. (2013).
What a rude email! Examining the differential effects of incivility versus support on mood, energy, engagement, and performance in an online context. Journal of Occupational Health Psychology, 18, 297-309.

Griffiths, M.D. (1995). Hey! Wait, just a minute, Mister Postman: The joy of e-mail. The Psychologist: Bulletin of the British Psychological Society, 8, 373.

Griffiths, M.D. (2004). Tips on…Managing your e-mails. British Medical Journal Careers, 329, 240.

Griffiths, M.D. & Dennis, F. (2000). How to beat techno-stress. Independent on Sunday (Reality section), May 7, p.22.

Sutton, M. & Griffiths, M.D. (2003). Emails with unintended criminal consequences. The Criminal Lawyer, 130, 6-8.

Sutton, M. & Griffiths, M.D. (2004). Emails with unintended consequences: New lessons for policy and practice in work, public office and private life. In P. Hills (Ed.). As Others See Us: Selected Essays In Human Communication (pp. 160-182). Dereham: Peter Francis Publishers.

Ng, K. (2016). Turn off automatic email updates to ease stress, psychologists advise. The Independent, January 5. Located at: http://www.independent.co.uk/life-style/health-and-families/health-news/turn-off-automatic-email-updates-to-ease-stress-psychologists-advise-a6794826.html

Radicati, S. & Levenstein, J. (2014). Email Statistics Report, 2014-2018. Located at: http://www.radicati.com/?p=10644

Dosh spice: A brief look at ‘findoms’ and ‘wallet rape’

“How do y’all feel about [findom]? Weird I know. Those guys are creeps. But I use to do findom. I never dressed up or did crazy stuff like that but I used to use guys for their money. No lie (how do you think I got so many clothes) and NO I never had to send naked pics meet up with these guys or nothing, it was all simply over the internet and Paypal. They just want to splurge on you for being pretty. Well I haven’t done it in like a year and randomly one of the guys messaged me today and wanted to spend on me. I said okay why not…I was expecting like $50 tops. I haven’t talked to this guy in forever. And well let’s just say I made an extra $416 dollars today. In one minute. Literally” (Baelessboutique, vinted.com)

Earlier this week, I was contacted by Chris Summers, a journalist at the Daily Star. Summers was writing an article on exophilia (sexual arousal from aliens) and had come across my blog on the topic and was looking for some academic input into his story. He then sent me some of the tabloid tales he had published on sexual paraphilias including one published a week or so ago on ‘wallet rape’. Most definitions of ‘wallet rape’ (such as the one in the online Urban Dictionary) describe wallet rape as paying “way too much for something” resulting in “feelings of victimization, embarrassment, and guilt”. However, this was not the focus of the Daily Star article. According to Summers’ story, wallet rape refers to men who get a sexual kick out of giving money to women. More specifically:

“Hundreds of men in Britain and thousands more worldwide enjoy being under the control of a financial dominatrix or ‘findom’. These guys are not ‘sugar daddies’ who shower young lovers with expensive gifts in return for a sexual pay-off. In most cases they don’t even get to meet the ‘goddess’ they worship. They just enjoy being ‘paypigs’ or ‘slaves’…[most findoms] never [have] sex with [their] clients”.

Summers interviewed a number of individuals for his article including ‘Goddess Haven’ (a 21-year old female findom). ‘Bill’ (a 60-year old businessman who works up to 14 hours a day and is a lifelong ‘submissive’), and Dr. Jess O’Reilly (Canadian sexologist and author of The New Sex Bible). According to Goddess Haven:

“I’ve learned so much about my clientele in the three years that I’ve been on this journey. When I first started if you asked me these men were just completely weird and out of their mind, but why would I care? I was getting what I wanted out of it. As my journey progressed I realised that a lot of these people are just looking to escape their boring every day lives. A great deal of these men that serve me are ‘high powered’ businessmen who just want to come home and not be the centre of attention. Some of these men don’t even have time to spend the money they make for themselves and just want to see a beautiful woman enjoy it with no strings attached. I’ve realised that most of my clientele are turned on by losing their sense of control and being taken advantage of by a powerful woman. I’ll usually meet clients that pay well and can afford to session with me in reality. I have clients all over the world. I’ve had requests to kidnap people, tie them up and leave them in the woods. There are some findoms out there who give it a bad name, especially as it becomes more popular. There are a lot of women who are just hopping on the bandwagon and have no idea what they’re doing.”

According to the Daily Star article, Bill met Goddess Haven on the online forum Collarspace (one of a number of internet forums where findoms can meet submissives) and now “serves” her. As he said to Summers:

“I have served dozens of women in the past 40 years. I have probably spent about $200,000. [Haven] is truly one of a kind and I adore her as my goddess…She needs more than just me to complete her life. She may have lovers and she may not want me to have a lover. Whether she wants to cuckold me or put me in chastity that’s fine with me. I am just happy to serve her. I have an addiction but I really do budget. I spend about $5,000 a year on my goddess. I have a son and family obligations so they come first but I push it to the limit. I’m a normal person but I just have an addiction to serving women. [Haven is] confident and eager to explore my submissiveness”.

There was little in the article about why Bill was a submissive although Bill said he had issues with his mother who was a model, and appeared to adhere to Sigmund Freud’s theorising about the ‘Oedipus complex’ – the sexual desire shared between a son and his mother. The psychologist that Summers interviewed (Dr. Jess O’Reilly) made a number of speculations (although none of them relating to Freud’s psychodynamic theories). One of her speculations concerned the rise of the internet in relation to sexual behaviours:

“Everything predates the internet and the practice of dominating another’s finances has existed as long as currency’s history. However digital communities have created space for wider dissemination of information and virtual connections. You no longer have to leave your house to foster relationships of any kind.”

This line of thinking is similar to a number of papers I have written describing how the internet can facilitate sexual addictions among predisposed individuals (as I argued in a 2001 issue of the Journal of Sex Research) and bring together individuals with niche sexual paraphilias (as I wrote about in a 2012 issue of the Journal of Behavioral Addictions). In trying to explain why men would pay lots of money to be humiliated, Dr. O’Reilly speculated that:

“Sometimes those who are charged with a great deal of control at work, at home or in their community may see this as an exciting way to relinquish control of one area of their lives. Or it could be the thrill of humiliation and ridicule. Just as some people associate praise and adoration with sexual arousal, others have an erotic script that is dominated by emotions that are traditionally viewed as negative. Being humiliated can be a turn-on, as it forces you to be vulnerable…A sexual fetish need not entail sexual activity in the traditional sense. Sex gives us a high or a pleasure rush and so too can financial domination/submission. I would leave it up to each pay pig to determine whether or not s/he considers this fetish sexual in nature…Having a woman more powerful than you, seductive and manipulative enough to get into your mind to make you WANT to willingly hand over your money…Maybe their wives are boring and don’t offer much, maybe their wives are submissive and they just want the role switched. There’s a different reason for every client.”

Dr. O’Reilly went on to look at both the upsides and downsides of such findom/submissive relationships:

“Like any behaviour, financial domination/submission can be perfectly healthy or significantly problematic depending on how it makes the participants feel and how it impacts their lives (and their relationships). For example, if the pay pig is hiding his financial activity from his primary partner, I could see this taking a toll on their relationship. Honesty, consent and respect underlie healthy relationships – sexual and otherwise. I imagine many derive a thrill from the taboo of giving money to a stranger. However, if they derive pleasure from hiding their financial activity from a partner with whom they’ve agreed to share finances, this could be quite problematic. Most people crave a balance of security/predictability and excitement/the unknown. Blackmail plays into the latter need. In many cases, blackmail games are part of role-play and fantasy as opposed to lived reality.”

Although there is no academic research on the topic of findoms, other stories in the national press have appeared (and there’s even a short film called FinDom that has just been released – “a witty, sensitive exploration of loneliness and sexuality”). For instance, in the summer of 2015, The Journal featured a piece by Michelle Hennessey on ‘Findom in Dublin: The Irish men who are turned on by women spending their money’. As Hennessey noted:

“Readers may already be familiar with the concept of Femdom which involves a woman being dominant over a man usually through bondage, physical restraint or humiliation. Findom, as the name suggests, is all about financial domination”.

Like the article in the Daily Star, the story in The Journal also featured some similar case studies (although the men were referred to as ‘cash pigs’ and ‘money slaves’ rather than ‘pay pigs’). According to Hennessey’s journalistic research:

“The women who do this professionally are extremely active on social media and fetish websites. They post photos of themselves wearing the clothes and shoes they have been sent, pictures of them drinking cocktails that are being paid for by one of their slaves or snaps of their perfectly manicured feet. They also offer camera sessions with a variety of options, most of which involve humiliation like the domme laughing at the man. Many of their posts are extremely raunchy with some uploading photos of themselves nude or scantily clad and telling the men they could never have a woman that looks this way”.

As with any fetishistic or paraphilic behaviour, if it is carried out by two consenting adults and legal, there is nothing problematic about engaging in such activity. However, given that money is involved, this could – in a minority of cases – end up being a behaviour akin to problem gambling in that the person enjoys engaging in the behaviour but becomes problematic because the activity goes beyond the individual’s disposable income and causes problems elsewhere in their lives.

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

Further reading

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

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

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

Griffiths, M.D. (2012). The use of online methodologies in studying paraphilia: A review. Journal of Behavioral Addictions, 1, 143-150.

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

Hennessy, M. (2015). Findom in Dublin: The Irish men who are turned on by women spending their money. The Journal, August 30. Located at: http://www.thejournal.ie/findom-dublin-2296085-Aug2015/

O’Reilly, J. (2014). The New Sex Bible: The New Guide To Sensual Love. London: Quiver.

Summers, C. (2015). ‘Wallet rape’: Meet the men who get a kick out of giving away money. Daily Star, December 27. Located at: http://www.dailystar.co.uk/news/weird-news/480000/Wallet-rape-financial-dominatrix

Tech’s appeal: Another look at Internet addiction

Generally speaking, Internet addiction (IA) has been characterized by excessive or poorly controlled preoccupation, urges, and/or behaviours regarding Internet use that lead to impairment or distress in several life domains. However, according to Dr. Kimberly Young, IA is a problematic behaviour akin to pathological gambling that can be operationally defined as an impulse-control disorder not involving the ingestion of psychoactive intoxicants.

Following the conceptual framework developed by Young and her colleagues to understand IA, five specific types of distinct online addictive behaviours were identified: (i) ‘cyber-sexual addiction’, (ii) ‘cyber-relationship addiction’, (iii) ‘net compulsions (i.e., obsessive online gambling, shopping, or trading), (iv) ‘information overload’, and (v) ‘computer addiction’ (i.e., obsessive computer game playing).

However, I have argued in many of my papers over the last 15 years that the Internet may simply be the means or ‘place’ where the most commonly reported addictive behaviours occur. In short, the Internet may be just a medium to fuel other addictions. Interestingly, new evidence pointing towards the need to make this distinction has been provided from the online gaming field where new studies (including some I have carried out with my Hungarian colleagues) have demonstrated that IA is not the same as other more specific addictive behaviours carried out online (i.e., gaming addiction), further magnifying the meaningfulness to differentiate between what may be called ‘generalized’ and ‘specific’ forms of online addictive behaviours, and also between IA and gaming addiction as these behaviours are conceptually different.

Additionally, the lack of formal diagnostic criteria to assess IA holds another methodological problem since researchers are systematically adopting modified criteria from other addictions to investigate IA. Although IA may share some commonalities with other substance-based addictions, it is unclear to what extent such criteria are useful and suitable to evaluate IA. Notwithstanding the existing difficulties in understanding and comparing IA with behaviours such as pathological gambling, recent research provided useful insights on this topic.

A recent study by Dr. Federico Tonioni (published in a 2014 issue of the journal Addictive Behaviors) involving two clinical (i.e., 31 IA patients and 11 pathological gamblers) and a control group (i.e., 38 healthy individuals) investigated whether IA patients presented different psychological symptoms, temperamental traits, coping strategies, and relational patterns in comparison to pathological gamblers, concluded that Internet-addicts presented higher mental and behavioural disengagement associated with significant more interpersonal impairment. Moreover, temperamental patterns, coping strategies, and social impairments appeared to be different across both disorders. Nonetheless, the similarities between IA and pathological gambling were essentially in terms of psychopathological symptoms such as depression, anxiety, and global functioning. Although, individuals with IA and pathological gambling appear to share similar psychological profiles, previous research has found little overlap between these two populations, therefore, both phenomena are separate disorders.

Despite the fact that initial conceptualizations of IA helped advance the current knowledge and understanding of IA in different aspects and contexts, it has become evident that the field has greatly evolved since then in several ways. As a result of these ongoing changes, behavioural addictions (more specifically Gambling Disorder and Internet Gaming Disorder) have now recently received official recognition in the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Moreover, IA can also be characterized as a form of technological addiction, which I have operationally defined as a non-chemical (behavioural) addiction involving excessive human-machine interaction. In this theoretical framework, technological addictions such as IA represent a subset of behavioural addictions featuring six core components: (i) salience, (ii) mood modification, (iii) tolerance, (iv) withdrawal, (v) conflict, and (vi) relapse. The components model of addiction appears to be a more updated framework for understanding IA as a behavioural addiction not only conceptually but also empirically. Moreover, this theoretical framework has recently received empirical support from several studies, further evidencing its suitability and applicability to the understanding of IA.

For many in the IA field, problematic Internet use is considered to be a serious issue – albeit not yet officially recognised as a disorder – and has been described across the literature as being associated with a wide range of co-occurring psychiatric comorbidities alongside an array of dysfunctional behavioural patterns. For instance, IA has been recently associated with low life satisfaction, low academic performance, less motivation to study, poorer physical health, social anxiety, attention deficit/hyperactivity disorder and depression, poorer emotional wellbeing and substance use, higher impulsivity, cognitive distortion, deficient self-regulation, poorer family environment, higher mental distress, loneliness, among other negative psychological, biological, and neuronal aspects.

In a recent systematic literature review conducted by Dr. Wen Li and colleagues (and published in the journal Computers and Human Behavior), the authors reviewed a total of 42 empirical studies that assessed the family correlates of IA in adolescents and young adults. According to the authors, virtually all studies reported greater family dysfunction amongst IA families in comparison to non-IA families. More specifically, individuals with IA exhibited more often (i) greater global dissatisfaction with their families, (ii) less organized, cohesive, and adaptable families, (iii) greater inter-parental and parent-child conflict, and (iv) perceptions of their parents as more punitive, less supportive, warm, and involved. Furthermore, families were significantly more likely to have divorced parents or to be a single parent family.

Another recent systematic literature review conducted by Dr. Lawrence Lam published in the journal Current Psychiatry Reports examined the possible links between IA and sleep problems. After reviewing seven studies (that met strict inclusion criteria), it was concluded that on the whole, IA was associated with sleep problems that encompassed subjective insomnia, short sleep duration, and poor sleep quality. The findings also suggested that participants with insomnia were 1.5 times more likely to be addicted to the Internet in comparison to those without sleep problems. Despite the strong evidence found supporting the links between IA and sleep problems, the author noted that due to the cross-sectional nature of most studies reviewed, the generalizability of the findings was somewhat limited.

IA is a relatively recent phenomenon that clearly warrants further investigation, and empirical studies suggest it needs to be taken seriously by psychologists, psychiatrists, and neuroscientists. Although uncertainties still remain regarding its diagnostic and clinical characterization, it is likely that these extant difficulties will eventually be tackled and the field will evolve to a point where IA may merit full recognition as a behavioural addiction from official medical bodies (ie, American Psychiatric Association) similar to other more established behavioural addictions such as ‘Gambling Disorder’ and ‘Internet Gaming Disorder’. However, in order to achieve official status, researchers will have to adopt a more commonly agreed upon definition as to what IA is, and how it can be conceptualized and operationalized both qualitatively and quantitatively (as well as in clinically diagnostic terms).

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

Please note: This article was co-written with Halley Pontes and Daria Kuss.

Further reading

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

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

Griffiths, M.D., Kuss, D.J., Billieux J. & Pontes, H.M. (2016). The evolution of internet addiction: A global perspective. Addictive Behaviors, 53, 193–195.

Griffiths, M.D. & Pontes, H.M. (2014). Internet addiction disorder and internet gaming disorder are not the same. Journal of Addiction Research and Therapy, 5: e124. doi:10.4172/2155-6105.1000e124.

Király, O., Griffiths, M.D., Urbán, R., Farkas, J., Kökönyei, G. Elekes, Z., Domokos Tamás, D. & Demetrovics, Z. (2014). Problematic internet use and problematic online gaming are not the same: Findings from a large nationally representative adolescent sample. Cyberpsychology, Behavior and Social Networking, 17, 749-754.

Kuss, D.J. & Griffiths, M.D. (2015). Internet Addiction in Psychotherapy. Basingstoke: Palgrave Macmillan.

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

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

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

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

Lam, L.T. (2014). Internet Gaming Addiction, Problematic use of the Internet, and sleep problems: A systematic review. Current Psychiatry Reports, 16(4), 1-9.

Li, W., Garland, E.L., & Howard, M.O. (2014). Family factors in Internet addiction among Chinese youth: A review of English-and Chinese-language studies. Computers in Human. Behavior, 31, 393-411.

Pontes, H. & Griffiths, M.D. (2015). Measuring DSM-5 Internet Gaming Disorder: Development and validation of a short psychometric scale. Computers in Human Behavior, 45, 137-143.

Pontes, H.M., Kuss, D.J. & Griffiths, M.D. (2015). The clinical psychology of Internet addiction: A review of its conceptualization, prevalence, neuronal processes, and implications for treatment. Neuroscience and Neuroeconomics, 4, 11-23.

Pontes, H.M., Szabo, A. & Griffiths, M.D. (2015). The impact of Internet-based specific activities on the perceptions of Internet Addiction, Quality of Life, and excessive usage: A cross-sectional study. Addictive Behaviors Reports, 1, 19-25.

Tonioni, F., Mazza, M., Autullo, G., Cappelluti, R., Catalano, V., Marano, G., … & Lai, C. (2014). Is Internet addiction a psychopathological condition distinct from pathological gambling?. Addictive Behaviors, 39(6), 1052-1056.

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

Young, K. (1998). Caught in the net. New York: John Wiley

Young K. (1999). Internet addiction: Evaluation and treatment. Student British Medical Journal, 7, 351-352.

Money for nothing (and your clicks for free?): Why do gamers buy ‘virtual assets’?


Video gaming has evolved from a single-player platform to a multi-player realm where interaction with other players is often a necessity. In order to enter the game, players must first create an avatar, a representation of their self in the game that is used to explore and interact with the virtual environment. When creating an avatar, players can also buy virtual assets to augment and/or enhance their online character. Virtual assets are items or customisations for video game avatars, bases, and characters that are purchased with real money.

In a previous blog, I looked at some of the anecdotal evidence that claimed a few individuals had become ‘addicted’ to buying virtual assets. At the time I wrote that article, there was almost nothing published academically on the psychology of virtual assets and why people bought virtual assets. A few months ago, Jack Cleghorn and I published a qualitative paper in the journal Digital Education Review based on our interviews with gamers that regularly bought virtual assets. Today’s blog looks at some of our findings.

For researchers, the buying of virtual assets provides an opportunity to try and understand why people become so immersed in games and what motivates gamers to spend real money on items that some would consider as having no value. In a multi-player environment, it becomes clear that the avatars seen on screen are graphical representations of someone real and may be part of human desires to be noticed, respected, and interacted with. Furthermore the gamer controlling their avatar has motivations, emotions, thoughts, and feelings. Virtual item purchases are therefore likely to impact on a gamer’s psychological wellbeing.

The growing market for virtual items indicates that transactions are becoming commonplace in gaming. The virtual market functions similarly to real markets in that there is demand, fluctuating markets, and profits to be made. The importance of virtual items to some people is illustrated by a divorce claim in a story on Hyped Talk in which a wife made a claim for over half of her husband’s virtual assets. In a different case (outlined in a 2005 issue of The Lawyer), Qiu Chengwei, a middle-aged man killed a fellow gamer over a dispute involving a virtual item. Obviously these cases are extreme but they highlight the fact that virtual items can have both financial and psychological value for gamers.

But why do people buy virtual items? Performance and general quality of an item is seen to be an important motivation whether the item is real or virtual. Online, an appeal to social status may be a better predictor for purchase behaviour than function. However, some claim that appealing to social status has no motivational significance in purchase behaviour. Another unique element of buying virtual items is the potential exclusivity. Exclusive or limited items tend to be unattainable through gameplay and instead must be bought with money. Exclusivity online has been shown to be of importance, and segmentation is a technique used by the games producers that limits certain items to certain classes, levels, or races. This has been shown to stimulate purchase behaviour. The amount of time invested in a game is also key to understanding spending patterns, and gamers will often buy virtual items after a dedicated amount of gameplay has been spent building an avatar.

Naturally, the longer the amounts of time that are spent online and in-game, the more the player emotionally and psychologically invests in the game. The concept of ‘flow’ (formulated by Mihaly Csikszentmihalyi in many papers and books) has been applied to gaming and can involve becoming emotionally attached to a character (in fact I published a paper on this with Damien Hull and Glenn Williams in a 2013 issue of the Journal of Behavioral Addictions). Flow is the feeling of complete absorption in an activity and affects consciousness and emotions of the individual experiencing it. A key element of feeling ‘flow’ is the experience and perception of the world of the avatar and has been applied to electronic media. The adaptation of ‘flow’ to the virtual world suggests that just like other leisure activities, an individual investing time in an environment where they feel socially accepted can become emotionally attached to their avatar. Gaming has been shown to affect consciousness and emotions of gamers that are both necessary in experiencing ‘flow’. It could be that purchasing of virtual items is also motivated – at least in part – by the feeling of emotional attachment to an avatar.

Gamers are being drawn in to an environment by the appeal of social interaction, manipulation of objects, exploration, and identification with the avatar. To some gamers, the virtual world can takes on more significance than ‘actual’ life and residency in their preferred games is what they consider their actuality. This suggests that the reward of gaming is great, indicating that those individuals who buy virtual items are doing so because they feel involved in an environment that benefits them personally.

Given the lack of empirical research, the qualitative study I published with Jack Cleghorn was based on in-depth interviews with six gamers who all regularly bought in-game virtual assets. We examined the (i) motivations for purchasing virtual items, (ii) psychological impact of purchasing virtual items on self-esteem and confidence, (iii) social benefits of gaming and virtual asset purchasing, (iv) emotional attachment to an avatar, (v) choice of items and customisation of the avatar as a form of self-expression, (v) impulsivity versus thoughtfulness in purchase intentions of virtual items, and (vii) impact of transaction machinery on the ‘game experience’ from a gamer’s perspective.

Using interpretative phenomenological analysis (IPA), the study was exploratory and aimed to understand the psychology underlying purchase intention of virtual items and assets among online gamers. As a result of interviewing the gamers, seven theses emerged: (i) motivation for purchase, (ii) social aspects of the gaming and purchasing, (iii) emotional attachment to the avatar, (iv) psychological reward and impact, (v) self-expression, (vi) ‘stock market gaming’ and gaming culture, and (vii) research/impulse buying. The use of IPA allowed each gamer to share their unique experience of playing and purchase behaviour.

Despite the negative aspects of online gaming, the gamers in our study emphasised a more positive side to buying virtual items and gaming more generally. Item exclusivity and item function were major motivating factors and contributed to an item’s importance in-game. Another key motivation for purchase behaviour was the appeal to social status. Attainment of items demonstrates to others how powerful the gamer is. Naturally, if an item has benefits for the avatar it is more likely that the gamer will spend money to obtain it. Function linked to progression, purchasing items, and buying in-game currency are all sometimes a necessity to progress. Novelty and collectability were also important motivators for some of our gamers. Despite subjective motivations, purchasing virtual items arose out of gaming as a predominant pastime. All of the gamers in our sample were dedicated gamers who spent relatively large amounts of time online and, as perhaps expected, larger gaming commitment to led to purchase behaviour.

An integral part of multiplayer gaming is the interaction with other gamers. The feeling of ‘social presence’ in an online environment is reliant on an emotional response to social interaction and the gamers in our study felt social satisfaction. The game sometimes enabled social interaction that might not otherwise be present. Previous research has shown how emotional attachment to games affects behaviour. Our study highlighted the role of emotional attachment to an avatar as a predictor for purchase intention. As well as emotional attachment increasing likelihood of spending, the spending of real money on items increases the attachment felt. It could be that purchasing virtual items may be a cyclical behaviour. It is also the case that purchasing affects the cognitions and emotions of gamers – ‘pride’ was a feeling that resonated among our interviewed gamers.

Our study also highlighted how gamers research items before purchasing them. It might be expected that easy-to-use transaction machinery might facilitate spending. However, in reality, the gamers we interviewed were guarded with their spending online and recommendations from friends playing a major role in purchase behaviour. Virtual assets can be then researched and the placing of real monetary value on the virtual items indicates the value they may hold to the gamer. Unlike media coverage focussing on the more negative impact of online gaming, our study highlighted the positive aspects of purchasing virtual assets for the gamer. They are able to feel connected socially, feel confidence in themselves and their success, express their inner and ideal self without constraint or fear, build lasting relationships, impress people, and generally benefit from gaming and buying virtual items.

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.

Csikszentmihalyi, M., & Csikszentmihalyi, I. (1992). Optimal experience: Psychological studies of flow in consciousness. Cambridge: Cambridge University Press.

Cole, H. & Griffiths, M. D. (2007). Social interactions in Massively Multiplayer Online Role-Playing gamers. CyberPsychology and Behavior, 10, 575-583.

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.

Griffiths, M.D., Hussain, Z., Grüsser, S., Thalemann, R., Cole, H. Davies, M.N.O. & Chappell, D. (2013). Social interactions in online gaming. In P. Felicia (Ed.), Developments in Current Game-Based Learning Design and Deployment (pp.74-90). Pennsylvania: IGI Global.

Guo, Y., & Barnes, S. (2011). Purchase behavior in virtual worlds: An empirical investigation in Second Life. Information and Management, 48(7), 303-312.

Hamari, J. & Lehdonvirta, V. (2010). Game design as marketing: How game mechanics create demand for virtual goods. International Journal of Business Science and Applied Management, 5(1), 14-29.

Hassouneh, D., & Brengman, M. (2011). Shopping in virtual worlds: Perceptions, motivations and behaviour. Journal of Electronic Commerce Research, 12(4), 320-335.

Huang, E. (2012). Online experiences and virtual goods purchase intention. Internet Research, 22(3), 252-274.

Hull, D., Williams, G. A. & Griffiths, M. D. (2013). Video game characteristics, happiness and flow as predictors of addiction among video game players: A pilot study. Journal of Behavioral Addictions, 2, 145-152.

Hyped Talk (2010). Virtually addicted Chinese woman claims virtual assets in her divorce plea. Available at: http://hypedtalk.blogspot.co.uk/2010/12/virtually-addicted-chinese-women-claims.html [Accessed: 6 March 2013].

Lee, P. (2005). The growth in the computer game market is leading to real legal issues in virtual worlds. The Lawyer, 19 (19), 14.

Lehdonvirta, V. (2009) Virtual item sales as a revenue model: Identifying attributes that drive purchase decisions. Electronic Commerce Research, 9(1-2), 97-113.

Li, Z. (2012). Motivation of virtual goods transactions based on the theory of gaming motivations. Journal of Theoretical and Applied Information Technology, 43(2), 254-260.

Manninen, T. & Kujanpää, T. (2007). The value of virtual assets – the role of game characters in MMOGs. International Journal of Business Science and Applied Management, 2(1), 21-33.

Are you ‘intexticated’?: Another look at excessive smartphone use

Yesterday, I received a copy of a new book called Too Much Of A Good Thing: Are You Addicted To Your Smartphone? by Dr. James Roberts (a Professor of Marketing at Baylor University in Waco, Texas). It’s a populist and easy-to-read book that you can read from cover to cover inside two hours. It’s not an academic book but there’s lots of input from various academics around the world (including me – which is why I was sent a copy of the book). It’s a fun read and is written by someone (who like myself) loves technology and all the great benefits it brings us.

The main thrust of the book doesn’t concern addiction per se, but is more concerned with how smartphones take us away from or compromises other things in our lives like our friends, our loved ones, our hobbies and (in extreme cases) our jobs. Roberts describes this as ‘cellularitis’ – “a Socially Transmitted Disease (STD) that results in habitual use of one’s cell phone to the detriment of his or her psychological and physical health and well-being”. In the second chapter, Dr. Roberts uses my addiction components model to describe his ‘Six Signs of Cell Phone Addiction Scale’ (although uses an older version of the components model taken from a paper I published on internet addiction back in 1999 in The Psychologist).

One of the chapters on the phenomena of ‘phubbing’ (i.e., phone snubbing – where someone you are socially interacting with would rather be on their smartphone, rather than talking to you). One recent paper by Dr. Roberts published in the journal Computers in Human Behavior even had the title ‘My life has become a major distraction from my cell phone’. The chapter also contains a 9-item ‘Phubbing Scale’ that Roberts developed with his colleague Dr. Meredith David (and a later chapter also includes the ‘Partner Phubbing Scale’). Academic research into phubbing has already started (see ‘Further reading below) and I’ll hopefully write a blog on that in the future. I also liked the concept of being ‘intexticated’ defined as being “distracted by the act of texting to such a degree that one seems intoxicated”.

In previous blogs I have examined the concept of mobile phone addiction, the most recent of which argued that there was nowhere near enough empirical evidence to be able to confirm whether addiction to smartphones exists. Dr. Roberts asked me about the topic for his book and here are the answers to the questions he asked me.

Can someone be addicted to their cell phone? Why or why not?

That depends on how ‘addiction’ is defined. I believe that anything can be potentially addictive if constant rewards and reinforcement are present. Some people may confuse habitual use of such technology as an addictive behaviour (when in reality it may not be). For instance, some people may consider themselves cell phone addicts because they never go out of the house without their cell phone, do not turn their cell phone off at night, are always expecting calls from family members or friends, and/or over-utilise cell phones in their work and/or social life. There is also the importance of economic and/or life costs. The crucial difference between some forms of cell phone use and pathological cell phone use is that some applications involve a financial cost. If a person is using the application more and is spending more money, there may be negative consequences as a result of not being able to afford the activity (e.g., negative economic, job-related, and/or family consequences). High expenditure may also be indicative of cell phone addiction but the phone bills of adolescents are often paid for by parents, therefore the financial problems may not impact on the users themselves.

It is very difficult to determine at what point cell phone use becomes an addiction. The cautiousness of researchers suggests that we are not yet in a position to confirm the existence of a serious and persistent psychopathological addictive disorder related to cell phone addiction on the basis of population survey data alone. This cautiousness is aided and supported by other factors including: (a) the absence of any clinical demand in accordance with the percentages of problematic users identified by these investigations, (b) the fact that the psychometric instruments used could be measuring ‘concern’ or ‘preoccupation’ rather than ‘addiction, (c) the normalisation of behaviour and/or absence of any concern as users grow older; and (d) the importance of distinguishing between excessive use and addictive use.

What signs or symptoms would you look for when deciding if someone is addicted to their cell phone?

You could argue that a person is no more addicted to their phone than an alcoholic is addicted to the bottle. Individuals tend to have addictions on their mobile phone rather than to their phone. For me to class someone as addicted to their mobile phone they would have to fulfill the following six criteria:

  • Salience – This occurs when the mobile phone use becomes the single most important activity in the person’s life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings) and behaviour (deterioration of socialised behaviour). For instance, even if the person is not actually on their phone they will be constantly thinking about the next time that they will be (i.e., a total preoccupation with their mobile phone).
  • Mood modification – This refers to the subjective experiences that people report as a consequence of mobile phone use and can be seen as a coping strategy (i.e., they experience an arousing ‘buzz’ or a ‘high’ or paradoxically a tranquilizing feel of ‘escape’ or ‘numbing’) when on the phone.
  • Tolerance – This is the process whereby increasing amounts of mobile phone use are mobile phone users gradually build up the amount of the time they spend on their phone every day.
  • Withdrawal symptoms – These are the unpleasant feeling states and/or physical effects (e.g., the shakes, moodiness, irritability, etc.) that occur when the person is unable to use their phone because there is no signal, mislaid or broken phone, etc.
  • Conflict – This refers to the conflicts between the person and those around them (interpersonal conflict), conflicts with other activities (social life, hobbies and interests) or from within the individual themselves (intra-psychic conflict and/or subjective feelings of loss of control) that are concerned with spending too much on their mobile phone.
  • Relapse – This is the tendency for repeated reversions to earlier patterns of excessive mobile phone use to recur and for even the most extreme patterns typical of the height of excessive mobile phone use to be quickly restored after periods of control.

What is one suggestion you could offer to help someone better control their cell phone use?

I don’t have a single suggestion. If there was a single suggestion to overcome or better control problematic phone use then I could give up my whole research career. However, my tips on digital detox can be found here.

 

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

Further reading

Bianchi, A. & Phillips, J.G. (2005). Psychological predictors of problem mobile phone use. Cyberpsychology and Behavior, 8, 39–51.

Billieux, J. (2012). Problematic use of the mobile phone: A literature review and a pathways model. Current Psychiatry Reviews, 8, 299–307.

Billieux, J., Maurage, P., Lopez-Fernandez, O., Kuss, D.J. & Griffiths, M.D. (2015). Can disordered mobile phone use be considered a behavioural addiction? An update on current evidence and a comprehensive model for future research. Current Addiction Reports, DOI 10.1007/s40429-015-0054-y

Carbonell, X., Chamarro, A., Beranuy, M., Griffiths, M.D. Obert, U., Cladellas, R. & Talarn, A. (2012). Problematic Internet and cell phone use in Spanish teenagers and young students. Anales de Psicologia, 28, 789-796.

Chóliz M. (2010). Mobile phone addiction: a point of issue. Addiction. 105, 373-374.

Griffiths, M.D. (1999). Internet addiction: Fact or fiction? The Psychologist: Bulletin of the British Psychological Society, 12, 246-250.

Griffiths, M.D. (2007). Mobile phone gambling. In D. Taniar (Ed.), Encyclopedia of Mobile Computing and Commerce (pp.553-556). Pennsylvania: Information Science Reference.

Griffiths, M.D. (2013). Adolescent mobile phone addiction: A cause for concern? Education and Health, 31, 76-78.

Karadağ, E., Tosuntaş, Ş. B., Erzen, E., Duru, P., Bostan, N., Şahin, B. M., … & Babadağ, B. (2015). Determinants of phubbing, which is the sum of many virtual addictions: A structural equation model. Journal of Behavioral Addictions, 4, 60-74.

Lopez-Fernandez, O., Honrubia-Serrano, L., Freixa-Blanxart, M., & Gibson, W. (2014). Prevalence of problematic mobile phone use in British adolescents. Cyberpsychology, Behavior and Social Networking, 17, 91-98.

Lopez-Fernandez, O., Kuss, D.J., Griffiths, M.D., & Billieux, J. (in press). The conceptualization and assessment of problematic mobile phone use. In Z. Yan (Ed.), Encyclopedia of Mobile Phone Behavior (Volumes 1, 2, & 3). Hershey, PA: IGI Global.

Roberts, J.A. (2016). Too Much Of A Good Thing: Are You Addicted To Your Smartphone? Austin: Sentia Publishing.

Roberts, J. A., & David, M. E. (2016). My life has become a major distraction from my cell phone: Partner phubbing and relationship satisfaction among romantic partners. Computers in Human Behavior, 54, 134-141

Smetaniuk, P. (2014). A preliminary investigation into the prevalence and prediction of problematic cell phone use. Journal of Behavioral Addictions, 3(1), 41-53.

Ugur, N. G., & Koc, T. (2015). Time for digital detox: Misuse of mobile technology and phubbing. Procedia-Social and Behavioral Sciences, 195, 1022-1031.