Stitches brew: A brief look at self-harm lip sewing

In previous blogs I have examined both self-harming behaviour (such as cutting off one’s own genitals, removing one’s own eye, removing one’s own ear, self-asphyxial risk taking in adolescence, and religious self-flagellation) and extreme body modification. One area where these two areas intersect is lip sewing. According to the Wikipedia entry on lip sewing:

“Lip sewing or mouth sewing, the operation of stitching together human lips, is a form of body modification. It may be carried out for aesthetic or religious reasons; as a play piercing practice; or as a form of protest. Sutures are often used to stitch the lips together, though sometimes piercings are made with needle blades or cannulas and monofilament is threaded through the holes. There is usually a fair amount of swelling, but permanent scarring is rare. Lip sewing may be done for aesthetic reasons, or to aid meditation by helping the mind to focus by removing the temptation to speak. BMEzine, an online magazine for body modification culture, published an article about a 23-year-old film student Inza, whose quest for body modifications was very varied. She spoke about her experiences with lip sewing as a form of play piercing”.

My reason for writing this blog was prompted by a case study published by Dr. Safak Taktak and his colleagues in the journal Health Care Current Reviews. (I ought to add that I have read a number of papers by Taktak and his colleagues as they have reported some interesting other interesting case studies including those on shoe fetishism, semen fetishism, and fetishes more generally – see ‘Further reading’ below). In this particular paper, they reported the case of a male prisoner who had continually sewed his lips together. Although they were aware of cases of sewing lips together as a form of protest, they claimed that there had never been any case reported in the medical literature.

The case report involved a male 37-year old Turkish (imprisoned) farmer, father of two children, with only basic education. After sewing his lips together, the man was brought into the hospital by the police, along with a handwritten note that read: “My jinns imposed speech ban to me and they made me sew my lips unwillingly. Otherwise, they threaten me with my children. I want to meet a psychiatrist urgently”. (Jinns I later learned are – in Arabian and Muslim mythology – intelligent spirits of lower rank than the angels, able to appear in human and animal forms and are able to possess humans). Not only were his lips sown together with black thread but he had also sewn both of his ears to the side of his head (these are also photographed in the paper and you can download the report free from here). This was actually the fourth time the man had sewed his lips together (but the first that he had sewn his ears). Each time, the doctors took out the stitches and dressed the wounds. The authors examined previous documentation about the man and reported that the man had been in prison for four years after injuring someone (no details were provided) and had been diagnosed with both anxiety disorder and anti-social personality disorder. On a prison ward comprising ten other prisoners, he had attempted suicide when trying to hang himself (in fact, you can clearly see the marks on his neck in the paper’s photographs). The authors reported that:

[The man] had blunted affect. He wasn’t able to stay in the [prison] ward because of the directive voices in his head. He declared he needed to stay in the ward alone. He heard all the words as swearing and he was punished by some people as well as some entities. He also said that some jinns in the form of animals threatened him not to speak and listen to anyone; otherwise they were going to kill his kids. He wanted to protect his children [and] he stitched his lips not to speak anyone and stitched his ears not to hear anyone. In his family history, he stated that his uncle committed suicide by hanging himself and saying ‘the birds are calling me’; his father was schizophrenia-diagnosed”.

The authors then reported:

“The patient stated that he sewed his lips with any colour of thread he could find. He had approximately fifteen pinholes on his upper and lower lips. He tended to suicide with directive auditory and visual hallucination (sic) and reference paranoid delirium. As he was imprisoned, he wasn’t able to use drugs. The patient who was thought to have a psychotic disorder was injected [with] 10 mg haloperidol intramuscularly and he was sent to a safe psychiatry hospital”.

As I have noted in my previous blogs on self-harming behaviour (and as noted in this particular paper), there are many different definitions of what constitutes self-destructive behaviour. This particular case was said to be suited to the psychotic behaviours characterised by Dr. Armando Favazza’s three self-destructive behaviours (i.e., compulsive, typical, and psychotic) outlined in his 1992 paper ‘Repetitive self-mutilation’ (published in the journal Psychiatry Annals). In their discussion of the case, the authors noted:

“The cases like sewing one’s own lips which we observe as a different type of destructing oneself in our case are mostly regarded as intercultural expression of feelings. The ones, who sew their lips in order to protest something, show their reactions by blocking the nutrition intake organ to the ones who want to continue their superiority. It can be expected in psychotic cases that the patients or his beloved ones might be harmed, damaged or affected emotionally. Thus, the patient who is furious and anxious might react by [attempting] violence as a reaction to these repetitive threats. Auditory hallucinations giving orders can cause the aggressive behaviours to start…In our psychotic case, this kind of behaviour is a way to prevent the voices coming from his inner world, not to answer them and hence making passive defending to world which he does not want to interact. By this means, he may harmonise with the secret natural powers which affect him and he may protect himself his children…[also] there can be a relief through sewing lips and ears or strangulation against the oppression created by the person not being able to adapt the prison…It should not be forgotten that the prison is a stressful environment and stressful living [increases] the disposition to psychopathologic behaviour that the living difficulties in prisons can affect the way of thinking and the capacity of coping and it may cause different psychiatric incidences”.

As noted at the start of this article, lip sewing is typically attributed to religious reasons, reasons of protest or aesthetic reasons. In this particular case, none of these reasons was apparent (and therefore notable – in the medical and psychiatric literature at the very least). The addition of sewing his ears appears to be even more rare, and thus warrants further research.

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

Further reading

Favazza, A.R. (1992). Repetitive self-mutilation. Psychiatric Annals, 22(2), 60-63.

Taktak, S., Ersoy, S., Ünsal, A., & Yetkiner, M. (2014). The man who sewed his mouth and ears: A case report. Health Care Current Reviews, 2(121), 2.

Taktak, S., Karakus, M., & Eke, S. M. (2015). The man whose fetish object is ejaculate: A case report. Journal of Psychiatry, 18(276), 2.

Taktak, S., Karakuş, M., Kaplan, A., & Eke, S. M. (2015). Shoe fetishism and kleptomania comorbidity: A case report. European Journal of Pharmaceutical and Medical Research, 2, 14-19.

Taktak, S., Yılmaz, E., Karamustafalıoglu, O., & Ünsal, A. (2016). Characteristics of paraphilics in Turkey: A retrospective study – 20years. International Journal of Law and Psychiatry, in press.

Wikipedia (2016). Lip sewing. Located at: https://en.wikipedia.org/wiki/Lip_sewing

Higher and higher: Can psychoactive substance use enhance creativity?

In a previous blog I examined whether celebrities are more prone to addictions. In that article I argued that many high profile celebrities have the financial means to afford a drug habit like cocaine or heroin. For many in the entertainment business such as being the lead singer in a famous rock band, taking drugs may also be viewed as one of the defining behaviours of the stereotypical ‘rock ‘n’ roll’ lifestyle. In short, it’s almost expected. There is also another way of looking at the relationship between celebrities and drugs and this is in relation to creativity, particularly as to whether the use of drugs can inspire creative writing or music. For instance, did drugs like cannabis and LSD help The Beatles create some of the best music ever such as Revolver? Did the Beach Boys’ Brian Wilson’s use of drugs play a major role in why the album Pet Sounds is often voted the best album of all time? Did the use of opium by Edgar Allen Poe create great fiction? Did William S. Burroughs’ use of heroin enhance his novel writing?

To investigate the question of whether drug use enhances creativity, I and my research colleagues Fruzsina Iszáj and Zsolt Demetrovics have just published a review paper in the International Journal of Mental Health and Addiction examining this issue. We carried out a systematic review of the psychological literature and reviewed any study that provided empirical data on the relationship between psychoactive substance use and creativity/artistic creative process that had been published in English in peer-reviewed journals or scientific books. Following a rigorous filtering process, we were surprised to find only 19 studies that had empirically examined the relationship between drug use and creativity (14 empirical studies and five case studies).

Six of the 19 studies (four empirical papers and two case reports) were published during the 1960s and 1970s. However, following the peak of psychedelia, only three papers (all of them empirical) were published in the following 20 years. Since 2003, a further 10 studies were published (seven empirical papers and three case studies). The majority of the studies (58%) were published in the USA. This dominance is especially true for the early studies in which six of the seven empirical papers and both case studies that were published before mid-1990s were written by US researchers. However, over the past 14 years, this has changed. The seven empirical papers published post-2000 were shared between six different countries (USA, UK, Italy, Wales, Hungary, Austria), and the three case studies came from three countries (USA, UK, Germany).

Seven empirical papers and two case studies dealt with the relationship between various psychoactive substances and artistic creation/creativity. Among the studies that examined a specific substance, six (three empirical papers and three case studies) focused on the effects of either LSD or psilocybin. One empirical study focused on cannabis, and one concerned ayahuasca.

With the exception of one study where the sample focused on adolescents, all the studies comprised adults. More non-clinical samples (15 studies, including case studies) were found than clinical ones (four studies). Three different methodological approaches were identified. Among the empirical studies, seven used questionnaires comprising psychological assessment measures such as the Torrance Test of Creative Thinking (TTCT).

According to the types of psychoactive substance effect on creativity, we identified three groups. These were studies that examined the effect of psychedelic substances (n=5), the effect of cannabis (n=1), and those that did not make a distinction between substances used because of the diverse substances used by participants in the samples (n=7). In one study, the substances studied were not explicitly identified.

The most notable observation of our review was that the findings of these studies show only limited convergence. The main reason for this is likely to be found in the extreme heterogeneity concerning the objectives, methodology, samples, applied measures, and psychoactive substances examined among the small number of studies. Consequently, it is hard to draw a clear conclusion about the effect of psychoactive substance use on creativity based on the reviewed material.

Despite the limited agreement, most of the studies confirmed some sort of association between creativity and psychoactive substance use, but the nature of this relationship was not clearly established. The frequently discussed view that the use of psychoactive substances leads to enhanced creativity was by no means confirmed. What the review of relevant studies suggests is that: (i) substance use is more characteristic in those with higher creativity than in other populations, and (ii) it is probable that this association is based on the inter-relationship of these two phenomena. At the same time, it is probable that there is no evidence of a direct contribution of psychoactive substances to enhanced creativity of artists.

It is more likely that substances act indirectly by enhancing experiences and sensitivity, and loosening conscious processes that might have an influence on the creative process. This means the artist will not be more creative but the quality of the artistic product will be altered due to substance use. On the other hand, it appears that psychoactive substances may have another role concerning artists, namely that they stabilize and/or compensate a more unstable functioning.

Beyond the artistic product, we also noted that (iii) specific functions associated with creativity appear to be modified and enhanced in the case of ordinary individuals due to psychoactive substance use. However, it needs to be emphasized that these studies examined specific functions while creativity is a complex process. In light of these studies, it is clear that psychoactive substances might contribute to a change of aesthetic experience, or enhanced creative problem solving. One study (a case study of the cartoonist Robert Crumb) showed that LSD changed his cartoon illustrating style. Similarly, a case study of Brian Wilson argued that the modification of musical style was connected to substance use. However, these changes in themselves will not result in creative production (although they may contribute to the change of production style or to the modification of certain aspects of pieces of arts). What was also shown is that (iv) in certain cases, substances may strengthen already existing personality traits.

In connection with the findings reviewed, one should not overlook that studies focused on two basically different areas of creative processes. Some studies examined the actual effects of a psychoactive substance or substances in a controlled setting, while others examined the association between creativity and chronic substance users. These two facets differ fundamentally. While the former might explain the acute changes in specific functions, the latter may highlight the role of chronic substance use and artistic production.

It should also be noted that the studies we reviewed differed not only regarding their objectives and methodology, but also showed great heterogeneity in quality. Basic methodological problems were identified in many of these studies (small sample sizes, unrepresentative samples, reliance on self-report and/or non-standardized assessment methods, speculative research questions, etc.). Furthermore, the total number of empirical studies was very few. At the same time, the topic is highly relevant both in order to understand the high level of substance use in artists and in order to clarify the validity of the association present in public opinion. However, it is important that future studies put specific emphasis on adequate methodology and clear research questions.

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

Further reading

Belli, S. (2009). A psychobiographical analysis of Brian Douglas Wilson: Creativity, drugs, and models of schizophrenic and affective disorders. Personality and Individual Differences, 46, 809-819.

Dobkin de Rios, M. & Janiger, O. (2003). LSD, spirituality, and the creative process. Rochester, VT: Park Street Press.

Edwards, J. (1993). Creative abilities of adolescent substance abusers. Journal of Group         Psychotherapy, Psychodrama & Sociometry, 46, 52-60.

Fink, A., Slamar-Halbedl, M., Unterrainer, H.F. & Weiss, E.M. (2012). Creativity: Genius, madness, or a combination of both? Psychology of Aesthetics, Creativity, and the Arts, 6(1), 11–18.

Forgeard, M.J.C. & Elstein, J.G. (2014). Advancing the clinical science of creativity. Frontiers in Psychology, 5, 613.

Frecska, E., Móré Cs. E., Vargha, A. & Luna, L.E. (2012). Enhancement of creative expression and entoptic phenomena as after-effects of repeated ayahuasca ceremonies. Journal of Psychoactive Drugs, 44, 191-199

Holm-Hadulla, R.M. & Bertolino, A. (2014). Creativity, alcohol and drug abuse: The pop icon Jim Morrison. Psychopathology, 47,167-73

Iszáj, F. & Demetrovics, Z. (2011). Balancing between sensitization and repression: The role of opium in the life and art of Edgar Allan Poe and Samuel Taylor Coleridge. Substance Use and Misuse, 46, 1613-1618

Iszaj, F., Griffiths, M.D. & Demetrovics, Z. (2016). Creativity and psychoactive substance use: A systematic review. International Journal of Mental Health and Addiction. doi: 10.1007/s11469-016-9709-8

Jones, M.T. (2007). The creativity of crumb: Research on the effects of psychedelic drugs on the comic art of Robert Crumb. Journal of Psychoactive Drugs, 39, 283-291.

Jones, K.A., Blagrove, M. & Parrott, A.C. (2009). Cannabis and ecstasy/ MDMA: Empirical measures of creativity in recreational users. Journal of Psychoactive Drugs. 41(4), 323-329

Kerr, B. & Shaffer, J. & Chambers, C., & Hallowell, K. (1991). Substance use of creatively talented adults. Journal of Creative Behavior, 25(2), 145-153.

Knafo, D. (2008). The senses grow skilled in their craving: Thoughts on creativity and addiction. Psychoanalytic Review, 95, 571-595.

Lowe, G. (1995). Judgements of substance use and creativity in ’ordinary’ people’s everyday lifestyles. Psychological Reports. 76, 1147-1154.

Oleynick, V.C., Thrash, T. M., LeFew, M. C., Moldovan, E. G. & Kieffaber, P. D. (2014). The scientific study of inspiration in the creative process: challenges and opportunities. Frontiers in Human Neuroscience, 8, 436.

Plucker, J.A., McNeely, A. & Morgan, C. (2009). Controlled substance-related beliefs and use: Relationships to undergraduates’ creative personality traits. Journal of Creative Behavior, 43(2), 94-101

Preti, A. & Vellante, M. (2007). Creativity and psychopathology. Higher rates of psychosis proneness and nonright-handedness among creative artists compared to same age and gender peers. Journal of Nervous and Mental Disease, 195(10), 837-845.

Schafer, G. & Feilding, A. & Morgan, C. J. A. & Agathangelou, M. & Freeman, T. P. &      Curran, H.V. (2012). Investigating the interaction between schizotypy, divergent thinking and cannabis use. Consciousness and Cognition, 21, 292–298

Thrash, T.M., Maruskin, L.A., Cassidy, S. E., Fryer, J.W. & Ryan, R.M. (2010). Mediating between the muse and the masses: inspiration and the actualization of creative ideas. Journal of Personality and Social Psychology, 98, 469–487.

Gaming desires: A brief look at ‘venatophilia’

In a previous blog on sexual paraphilias that have yet to be studied empirically, I briefly mentioned ‘venatophilia’.  In an online article about cartoon quicksand fetishes (which I discuss below), there was mention of a fetish group called ‘Giant Video Game Girls’ and they appear to have coined the term ‘venatophilia’ from the Latin venatus, meaning ‘game’ and describes sexual attraction to or fascination with video game characters. Venatophilia also gets a mention on the Wiktionary protologism page (a page that lists prototype neologisms) where it listed alongside venatology (“the study of games, the act of playing them, and the players and cultures surrounding them”), venatomania (an obsession with games), and venatophobia (a fear of games). Personally I find this somewhat strange as most paraphilias derive from Greek (rather than Latin) names. If this paraphilia exists I would argue that it is a sub-type of toonophilia (sexual attraction to cartoon characters) that I examined in a previous blog.

Cartoon quicksand fetishes are an integration of quicksand fetishes (itself a form of ‘stuck fetishism‘ that I examined in a previous blog) and (as mentioned above) cartoon fetishism (‘toonophilia‘). The Motherboard article by Jagger Gravning featured an interview with ‘quicksand artist’ A-020 who draws fictional damsels, women that are stuck in quicksand typically wearing a “tight miniskirt, pantyhose, heels, and boots”. (If you are interested, there is lots of art featuring women stuck in quicksand on the Deviant Art webpage). A-020 said:

 “I’m open with [my quicksand cartoon fetish] online because I’m comfortable under a screenname…Though when it comes to knowing me in person, it’s pretty much a secret! I haven’t been in a situation where I had to reveal this fetish…I was pretty young, maybe 7 or 8, when I started seeing quicksand scenes in a movie or a TV show. Some of those films I recall seeing were Beastmaster, Neverending Story, A Nightmare on Elm Street 4 and Ursus in the Valley of the Lions…Once in a while, I’d fantasize about it”.

Gravning makes the point that there are other fetishes that cartoonists incorporate into their videogame graphics. Some of these are strange behaviors that I outlined in a previous blog – ‘unbirthing’ (i.e., returning to the womb) such as that featuring ‘Princess Peach’ and Pokemon characters (such as those here and here) and vore (vorarephilia). In fact, Zeus Tipado wrote an online article for The Stoned Gamer about the “vore fetish of game characters swallowing each other whole”. There are also online articles that examine the best sexual moments in videogame history. In an online article entitled ‘Gamers as fetishists‘  by Gus Mastrapa on the Joystick Division website notes:

“Nowadays we equate fetishism with perversity, but the roots of the word are about perceiving power in objects or things. A religious idol is a fetish object. In the days when more and more parts of our lives are digital it is easy to fetishize the physical. Gamers, I think, have a bit of a head start. Because the videogames we play have long been about making our imaginations physical – by embodying and creating the ideals and fantasies we carry around with us. I mean just look at the characters in a Final Fantasy game and tell me that gamers aren’t serious fetishists…There’s a huge swath of the gaming community who love JRPGs [Japanese role playing games] like Final Fantasy and Persona – where characters are defined more by what they wear than their facial features. Costumes are a huge concern for these fans…It is easy to pick on anime nerds and their weird fixation with trench coats, boots and nerdy glasses. But this exercise would be pointless without self-examination…Gamer fetishism goes beyond the aesthetic…Games encourage obsession. They draw it out of us or provide a vessel for us to pour it into. And so it makes sense that they’d also be filled with objects of our obsession. Weapons, riches, vehicles, clothing, other people – they’re all things we want because we fill them with our dreams and desires”

Earlier this year, the makers of World of Warcraft launched a new videogame, Overwatch which according to an article in Maxim magazine by Zeynep Yenisey is “an over-sexualized first-person shooter featuring tons of big-breasted anime chicks”. Yenisey reported that after the game was released, there had been an 817% increase on Pornhub for Overwatch-related searches particularly for the buxom character Tracer.

So what is the psychology behind fetishes and sexual attraction to videogame characters? Gravning interviewed the evolutionary psychologist Dr. Catherine Salmon

“If somebody has attached to a character because they play a game a lot and fantasize about that character, it wouldn’t be surprising that they take that character and stick it somewhere else. It’s not surprising that some of the female characters in video games who are heroines and are portrayed as very sexual characters in terms of the way that they’re drawn might end up as the stars of gamers’ sexual fantasies. The social aspect of using familiar characters is another reason for using them in quicksand imagery and other fetishes. If you use a known character for a fetish, it gives your work some degree of a built-in audience, a device often used for fanfiction…There is a community of men who are creating and sharing these stories or these images. If they share an interest in the original material as well, then using that original material creates an additional commonality of interest. It’s one thing to have your sexual fantasies and it’s another thing to share your sexual fantasies. If you’re creating art or fiction and you’re putting it on the web, you’re not just doing it for yourself, it’s not just your fantasy that you’re jerking off to, you’re giving that to other people as well. To do that, you find a built-in community if you’re using a shared character”.

Gravning notes some of the “shared characters” find themselves in “exactly the same situations that these artists fetishize” and asked Dr. Salmon whether witnessing individuals repeatedly stuck in quicksand when a child could possibly lead to such unusual fetishes:

“It could be something like that. Whether it’s quicksand or tar pits, there’s things like that in children’s cartoons. It could be something as simple as that. Part of it is the damsel in distress kind of image. Watching ‘Wonder Woman’ caught in that kind of circumstance when people are younger – [it’s] an image that’s eroticized, a very sexually drawn, very feminine image. And they might enjoy watching that sort of thing or the struggle, as she’s trying to get out of whatever that circumstance is. There are a lot of unusual circumstances in cartoons and fantasy and you may get aroused while you’re watching it and then carry some of that too”.

Gravning also interviewed the sex therapist Dr. Elizabeth Lars (who shares my own view on this by alluding to classical conditioning). Dr. Lars calls such associations “accidents of learning” in which the associations “don’t have to be exactly like the fantasy that comes, it just has to resemble it”. Furthermore, she went on to speculate:

[Quicksand fetishists] probably fantasized and got into the feeling that goes with that, not just watching. It could [also] be identifying with it. The kid imagining himself stuck in quicksand in the victim’s place, for example, could be part of its erotic appeal. You could either be observing it or experiencing it. You could be doing both at the same time in a fantasy. Some evidence certainly suggests that sexual patterns are already there, for sure in males, by the age of eight. They may or may not have begun masturbating to fantasies until adolescence, but something is going on internally at a very young age. This highly influential period of age eight through adolescence is also probably for many a prime time for the ingestion of the bizarre imagery and situations contained in video games and cartoons, which often also incorporate sexualized heroines. It looks like what we call fetishes are remarkably easy to install in the early learning experiences. Same thing about fears too.”

Back in the late 1990s, I had a regular column with the now defunct magazine Arcade. My very first column (which you can download here) was on the psychology of Tomb Raider and the sexualization of lead character Lara Croft and the influence it might have on young boys and emerging adolescents. This is echoed by the neuroscientist Dr. Ogi Ogas who when interviewed by Gravning said that pubertal males probably spending a lot of time with sexualized videogame characters like Lara Croft.

“They are seeing these characters during their formative time. They are kind of perfect and ideal – and you don’t have to actually interact with them. Psychologically, it’s truly like a stripped-down, pure erotic stimuli. So it’s much easier to imprint on that, to fetishize that. Part of the fascination is simply being culturally exposed to characters like Lara Croft…[In relation to quicksand fetishes], the notion of being smothered or trapped is universal in the sense that it exists to greater and lesser degrees all over. It’s not just one or two people that have it. It is found in a lot of places. Clearly our normal brain design is not that far removed from [wanting to be] enveloped. It’s probably something to do with our tactile system, our touch system of the brain, that’s quite naturally wired to our sexual arousal system. The tactile system is also interconnected with sensations like being smothered and being interred, being doused with water. Probably, somehow – and I’m speculating here – that’s what got crossed up for whatever reasons. How someone’s brain entangles sexual arousal with the notion of being trapped or smothered might simply be a perturbation of the neural system. A quirk in the brain, essentially. It could be some randomness in the seemingly infinite complexity of your DNA. So, from a perspective rooted in computational neuroscience, niche sexual desires needn’t be wholly, or at all, explained as the result of social construction or evolutionary adaptation. As we’re learning more about the genetics of brain construction, “we’re coming to understand the genetic expression that leads to different neural wiring is highly variable and dependent on so many things [that] could happen in the womb, things that happen in early life, different environmental things. There’s just myriad, myriad factors that can cause unusual neural wiring to arise.”

Dr. Ogas also claimed are fundamental to the human condition and that one in particular (domination/submission) seems to underlie many fetishes:

“The most important, underappreciated sexual interest in our species is an interest in domination and submission. This interest in manifestations of domination and submission applies to people worldwide. To men, women, whether they be gay, lesbian, straight, or anything else. Everybody. Whether your mindset is to be dominant or submissive sexually is fundamental to your sexual identity even though this interest is thought of culturally as an atypical fetish. The concept that one person has power, one person doesn’t, runs through all forms of erotica across the world”.

Based on what I’ve seen and read online, venatophilia appears to exist although it could be argued that videogame fetishes are just sub-classes of other types of fetishes and paraphilias such as vorarephilia, unbirthing, and stuck fetishism.

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

Further reading

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

Gravning, J. (2016). The fetish for video game characters trapped in quicksand. Motherboard, March 19. Located at: http://motherboard.vice.com/read/quicksand

Griffiths, M.D. (1998). Shrink rap: The Croft Report. Arcade, 1 (November), p. 49.

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

Mastrapa, G. (2011). Gamers are fetishists. Joystick Division, March 9. Located at: http://www.joystickdivision.com/2011/09/gamers_are_fetishists.php

McCombs, E. (2008). Toonophilia: Is it porn? Huffington Post, October 1^st. Located at: http://www.asylum.com/2008/10/01/toonophilia-is-it-porn/

Monroe, W. (2012). Fetish of the week: Schediaphilia (toonophilia). ZZ Insider, March 12. Located at: http://www.zzinsider.com/blogs/view/fetish_of_the_week_schediaphilia_toonophilia

Tipado, Z. (2015). Exploring the vore fetish of game characters eating each other whole. The Stoned Gamer, October 25. Located at: http://thestonedgamer.com/features/item/351-exploring-the-vore-fetish-of-game-characters-swallowing-each-other-whole

Yenisey, Z. (2016). How the bizarre ‘overwatch’ fetish is getting gamers hot and bothered. Maxim, May 11. Located at: http://www.maxim.com/entertainment/overwatch-pornhub-2016-5

Play a way: A brief overview of our recent papers on Game Transfer Phenomena

Following my recent blogs where I outlined some of the papers that my colleagues and I have published on mindfulness, Internet addiction, gaming addiction, workaholism, and youth gambling, here is a round-up of recent papers that Dr. Angelica Ortiz de Gortari and I have published on Game Transfer Phenomena.

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

• Game Transfer Phenomena (GTP) (i.e. altered perceptions, spontaneous thoughts and behaviors with game content) occur on a continuum from mild to severe. This study examined the differences between mild, moderate and severe levels of GTP. A total of 2281 gamers’ participated in an online survey. The majority of gamers experienced a mild level of GTP. The factors significantly associated with the severe level of GTP were: (i) being students, (ii) being aged 18 to 22 years, (iii) being professional gamers, (iv) playing videogames every day in sessions of 6 h or more, (iv) playing to escape from the real world, (v) having a sleep disorder, mental disorder or reported dysfunctional gaming, and (vi) having experienced distress or dysfunction due to GTP. In addition, having used drugs and experiencing flashbacks as side- effects of drug use were significantly less likely to be reported by those with mild level of GTP. In a regression analysis, predictors of severe GTP included positive appraisals of GTP, distress or dysfunction due to GTP, and tendency to recall dreams. In general, the findings suggest that those with severe level of GTP share characteristics with profiles of gamers with dysfunctional gaming (e.g., problematic and/or addictive gaming).

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

• Previous qualitative and quantitative studies examining Game Transfer Phenomena (GTP) have demonstrated that GTP experiences are common. These studies have shown that many gamers report altered perceptions, involuntary thoughts and behaviors after playing video games (e.g., pseudo-hallucinatory experiences, automatic motor activations, etc.). However, the factors associated with GTP are unknown. In the present study, a total of 2362 gamers were surveyed using an online questionnaire to examine the relationship between GTP and socio-demographic factors, gaming habits, individual characteristics, and motivations for playing. Results showed that having a pre-existing medical condition, playing for 3–6 h, and playing for immersion, exploration, customization, mechanics and escape from the real world were significantly associated with having experienced GTP. Those who were 33–38 years old, playing sessions for less than one hour, being a professional player, being self-employed, and never recalling dreams, were significantly more likely to have not experienced GTP. The findings suggest that attention should be paid to young adults and the length of gaming sessions, as well as taking into consideration underlying factors such as medical conditions that may make gamers more prone to GTP.

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

• A variety of instruments have been developed to assess different dimensions of playing video games and its effects on cognitions, affect, and behaviors. The present study examined the psychometric properties of the Game Transfer Phenomena Scale (GTPS) that assesses nonvolitional phenomena experienced after playing video games (i.e., altered perceptions, automatic mental processes, and involuntary behaviors). A total of 1,736 gamers participated in an online survey used as the basis for the analysis. Confirmatory factor analysis (CFA) was performed to confirm the factorial structure of the GTPS. The five-factor structure using the 20 indicators based on the analysis of gamers’ self-reports fitted the data well. Population cross-validity was also achieved, and the positive associations between the session length and overall scores indicate the GTPS warranted criterion-related validity. Although the understanding of Game Transfer Phenomena is still in its infancy, the GTPS appears to be a valid and reliable instrument for assessing nonvolitional gaming-related phenomena. The GTPS can be used for understanding the phenomenology of post-effects of playing video games.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2015). Auditory experiences in Game Transfer Phenomena: An empirical self-report study. In: Gamification: Concepts, Methodologies, Tools, and Applications (pp.1329-1345). Pennsylvania: IGI Global.

• This study investigated gamers’ auditory experiences as after effects of playing. This was done by classifying, quantifying, and analysing 192 experiences from 155 gamers collected from online videogame forums. The gamers’ experiences were classified as: (i) involuntary auditory imagery (e.g., hearing the music, sounds or voices from the game), (ii) inner speech (e.g., completing phrases in the mind), (iii) auditory misperceptions (e.g., confusing real life sounds with videogame sounds), and (iv) multisensorial auditory experiences (e.g., hearing music while involuntary moving the fingers). Gamers heard auditory cues from the game in their heads, in their ears, but also coming from external sources. Occasionally, the vividness of the sound evoked thoughts and emotions that resulted in behaviours and copying strategies. The psychosocial implications of the gamers’ auditory experiences are discussed. This study contributes to the understanding of the effects of auditory features in videogames, and to the phenomenology of non-volitional auditory experiences.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2016). Prevalence and characteristics of Game Transfer Phenomena: A descriptive survey study. International Journal of Human-Computer Interaction, 32, 470-480.

• Previous qualitative studies suggest that gamers experience Game Transfer Phenomena (GTP), a variety of non-volitional phenomena related to playing videogames including thoughts, urges, images, and sounds when not playing. To investigate (i) which types of GTP were more common and (ii) their general characteristics, the present study surveyed a total of 2362 gamers via an online survey. The majority of the participants were male, students, aged between 18 and 27 years, and “hard-core” gamers. Most participants reported having experienced at least one type of GTP at some point (96.6%), the majority having experienced GTP more than once, with many reporting 6 to 10 different types of GTP. Results demonstrated that videogame players experienced (i) altered visual perceptions, (ii) altered auditory perceptions, (iii) altered body perceptions, (iv) automated mental processes, and (v) behaviors. In most cases, GTP could not be explained by being under the influence of a psychoactive substance. The GTP experiences were usually short-lived, tended to occur after videogame playing rather than during play, occurred recurrently, and usually occurred while doing day-to-day activities. One in five gamers had experienced some type of distress or dysfunction due to GTP. Many experienced GTP as pleasant and some wanted GTP to happen again.

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

Further reading

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

Ortiz de Gotari, A., Aronsson, K. & Griffiths, M.D. (2011). Game Transfer Phenomena in video game playing: A qualitative interview study. International Journal of Cyber Behavior, Psychology and Learning, 1(3), 15-33.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2012). An introduction to Game Transfer Phenomena in video game playing. In J. Gackenbach (Ed.), Video Game Play and Consciousness (pp.223-250). Hauppauge, NY: Nova Science.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Altered visual perception in Game Transfer Phenomena: An empirical self-report study. International Journal of Human-Computer Interaction, 30, 95-105.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Auditory experiences in Game Transfer Phenomena: An empirical self-report study. International Journal of Cyber Behavior, Psychology and Learning, 4(1), 59-75.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2014). Automatic mental processes, automatic actions and behaviours in Game Transfer Phenomena: An empirical self-report study using online forum data. International Journal of Mental Health and Addiction, 12, 432-452.

Ortiz de Gortari, A.B. & Griffiths, M.D. (2016). Playing the computer game Tetris prior to viewing traumatic film material and subsequent intrusive memories: Examining proactive interference. Frontiers in Psychology, 7, 260. doi: 10.3389/fpsyg.2016.00260

One giant step for man: Another look at macrophilia

Earlier this week, an article by Felicity Monk was published on the Broadly website about macrophilia (individuals derive sexual arousal from a fascination with giants and/or a sexual fantasy involving giants) and also known as giant (or giantess) fetishism. Broadly is an offshoot of Vice.com and is a website is a website “devoted to representing the multiplicity of women’s experiences”. I have been interviewed by both Broadly and Vice over the last few years on a number of topics including gambling, dacryphilia, and Alice in Wonderland Syndrome. I was interviewed for the Broadly article mainly because I’m one of the few academics ever to have written an article on the topic. I was quoted as saying in the Broadly article that “no-one has ever published even so much as an interview with a macrophile in an academic journal”.

In the Broadly article, Monk managed to interview a couple of macrophiles including Katelyn, a bisexual female in her thirties (five foot two inches tall) who has a number of co-occurring fetishes including macrophilia (in which she is sexually aroused by the thought of being a giant). She also has her own giantess website (which can be accessed here, but please be warned that the site features sexually explicit content) which she set up so that macrophiles could come and “worship” her. For Katelin, her macrophilic tendencies started from watching Tom and Jerry cartoons and the disparate size of the characters. As Katelyn said:

“The first time I had a good tingly feeling was when I was watching Tom have so much fun trying to catch Jerry. I always liked how Jerry got away so that the game would continue. I so badly wanted to be that cat. Little did I know it was the start of my sexuality. [By the time I got to high school I] was fantasising about literally crushing [my] high school crushes, swallowing [my] boyfriends and girlfriends alive, and putting [my] entire foot through the school. Most of the time I felt out of place and very alone sexually. [My preferred size of being a giant] changes depending on what mood [I’m] in. Some days I’m in the mood to play with the entire earth/galaxy, and other times I’m in the mood to attack a lone city as a 100ft woman. I rarely go below 100 feet. Most commonly, however, I’m fantasizing about being mega – 3000-plus feet tall”.

Katelyn has now monetized her fetish by turning her website into a commercial venture. As the article in Broadly notes:

“[On Katelyn’s website you] will find videos for sale – many of which feature miniature, plastic people being swallowed or crushed under huge feet. There are also stories, comics, photographs, collages, a blog, and a link to Katelyn’s Amazon wish list, so her worshippers can purchase her gifts: underwear, Starbucks gift cards, vitamins so she can ‘grow’ bigger, and non-stick saucepans. Visiting the site is free, but each month around 700 of her fans make a purchase”.

My own research into macrophilia suggests that the overwhelming majority of macrophiles appear to be heterosexual males that are sexually attracted to female giantesses. However, I’ve also noted that even non-sexual scenarios involving giants can result in sexual stimulation. Each fantasy situation is different for every macrophile as the behaviour is fantasy-based. Even the preferred heights of the fantasy giants differ between individuals. For instance, some macrophiles have a preference for people only a few feet taller than themselves, whereas others involve giants who are hundreds of feet high.

In the Broadly article, Katelyn admitted she had other sexual fetishes including an “extreme mouth fetish” of similar intensity to her giantess fetish as well as furry and hentai fetishes (anime and manga pornography). This concurs with what I noted in my previous blog on macrophilia where I said that it had also been associated with other sexual paraphilias. I claimed the most noteworthy were:

• Breast fetishism: This is a sexual fetish in which an individual derives sexual arousal from being pressed against, or placed in between, the breasts of a giant woman.
• Dominance/submission: This is a sexual fetish in which an individual derives sexual pleasure being at the mercy of a giant, or from being in control of a tiny person.
• Sadism/masochism: This is a sexual paraphilia in which an individual derives sexual pleasure from being physically harmed or even killed (in this case by a giant).
• Vorarephilia: This is a sexual paraphilia in which individuals derive sexual arousal from the idea of being eaten, eating another person, or observing this process. Although there are cases of real life vorarephilia (that I wrote about in a previous blog), the behaviour is typically fantasy-based (e.g., fictional stories, fantasy art, fantasy videos, and bespoke video games).
• Zoophilia: This is a sexual paraphilia in which individuals derive sexual pleasure from sex with animals (in this case, the desire is to have sex with a giant animal that is given human characteristics (i.e., anthropomorphism). This also has some crossover with furries (those individuals who – amongst other behaviours – like to dress as animals when having sex)
• Crush fetishism: This is a sexual fetish in which an individual derives sexual arousal from being stepped or sat on by a giant person, and is also a variant of sexual masochism.

When Monk interviewed me, one of the most important questions she wanted an answer for was how people develop macrophilic tendencies. I told her that the roots of most fetishes lie in childhood and early adolescence where sexual arousal is, at first, accidentally associated with giants – maybe watching a TV programme where a giantess initiates feelings of sexual arousal. Over time the giant itself is enough to cause sexual arousal through classical conditioning. However, as there are no case studies in the literature, this is complete speculation on my part. However, she also interviewed one of Katelyn’s ‘worshippers’ (‘Mark’) who appeared to confirm my speculative thoughts.

“[I remember] seeing a re-run of Attack of the 50 Foot Woman when [I] was around 13 years old. The [point of view] of Allison Hayes walking across the desert was the first time I can recall being turned on. Seeing her tear the roof off of the building to get at her husband overwhelmed my young brain at the time. Shortly after that, another movie called Village of the Giants did the same thing. I can remember one of the giantesses in the movie said something like ‘Oh, why don’t I just step on him?’ which again turned my underage mind on like nothing prior. I would be uncontrollably drawn to [the giantess’] beauty and power despite the danger such an encounter would bring. As a superior being, she would have little regard for me other than supplying her own needs. Whether it be as food to nourish her superior body, or as a sexual play toy to be used and broken after, I would have no other choice other than submit myself to her. To have my life be hers to do with as she pleased would become the sole purpose for my existence. The exhilaration, danger, fear and sexual excitement would outweigh my very instinct for survival. I only wish it would become real”.

For her article, Monk also interviewed the Australian sex and relationship therapist Pamela Supple. Supple claimed that:

“Power, domination and vulnerability are at the heart of macrophilia. It’s allowing your mind to go wherever it wants to go, whilst engaging in play to gain the maximum sexual arousal. Some want to feel and experience terror – being crushed or controlled. Everyone is different in what they want to experience.”

Both I and Supple agree that macrophilia has enjoyed a massive surge in popularity in the past few years, with both of us citing the crucial role of the internet in helping to both create and facilitate the fetish “and, in some cases, introducing the fetish to those who have been looking for a name for what they feel”. This was confirmed by another one of Katelyn’s worshippers (‘Semeraz’). As he explained:

“[I didn’t know macrophilia’ was a thing” until [I] discovered Katelyn’s website. Before then, remember being in fifth grade and playing a game where the teacher assigned team names of ‘predator’ and ‘prey’ and becoming excited when a girl taunted him saying: ‘We’re going to eat you!’ But I never thought of it as a sexual fetish until running into Katelyn’s site”.

Since writing my article on macrophilia over four years ago, the presence of maxcrophilia online appears to have grown. Katelyn claims that her website was very niche when she set it up a number of years ago:

“It only had a handful of websites and contributors, a lot of lurkers – fetishes were much more taboo a decade ago – the content production was scarce and I was the only girl who had come out of the closet with the giantess fetish. Members thought there was no way a girl could have the giantess fetish. That made me feel alone, because I was the only giantess, and a lot of people doubted my sexuality. Nowadays, there’s so much giantess fetish content that you wouldn’t be able to see everything in a lifetime. There are millions of collages, stories, artists, producers, models, videos, and more.”

I’m not sure there are “millions of collages, stories, artists, producers, models, videos” out there on the internet but macrophilia is probably a lot less rare than I thought a few years ago.

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

Further reading

Biles, J. (2004). I, insect, or Bataille and the crush freaks. Janus Head: Journal of Interdisciplinary Studies in Literature, Continental Philosophy, Phenomenological Psychology and the Arts, 7(1), 115-131.

Bowen, J. (1999). Urge: A giant fetish. Salon, May 22. Located at: http://www.salon.com/1999/05/22/macrophilia/

Gates, K. (2000). Deviant Desires: Incredibly Strange Sex. New York: RE/Search Publications.

Love, B. (1992). Encyclopedia of Unusual Sex Practices. Fort Lee, NJ: Barricade Books.

Monk, F. (2016). The men who want to have sex with actual giants. Broadly, October 26. Located at: https://broadly.vice.com/en_us/article/macrophilia-fetish-the-men-who-want-to-have-sex-with-actual-giants

Pearson, G.A. (1991). Insect fetish objects. Cultural Entomology Digest, 4, (November).

Ramses, S. (undated). Introduction to macrophilia. Located at: http://www.pridesites.com/fetish/mac4black/intro2macro.htm

Slothrop, T. (2012). The Bible and Macrophilia: He Thong’s Goliath Art. Remnant of Giants, February 6. Located at: https://remnantofgiants.wordpress.com/2012/02/06/the-bible-and-macrophilia-he-thongs-goliath-art/

Meditation as self-medication: Can mindfulness be addictive?

(Please note, the following blog is an extended version of an article by my research colleagues Dr. Edo Shonin and William Van Gordon (that was first published here) and to which I have added some further text. If citing this article, we recommend: Shonin, E., Van Gordon, W. & Griffiths, M.D. (2016). Meditation as self-medication: Can mindfulness be addictive? Located at: https://drmarkgriffiths.wordpress.com/2016/10/24/meditation-as-self-medication-can-mindfulness-be-addictive/).

Mindfulness is growing in popularity and is increasingly being used by healthcare professionals for treating mental health problems. There has also been a gradual uptake of mindfulness by a range of organisations including schools, universities, large corporations, and the armed forces. However, the rate at which mindfulness has been assimilated by Western society has – in our opinion – meant that there has been a lack of research exploring the circumstances where mindfulness may actually cause a person harm. An example of a potentially harmful consequence of mindfulness that we have identified in our own research is that of a person developing an addiction to mindfulness.

In a previous blog, the issue of whether meditation more generally can be addictive was examined. In a 2010 article by Michael Sigman in the Huffington Post entitled “Meditation and Addiction: A Two-Way Street?”, Sigman recounted the story about how one of his friends spent over two hours every day engaging in meditation while sat in the lotus position. He then claimed:

“There are those few for whom meditation can become compulsive, even addictive. The irony here is that an increasing body of research shows that meditation – in particular Buddhist Vipassana meditation – is an effective tool in treating addiction. One category of meditation addiction is related to the so-called ‘spiritual bypass’. Those who experience bliss when they meditate may practice relentlessly to recreate that experience, at the expense of authentic self-awareness. A close friend who’s done Transcendental Meditation for decades feels so addicted to it, she has a hard time functioning when she hasn’t ‘transcended’”.

Obviously, this is purely anecdotal but at least raises the issue that maybe for a very small minority, meditation might be addictive. In addition, empirical studies have shown that meditation can increase pain tolerance, and that the body produces its own morphine-like substances (i.e., endorphins). Therefore, the addictive qualities of meditation may be due to increased endorphin production that creates a semi-dissociative blissful state.

Being addicted to meditation – and more specifically mindfulness – would constitute a form of behavioural addiction (i.e., as opposed to chemical addiction). Examples of better known forms of behavioural addiction are gambling disorder, internet gaming disorder, problematic internet use, sex addiction, and workaholism. According to the components model of addiction, a person would suffer from an addiction to mindfulness if they satisfied the following six criteria:

• Salience: Mindfulness has become the single most important activity in their life.
• Mood modification: Mindfulness is used in order to alleviate emotional stress (i.e., escape) or to experience euphoria (i.e., a ‘high’).
• Tolerance: Practising mindfulness for longer durations in order to derive the same mood-modifying effects.
• Withdrawal: Experiencing emotional and physical distress (e.g., painful bodily sensations) when not practising mindfulness.
• Conflict: The individual’s routine of mindfulness practice causes (i) interpersonal conflict with family members and friends, (ii) conflict with activities such as work, socialising, and exercising, and (iii) psychological and emotional conflict (also known as intra-psychic conflict).
• Relapse: Reverting to earlier patterns of excessive mindfulness practice following periods of control or abstinence.

In modern society, the word ‘addiction’ has negative connotations but it should be remembered that addictions have been described by some as both positive and negative (for instance, Dr. Bill Glasser has spent his whole career talking about ‘positive’ addictions). For example, in separate clinical case studies that we conducted with individuals suffering from pathological gambling, sex addiction, and workaholism, it was observed that the participants substituted their addiction to gambling, work, or sex with mindfulness (and maybe even developed an addiction to it, depending upon the definition of addiction). In the beginning phases of psychotherapy, this process of addiction substitution represented a move forward in terms of the individual’s therapeutic recovery. However, as the therapy progressed and the individual’s dependency on gambling, work, or sex began to weaken, their “addiction” to mindfulness was restricting their personal and spiritual growth, and was starting to cause conflict in other areas of their life. Therefore, it became necessary to help them change the way they practiced and related to mindfulness.

Mindfulness is a technique or behaviour that an individual can choose to practice. However, the idea is that the individual doesn’t separate mindfulness from the rest of their lives. If an individual sees mindfulness as a practice or something that they need to do in order to find calm and escape from their problems, there is a risk that they will become addicted to it. It is for this reason that we always exercise caution before recommending that people follow a strict daily routine of mindfulness practice. In fact, in the mindfulness intervention that we (Shonin and Van Gordon) developed called Meditation Awareness Training, we don’t encourage participants to practice at set times of day or to adhere to a rigid routine. Rather, we guide participants to follow a dynamic routine of mindfulness practice that is flexible and that can be adapted according to the demands of daily living. For example, if a baby decides to wake up earlier than usual one morning, the mother can’t tell it to wait and be quite because it’s interfering with her time for practising mindfulness meditation. Rather, she has to tend to the baby and find another time to sit in meditation. Or better still, she can tend to the baby with love and awareness, and turn the encounter with her child into a form of mindfulness practice. We live in a very uncertain world and so it is valuable if we can learn to be accommodating and work mindfully with situations as they unfold around us.

One of the components in the components model of addiction is ‘salience’ (put more simply, importance). In general, if an individual prioritises a behaviour (such as gambling) or a substance (such as cannabis) above all other aspects of their life, then it’s probably fair to say that their perspective on life is misguided and that they are in need of help and support. However, as far as mindfulness is concerned, we would argue that it’s good if it becomes the most important thing in a person’s life. Human beings don’t live very long and there can be no guarantee that a person will survive the next week, let alone the next year. Therefore, it’s our view that it is a wise move to dedicate oneself to some form of authentic spiritual practice. However, there is a big difference between understanding the importance of mindfulness and correctly assimilating it into one’s life, and becoming dependent upon it.

If a person becomes dependent upon mindfulness, it means that it has remained external to their being. It means that they don’t live and breathe mindfulness, and that they see it as a method of coping with (or even avoiding) the rest of their life. Under these circumstances, it’s easy to see how a person can develop an addiction to mindfulness, and how they can become irritable with both themselves and others when they don’t receive their normal ‘fix’ of mindfulness on a given day.

Mindfulness is a relatively simple practice but it’s also very subtle. It takes a highly skilled and experienced meditation teacher to correctly and safely instruct people in how to practise mindfulness. It’s our view that because the rate of uptake of mindfulness in the West has been relatively fast, in the future there will be more and more people who experience problems – including mental health problems such as being addicted to mindfulness – as a result of practising mindfulness. Of course, it’s not mindfulness itself that will cause their problems to arise. Rather, problems will arise because people have been taught how to practice mindfulness by instructors who are not teaching from an experiential perspective and who don’t really know what they are talking about. From personal experience, we know that mindfulness works and that it is good for a person’s physical, mental, and spiritual health. However, we also know that teaching mindfulness and meditation incorrectly can give rise to harmful consequences, including developing an addiction to mindfulness.

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

Further Reading

Glasser, W. (1976). Positive addictions. Harper & Row, New York, NY.

Griffiths, M.D. (1996). Behavioural addictions: An issue for everybody? Journal of Workplace Learning, 8(3), 19-25.

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

Griffiths, M.D. (2011). Behavioural addiction: The case for a biopsychosocial approach. Trangressive Culture, 1, 7-28.

Larkin, M., Wood, R.T.A. & Griffiths, M.D. (2006). Towards addiction as relationship. Addiction Research and Theory, 14, 207-215.

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

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

Shonin, E., Van Gordon W., & Griffiths, M.D. (2014). Mindfulness as a treatment for behavioral addiction. Journal of Addiction Research and Therapy, 5, e122. doi: 10.4172/2155- 6105.1000e122.

Shonin, E., Van Gordon W., & Griffiths, M.D. (2015). Are there risks associated with using mindfulness for the treatment of psychopathology? Clinical Practice, 11, 389-382.

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

Sigman, M. (2010). Meditation and addiction: A two-way street? Huffington Post, November 15. Located at: http://www.huffingtonpost.com/michael-sigman/meditation-and-addiction_b_783552.htm

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

Van Gordon, W., Shonin, E., & Griffiths, M.D. (2015). Mindfulness in mental health: A critical reflection. Journal of Psychology, Neuropsychiatric Disorders and Brain Stimulation, 1(1), 102.

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

Van Gordon, W., Shonin, E., & Griffiths, M.D. (2016). Ontological addiction: Classification, etiology, and treatment. Mindfulness, 7, 660-671.

Game on: A brief look at gambling on eSports

Like daily fantasy sports, betting on eSports (i.e., professional video gaming) has increased in popularity over the last few years and has given rise to allegations of unregulated and underage gambling. The eSports market is large. According to a 2016 report by Superdata, professional eSports is growing exponentially and is worth an estimated $612 (US) million a year. Furthermore, Eilers and Krejcik Gaming estimate that real money betting on eSports betting will reach $10 billion (US) by 2020. The professionalization and sportification of this entertainment form has brought sports-world elements to it: stadium-like facilities, cheering stands, sponsors, big rewards, and competition. Instant replays, jumbotrons (i.e., super-huge television screens), and referees add to the sport dramatisation. In some notorious cases, prizes have gone beyond the $10 million [US] threshold in a packed arena housing 73,000 fans. According to by John McMullan and Delthia Miller in a 2008 issue of the Journal of Gambling Issues, sportification is the process of incorporating the logics of sport to non-sporting contexts (e.g., poker, eSports. This can materialise in many ways but most commonly occurs when (i) other industries capitalise on the positive attributes of sport (e.g., popularity, engagement, or sanity and health inferences); and (ii) non-sport fields try to increase the entertainment and playability of their products and their association with joy and excitement.

Twitch, an online platform that streams live video gaming, informs its’ advertisers that it has 100 million monthly viewers, who watch for an average of 106 minutes a day. Betting on eSports presents new challenges. As a news report in Bloomberg news observed in relation to betting on the game Counterstrike: Global Offensive (CSGO):

“Gambling – licensed, regulated, and by adults – is generally accepted in eSports. There is growing concern, though, that teenagers are being attracted to different forms of betting facilitated by third-party providers. One such platform is CSGO Lounge (an independent site not affiliated with Valve Software, which develops the game itself). The site allows spectators to bet in-game add-ons known as skins – weapons, tools and the like – on the results of matches. Not all skins are created equal, and the rarity of some means they can cost hundreds of real dollars on marketplace sites like SkinXchange.com. The temptation is too much for some”.

Put simply, skin gambling is the use of virtual goods and items (typically cosmetic elements that have no direct influence on gameplay) as virtual currency to bet on the outcome of professional matches. The Bloomberg article also claims on the basis of interviews with industry insiders that underage skin gambling is a “huge problem”. Justin Carlson (lead developer of SkinXchange) claims there are “countless” parents whose children have used their credit cards without their knowledge to buy skins and bet on gaming on other sites. Although anecdotal, Carlson claims that some minors have “racked up hundreds or thousands of dollars in skins on ‘SkinXchange’ just to lose them all on some betting or jackpot site”. It’s clear that people trading skins in eSports has grown over the last few years and various regulators around the world – such as the UK Gambling Commission (UKGC) – are considering regulation and says it is an “emerging product” and an “area for continuing future focus”. More specifically, the UKGC’s 2016 Annual Report notes:

 “The growing market in esports and computer gaming has scope to present issues for regulation and player protection – issues which are being examined by gambling regulators in other international markets…These issues range from the emergence of real money esports betting markets, to trading in-game items which blur the lines between gambling and social gaming. Our focus will be to understand developments, including engaging with key stakeholders, and we will work wherever we can to ensure the risks associated with these, particularly to children and young people, are minimised”.

One of the complicating factors for eSports gambling is that while cash is the currency for many gamblers, there is a growing trend towards the use of virtual currencies, or ‘in-game items’ which, according to the UKGC, can be “won, traded, sold or used as virtual currency to gamble with and converted into money or money’s worth”. These, according to the UKGC, “include digital commodities (such as ‘skins’) which can be won or purchased within the confines of computer games and can then be used as a form of virtual currency on a growing number of gambling websites”. No academic research has examined underage skin gambling but this is an issue that is unlikely to diminish over the coming years.

It is also worth noting that this massive interest in eSports followed by a massive audience has led most major betting operators to include eSports in their daily gambling offer. However, the singularities of eSports market pose new challenges that conventional online betting sites struggle to address. Suraj Gosai, co-founder of Blinkpool, an eSports dedicated betting platform, laid out two main problems: in-play betting limitations and odds algorithmic programming. For in-play betting to be viable, companies need to get access to reliable, instantaneous, and unambiguous data that can settle bets and separate winners from losers. Data companies like Perform do that in sport, and betting operators rely on their data to offer in-play action to gamblers. The problem in eSports is that actions are not as quantified and standardised as in real-life sports. To counteract that, Blinkpool created a computer vision technology that extracts data from real-time action and promotes hyper-contextual opportunities, that is, 10- to 45-second in-play betting mini-markets concerning very specific developments in the narrative of the games.

Odds programming in sports betting is fundamentally based on historical data from hundreds of thousands of games, from which each factor (home advantage, table position, head-to-head, etc.) is weighted in to determine the probability of an event occurring. In the fixed-odds betting market, the bookmaker makes available to bettors that probability plus a benefit margin. When placing a bet, an individual bets against the probability that the house has predicted. This is not yet feasible in eSports because the historical data are scarce and the modelling is complex. Companies are circumventing this problem by offering exchange betting rather than fixed-odds. This method comprises peer betting, that is, bettors do not bet against the house but between one another. This way, the house gets a commission from winning bets and operates a much less risky business.

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

Further reading

Bracken, G. (2016). We hope to be the home of eSports betting. Gambling Insider. Available from: https://www.gamblinginsider.com/in-depth/1909/we-hope-to-be-the-home-of-esports-betting

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

Gambling Commission (2016). Annual Report 2015/16. Birmingham: Gambling Commission.

McMullan, J. L., & Miller, D. (2008). All in! The commercial advertising of offshore gambling on television. Journal of Gambling Issues, 22, 230-251.

Melbourne, K. & Campbell, M. (2015). Professional gaming may have an underage gambling problem. Bloomberg, September 7. Available at: http://www.bloomberg.com/news/articles/2015-09-07/professional-video-gaming-has-an-underage-gambling-problem

Superdata (2016). eSports Market Report. Available at: https://www.superdataresearch.com/market-data/esports-market-brief/

Wingfield, N. (2014) In e-Sports, video gamers draw real crowds and big money. New York Times, August 30. Available from: http://www.nytimes.com/2014/08/31/technology/esports-explosion-brings-opportunity-riches-for-video-gamers.html?_r=0

Wood, J. (2016). UK Gambling Commission: We’ll work to minimize risks from emerging esports betting markets. Esports Betting Report, July 19. Available at: http://www.esportsbettingreport.com/uk-regulators-address-esports-betting/

No laughing matter: A brief look at scary clowns and coulrophobia

A few days ago, the Nottingham Trent University Press Office asked if I would be interested in speaking to BBC Online News about coulrophobia (i.e., a fear of clowns). Obviously this is not my specialist area and the only article I’ve ever written about clown psychology was a previous blog on coulrophilia (i.e., sexual arousal from clowns) and an article on the psychology of fancy dress. It turned out that the BBC were writing a story about the British police being inundated with clowns scaring people by jumping out and chasing them. More specifically, the story claimed:

“Police across England have been called to dozens of incidents in which pranksters dress as ‘creepy clowns’ to deliberately scare people. The culprits are said to be following a trend that started in the US [and has spread to other countries, including Canada, Australia and France]. A 30-year-old man was arrested in Norwich after someone dressed as a clown jumped out from behind a tree and “terrified” a woman in a public park. On Sunday Thames Valley Police said it had been called to 14 incidents in 24 hours. In County Durham on Friday, four children were followed to school by a man in a clown outfit who was armed with what turned out to be a plastic machete. In a separate clowning caper in County Durham on Friday, police in Peterlee posted a photo on their Facebook page of items including two masks confiscated from two 12-year-olds who officers said had gone to a primary school to scare children. Meanwhile, in Kidlington, Oxfordshire, a man dressed as a clown and carrying a baseball bat was reported to have chased a 10-year-old child through a park. Gloucestershire Police said it had received six reports of ‘clowns’ behaving suspiciously or carrying knives. In one instance a child was followed. A cyclist in Eastbourne, Sussex, was left ‘shaken’ after someone dressed as a clown jumped out from a bush brandishing what he believed was an offensive weapon. And in Sudbury, Suffolk, a boy was chased by “several people dressed as clowns”.

As there was little academic research in coulrophobia, I felt I was as qualified as anyone to speculate on the roots of coulrophobia. I told the BBC that clowns tend to be scary because of their exaggerated looks and evil representation in films. Obviously, the vast majority of individuals are not scared of clowns in a day-to-day context but a clown’s face has become part of a scare culture. I noted that there is a stereotype of the nasty, evil, eerie clown. If you look at clowns facially what you tend to find is part of their face or feet are exaggerated, they have huge noses, scary mouths, huge elongated shoes, and wildfire hair. I also made reference to the cinematic trope of the evil clown. If you look at everything from Heath Ledger as The Joker in Batman to the clown in Stephen King‘s It. These clowns or characters with clown faces are either killers or they are doing really nasty things. Even if you have not come into contact with clowns, you’re likely to be influenced by what you see in television and films. According to the Wikipedia entry on coulrophobia:

“Clown costumes tend to exaggerate the facial features and some body parts, such as hands and feet and noses. This can be read as monstrous or deformed as easily as it can be read as comical. The significant aberrations in a clown’s face may alter a person’s appearance so much that it enters the so-called ‘uncanny valley’ in which a figure is lifelike enough to be disturbing, but not realistic enough to be pleasant—and thus frightens a child so much that they carry this phobia throughout their adult life. According to psychology professor Joseph Durwin at California State University, Northridge, young children are ‘very reactive to a familiar body type with an unfamiliar face. Researchers who have studied the phobia believe there is some correlation to the uncanny valley effect. Additionally, the fact that much clown behavior is ‘transgressive’ (anti-social behavior) can create feelings of unease”.

A couple of weeks ago after the spate of US clown attacks, Professor Frank McAndrew wrote an article for The Conversation on the psychology of what creeps us out about clowns. He compared his own thinking to that of the Canadian psychologist Dr. Rami Nader. More specifically, Professor McAndrew noted:

“[Dr. Nader] believes that clown phobias are fueled by the fact that clowns wear makeup and disguises that hide their true identities and feelings. This is perfectly consistent with my hypothesis that it is the inherent ambiguity surrounding clowns that make them creepy. They seem to be happy, but are they really? And they’re mischievous, which puts people constantly on guard. People interacting with a clown during one of his routines never know if they are about to get a pie in the face or be the victim of some other humiliating prank. The highly unusual physical characteristics of the clown (the wig, the big red nose, the makeup, the odd clothing) only magnify the uncertainty of what the clown might do next”.

No-one knows why the spate of clown attacks have occurred in the UK (or elsewhere). My own take on it is that the flurry of media stories about the phenomenon has probably contributed to some copycat cases (which then led one news story to the headline based on my radio interview with Talk Radio: “Killer clown attacks: Leading professor says sensationalist media has fuelled ‘Clownpocalypse’”) although there are likely to be other reasons (given that Halloween is coming up). As a psychologist I am far more interested in why someone would attack others dressed as a clown in the first place.

Here, I see a lot of similarities with online behaviour in that dressing up as a character is like the taking on of another persona when people are online carrying out anti-social acts such as trolling. While the psychological core and personality of an individual online or dressed up in an outfit with a mask (or thick hideous make-up) is still that same person, the anonymity provided by the nature of online interactions and the anonymity provided by wearing a different face or mask both lead to the person becoming more disinhibited and doing things that they would never do in a normal face-to-face situation. In essence, such people are taking on other identities – at least momentarily – and carrying out anti-social acts that they would normally not do. However, there will also be those who carry out such attacks because they get crazed and/or sadistic pleasure from doing so. Their motives may be as simple as boredom, revenge and/ or just wanting to ‘have a laugh’ – the main motives that have been found in my own research among people who troll online.

The current spate of clown attacks may well die down as quickly as they have come about and I’m sure as the media reporting decreases there will be less of such attacks (at least I am hoping so).

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

Further reading

BBC News (2016). ‘Creepy clown’ police warnings as craze spreads. October 10, Located at: http://www.bbc.co.uk/news/uk-england-37605841

Dolan, L. (2016). Killer clown attacks: Leading professor says sensationalist media has fuelled ‘Clownpocalypse’. Talk Radio, October 11. Located at: http://talkradio.co.uk/news/killer-clown-attacks-leading-professor-says-sensationalist-media-has-fuelled-clownpocalypse#eO77SQMbGBWXECHO.99

Griffiths, M.D. (2014). Adolescent trolling in online environments: A brief overview. Education and Health, 32, 85-87.

Hayden, D. (2016). ‘Creepy clowns’ craze: Professionals hit out at pranksters. BBC News, October 11. Located at: http://www.bbc.co.uk/news/uk-england-37611993

McAndrew, F.T. (2016). The psychology behind why clowns creep us out. The Conversation, September 29. Located at: https://theconversation.com/the-psychology-behind-why-clowns-creep-us-out-65936

Thacker, S. & Griffiths, M.D. (2012). An exploratory study of trolling in online video gaming. International Journal of Cyber Behavior, Psychology and Learning, 2(4), 17-33.

Wikipedia (2016). Coulrophobia. Located at: https://en.wikipedia.org/wiki/Coulrophobia

Wikipedia (2016). Uncanny valley. Located at: https://en.wikipedia.org/wiki/Uncanny_valley

Zidbits (2011). Why are some people afraid of clowns? October 20. Located at: http://zidbits.com/2011/10/why-are-some-people-afraid-of-clowns/

Teaming with gain: Are daily fantasy sports a form of gambling?

Fantasy sports games have been popular for many years and involves individuals assuming the role of a professional sports team manager (typically football) and assembling a virtual team of sportsmen to compete against other players within a private or public league. For decades, the game was played out across the whole season with the winners being those that had accumulated the most points (with the points gained being based on the real-life statistics of individual sportsmen using a predetermined scoring system).

However, fantasy sports have changed dramatically over the last few years. Although the game can still be played over a whole season, the playing of daily fantasy sports (DFS) has become increasing popular (particularly in countries such as the USA, Canada, and Australia) and can operate over much shorter time periods. In DFS, players can pay to play and this has led to the blurring of lines of whether the activity is a game or whether it is gambling. As Dr. Dylan Pickering and his colleagues noted in a 2016 issue of Current Addiction Reports:

“Daily fantasy sports (DFS) is the most recent and controversial of FS games…It is an accelerated version of FS conducted over much shorter time periods: generally a single game (per day) or weekly round of competition. Users pay entry fees ranging from US 25 cents to US $5000 per league, which is deposited into a prize pool typically paid out to the highest ranked users in the contest. A portion of the entry fees also goes to the operator as commission. Accordingly, DFS, as such, is most associated with wagering. Currently, the US DFS market is dominated by ‘FanDuel’ and ‘DraftKings’ (combined with about 95 % of the market)”.

According to figures in the same paper, in the USA, the fantasy sports (FS) market is currently estimated to be between $3 billion and $4 billion. In 2015, approximately 57 million Americans played FS. Research suggests that the prevalence rates are higher in North America than elsewhere with 19% of Canadian adults and 16% of American adults engaging in FS compared to 10% of British adults and 6% of Australian adults (Pickering et al., 2016). However, these figures relate to FS rather than DFS and many FS players do not pay money to participate in the game and simply play for fun. Some research by Dr. Joris Drayer and colleagues in a 2013 issue of the European Sport Management Quarterly also suggests that those who engage in playing DFS do not typically engage in other forms of gambling. Furthermore, in a 2011 issue of Journal of Sport Management, Dr. Brendan Dwyer and Dr. Yongjae Kim reported that compared to more traditional forms of gambling, the elements of fun, excitement, competition play a bigger role than winning money in the playing of DFS games.

A study carried out by Dr. Ryan Martin and Dr. Sarah Nelson published in a 2014 issue of Addictive Behaviors found that college students who were FS users (free and fee-based) were five times more likely to incur gambling problems than non-FS users, and students who played FS for money had significantly higher rates of gambling problems than those who played in free leagues. A more recent 2016 study by Loredana Marchica and Dr. Jeff Derevensky in the International Journal of Mental Health and Addiction examined data from national surveys of collegiate athletes and reported a steady rise in FS participation among college students between 2004 and 2012. They reported that approximately half of the male and a quarter of the female college athletes who qualified as at-risk or problem gamblers also reported wagering on FS.

There has been much debate (particularly by US legislators) as to whether playing DFS for money is classed as a legitimate form of gambling. If gambling is defined as “an agreement between two or more parties to deliberately stake something of value (typically money) with intent to profit on the outcome of an event that is determined wholly, or partially by chance” (by Pickering and colleagues), then DFS could well be a form of gambling as they argue:

“DFS can be construed as representing a form of gambling: (a) DFS includes an agreement between an individual and others, (b) money is staked on the relative performances of athletes across a certain number of sporting events with the outcome determined by both chance and skill, and (c) chance is involved given that multiple unknown factors can influence outcomes. In this regard, similarities are found in horse and sports wagering where some skill in selecting horse/sports outcomes is present, but unpredictable variables influence results (i.e., chance)…Literature from the legal field asserts that gambling must contain three elements: (a) consideration (staking something of value in order to participate), (b) chance (luck is a substantial factor in determining results), and (c) prizes (cash, merchandise, services, or points) are redeemable…While the first and third elements are clearly present in DFS, the second element, chance, is the source of current disagreement”.

The US legislation on gambling rests on whether an activity is more skill than chance determined. If DFS is predominantly a game of skill it is not deemed to be a form of gambling. The DFS operators claim that DFS games are not gambling because of the “substantial” amount of skill involved in the selection and management of FS teams. But is this any different for the professional gambler who bets on horse racing given the many factors that the person gambling has to take into account (the form of the horse, the skill of the jockey, the weather conditions, the state of the track, the number of other horses involved in the race, etc.). Similarly, poker and blackjack are both games that players can win big if they are skilful. Personally, I believe that playing DFS games for money is definitely a form of gambling, and even if it isn’t legally classed as a form of gambling, the games contain structural elements (including high event frequencies, low entry fee per game, lots of games, etc.) that can facilitate excessive use and expose vulnerable players to harm. DFS operators also allow team line-ups from a previous sporting event to populate other events which increases the speed of play, another factor that can facilitate habitual use. Furthermore, as Dr. Samantha Thomas and her colleagues argued in a recent 2015 report, the enhanced participatory role that fantasy games introduce could facilitate the illusion of control as they perform actions, making bettors overestimate the importance of skills and knowledge for the outcome of the competitions.

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

Further reading

Drayer, J., Dwyer, B., & Shapiro, S. L. (2013). Examining the impact of league entry fees on online fantasy sport participation and league consumption. European Sport Management Quarterly, 13(3), 339-335.

Dwyer, B., & Kim, Y. (2011). For love or money: Developing and validating a motivational scale for fantasy football participation. Journal of Sport Management, 25(1), 70-83.

Marchica, L., & Derevensky, J. (2016). Fantasy sports: A growing concern among college student-athletes. International Journal of Mental Health and Addiction, 1-15. Epub ahead of print.

Martin, R. J., & Nelson, S. (2014). Fantasy sports, real money: Exploration of the relationship between fantasy sports participation and gambling-related problems. Addictive Behaviors, 39(10), 1377-138.

Pickering, D., Blaszczynski, A., Hartmann, M., & Keen, B. (2016). Fantasy sports: Skill, gambling, or are these irrelevant issues? Current Addiction Reports, 3(3), 307-313.

Thomas, S., Bestman, A., Pitt, H., Deans, E., Randle, M., Stoneham, M., & Daube, M. (2015). The marketing of wagering on social media: An analysis of promotional content on YouTube, Twitter and Facebook. Victoria, Australia: Victorian Responsible Gambling Foundation.

No joking on smoking: My top ten tips for giving up smoking this Stoptober

Although most of my academic research is on behavioural addiction, I have published quite a few papers on more traditional addictions such as alcohol addiction and nicotine addiction (see ‘Further reading’ below). In 2012, I had to watch my mother fight a losing battle with smoking-related lung cancer and chronic obstructive pulmonary disease. She died in September 2012 aged 66 years, and had chain-smoked most of her adult life. This followed the death of my father who also died of smoking-related heart disease, aged just 54.

In my previous blog I looked at ways to reduce alcohol intake as part of the ‘Go Sober For October‘ campaign. In today’s blog I provide my advice for giving up smoking as part of the annual ‘Stoptober’ campaign. In the UK smoking accounts for approximately one in four cancer deaths, and as I said, it’s something I’ve witnessed first-hand. I’m sure most people reading this are aware of the addictive nature of nicotine. As soon as nicotine is ingested via cigarettes, it can pass from lungs to brain within ten seconds and stimulates the release of the neurotransmitter dopamine. The release of dopamine into the body provides reinforcing mood modifying effects. Despite nicotine being a stimulant, many people use cigarettes for both tranquillising and euphoric effects.

Most authorities accept that nicotine is one of the most addictive drugs on the planet and that smokers can become hooked quickly. One of the reasons my own parents were never able to give up was because of the prolonged withdrawal effects they experienced whenever they went more than a few hours without smoking. This would lead to intense cravings for a cigarette. Watching both my parents’ die of smoking-related diseases is enough incentive for me to never smoke a cigarette. Hopefully, others can find the incentives they need to help them give up permanently. Here are my top ten tips to help you (or someone you know and love) stop smoking:

• (1) Develop the motivation to stop smoking: Many smokers say they would like to stop but don’t really want to. When you take stock, make sure you are clear as to why you want to give up. It may be to save money, to improve your health, to prevent yourself getting a smoking-related disease, or to protect your family from passive smoking. (It could of course be all of the above). Really wanting to give up is the best predictor of successful smoking cessation.
• (2) Get all the emotional support you can: Another good predictor of whether someone will overcome their addiction to nicotine is having a good support network. You need people around you that will support your efforts to quit. Tell as many people that you know that you are trying to quit. It could be the difference between stopping and starting again.
• (3) Avoid ‘cold turkey’: Although some people can stop through willpower alone, most people will need to reduce their nicotine intake slowly. The best way of doing this is to replace cigarettes with a safe form of nicotine such as those available from the pharmacy, or on prescription from the doctor.
• (4) Get support from a professional: Even if you are using a safe form of nicotine from your pharmacist or doctor, cutting out cigarettes completely can be hard. Getting support from a trained NHS stop smoking adviser can double your chances of stopping smoking. To find your nearest free NHS stop smoking service (in the UK call 0300 123 1044) or visit the Smokefree website.
• (5) Use non-nicotine cigarette shaped substitutes: Smoking is also a habitual behaviour where the feel of it in your hands may be as important as the nicotine it contains. The use of plastic cigarettes or e-cigarettes will help with the habitual behaviour associated with smoking but contain none of the addictive nicotine.
• (6) Use relaxation techniques: When cravings strike, use relaxation exercises to help overcome the negative feelings. At the very least take deep breaths. There are dozens of relaxation exercises online. Practice makes perfect.
• (7) Treat yourself: One of the immediate benefits of stopping smoking will be the amount of money you save. At the start of the cessation process, treat yourself to rewards with the money you save.
• (8) Focus on the positive: Giving up smoking is one of the hardest things that anyone can do. Write down lists of all the positive things that will be gained by stopping smoking. Constantly remind yourself of what the long-term advantages will be that will outweigh the short-term benefits of smoking a cigarette. In short, focus on the gains of stopping rather than what you will miss about cigarettes.
• (9) Know the triggers for your smoking: Knowing the situations in which you tend to smoke can help in overcoming the urges. Lighting up a cigarette can sometimes be the result of a classically-conditioned response (e.g. having a cigarette after every meal). These often occur unconsciously so you need to break the automatic response and de-condition the smoking. You need to replace the unhealthy activity with a more positive one and re-condition your behaviour.
• (10) Fill the void: One of the most difficult things when cigarette craving and withdrawal symptoms strike is not having an activity to fill the void. Some things (like engaging in physical activity) may help you in forgetting about the urge to smoke. Plan out alternative activities and distraction tasks to help fill the hole when the urge to smoke strikes (e.g. chew gum, eat something healthy like a carrot stick, call a friend, occupy your hands, do a word puzzle, etc.). However, avoid filling the void with other potentially addictive substances (e.g. alcohol) or activities (e.g. gambling).

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

Further reading

Griffiths, M.D. (1994). An exploratory study of gambling cross addictions. Journal of Gambling Studies, 10, 371-384.

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

Griffiths, M.D. (2012). First person: Highly-addictive drug killed both of my parents. Nottingham Post, October 1, p.13.

Griffiths, M.D., Parke, J. & Wood, R.T.A. (2002). Excessive gambling and substance abuse: Is there a relationship? Journal of Substance Use, 7, 187-190.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2010). Gambling, alcohol consumption, cigarette smoking and health: findings from the 2007 British Gambling Prevalence Survey. Addiction Research and Theory, 18, 208-223.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2011). Internet gambling, health. Smoking and alcohol use: Findings from the 2007 British Gambling Prevalence Survey. International Journal of Mental Health and Addiction, 9, 1-11.

Resnick, S. & Griffiths, M.D. (2010). Service quality in alcohol treatment: A qualitative study. International Journal of Mental Health and Addiction, 8, 453-470.

Resnick, S. & Griffiths, M.D. (2011). Service quality in alcohol treatment: A research note. International Journal of Health Care Quality Assurance, 24, 149-163.

Resnick, S. & Griffiths, M.D. (2012). Alcohol treatment: A qualitative comparison of public and private treatment centres. International Journal of Mental Health and Addiction, 10, 185-196.

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

Umeh, K. & Griffiths, M.D. (2001). Adolescent smoking: Behavioural risk factors and health beliefs. Education and Health, 19, 69-71.