Spinal rap: A brief look at my surgical recovery (so far) – Part 1

On April 15 I had an operation to decompress my spinal cord and to have the C5 disc in my neck replaced with a new titanium disc. I ended up in hospital for 67 days. Here’s the back story (no pun intended). 

For the past 18 years I have lived with a compressed spinal cord. Although I had the condition since 2003, it wasn’t diagnosed until an MRI scan in 2007. The scan showed that the C5 disc in my neck was completely herniated and that the disc was pressing directly onto my spinal cord causing hundreds of electric shocks every single day. I was prescribed daily amitriptyline which significantly reduced the number of shocks I felt. I was also prescribed heavy duty painkillers (dihydrocodeine) but I soon realised that work was the best analgesic in the world. Instead of taking up to four doses of dihydrocodeine every day, I worked (and worked). I rarely took more than four doses of dihydrocodeine a year let alone a day. I was also given details of an operation I could have but just the very thought of it scared me – especially because of the risk of being left paralysed from the neck or chest down. I was told to come back if I changed my mind about having an operation. 

I am not 100% sure what caused the complete herniation of the disc in my neck but I suspect it was a minor traffic collision I was involved in at the beginning of November 2003. I was sitting on the front seat on the top floor of a double decker bus when a taxi crashed into the right-hand side of the bus and I was propelled forward onto the bus’s front window where my head hit the glass window, smashed the glasses I was wearing, and left me concussed. I was highly stressed that day because I was on my way to have a CT scan to look at swollen lumps in my throat for suspected Hodgkin’s or non-Hodgkin’s lymphoma. Later that week I had a lymphadenectomy and the biopsy showed that I didn’t have cancer but was diagnosed with toxoplasma lymphadenitis. It was after this operation that I began to get the constant daily electric shocks (over 100 a day) every time I moved my neck. I assumed that the constant electric shocks were as a result of my operation but I was later told that the shocks were being caused by a compressed spinal cord and that my lymphadenectomy was not the cause.

Over the next decade or so, the pain caused the constant compression of my spinal cord got progressively worse. Walking became increasingly difficult but I used excessive work as the strategy to suppress the increasing physical pain. In short, work became the perfect distractor task. When I was 100% cognitively engaged (e.g., giving a paper or teaching, writing or editing papers, etc.) I was in no pain whatsoever. I returned to the workaholic tendencies that I had before I had children. One of my consultants also described me as having “unspent youthfulness” which masked my medical condition for years. 

The lifestyle I was leading in the years leading up to my operation probably didn’t help. I was travelling excessively averaging 20-25 overseas trips a year for conferences, consultancy, and research meetings. Walking became increasingly difficult as I was unable to lift my right foot properly. During 2019, I had a number of really bad falls abroad (tripping over because my right foot wouldn’t lift) including three in Abu Dhabi and a couple in Auckland which left me with horrendous bursitis on both of my elbows. 

During the lockdown period, my health deteriorated badly. I was not globe-trotting anymore and I was housebound for over a year. My working life (and social life) became increasingly sedentary. I was doing everything from home including all my teaching. I had not stepped foot in my university office since the end of February 2020 (and still haven’t).

In August 2020, I saw one of my consultants and told him that my health condition had got significantly worse and that I now wanted the operation. However, because my surgery was classed as ‘elective’ as opposed to ‘urgent’ a date for surgery never came as the Nottingham hospitals were full of very ill COVID-19 patients. At one point during the pandemic, Nottingham was the UK city with the most COVID-19 infections. By February 2020 I could hardly walk and was becoming increasingly immobile. I rang my consultant’s secretary every week asking if I could have an appointment. I finally got one at the end of March 2021 and after seeing how bad my mobility was, I got an operation date very quickly. Thursday April 15, 2021. I was told by my consultant who was performing the surgery that he expected my to be back home the next day if the surgery was successful.

I have to be honest and say that the operation still scared me. Although there was a small chance of dying, that didn’t worry me. It was the thought of waking up paralysed which dominated my thoughts for over a week prior to the operation. Loss of limb use. Loss of job and livelihood Loss of identity. Loss of salary. There are many risks with any operation but spinal surgery carries many extra risks. I was told that some of the consequences could be eating and drinking difficulties and voice loss (as they would be carrying out the surgical procedure through the front of my neck and having to decompress my spinal cord by going via my trachea and oesophagus). I told my consultant that I would rather be dead than paralysed from the chest or neck down.

As the day of the operation approached, I again used work to block out my fears and negative thoughts. On April 15, my partner dropped me off at the hospital at 7am in the morning. Before my operation I had talks with the anaesthetist and one of the surgical team. I then had to sign the consent form which included a very long list of all the things that could go wrong. However, the weeks prior to my operation were surviving not living. I felt I was in the last chance saloon.

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

Net bets: What makes betting online attractive to gamblers?

Over the past two decades I have carried out a lot of research on what factors are important in attracting people to engaging in online activities such as online video gaming, online gambling, online shopping, and online sex. Research has shown that virtual environments have the potential to provide short-term comfort, excitement and/or distraction – all of which can be highly reinforcing to internet users. My research has consistently shown that there are many generic factors that facilitate online use including accessibility, anonymity, affordability, convenience, escape, immersion, interactivity, disinhibition, and simulation. Today’s blog briefly examines these factors.

Accessibility – Access to the Internet is now commonplace and widespread, and can be done easily from the home, the workplace and (via mobile gambling) on the move. Given that the uptake of consumptive behaviours is strongly correlated with increased access to the activity, it is not surprising that the incidence of activities like online gambling and online gaming is slowly increasing across different populations across the world. Fundamentally, increased accessibility of these activities enables the individual to rationalize involvement by removing previously restrictive barriers such as time constraints emanating from occupational and social commitments.

Anonymity – The anonymity of the Internet allows users to privately engage in such activities as sex and gambling without the fear of stigma. This anonymity can also provide the user with a greater sense of perceived control over the content, tone, and nature of the online experience. Anonymity also has the capacity to increase feelings of comfort since there is a decreased ability to look for, and thus detect, signs of insincerity, disapproval, or judgment in facial expression, as would be typical in face-to-face interactions. For activities such as gambling, this may be a positive benefit – particularly when losing – as no-one will actually see the face of the loser. Anonymity, like increased accessibility, may reduce social barriers to engaging in gambling, particularly skill-based gambling activities such as poker that are relatively complex and often possess tacit social etiquette. The potential discomfort of committing a structural or social faux-pas in the gambling environment because of inexperience is minimized because the individual’s identity remains concealed.

Affordability – Given the wide accessibility of the Internet, it is now relatively inexpensive to use online services on offer. Furthermore, the overall cost of has been reduced significantly through technological developments, again, rendering affordability less of a restrictive force when it comes to rationalizing involvement in the behaviour. For example, the saturation of online gambling industry has lead to increased competition, and the consumer is benefiting from the ensuing promotional offers and discounts available on gambling outlay. Regarding interactive wagering, the emergence of peer-to-peer gambling through the introduction of betting exchanges has provided punters with commission free sporting gambling odds, which in effect means the player needs to risk less money to obtain potential revenue. Finally, ancillary costs of face-to-face gambling, such as parking, tipping and purchasing refreshments, is removed when gambling within the home and therefore the overall cost of gambling is reduced making it more affordable.

Convenience – Online behaviours usually occur in the familiar and comfortable environment of home or workplace thus reducing the feeling of risk and allowing even more adventurous behaviours. For the internet user, not having to move from their home or their workplace is of great positive benefit and increases the attractiveness of online activities compared to offline activities.

Escape – For some internet users, the primary reinforcement to engage in an online behaviour is the gratification they experience online. However, the experience of activities like online gambling, online gaming and/or online sex may be reinforced through a subjectively and/or objectively experienced ‘high’ or positive change in mood state. The mood-modifying experience has the potential to provide an emotional or mental escape and further serves to reinforce the behaviour. In short, online activities can provide a potent escape from the stresses and strains of real life.

Immersion – The medium of the Internet can provide feelings of dissociation and immersion and may facilitate feelings of escape (see above). Immersion can produce lots of different types of feelings that may be reinforcing for the internet user such as losing track of time, feeling like you’re someone else, and being in a trance like state.

Interactivity – The interactivity component of the Internet can also be psychologically rewarding and different from other more passive forms of entertainment (e.g., television). The interactive nature of the Internet can therefore provide a convenient way of increasing such personal involvement that can – in online situations – lead to increased online use. Furthermore, the alternative methods of peer interaction are available within interactive online activities that retain the socially reinforcing aspects of the behaviour. Individuals can communicate via computer-mediated communication in most online activities (including gambling and gaming).

Disinhibition – The feeling of disinhibition is one of the Internet’s key appeals as there is little doubt that the Internet makes people less inhibited when they are online. Online users appear to open up more quickly online compared to offline situations and reveal themselves emotionally much faster than in the offline world. This has been referred to by Dr. John Suler as ‘hyperpersonal communication’. According to Dr. Suler, this occurs because of four features of online communication: 

• The communicators usually share social categories so will perceive each other as similar (e.g., all online poker players)
• The message sender can present themselves in a positive light, and so may be more confident
• The format of online interaction (e.g., there are no other distractions, users can spend time composing messages, mix social and task messages, users don’t waste cognitive resources by answering immediately)
• The communication medium provides a feedback loop whereby initial impressions are built upon and strengthened.

Simulation – Finally, simulations provide an ideal way in which to learn about something and which tends not to have any of the possible negative consequences. For instance, most online gambling sites have a practice mode format, where potential gamblers can place a non-monetary bet in order to see and practice the procedure of gambling on that site. Furthermore, gambling in practice modes can build self-efficacy and potentially increase perceptions of control in determining gambling outcomes motivating participation in their ‘real cash’ counterparts within the site.

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

Further reading

Griffiths, M.D. (1998). Internet addiction: Does it really exist? In J. Gackenbach (Ed.), Psychology and the Internet: Intrapersonal, Interpersonal and Transpersonal Applications. pp. 61-75. New York: Academic Press.

Griffiths, M.D. (2003). Internet gambling: Issues, concerns and recommendations. CyberPsychology and Behavior, 6, 557-568.

Griffiths, M.D. (2009). Internet gambling in the workplace. Journal of Workplace Learning, 21, 658-670.

Griffiths, M.D. (2010). Gambling addiction on the Internet. In K. Young & C. Nabuco de Abreu (Eds.), Internet Addiction: A Handbook for Evaluation and Treatment (pp. 91-111). New York: Wiley.

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

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

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

Griffiths, M.D. & Parke, J. (2002). The social impact of internet gambling. Social Science Computer Review, 20, 312-320.

Griffiths M.D. & Szabo, A. (2014). Is excessive online usage a function of medium or activity? An empirical pilot study. Journal of Behavioral Addictions, 3, 74–77.

Kuss, D.J. & Griffiths, M.D. (2011). Online social networking and addiction: A literature review of empirical research. International Journal of Environmental and Public Health, 8, 3528-3552.

Kuss, D. & Griffiths, M.D. (2012).  Internet gambling behavior. In Z. Yan (Ed.), Encyclopedia of Cyber Behavior (pp.735-753. Pennsylvania: IGI Global

Kuss, D.J. & Griffiths, M.D. (2012). Online gaming addiction in adolescence: A literature review of empirical research. Journal of Behavioral Addictions, 1, 3-22.

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

Kuss, D.J. & Griffiths, M.D. (2012). Online gaming addiction: A systematic review. International Journal of Mental Health and Addiction, 10, 278-296.

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

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

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

Suler, J. (2004). The online disinhibition effect. CyberPsychology & Behavior, 7, 321-326.

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

Widyanto, L. & Griffiths, M.D. (2009). Unravelling the Web: Adolescents and Internet Addiction. In R. Zheng, J. Burrow-Sanchez & C. Drew (Eds.), Adolescent Online Social Communication and Behavior: Relationship Formation on the Internet. pp. 29-49. Hershey, Pennsylvania: Idea Publishing.

Pressing the right buttons: The positives of playing video games

Whether playing video games has negative effects is something that has been debated for 30 years, in much the same way that rock and roll, television, and even the novel faced much the same criticisms in their time. Purported negative effects such as gaming addiction, increased aggression, and various health consequences such as obesity and repetitive strain injuries tend to get far more media coverage than the positives. I know from my own research examining both sides that my papers on video game addiction receive far more publicity than my research into the social benefits of, for example, playing online role-playing games.

However there is now a wealth of research which shows that video games can be put to educational and therapeutic uses, as well as many studies which reveal how playing video games can improve reaction times and hand-eye co-ordination. For example, research has shown that spatial visualisation ability, such as mentally rotating and manipulating two- and three-dimensional objects, improves with video game playing.

To add to this long line of studies demonstrating the more positive effects of video games is a study in the Proceedings of the National Academy of Sciences by Vikranth Bejjanki and colleagues. Their paper demonstrates that the playing of action video games – the sort of fast-paced, 3D shoot-em-up beloved of doomsayers in the media – confirms what other studies have revealed, that players show improved performance in perception, attention, and cognition.

In a series of experiments on small numbers of gamers (10 to 14 people in each study), the researchers reported that gamers with previous experience of playing such action video games were better at perceptual tasks such as pattern discrimination than gamers with less experience. In another experiment, they trained gamers that had little previous experience of playing action games, giving them 50 hours practice. It was showed that these gamers performed much better on perceptual tasks than they had prior to their training. The paper concludes:

“The enhanced learning of the regularity and structure of environments may act as a core mechanism by which action video game play influences performance in perception, attention, and cognition”.

In my own papers, I have pointed out many features and qualities that make video games potentially useful. For instance, in an educational context, video games can be fun and stimulating, which means it’s easier to maintain a pupil’s undivided attention for longer. Because of the excitement, video games may also be a more appealing way of learning than traditional methods for some.

Video games have an appeal that crosses many demographic boundaries, such as age, gender, ethnicity, or educational attainment. They can be used to help set goals and rehearse working towards them, provide feedback, reinforcement, self-esteem, and maintain a record of behavioural change. Their interactivity can stimulate learning, allowing individuals to experience novelty, curiosity and challenge that stimulates learning. There is the opportunity to develop transferable skills, or practice challenging or extraordinary activities, such as flight simulators, or simulated operations. Because video games can be so engaging, they can also be used therapeutically. For instance, they can be used as a form of physiotherapy as well as in more innovative contexts. A number of studies have shown that when children play video games following chemotherapy they need fewer painkillers than others.

Video games can have great educational potential in addition to their entertainment value. Games specifically designed to address a specific problem or teach a specific skill have been very successful, precisely because they are motivating, engaging, interactive, and provide rewards and reinforcement to improve. But the transferability of skills outside the game-playing context is an important factor. What’s also clear from the scientific literature is that the negative consequences of playing almost always involve people that are excessive video game players. There is little evidence of serious acute adverse effects on health from moderate play.

A version of this article was first published in The Conversation.

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

Further reading

Bejjanki, V. R., Zhang, R., Li, R., Pouget, A., Green, C. S., Lu, Z. L., & Bavelier, D. (2014). Action video game play facilitates the development of better perceptual templates. Proceedings of the National Academy of Sciences, 111(47), 16961-16966.

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

Griffiths, M.D. (1997). Video games and clinical practice: Issues, uses and treatments. British Journal of Clinical Psychology, 36, 639-641.

Griffiths, M.D. (2002). The educational benefits of videogames Education and Health, 20, 47-51.

Griffiths, M.D. (2003). The therapeutic use of videogames in childhood and adolescence. Clinical Child Psychology and Psychiatry, 8, 547-554.

Griffiths, M.D. (2004). Can videogames be good for your health? Journal of Health Psychology, 9, 339-344.

Griffiths, M.D. (2005). Video games and health. British Medical Journal, 331, 122-123.

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

Griffiths, M.D. (2010). Adolescent video game playing: Issues for the classroom. Education Today: Quarterly Journal of the College of Teachers, 60(4), 31-34.

Griffiths, M.D., Kuss, D.J., & Ortiz de Gortari, A. (2016). Videogames as therapy: An updated selective review of the medical and psychological literature. International Journal of Privacy and Health Information Management, in press.

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

Griffiths, M.D. & Sutton, M. (2013). Proposing the Crime Substitution Hypothesis: Exploring the possible causal relationship between excessive adolescent video game playing, social networking and crime reduction. Education and Health, 31, 17-21.

Griffiths, M.D. & Sutton, M. (2015). Screen time and crime: The ‘Crime Substitution Hypothesis’ revisited. Education and Health, 33, 85-87.