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The song and binding mode: Musical hallucinations in video game playing

According to a 2015 review in the journal Frontiers in Psychology by Jan Coebergh and colleagues, musical hallucinations (MHs) “are auditory hallucinations characterized by songs, tunes, melodies, harmonics, rhythms, and/or timbres…and that the mechanisms responsible for the mediation of MH are probably diverse”. While Danilo Vitorovic and Jose Biller reported in a 2013 issue of Frontiers in Neurology that the prevalence rate of MHs among the general population is at present unknown and/or rare, ‘involuntary musical imagery’ (INMI) is thought to be more commonplace. For instance, in a 2012 Finnish study in the journal Psychology of Music, Lassi Liikkanen reported that 89% of the total sample (n=12,519) reported experiencing INMI at least once a week. Music hallucination prevalence rates among various groups have been reported including obsessive-compulsive disorder patients (41%; Journal of Clinical Psychiatry, 2004), elderly people with auditory problems (2.5%; International Journal of Geriatric Psychiatry, 2002), and general hospital setting patients (0.16%; Psychosomatics, 1998).

Although Coebergh and colleagues described MHs, they were not explicitly defined. In a review in a 2014 issue of the Journal of Medical Case Reports, Woo and colleagues defined MHs as complex auditory perceptions in the absence of an external acoustic stimulus and are often consistent with previous listening experience” whereas the 2013 review by Vitorovic and Biller (see above) noted that MHs represent a specific form of auditory hallucinations whereby patients experience formed songs, instrumental music, or tunes, without an external musical stimulus”. In a 2015 paper in the journal Psychomusicology: Music, Mind, and Brain, Tim Williams provided a classification of INMI and noted they cover a number of different types of involuntary musical experience (including MHs). Despite the lack of detailed definition, it is known that MHs occur within the context of an individual’s culture and are often viewed by those experiencing them as intrusive and sometimes unpleasant.

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In 2015, Dr. Angelica Ortiz de Gortari and I wrote a commentary paper on musical hallucinations in videogame playing in response to the review by Coebergh and colleagues. As far as we were aware, we noted that no review paper examining musical hallucinations had ever included papers referring to musical hallucinations arising from playing video games. The earliest report in the psychological literature is by Sean Spence (published in 1993 in the Irish Journal of Psychological Medicine) who reported the case of a 20-year-old female patient with a family history of psychosis. She presented with persecutory delusions, suicidal ideation, violent behaviour and third-person auditory hallucinations comprising 48 hours of constant MHs from the Mario Brothers videogame that developed into delusional thoughts. No drugs were found in her urinary system and her EEG was normal when MHs occurred. The MHs from the videogame decreased within 48 hours of treatment (using antidepressants and neuroleptics).

More recently, a series of papers by Dr. Ortiz de Gortari and I examined Game Transfer Phenomena (GTP). GTP research has demonstrated how the videogame can keep on playing even after the game has been turned off. GTP are non-volitional phenomena (e.g., altered perceptions, automatic mental processes, and involuntary behaviors). In an analysis of over 1600 gamers’ self-reports, our research has shown that videogame playing can lead to (i) perceptual distortions of physical objects, environments, and/or sounds, (ii) misperceptions of objects and sounds that are similar to those in the videogame, (iii) interpretation of events in real life contexts that utilize the logic of the videogame, (iv) ghost perceptions and sensations of images, sounds, and tactile experiences, and (v) involuntary actions and behaviors based on experiences from the videogame.

One study that we published in a 2014 issue of the International Journal of Cyber Behavior, Psychology and Learning specifically examined auditory GTP experiences. Gamers’ experiences identified as GTP in one or more modalities (e.g., visual, auditory) were collected from 60 online videogame forums over seven months. Of these, there were 192 auditory experiences from 155 gamers collected. The largest numbers of experiences (90%) were identified as involuntary auditory imagery. This manifested as hearing music (n = 73), sound (n = 83), or voices from within the game (n = 12). Some experiences were triggered by external cues associated with the game, while others were not. Experiences with music included hearing high pitch music in addition to calm and classical music.

Music from the videogames was usually experienced persistently, while sound effects or voices appeared to have occurred more episodically. Hearing the music persistently provoked sleep deprivation, annoyance, and uncertainty. When the music was re-experienced very vividly, the gamers attributed them to external sources associated with the videogame. More specifically, when auditory cues were associated with adverse videogame content, they resulted in irrational thoughts, reactions and changes in behaviour. In many cases, the gamers said that they had been playing intensively (i.e., either playing long sessions or playing frequently). Previous studies have linked hearing music in absence of auditory stimuli with the recent or repeated exposure to music (see ‘Further reading’ below including: Gardner, 1985; Gerra et al., 1998; Hyman et al., 2012).

In our study, one gamer said that he heard the sound of music coming out from the speakers so he stood up to check them while another heard music from Pokémon when vacuuming. It also appears that musical hallucinations can cross sensory modalities. For instance, some gamers have reported hearing music while seeing images from the video game. An online survey about GTP with a convenience sample of 2,362 gamers found that hearing music from videogames when not playing were the more prevalent (74%) than hearing sounds (65.0%) or voices (46%) when not playing (Ortiz de Gortari & Griffiths, 2015b).

Based on what is known empirically, our paper concluded that (i) MHs from videogame playing – although not well documented – appear to be relatively commonplace among gamers and prevalence appears to be higher than found in other populations, (ii) individual interpretation of MHs from videogames are influenced by the meanings and uses of auditory cues in the videogames, (iii) MHs can manifest beyond one sensory modality and has been reported across-sensory channels (e.g., hearing music while seeing ghost images from the game), (iv) there is little evidence that MHs among videogame players are linked to other underlying pathology (e.g., epilepsy, psychiatric disorder, etc.), (v) those researching in the field of MHs and INMI appear to have overlooked the literature on these phenomena related to videogame playing, and (vi) better definitions are needed for MHs and a distinction between MHs and INMI is required.

(Please note: This blog is based on material used in the following paper: Griffiths, M.D. & Ortiz de Gortari, A.B. (2015). Musical hallucinations: Review of treatment effects. Frontiers in Psychology, 6, 1885. doi: 10.3389/fpsyg.2015.01885).

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

Further reading

Coebergh, J. A. F., Lauw, R. F., Bots, R., Sommer, I. E. C., & Blom, J. D. (2015) Musical hallucinations: review of treatment effects. Frontiers in Psychology, 6, 814.

Cole M.G., Dowson, L., Dendukuri, N., & Belzile, E. (2002). The prevalence and phenomenology of auditory hallucinations among elderly subjects attending an audiology clinic. International Journal of Geriatric Psychiatry (2002) 17, 444–52.

Fukunishi, I., Horikawa, N., & Onai, H. Prevalence rate of musical hallucinations in a general hospital setting. Psychosomatics (1998) 39, 175.

Hermesh H. (2004). Musical hallucinations: prevalence in psychotic and nonpsychotic outpatients. Journal of Clinical Psychiatry, 65, 191–7. doi:10.4088/JCP.v65n0208

Gardner, M. P. (1985). Mood states and consumer behavior: A critical review. Journal of Consumer Research, 12, 281-300.

Gerra, G., Zaimovic, A., Franchini, D., Palladino, M., Giucastro, G., Reali, N., . . . Brambilla, F. (1998). Neuroendocrine responses of healthy volunteers to `techno-music’: relationships with personality traits and emotional state. International Journal of Psychophysiology, 28(1), 99-111.

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

Hyman, I. E., Burland, N. K., Duskin, H. M., Cook, M. C., Roy, C. M., McGrath, J. C., & Roundhill, R. F. (2012). Going gaga: Investigating, creating, and manipulating the song stuck in my head. Applied Cognitive Psychology, 27, 204-215.

Liikkanen, L. A. (2012). Musical activities predispose to involuntary musical imagery. Psychology of Music, 40(2), 236-256.

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

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

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

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

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

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

Ortiz de Gortari, A.B. & Griffiths, M.D (2015b). Prevalence and characteristics of Game Transfer Phenomena: A descriptive survey study. Manuscript under review.

Spence, S. A. (1993). Nintendo hallucinations: A new phenomenological entity. Irish Journal of Psychological Medicine, 10, 98–99.

Vitorovic, D. & Biller, D. (2013). Musical hallucinations and forgotten tunes – case report and brief literature review. Frontiers in Neurology, 4, 109. doi: 10.3389/fneur.2013.00109

Williams, T. I. (2015). The classification of involuntary musical imagery: The case for earworms. Psychomusicology: Music, Mind, and Brain, 25(1), 5-13.

Woo, P. Y. M. Leung, L. N. Y., Cheng, S. T. M. & Chan, K-Y. (2014). Monoaural musical hallucinations caused by a thalamocortical auditory radiation infarct: a case report. Journal of Medical Case Reports, 8, 400.

Gore-ist information: A brief look at virtual reality horror games

“I recently played ‘The Visitor’ in VR. In front of an audience of drunken friends egging on my high pitch outbursts. I lasted seven out of the ten minutes, finally succumbing after a close encounter with a pixelated pillow. The Visitor’s story is about an unexpected guest calling to your house in the middle of the night. Developed by ‘NostalgicBear VR’ for the ‘Oculus Rift’ and ‘HTC Vive’ it relies on atmosphere to unsettle players, using visual cues in the form of intermittent flickering lights to inform the player where to look. Paralysed and lying in bed, you can only wait and watch as the strange occurrences culminate in one of the biggest jump scares I’ve ever experienced. As virtual reality goes, this particular experience has a high creep factor. It’s one of those new VR ‘games’ that really should come with a free pair of pants…In the wake of the PlayStation VR release, headed up by the dark and psychological Here They Lie, pretty much every major gaming outlet slashed their prices on horror games and gamers all over the world have been celebrating Halloween with their first exposure to a virtual reality freak out…VR grips the gamer with such a suspension of disbelief; when the headset is on there is seemingly no escape. Do developers take into account the psychological differences between previous gaming horror experiences and that of VR?”

The opening quote in today’s blog is from an article by Gareth May published last month for the Wareable website (‘Could VR horror be too…horrifying?’). I was interviewed by May for the story and is one of a number of media stories that I have been interviewed over the last year concerning virtual reality. Regular readers of my blog will know that I have a personal interest in horror films and a professional interest in excessive use of virtual reality so it was an interview I enjoyed doing (in fact, May interviewed me for two stories simultaneously, the other being on mechanophilia – sexual arousal from machines – which also was published last month in an article in the Daily Telegraph).

In his article on VR horror, May wanted to know about whether the playing of VR horror games could be problematic in any way (or as May asked me, ‘Is it possible that VR is just a bit too ‘real’?’). I pointed out that there had been little empirical research on the topic and that almost everything that I said was speculative. I noted that while VR is certainly more immersive than usual, we should remember that immersion can occur even without being in an VR environment. For instance, a lot of my research into video gaming demonstrates that gaming can be immersive (particularly the research I have been carrying out with Dr. Angelica Ortiz de Gortari on game transfer phenomena and some research I co-authored in the mid-2000s on time loss in video game play). I did point out to May that for most people, there’s not going to be a problem with playing VR horror games. Those that already enjoy watching horror films, the vast majority will probably love it even more in VR and it’s not going to have a negative impact on them. I told May that I loved gore in horror films and said that I would probably be fine playing an immersive horror VR game and that seeing somebody being disembowelled in front of me would have little effect on me psychologically. (However, I ought to point out that my few experiences of VR have left me feeling sick as I suffer from motion sickness). However, you can never rule out a small minority of individuals that it may negatively affect either psychologically or traumatically. In short, I don’t have many concerns about this until scientific evidence proves otherwise.

May also interviewed Professor Tanya Krzywinska, Director of the Games Academy at Falmouth University who thinks that VR and horror video games are a good match:

“VR is the next natural step for one of gaming’s most popular genres. Horror made its way into video games very early on [such as] the 1995 point and click ‘Phantasmagoria’ [was] an early breakthrough game due to its use of video snippets to show a ‘real’ actress reacting to the horrific events as they unfolded around her…’Silent Hill’ [was also] a game-changer for its use of sound and its surreal ‘Twin Peak-ish twist’ on survival horror. Both these games utilise a particular emotional palette that I regard as central to games: a sense of claustrophobia and the sense of being unable to act effectively on a situation…VR can make very good use of this palette because of its immersive nature and I think horror is one of the few genres that VR really suits…Horror is very inclined to want to take advantage of new formats to refresh the palette and work with the cache that the novelty provides. Without that novelty, repetition occurs and you then only manage to engage younger audiences who haven’t been around the horror block. Horror is a very suitable place to take a good, long, critical look at ethics and I hope that some game designers see that”.

So is the introduction of VR for the horror genre a game-changer? May also interviewed the independent games developer Sergio Hidalgo, creator of the creepy dungeon game Dreadhalls. He was quoted as saying:

“VR can work as an immersion multiplier, and given that the horror genre is built on immersion, it simply opens more opportunities to create experiences that take advantage of that sense of physicality it can provide. Simply being in a scary environment can be a very engaging experience in VR on its own. This was already true when I started ‘Dreadhalls’ but the technology keeps moving forward and improving with new developments such as room scale or motion tracked controllers…In ‘Dreadhalls’ there are monsters that react to the player’s gaze direction, forcing the player to either not look at them directly or the opposite. This is a much richer interaction when the player is performing it herself rather than via a mouse or controller. ‘Dreadhalls would never have gathered such attention if it weren’t for the new types of interactions and features made possible by VR tech…The main ethical recommendation I have in this regard is that of not betraying the player’s trust. When the player enters a VR experience and surrenders control over their senses to the developer, it’s important that [the players are] aware of exactly what to expect, and that this promise isn’t broken by the developer”.

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In an interview that May had with Ben Tester, the games developer of VR horror game Don’t Knock Twice, Tester noted:

“Developers are in a strange predicament where it’s now possible to make a game that’s too scary. For that reason, ‘Don’t Knock Twice’ includes traditional adventure gameplay elements, such as puzzle solving and environmental props, to aid storytelling and remind the player every once in a while that they are still playing a game. We want to make a great horror game that people will remember for sure but we don’t want to make it so uncomfortable that it makes it unplayable. In ‘Don’t Knock Twice’, we want to avoid the player going through a constant stream of scares one after another and instead, create an interesting and atmospheric environment which will creep out any horror enthusiast. It’s about finding the right balance between having a solid gaming experience and immersing the player in a terrifying horror situation…In the VR demo of ‘Don’t Knock Twice’, players can break down a door with an axe. [This often leads to players] leaning their heads forward and triggering the classic ‘Here’s Johnny’ moment [from ‘The Shining’], which only amplifies the jump scare which follows. A scare that wouldn’t have been half as effective if it was in traditional gaming style”.

Finally, May asked me for some advice for those who were scared witless by playing VR horror games. My quoted response? “Just shut your eyes”.

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

Further reading

Ashcroft, S. (2015). VR revenue to hit $21.8 billion by 2020. Wareable, July 29. Located at: http://www.wareable.com/vr/vr-revenues-could-reach-dollar-218-billion-by-2020-1451

Griffiths, M.D. (2016). Can virtual reality be addictive? Virtual Reality News, June 28. Located at: http://www.virtualreality-news.net/news/2016/jun/28/can-virtual-reality-really-be-addictive/

Juniper Research (2016). White paper: The rise of virtual reality. Available from: http://www.juniperresearch.com/document-library/white-papers/the-rise-of-virtual-reality

May, G. (2016). Could VR horror be too…horrifying? Wareable, November 3. Located at: http://www.wareable.com/vr/virtual-reality-horror-experiences-too-real-ethics-55

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

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

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

Stables, J. (2016).  Gambling, gaming and porn: Research says VR is set to blast off. Wareable, September 15. Located at: http://www.wareable.com/vr/gaming-gambling-and-porn-research-says-vr-is-set-to-blast-off-1682

Sung, D. (2015). VR and vice: Are we heading for mass addiction to virtual reality fantasies? Wareable, October 15. Located at: http://www.wareable.com/vr/vr-and-vice-9232

Tractica (2015). Virtual reality for consumer markets. Available at: https://www.tractica.com/research/virtual-reality-for-consumer-markets/

Wood, R.T.A. & Griffiths, M.D. (2007). Time loss whilst playing video games: Is there a relationship to addictive behaviours? International Journal of Mental Health and Addiction, 5, 141-149.

Wood, R.T.A., Griffiths, M.D. & Parke, A. (2007). Experiences of time loss among videogame players: An empirical study. CyberPsychology and Behavior, 10, 45-56.

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.

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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

I love view: Can Google Glass be addictive?

Last week, The Guardian (and news media all over the world) reported the story of a man being treated for internet addiction disorder brought on by his excessive use of Google Glass. According to The Guardian’s report:

“The man had been using the technology for around 18 hours a day – removing it only to sleep and wash – and complained of feeling irritable and argumentative without the device. In the two months since he bought the device, he had also begun experiencing his dreams as if viewed through the device’s small grey window…[The patient] had checked into the Sarp [Substance Addiction Recovery Program] in September 2013 for alcoholism treatment. The facility requires patients to steer clear of addictive behaviours for 35 days – no alcohol, drugs, or cigarettes – but it also takes away all electronic devices. Doctors noticed the patient repeatedly tapped his right temple with his index finger. He said the movement was an involuntary mimic of the motion regularly used to switch on the heads-up display on his Google Glass”.

The story was based on a case study that has just been published in the journal Addictive Behaviors by Dr. Kathryn Yung and her colleagues from the Department of Mental Health, Naval Medical Center in San Diego (United States). The authors claim that the paper (i) reported the first ever case of internet addiction disorder involving the problematic use of Google Glass, (ii) showed that excessive and problematic uses of Google Glass can be associated with involuntary movements to the temple area and short-term memory problems, and (iii) highlighted that the man in their case study displayed frustration and irritability that were related to withdrawal symptoms from excessive use of Google Glass. For those reading this who have not yet come across what Google Glass is, the authors provided a brief description: 

Google Glass™ was named as one of the best inventions of the year by Time Magazine in 2012. The device is a wearable mobile computing device with Bluetooth connectivity to internet-ready devices. Google Glass™ has an optical head-mounted display, resembling eyeglasses; it displays information in a Smartphone-like, but hands-free format that is controlled via voice commands and touch”.

The man that came in for treatment was a 31-year old enlisted service member who had served seven months in Afghanistan. Although he did not suffer any kind of post-traumatic stress disorder (PTSD) he was reported by the authors as having a mood disorder, most consistent with a substance-induced hypomania overlaying a depressive disorder, anxiety disorder with characteristics of social phobia, obsessive–compulsive disorder, and severe alcohol and tobacco use disorders”. His referral to the substance use program was because he had resumed problematic alcohol drinking following a previous eight-week intensive outpatient treatment. It was only after re-entering the program that staff noticed other behaviours that were nothing to do with his alcohol problem. More specifically, they reported that:

“The patient had been wearing the Google Glass™ device each day for up to 18 h for two months prior to admission, removing the device during sleep and bathing. He was given permission by his superiors to use the device at work, as the device allowed him to function at a high level by accessing detailed and complicated information quickly. The patient shared that the Google Glass™ increased his confidence with social situations, as the device frequently became an initial topic of discussion. All electronic devices and mobile computing devices are customarily removed from patients during substance rehabilitation treatment. The patient noted significant frustration and irritability related to not being able to use the device during treatment. He stated, ‘The withdrawal from this is much worse than the withdrawal I went through from alcohol’, He noted that when he dreamed during his residential treatment, he envisioned the dream through the device. He would experience the dream through a small gray window, which was consistent with what he saw when wearing the device while awake. He reported that if he had been prevented from wearing the device while at work, he would become extremely irritable and argumentative. When asked questions by the examiner, the patient was noted on exam to reach his right hand up to his temple area and tap it with his forefinger. He explained that this felt almost involuntary, in that it was the familiar motion he would make in order to turn on the device in order to access information and answer questions. He found that he almost ‘craved’ using the device, especially when trying to recall information”.

Even though my primary area of research interest in behavioural addictions, the thing that caught my attention in the description above was the observation that his dreams were experienced in the way he viewed things through Google Glass while he was awake. On first reading this I thought this sounding very much like some research I have been doing with my colleague Angelica Ortiz de Gortari on Game Transfer Phenomena (GTP) in which gamers transfer aspects of their game playing into real life situations. Our work is an extension of the so-called Tetris Effect where Tetris players see falling blocks before their eyes even when they are not playing the game. It appears the authors of this case study has also made the same connection as they reported:

The patient’s experiences of viewing his dreams through the device appear to be best explained solely by his heavy use of the device and may be consistent with what is referred to as the ‘Tetris Effect’. When individuals play the game Tetris for long periods of time, they report seeing invasive imagery of the game in their sleep (Stickgold, Malia, Maguire, Roddenberry, & O’Connor, 2000). Interestingly, Stickgold et al. noted that patients with amnesia due to traumatic brain injury, who had trouble with short-term memory recall, reported invasive imagery of the game during sleep even though they did not recall playing the game (Stickgold et al., 2000). Technology-assisted learning devices and video gaming appear to be powerful methods to aid in the acquisition of new information. Further studies in the field of traumatic brain injury utilizing gaming and technology-assisted learning are needed”.

At the end of the 35-day inpatient stay, the outcome was reported as being good. The patient reported he felt less irritable, and he was making far fewer compulsive movements to his temple. However, no further follow-up was reported by Yung and her colleagues. There are, of course, wider questions about whether addiction to the internet even exists although the article in The Guardian did provide a link to a comprehensive and systematic review of internet addiction that I co-authored with Dr. Kuss and others in the journal Current Pharmaceutical Design. As regular readers of my blog will be aware, I believe that there is a fundamental difference between addictions on the internet and addictions to the internet. The vast majority of people appear to have addictions on the internet (such as gambling addiction, gaming addiction, sex addiction, shopping addiction, etc.) where the internet facilitates other addictive behaviours. However, there is growing evidence of internet-only addictive behaviour (with social networking addiction being the most common).

In relation to this case study, there have been some that have said that the study doesn’t have face validity because the battery life of Google Glass is so small that it is impossible to spend up to 18 hours a day wearing it. (For instance, check out an interesting article written by Taylor Hatmaker published by the Daily Dot). I ought to add that one of the study’s co-authors, Dr. Andrew Doan did say to various news outlets that:

“A wearable device is constantly there – so the neurological reward associated with using it is constantly accessible. There’s nothing inherently bad about Google Glass. It’s just that there is very little time between these rushes. So for an individual who’s looking to escape, for an individual who has underlying mental dysregulation, for people with a predisposition for addiction, technology provides a very convenient way to access these rushes. And the danger with wearable technology is that you’re allowed to be almost constantly in the closet, while appearing like you’re present in the moment”.

Based on the two-page paper that was published, I don’t think there was enough evidence presented to say whether the man in question was addicted to the internet via Google Glass. There were certainly elements associated with addiction but that doesn’t mean somebody is genuinely addicted. Furthermore, most addictive behaviours have to have been present for at least six months before being diagnosed as a genuine addiction. In this case, the man had only been using Google Glass for two months before entering the treatment program.

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

Further reading

Ghorayshi, A. (2014). Google glass user treated for internet addiction caused by device. The Guardian, October 14. Located at: http://www.theguardian.com/science/2014/oct/14/google-glass-user-treated-addiction-withdrawal-symptoms

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

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

Hatmaker, T. (2014). There is no such thing as Google Glass addiction. The Daily Dot, October 15. Located at: https://www.dailydot.com/technology/google-glass-internet-addiction/

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

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

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

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

Ortiz de Gotari, A., Aronnson, 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.

Stickgold, R., Malia, A., Maguire, D., Roddenberry, D., & O’Connor, M. (2000). Replaying the game: Hypnagogic images in normals and amnesics. Science, 290, 350–353.

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

Yung, K., Eickhoff, E., Davis, D. L., Klam, W. P., & Doan, A. P. (2014). Internet Addiction Disorder and problematic use of Google Glass™ in patient treated at a residential substance abuse treatment program. Addictive Behaviors, http://dx.doi.org/10.1016/j.addbeh.2014.09.024.

Blocked-in syndrome: Another look at Game Transfer Phenomena

Back in the early 1990s, I used to play the video game Tetris on my handheld Nintendo Game Boy. Although I say so myself, I was a really good player and I used to play for hours every day. When I went to bed I would see falling blocks as I closed my eyes. I often experienced the same thing when waking up. What I didn’t realise was that many other gamers experienced this too and that it had a name – ‘The Tetris Effect’. According to Wikipedia,the Tetris effect occurs when people devote so much time and attention to an activity that it begins to pattern their thoughts, mental images, and dreams.”

In the late 1980s I started researching into the area of video game addiction. One of the papers I cited a lot in my early research concerning the side effects of excessive playing was a 1993 case study published in the Irish Journal of Psychological Medicine by Dr. Sean Spence. Dr. Spence reported the case of a female video game player who was diagnosed as suffering from persecutory delusions, exhibiting violent behaviour, and experiencing constant imaginary auditory hallucinations triggered by the music of the Super Mario Brothers video game. This case study and the Tetris effect are both examples of what I and my research colleague Angelica Ortiz de Gortari call ‘game transfer phenomena’ (GTP).

These phenomena tend to occur when video game players become so immersed in their gaming that when they stop playing, they sometimes transfer some of their virtual gaming experiences to the real world. These phenomena can occur both visually and aurally as well is in the form of unconscious bodily movements.

We have been researching GTP for a number of years and our first published study in 2011 made worldwide news. Some of the press coverage was both sensationalist (“Gamers can’t tell real world from fantasy, say researchers) and misleading (“How video games blur real life boundaries and prompt thoughts of violent solutions to players’ problems) and angered some of the gaming community. Our first published study in the International Journal of Cyber Behavior, Psychology and Learning was an exploratory study in which 42 gamers were interviewed. Although the sample was small, we reported that all our participants had, at some point, experienced some type of involuntary sensations, thoughts, actions and/or reflexes in relation to videogames when not playing them. For instance, one gamer reported witnessing a mathematics equation appearing in a bubble above his teacher’s head while another reported health bars hovering over football players from a rival team. However, this didn’t stop some of the press coverage being derogatory (Unscientific survey of 42 gamers concludes video games interfere with perceptions of reality).

Since then we have published three more studies from a self-selected dataset of over 1,600 gamers’ experiences (all of who had experienced some form of GTP) in various academic journals (International Journal of Human Computer Interaction; International Journal of Mental Health and Addiction; International Journal of Cyber Behavior, Psychology and Learning). Our findings have shown that some gamers (i) are unable to stop thinking about the game, (ii) expect that something from the game will happen in real life, (iii) display confusion between video game events and real life events, (iv) have impulses to perform something as in the video game, (v) have verbal outbursts, and (vi) experience voluntary and involuntary behaviours.

While some gamers qualify their experiences as funny, amusing, or even normal, others said they got surprised, felt worried, embarrassed and their experiences were a reason to quit playing. Based on our research so far, Game Transfer Phenomena appear to be commonplace among excessive gamers but the good news is that most of these phenomena are short-lasting, temporary, and appear to resolve of their own accord.

Despite instances of GTP elsewhere in the psychological and medical literature, we argue that there are important reasons for not using the ‘Tetris effect’ concept when studying game transfer effects. Among the most important are that: (i) the Tetris effect definition is very broad and does not emphasize the importance of the association between real life stimulus and video game elements as a trigger of some of the transfer experiences, (ii) it does not make a clear distinction between sensorial modalities in the game transfer experiences or talk about players’ experiences across sensorial modalities (e.g., hearing a sound and visualizing a video game element), and (iii) the name itself is inspired by a one specific stereotypical puzzle game (i.e., Tetris). This simple name indicates that it is repetition that triggers the transfer effects but there are other factors involved in game transfer experiences. Furthermore, modern video games use more than abstract shapes and offer more flexible scenarios compared to Tetris and similar games.

Our latest study that surveyed over 2,500 gamers is currently being analysed but preliminary results indicate that game transfer phenomena appear to be common among players – especially those that play heavily. It could be that some gamers are more susceptible than others to experience GTP. Although for many gamers the effects of these experiences appear to be short lived, our research also shows that some gamers experience them recurrently. More research is needed to understand the cognitive and psychological implications of GTP. Our studies to date show there is a need to investigate neural adaptations and after-effects induced by video game playing as a way of encouraging healthy and safe video game playing.

Note: This blog is an extended version of an article first published in The Conversation

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

Further reading

Gackenbach, J.I (2008). Video game play and consciouness development: A transpersonal perspective. Journal of Transpersonal Psychology, 40(1), 60-87.

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.

Ortiz de Gotari, A., Aronnson, 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). 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.

Parfitt, B. (2011). Metro “can’t tell real world from fantasy”. MCV. September 21. Located at: http://www.mcvuk.com/news/read/metro-can-t-tell-real-world-from-fantasy/085065

Purchase, R. (2011). Prof clarifies Game Transfer Phenomena. Eurogamer.net. September 21. Located at: http://www.eurogamer.net/articles/2011-09-21-game-transfer-phenomena-authors-defence

Spence, S.A. (1993). Nintendo hallucinations: A new phenomenological entity. Irish Journal of Psychological Medicine, 10, 98-99.

The Tetris Effect. Located at: http://en.wikipedia.org/wiki/Tetris_effect

It’s all in the game: The psychology of Game Transfer Phenomena

Back in September, one of our research studies on video gaming – more specifically a paper on game transfer phenomena (GTP) that I co-authored with Angelica Ortiz de Gortari (Nottingham Trent University) and Karin Aronsson (Stockholm University) – received a lot of national and international press coverage. Some of the press coverage – particularly that published in the Daily Mail and the Metro – was both sensationalist (“Gamers can’t tell real world from fantasy, say researchers”) and misleading (“How video games blur real life boundaries and prompt thoughts of violent solutions to players’ problems”) and angered some of the gaming community. This is not the first time that I have been on the receiving end of misleading media coverage but I knew from the initial interviews I did with the journalists at the Mail and the Metro that they had already decided what their story was going to be even before talking to me. So what was the real story and what did we say in our research?

The heart of the GTP story lay in our findings that some video game players appear to be so immersed in their gaming that when they stop playing, they sometimes transfer some of their virtual experiences to the real world.  Our published study was a qualitative study and comprised 42 in-depth interviews with Swedish gamers aged between 15 and 21 years old. We categorized player experiences into two main categories – GTP that occurred involuntarily, without premeditation, and those that were intentional.

Almost all the participants had, at some point, experienced some type of involuntary thoughts in relation to videogames. They thought in the same way as when they were gaming, with half of participants often looking to use something from a video game to resolve a real-life issue. In some cases these thoughts were accompanied by reflexes – such as reaching to click a button on the controller when it wasn’t in their hands – while on other occasions gamers visualised their thoughts in the form of game menus. Some gamers reached for the search button when looking for someone in a crowd or saw energy boxes appear above people’s heads. One gamer reported seeing a menu of topics that were available for him to think about, while another, after a lengthy gaming session, created a list of possible responses in their head after being insulted. Another gamer reported witnessing a maths equation appearing in a bubble above a teacher’s head while another reported health bars hovering over players from a rival football team. Players also reported using videogames for interacting with others as a form of amusement, modelling or mimicking video game content, and daydreaming about videogames.

Our findings suggest that some video game players experience intrusion in their cognitive processing and learn from videogames to react and perceive things in real-life, at least for a few seconds, in ways informed by virtual life. In some cases these automatic actions are triggered by a similarity between real-life and the video game, and on other occasions they occur when the players react to real-life stimuli similar to that seen in the game. One of the things we pointed out is that GTP have been reported in the gaming literature before, the most well know example being the ‘Tetris effect’ where players see Tetris pieces falling at the edges of their visual fields or when they close their eye. Other examples include players hearing auditory hallucinations related to the game when not playing.

Despite instances of GTP elsewhere in the psychological and medical literature, we argue that there are important reasons for not using the “Tetris effect” concept when studying game transfer effects. Among the most important are that: (i) the ‘Tetris effect’ definition is very broad and does not emphasize the importance of the association between real life stimulus and video game elements as a trigger of some of the transfer experiences, (ii) it does not make a clear distinction between sensorial modalities in the game transfer experiences or talk about players’ experiences across sensorial modalities (e.g., hear a sound and visualize a video game element), and (iii) the name itself is inspired by a one specific stereotypical puzzle game (i.e., Tetris). This simple name indicates that it is repetition that triggers the transfer effects but there are other factors involved in game transfer experiences. Furthermore, modern video games use more than abstract shapes and offer more flexible scenarios compared to Tetris and similar games.

We believe our study is the first to attempt to systematically explore these type of experience and to conceptualize the experiences within a wider framework (i.e., game transfer phenomena). Our initial findings have proved extremely interesting and almost all the players in our first study reported some type of GTP. However, they were experienced in different ways and with varying degrees of intensity. As we outline in this week’s New Scientist (December 24 issue), we are now following this up with further studies on a much larger number of gamers across many different countries. You can also check out Angelica’s dedicated game transfer phenomena website (http://www.gametransferphenomena.com/).

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

Further reading

Gackenbach, J.I (2008). Video game play and consciouness development: A transpersonal perspective. Journal of Transpersonal Psychology, 40(1), 60-87.

Ortiz de Gotari, A., Aronnson, 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.

Parfitt, B. (2011). Metro “can’t tell real world from fantasy”. MCV. September 21. Located at: http://www.mcvuk.com/news/read/metro-can-t-tell-real-world-from-fantasy/085065

Purchase, R. (2011). Prof clarifies Game Transfer Phenomena. Eurogamer.net. September 21. Located at: http://www.eurogamer.net/articles/2011-09-21-game-transfer-phenomena-authors-defence

Spence, S.A. (1993). Nintendo hallucinations: A new phenomenological entity. Irish Journal of Psychological Medicine, 10, 98-99.

The Tetris Effect. Located at: http://en.wikipedia.org/wiki/Tetris_effect