Sense and sense-ability: A brief look at ‘virtual reality addiction’

Ever since I started researching into technological addictions, I have always speculated that ‘virtual reality addiction’ was something that psychologists would need to keep an eye on. In 1995, I coined the term ‘technological addictions’ in a paper of the same name in the journal Clinical Psychology Forum. In the conclusions of that paper I asserted:

“There is little doubt that activities involving person-machine interactivity are here to stay and that with the introduction of such things [as] virtual reality consoles, the number of potential technological addictions (and addicts) will increase. Although there is little empirical evidence for technological addictions as clinical entities at present, extrapolations from research into fruit machine addiction and the exploratory research into video game addiction suggest that they do (and will) exist”.

Although I wrote the paper over 20 years ago, there is little scientific evidence (as yet) that individuals have become addicted to virtual reality (VR). However, that is probably more to do with the fact that – until very recently – there had been little in the way of affordable VR headsets. (I ought to just add that when I use the term ‘VR addiction’ what I am really talking about is addiction to the applications that can be utilized via VR hardware rather than the VR hardware itself).

VR’s potential in mass commercial markets appears to be finally taking off because of mass-produced affordable hardware such as Oculus Rift, HTC Vive, PlayStation VR and the (ultra-cheap) Google Cardboard (in which a smartphone can be inserted into cardboard VR headset frame). Last year, a report by the marketing and consulting company Tractica claimed that spending on virtual reality hardware could be as much as $21.8 billion (US) by 2020. A more recent report by online and digital market research company Juniper estimated that global sales of VR headsets would rise from 3 million in 2016 to 30 million by 2020. Three markets are likely drive sales, and they all happen to be areas that I research into from an addiction perspective – video gaming, gambling, and sex. I’ve noted in many of my academic papers over the years (particularly my early papers on online gambling addiction and online sex addiction) that when new technological advances occur, the sex and gambling industries always appear to be the first to invest and produce commercial products and services using such technologies, and VR is no different. As an online article in Wareable by Dan Sung on VR sex noted:

“What [VR] headsets offer is immersion; 180-degree (or more), stereoscopic action with you as the star of the show and the adult actors and actresses looking deep and lustfully into your eyes as they tend to your genitalia. It’s small wonder that users have been donning their headsets and earphones in numbers and praying to their god that nobody walks in. Yet gambling and porn are synonymous with addiction, and increasingly, questions are being asked about whether the VR revolution could finally ensnare us humans into virtual worlds”.

I was interviewed by Sung for the same article and I made a number of different observations about VR sex. I commented that in terms of people feeling reinforced, aroused, rewarded, sex is the ultimate in things that are potentially addictive. Sex is one of those activities that is highly reinforcing, it’s highly rewarding and how people feel is probably better than the highs and buzzes from other behaviours. Theoretically, I can see that VR sex addiction would be possible but I don’t think it’s going to be on the same scale as other more traditional addictions. The thing about VR (and VR sex) – and similarly to the internet – is that it’s non-face-to-face, it’s non-threatening, it’s destigmatising, and it’s non-alienating. VR sex could be like that whether it’s with fictitious partners, someone that you’re actually into, or someone that you’ve never met before. Where VR sex is concerned, if you can create a celebrity in a totally fictitious way, that will happen. There may be celebrities out there that will actually endorse this and can make money and commercialise themselves to do that. It can work both ways. Some people might find it creepy while others might see something they can make money from.

In one of my previous blogs I looked at the area of ‘teledildonics’, a VR technology that has been around for over two decades (in fact I was first interviewed on this topic on a 1993 Channel 4 television programme called Checkout ’93). Dan Sung also interviewed Kyle Machulis who runs the Metafetish teledildonics website for his article. He said that in relation to VR sex there is a problem with haptics (i.e., the science of applying tactile sensation and control to interaction with computer applications):

 “We’re good on video and audio but haptics is a really, really hard problem…A lot of toys out there right now are horrible and it’s very hard to come up with something quality. So, instead, what the porn industry is aiming for right now is immersion. It may not feel better but they’re so much closer to the action that it may be better, and I think we’re on the cusp of that right now.” First, we need consumer hardware. We need things to be released and available to customers to see if it’s really going to take off or not. But when this happens – late this year, the beginning of next – as soon as the headsets are available, the media is ready and waiting…Of course, there’s straight women, gay men and gay women to develop for too but, for a lot of people, the perfect porn experience is doing something that’s not even physically possible – either through the laws of physics or the laws of land, and that’s something that only VR can solve…Even so, what we saw in teledildonics in gaming is that people used them to begin with but there’s always a lot of fall off with new technologies like this. So, there’s going to be a hardcore set of people who stay with VR porn but it’s hard to say how popular it will be beyond that. We’re all still guessing at the moment. This time next year it will be a completely different story”.

Another area that we will need to monitor is how the gambling industry will harness VR technology. The most obvious application of VR in the gambling world is in the online gambling sector. I can imagine some online gamblers wanting their gambling experiences to be more immersive and for their online gambling sessions to be more akin to gambling offline surrounded by the sights and sounds of an offline gambling venue. There is no technical reason that I know of why people that gamble via their computers, laptops, smartphones or tablets could not wear VR headsets and be playing poker opposite a virtual opponent while still sat on the sofa at home. As Paul Swaddle (CEO of Pocket App) noted in a recent issue of Gambling Insider:

We already know that participation in online gambling is snowballing, so if the entertainment industry can use VR to simulate the experience of being inside a video game, or social media sites can give you the opportunity to not just see your friends’ pictures, but to walk through them, why shouldn’t online casinos be able to do the same? VR may actually be the hook that mobile and online casinos need to draw in more millennials, with the average age of players in mobile casinos currently being 40 [years old], and the average age of mobile gamblers in general being 35 [years old]. Millennials simply aren’t engaging with mobile and online casinos to the same extent as older generations, and I suspect that this is down to younger players being much more used to immersive and sociable gaming, as a result of the cutting-edge developments that are being constantly rolled out in the video gaming industry”.

I agree with Swaddle’s observations as the gambling industry are constantly thinking about the ways to bring in newer players. Today’s modern screenagers love technology and do not appear to have any hang-ups about using wearable technology including Fitbit and the Apple Watch. As Swaddle goes on to say:

“By using 
VR technology to transport players and their friends to exciting locations for their online gambling experience, such as a famous casino in Las Vegas, or a smoky basement room in 1920s New York, or even to the poker table in the James Bond film Casino Royale, mobile and online casinos may stand a better chance of drawing in younger audiences if they use VR to gamify the casino experience”.

Again, this makes a lot of sense to me and I wouldn’t bet against this happening. Swaddle thinks that such VR gambling experiences will become commonplace in the years to come and that the gambling industry needs to get on the VR bandwagon now. 

Perhaps of most psychological concern is the use of VR in video gaming. There is a small minority of players out there who are already experiencing genuine addictions to online gaming. VR takes immersive gaming to the next level, and for those that use games as a method of coping and escape from the problems they have in the real world it’s not hard to see how a minority of individuals will prefer to spend a significant amount of their waking time in VR environments rather than their real life.

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. (1995). Technological addictions. Clinical Psychology Forum, 76, 14-19.

Griffiths, M.D. (1996). Gambling on the internet: A brief note. Journal of Gambling Studies, 12, 471-474.

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

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

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

Griffiths, M.D., Király, O., M. Pontes, H.M. & Demetrovics, Z. (2015). An overview of problematic gaming. In Starcevic, V. & Aboujaoude, E. (Eds.), Mental Health in the Digital Age: Grave Dangers, Great Promise (pp.27-55). Oxford: Oxford University Press.

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

Király, O., Nagygyörgy, K., Koronczai, B., Griffiths, M.D. & Demetrovics, Z. (2015). Assessment of problematic internet use and online video gaming. An overview of problematic gaming. In Starcevic, V. & Aboujaoude, E. (Eds.), Mental Health in the Digital Age: Grave Dangers, Great Promise (pp.46-68). Oxford: Oxford University Press.

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

Swaddle, P. (2016). Is virtual reality the future of mobile and online gambling? Gambling Insider, 23, June 3, p.9

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/

Views news: A brief look at the ‘Problem Series Watching Scale’

A few weeks ago I published the third of three articles on ‘box set bingeing’ (people like myself who sit and watch a whole television series at once either on DVD or on television catch-up services). Not long after writing the last article, a paper was published in the Journal of Behavioral Addictions about the development of a new psychometric instrument that assesses problematic television series watching – the Problematic Series Watching Scale (PSWS) – developed by Dr. Gabor Orosz and his colleagues at Eötvös Loránd University in Budapest (Hungary). The authors noted that:

“[Problematic series watching] might be a relevant issue for many people because accessing series by downloading or streaming is (a) very cheap (or free), (b) it is available for almost everyone who has broadband Internet access, (c) it does not depend on a certain place and time (i.e. playing squash depends on a certain place and time), (d) series have a high variety – everyone can find one which fits his/her interest, (e) they are not age- and socio-economic status-dependent, (f) it does not take effort to watch them, [and] (g) and they are constructed to be highly enjoyable and often contain cliffhangers which motivate the viewer to continue. These characteristics are highly similar to the ones mentioned by Cooper (1998) regarding Internet and pornography…In our research, we aimed to differentiate problematic series watching from the concept of television addiction as we focused on the content of the problematic use (series watching) rather than on the medium through which the problematic use happens (television). In our research, we observed problematic series watching which could be done either through a television (i.e. classical TV series) or a screen attached to a computer (i.e. Netflix)”.

The new scale was developed with over 1,100 participants and was based on my ‘addiction components model’ and comprised the following questions which can each be answered ‘never’, ‘rarely’, ‘sometimes’, ‘often’ and ‘always’. Each of the six items taps into a criterion for addiction (i.e., salience, tolerance, mood modification, withdrawal, conflict, and relapse). More specifically, the questions asks During the last year, how often have you:

• Thought of how you could free up more time to watch series? [Salience]
• Spent much more time watching series than initially intended? [Tolerance]
• Watched series in order to reduce feelings of guilt, anxiety, helplessness and depression? [Mood modification]
• Been told by others to cut down on watching series without listening to them? [Relapse]
• Become restless or troubled if you have been prohibited from watching series? [Withdrawal]
• Ignored your partner, family members, or friends because of series watching? [Conflict]

For those of you interested in the psychometric properties, the scale had good factor structure and reliability.

“Respondents watch series more than one hour per day which is more than one-fifth of their free time which indicated that series watching might be an important free time activity. However, the amount of free time one has is not associated with PSWS scores. Women had higher scores on PSWS and respondents with higher education had lower scores on it…Given the lack of empirical research on series watching, we supposed that it might be similar to other problematic screen-related behaviors (e.g. online gaming, Internet or Facebook use)… Other possible covariates could be examined in the future such as loneliness or urgency. Also, further investigation is needed whether extensive series watching can lead to health and psychosocial problems…PSWS scores are positively related with time spent on series watching, whereas the amount of free time does not have an effect on PSWS scores. In the more and more digitalized world there are many forces which encourage people watching online series. In the light of these changes, research on problematic series watching will be increasingly relevant”.

The authors also acknowledged that problematic television series watching doesn’t appear to affect many people and that we should be careful of pathologizing everyday behaviours as behavioural addictions (a criticism that has been made against some of my own research papers more recently – with ‘dance addiction’ and ‘study addiction’ being the most obvious ones).

Dr. Orosz and his colleagues have also just published another paper on problematic series watching in the journal Personality and Individual Differences. This second paper examined correlates of passion toward screen-based activities (i.e., problematic series watching and Facebook use). The paper included two studies comprising young adults (Study 1 with 256 individuals, and Study 2 with 420 individuals) who completed the Passion Scale with respect to their series watching and Facebook use as well as examining impulsivity. The Passion Scale comprises two types of passion – obsessive passion (negative, pressured, and controlling) and harmonious passion (positive, flexible, and related to intrinsic motivation). The results showed that impulsivity predicted obsessive (but not harmonious) passion, and that obsessive passion was positively associated with Facebook overuse whereas harmonious passion was positively associated with series watching. They concluded that it was the type of passion underlying the involvement in excessive screen-based activity that determines what’s experienced by the individual.

My argument has always been that depending upon the definition of ‘addiction’ used, almost any activity can be potentially addictive if constant rewards and reinforcement are in place. The watching of DVD or television box sets can certainly be rewarding and reinforcing but I imagine most people are like myself in that they occasionally experience negative consequences as a result of the activity (lack of sleep due to going to bed very late, or ignoring family members while watching an episode or four of your favourite programmes) but that overall the problems are short-lived and have few long-term consequences.

[I ought to note that I have recently been working with Dr. Orosz in the area of workaholism and that we recently published a paper in the topic in the International Journal of Mental Health and Addiction – see ‘Further reading’ below).

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

Further reading

Atroszko, P.A., Andreassen, C.S., Griffiths, M.D. & Pallesen, S. (2015). Study addiction – A new area of psychological study: Conceptualization, assessment, and preliminary empirical findings. Journal of Behavioral Addictions, 4, 75–84.

Atroszko, P.A., Andreassen, C.S., Griffiths, M.D. & Pallesen, S. (2016). Study addiction: A cross-cultural longitudinal study examining temporal stability and predictors of its changes. Journal of Behavioral Addictions, DOI: 10.1556/2006.5.2016.024

Bates, D. (2015). Watching TV box-set marathons is warning sign you’re lonely and depressed – and will also make you fat. Daily Mail, January 29. Located at: http://www.dailymail.co.uk/health/article-2931572/Love-marathon-TV-session-warning-sign-lonely-depressed.html

Cooper, A. (1998). Sexuality and the Internet: Surfing into the new millennium. CyberPsychology and Behavior, 1(2), 187–193.

Daily Edge (2014). 11 signs of you’re suffering from a binge-watching problem. Located at: http://www.dailyedge.ie/binge-watching-problem-signs-1391910-Apr2014/

Kompare, D. (2006). Publishing flow DVD Box Sets and the reconception of television. Television & New Media, 7(4), 335-360.

Maraz, A., Urbán, R., Griffiths, M.D. & Demetrovics Z. (2015). An empirical investigation of dance addiction. PloS ONE, 10(5): e0125988. doi:10.1371/journal.pone.0125988.

Orosz, G., Bőthe, B., & Tóth-Király, I. (2016). The development of the Problematic Series WatchingScale (PSWS). Journal of Behavioral Addictions, 5(1), 144-150.

Orosz, G., Dombi, E., Andreassen, C.S., Griffiths, M.D. & Demetrovics, Z. (2016). Analyzing models of work addiction: Single factor and bi-factor models of the Bergen Work Addiction Scale. International Journal of Mental Health and Addiction, DOI 10.1007/s11469-015-9613-7

Orosz, G., Vallerand, R. J., Bőthe, B., Tóth-Király, I., & Paskuj, B. (2016). On the correlates of passion for screen-based behaviors: The case of impulsivity and the problematic and non-problematic Facebook use and TV series watching. Personality and Individual Differences, 101, 167-176.

Spangler, T. (2013). Poll of online TV watchers finds 61% watch 2-3 episodes in one sitting at least every few weeks. Variety, December 13. Located at: http://variety.com/2013/digital/news/netflix-survey-binge-watching-is-not-weird-or-unusual-1200952292/

Sussman, S., & Moran, M.B. (2013). Hidden addiction: Television. Journal of Behavioral Addictions, 2(3), 125-132.

Walton-Pattison, E., Dombrowski, S.U. & Presseau, J. (2016). ‘Just one more episode’: Frequency and theoretical correlates of television binge watching. Journal of Health Psychology, doi:1359105316643379

Watch this space: Another look at box-set bingeing

Regular readers of my blog will know that I have both a professional and personal interest in ‘box set binging’ – people like myself who sit and watch a whole television series at once either on DVD or on television catch-up services (see my two previous articles on the topic here and here). In my previous blogs on the topic I noted there was a lack of published academic research on the topic. However, a new study on the phenomenon – ‘Just one more episode’: Frequency and theoretical correlates of television binge watching’ – has just been published by Emily Walton-Pattison and her colleagues in the Journal of Health Psychology. The paper argues that binge watching may have detrimental health implications and that binge watching has impulsive aspects. As the authors noted in their paper:

“With the emergence of online streaming television services, watching television has never been so easy and a new behavioural phenomenon has arisen: television binge watching, that is, viewing multiple episodes of the same television show in the same sitting. Watching television is the most widespread leisure-time sedentary activity in adults (Wijndaele et al., 2010), involving little metabolic activity (Hu et al., 2003). In the United Kingdom, over one-third of adults spend at least four hours a day watching television (Stamatakis et al., 2009). Up to 33% of men and 45% of women in the United Kingdom fail to achieve recommended physical activity levels (Craig and Mindell, 2014). As lack of physical activity is the fourth leading mortality risk factor (World Health Organization, 2010), identifying factors that pre- vent achieving health-protective levels of physical activity remains important Furthermore, sedentary behaviour is linked with adverse health outcomes independently of physical activity (Veerman et al., 2012). Time spent watching television is also linked with obesity and reduced sleep time (Vioque et al., 2000). Understanding the factors that lead to watching television at ‘binge’ levels may help to target interventions to reduce sedentary activity and obesity rates and improve sleep hygiene”.

The study involved 86 people who completed an online survey that assessed (among other things) outcome expectations (assessed via six attitudinal items such as ‘Watching more than two episodes of the same TV show in the same sitting over the next 7 days will lead me to be physically healthier’), proximal goals (assessed via one question ‘On how many days do you intend to watch more than two episodes of the same TV show in the same sitting over the next 7 days?’), self-efficacy (assessed via five attitudinal items such as ‘I am confident that I can stop myself from watching more than two episodes of the same TV show if I wanted to’), anticipated regret (assessed via two items – ‘If I watched more than two episodes of the same TV show in the same sitting in the next 7 days, I would feel regret’ and ‘If I watched more than two episodes of the same TV show in the same sitting in the next 7 days I would later wish I had not’), goal conflict (with two items such as ‘How often does it happen that because of watching more than two episodes of the same TV show in the same sitting, you do not invest as much time in other pursuits as you would like to?’), goal facilitation (assessed via three items such as ‘Watching more than two episodes of the same TV show in the same sitting in the next 7 days will help/facilitate my participation in regular physical activity’), and self-reported binge watching over the last week (defined as “watching more than two episodes of the same TV show in one sitting”), as well as noting various demographic details (age, gender, marital status, number of children, and body mass index).

The study found that their participants reported binge watching at least once a week (an average of 1.42 days/week) and that binge watching was predicted most by intention and outcome expectations. Automaticity, anticipated regret, and goal conflict also contributed to binge watching. Based on their results, the authors noted:

“The findings have implications for theory development and intervention…The role of automaticity suggests that interventions aiming to address problematic binge watching (e.g. due to increased sedentary activity) could consider techniques that address automaticity. For example, some online streaming services include in-built interruptions after a number of consecutive episodes have been viewed. There would be opportunities to harness these interruptions. Goal conflict findings indicated that participants who reported more binge watching also reported that binge watching undermined other goal pursuits. Linking such findings to an intervention addressing anticipated regret could provide a useful opportunity…Drawing upon the addiction literature in relation to other types of binge behaviours may further refine potential appetitive and loss of control features that may extend from addictive behaviours with a binge potential, such as eating, sex and drugs, to binge watching”.

Obviously the study relied on self-reports among a small sample of television viewers but given that this is the first-ever academic study of binge watching, it provides a basis for further research to be carried out. As in my own research into gambling where we have begun to use tracking data provided by gambling companies, the authors also note that such objective measures could also be used in the field of researching into television binge watching:

“[Future research] could include using objective measures of binge watching including ecological momentary assessment, ambient sound detection, recording and/or partnering with streaming firms or software-based monitoring. Further insight into binge watching could make a distinction between television show-specific factors, such as genre, length, real-time versus on-demand services, as well as contextual factors (e.g., where binge watching occurred, with whom and when) and assess the association between binge watching and health outcomes including physical activity, eating and sleep hygiene”.

This is one of the first times I can end one of my articles by saying that this is literally a case of “watch this space”!

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

Further reading

Bates, D. (2015). Watching TV box-set marathons is warning sign you’re lonely and depressed – and will also make you fat. Daily Mail, January 29. Located at: http://www.dailymail.co.uk/health/article-2931572/Love-marathon-TV-session-warning-sign-lonely-depressed.html

Craig, R. & Mindell, J. (2014). Health Survey for England 2013. London: The Health & Social Care Information Centre.

Daily Edge (2014). 11 signs of you’re suffering from a binge-watching problem. Located at: http://www.dailyedge.ie/binge-watching-problem-signs-1391910-Apr2014/

Griffiths, M.D. (1995). Technological addictions. Clinical Psychology Forum, 76, 14-19.

Hu, F.B., Li, T.Y., Colditz, G.A., et al. (2003) Television watching and other sedentary behaviors in rela- tion to risk of obesity and type 2 diabetes mellitus in women. JAMA, 289, 1785–1791.

Kompare, D. (2006). Publishing flow DVD Box Sets and the reconception of television. Television & New Media, 7(4), 335-360.

Spangler, T. (2013). Poll of online TV watchers finds 61% watch 2-3 episodes in one sitting at least every few weeks. Variety, December 13. Located at: http://variety.com/2013/digital/news/netflix-survey-binge-watching-is-not-weird-or-unusual-1200952292/

Stamatakis, E., Hillsdon, M., Mishra, G., et al. (2009) Television viewing and other screen-based entertainment in relation to multiple socioeconomic status indicators and area deprivation: The Scottish Health Survey 2003. Journal of Epidemiology & Community Health, 63, 734–740.

Sussman, S., & Moran, M.B. (2013). Hidden addiction: Television. Journal of Behavioral Addictions, 2(3), 125-132.

Veerman, J.L., Healy, G.N., Cobiac, L.J., et al. (2012) Television viewing time and reduced life expec- tancy: A life table analysis. British Journal of Sports Medicine, 46, 927–930.

Vioque, J., Torres, A. & Quiles, J. (2000) Time spent watching television, sleep duration and obesity in adults living in Valencia, Spain. International Journal of Obesity, 24, 1683–1688.

Walton-Pattison, E., Dombrowski, S.U. & Presseau, J. (2016). ‘Just one more episode’: Frequency and theoretical correlates of television binge watching. Journal of Health Psychology, doi:1359105316643379

Wijndaele, K., Brage, S., Besson, H., et al. (2010) Television viewing time independently predicts all-cause and cardiovascular mortality: The EPIC Norfolk study. International Journal of Epidemiology, 40, 150–159.

Tech your time: 12 top tips for a digital detox

Over the last few years there has been increasing use of the term ‘digital detox’. According to the Oxford Dictionary, digital detox is “a period of time during which a person refrains from using electronic devices such as smartphones or computers, regarded as an opportunity to reduce stress or focus on social interaction in the physical world”. I have to admit that I often find it hard to switch off from work (mainly because I love my job). Given that my job relies on technology, by implication it also means I find it hard to switch off from technology. Today’s blog is as much for me as anyone reading this and provides some tips on how to cut down on technology use, even if it’s just for the weekend or a holiday. I have compiled these tips from many different online articles as well as some of my own personal strategies. 

Digitally detox in increments: For some people, going a few minutes without checking their smartphone or emails is difficult. For many, the urge is reflexive and habitual. If you are one of those people, then ‘baby steps’ are needed. Such individuals need to learn to digitally detox in small increments (i.e., go on a ‘digital diet’). Start by proving to yourself that you can go 15 minutes without technology. Over time, increase the length of time without checking (say) Twitter, Facebook and emails (e.g., 30 minutes, 60 minutes, a couple of hours) until you get into a daily habit of being able to spend a few hours without the need to be online. Another simple trick is to only keep mobile devices partially topped up. This means users have to be sparing when checking their mobile devices.

Set aside daily periods of self-imposed non-screen time: One of the secrets to cutting down technology use to acceptable levels is to keep aside certain times of the day technology-free (meal times and bedtime are a good starting place – in fact, these rooms should be made technology-free). For instance, I rarely look at any emails between 6pm and 8pm as this is reserved for family time (e.g., cooking and eating dinner with the family). Another strategy to try is having a technology-free day at the weekends (e.g., not accessing the internet at all for 24 hours). However, watching television or using an e-reader is fine. Another simple strategy is to have technology-free meal times (at both home and work). Don’t bring your smartphone or tablet to the table.

Only respond to emails and texts at specific times of the day: Only a few individuals are ‘on call’ and have to assume that the message they receive will be an emergency. Looking at emails (say) just three times a day (9am, 1pm, 4pm) will save lots of time in the long run. Turning off email and social media, disabling push notifications, or simply turning the volume setting to silent on electronic devices will also reduce the urge to constantly check mobile devices.

Don’t use your smartphone or tablet as an alarm clock: By using a standard alarm clock to wake you in the morning, you will avoid the temptation to look at emails and texts just as you are about to go to sleep or just wake up (or in the middle of the night if you are a workaholic!).

Engage in out-of-work activities where it is impossible (or frowned upon) to use technology: Nowadays, leisure activities such as going to the pub, having a meal, or going to the cinema, don’t stop people using wireless technology. By engaging in digitally incompatible activities where it is impossible to access technology simultaneously (e.g., jogging, swimming, meditation, outdoor walks in wi-fi free areas) or go to places where technology is frowned upon (e.g., places of worship, yoga classes, etc.) and individual will automatically decrease the amount of screen time. In social situations, you can turn people’s need to check their phones into a game. For instance, in the pub, you could have a game where the first one to check their phone has to buy a round of drinks for everyone else.

Tell your work colleagues and friends you are going on a digital detox: Checking emails and texts can become an almost compulsive behaviour because of what psychologists have termed ‘FOMO’ (fear of missing out) that refers to the anxiety that an interesting or exciting event may be happening elsewhere online. By telling everyone you know that you will not be online for a few hours, they will be less likely to contact you in the first place and you will be less likely check for online messages in the first place. Alternatively, Put your ‘out-of-office’ notification on for a few hours and do something more productive with your time.

Reduce your contact lists: One way to spend less time online is to reduce the number of friends on social networking sites, stop following blogs (but not mine, of course!), delete unused apps, and unsubscribe from online groups that have few benefits. Also, delete game apps that can be time-consuming (e.g., Angry Birds, Candy Crush Saga, etc.).

Get a wristwatch: One of the most common reasons for looking at a smartphone or a tablet is to check the time. If checking the time also leads to individuals noticing they have a text, email or tweet, they will end up reading what has been sent. By using an old fashioned wristwatch (as opposed to new smart watches like the Apple Watch), the urge to reply to messages will decrease.

Think about the benefits of not constantly being online: If you are the kind of person that responds to emails, texts and tweets as they come in, you will write longer responses than if you look at them all in a block. The bottom line is that you can save loads of time to spend on other things if you didn’t spend so long constantly reacting to what is going on in the online world.

Enjoy the silence: Too many people fail to appreciate being in the moment and allowing themselves to resist the urge to log onto their laptops, mobiles and tablets. It is at these times that some people might interpret as boredom that we can contemplate and be mindful. This could be made more formal by introducing meditation into a daily routine. There are also many places that run whole weekends and short breaks where technology is forbidden and much of the time can be spent in quiet contemplation. 

Fill the void: To undergo digital detox for any length of time, an individual has to replace the activity with something that is as equally rewarding (whether it is physically, psychologically or spiritually). When I’m on holiday, I catch up on all the novels that I’ve been meaning to read. In shorter spaces of time (such as sitting in boring meetings) I doodle, write ‘to do’ lists, generate ideas to write about, or simply do nothing (and be mindful, aware of the present moment). In short, I try to productive (or unproductive) without having to resort to my technology. 

Use technology to beat technology: One thing that can shock technology users is how much time they actually spend on their mobile devices. Working out how much time is actually spent online can be the first step in wanting to cut down. (For instance, someone I once worked with was shocked to find he had spent 72 [24-hour] days in one year playing World of Warcraft). Tech users can download apps that tell them how much time spending online, (e.g., Moment). Being made aware of a problem is often the first step in enabling behavioural change.

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

Further reading

Goodnet (2013). 7 steps to planning your next digital detox. October 22. Located at: http://www.goodnet.org/articles/7-steps-to-planning-your-next-digital-detox

Hosseini, M.D. (2013). Top 10 tips to unplug this summer with a digital detox. Advertising Week Social Club, June 28. Located at: http://www.theawsc.com/2013/06/28/top-10-tips-to-unplug-this-summer-with-a-digital-detox/

Huffington Post (2013). 10 digital detox vacation hacks to help you truly unplug. July 31. Located at: http://www.huffingtonpost.com/2013/07/31/vacation-hacks-_n_3676474.html

Levy, P. (2015). 15 tips for a total digital detox. Mind Body Green, January 15. Located at: http://www.mindbodygreen.com/0-17030/15-tips-for-a-total-digital-detox.html

Lipman, F. (2015). 12 tips for your next digital detox. March 2. Located at: http://www.drfranklipman.com/shake-it-off-12-tips-for-your-next-digital-detox/

Lipman, F. (2014). 8 ways to disconnect from technology and get more done. November 5. Located at: http://www.drfranklipman.com/8-ways-to-disconnect-from-technology-and-get-more-done/

South China Morning Post (2015). Five tips for a digital detox. Located at: http://www.scmp.com/lifestyle/technology/article/1673273/five-tips-digital-detox

Vozza, S. (2013). A realistic digital detox in 5 easy steps. Entrepreneur, November 12. Located: http://www.entrepreneur.com/article/229783

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

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

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Further reading

Bowman, N. D., Schultheiss, D., & Schumann, C. (2012). ‘‘I’m attached, and I’m a good guy/gal!’’: How character attachment influences pro- and anti-social motivations to play massively multiplayer online role-playing games. CyberPsychology, Behavior and Social Networking, 15(3), 169-174.

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

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

Griffiths, M. D. (2010). The role of context in online gaming excess and addiction: Some case study evidence. International Journal of Mental Health and Addiction, 8, 119-125.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

Further reading

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ringing the changes: Can disordered mobile phone use be considered a behavioural addiction?

Over the last decade, I have published various papers on excessive mobile phone use both in general and related to particular aspects of mobile phone use (such as gambling and gaming via mobile phones (see ‘Further reading’ below). Recently, some colleagues and I (and led by Dr. Joël Billieux) published a new review in the journal Current Addiction Reports examining disordered mobile phone use.

I don’t think many people would say that their lives are worse because of mobile phones as the positives appear to greatly outweigh the negatives. However, in the scientific literature, excessive mobile phone use has been linked with self-reported dependence and addiction-like symptoms, sleep interference, financial problems, dangerous use (phoning while driving), prohibited use (phoning in banned areas), and mobile phone-based aggressive behaviours (e.g., cyberbullying).

Despite accumulating evidence that mobile phone use can become problematic and lead to negative consequences, its incidence, prevalence, and symptomatology remain a matter of much debate. For instance, our recent review noted that prevalence studies conducted within the last decade have reported highly variable rates of problematic use ranging from just above 0% to more than 35%. This is mainly due to the fact most studies in the field have been conducted in the absence of a theoretical rationale.

Too often, excessive mobile phone use has simply been conceptualized as a behavioural addiction and subsequently develop screening tools using items adapted from the substance use and pathological gambling literature, without taking into account either the specificities of mobile phone “addiction” (e.g., dysfunctional mobile phone use may often be related to interpersonal processes) or the fact that the most recent generation of mobile phones (i.e., smartphones) are tools that – like the internet – allow the involvement in a wide range of activities going far beyond traditional oral and written (SMS) communication between individuals (e.g., gaming, gambling, social networking, shopping, etc.).

The first scientific studies examining problematic mobile phone use (PMPU) were published a decade ago. Since then, the number of published studies on the topic has grown substantially. At present, several terms are frequently used to describe the phenomenon, the more popular being ‘mobile phone (or smartphone) addiction’, ‘mobile phone (or smartphone) dependence’ or ‘nomophobia’ (that refers to the fear of not being able to use the mobile phone).

PMPU is generally conceptualized as a behavioural addiction including the core components of addictive behaviours, such as cognitive salience, loss of control, mood modification, tolerance, withdrawal, conflict and relapse. Accordingly, the criteria (and screening tools developed using such criteria) that have been proposed to diagnose an addiction to the mobile phone have been directly transposed from those classifying and diagnosing other addictive behaviours, i.e., the criteria for substance use and pathological gambling. For example, in a recent study published in the Journal of Behavioral Addictions, Dr. Peter Smetaniuk reported a prevalence of PMPU around 20% in U.S. undergraduate students using adapted survey items that were initially developed to diagnose disordered gambling.

Although many scholars believe that PMPU is a behavioural addiction, evidence is still lacking that either confirms or rejects such conceptualization. Indeed, the fact that this condition can be considered as an addiction is to date only supported by exploratory studies relying on self-report data collected via convenience samples. More specifically, there is a crucial lack of evidence that similar neurobiological and psychological mechanisms are involved in the aetiology of mobile phone addiction compared to other chemical and behavioural addictions. Such types of evidence played a major role in the recent recognition of Gambling Disorder and Internet Gaming Disorder as addictive disorders in the latest (fifth) addiction of the DSM (i.e., DSM-5) In particular, three key features of addictive behaviours, namely loss of control, tolerance and withdrawal, have – to date – received very limited empirical support in the field of mobile phone addiction research.

Given these concerns, it appears that the empirical evidence supporting the conceptualization of PMPU as a genuine addictive behaviour is currently scarce. However, this does not mean that PMPU is not a genuine addictive behaviour (at least for a subgroup of individuals displaying PMPU symptoms), but rather that the nature and amount of the available data at the present time are not sufficient to draw definitive and valid conclusions. Therefore, further studies are required. In particular, longitudinal and experimental research is needed to obtain behavioural and neurobiological correlates of PMPU. In the absence of such types of data, all attempts to consider PMPU within the framework of behavioural addictions will remain tentative. It is worth noting here that it took decades of empirical research before disordered gambling was officially recognized as an addiction (as opposed to a disorder of impulse control) in the DSM-5.

The current conceptual chaos surrounding PMPU research can also be related to the fact that while the number of empirical studies is growing quickly, these studies have (to date) primarily been based on concepts borrowed from other disorders (e.g., problematic Internet use, pathological gambling, substance abuse, etc.). This approach is atheoretical and lacks specificity with regard to the phenomenon under investigation. In fact, by adopting such a ‘confirmatory approach’ relying on deductive quantitative studies, important findings that are unique to the experience of PMPU have been neglected. As an illustration, no qualitative analyses of PMPU exist, and only a few models have been proposed. This implies that most studies have been conducted without a theoretical rationale that goes beyond transposing what is known about addictions in the analysis of PMPU.

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

Additional input: Joël Billieux, Pierre Maurage, Olatz Lopez-Fernandez and Daria J. Kuss

Further reading

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

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

Billieux, J., Maurage, P., Lopez-Fernandez, O., Kuss, D.J. & Griffiths, M.D. (2015). Can disordered mobile phone use be considered a behavioral addiction? An update on current evidence and a comprehensive model for future research. Current Addiction Reports, 2, 154-162.

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

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

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

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

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

Lopez-Fernandez, O., Kuss, D.J., Griffiths, M.D., & Billieux, J. (2015). The conceptualization and assessment of problematic mobile phone use. In Z. Yan (Ed.), Encyclopedia of Mobile Phone Behavior (Volumes 1, 2, & 3) (pp. 591-606). Hershey, PA: IGI Global.

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

Net losses: Another look at problematic online gaming

I have examined problematic and/or addictive video gaming in a number of my previous blogs. Despite the increasing amount of empirical research into problematic online gaming, the phenomenon still sadly lacks a consensual definition. Some researchers (including myself, and others such as John Charlton and Ian Danforth) consider video games as the starting point for examining the characteristics of this specific pathology, while other researchers consider the internet as the main platform that unites different addictive internet activities including online games (such as my friends and colleagues Tony Van Rooij and Kimberley Young). There are also recent studies that have made an effort to integrate both approaches (such as some work I carried out with Zsolt Demetrovics and his team of Hungarian researchers in the journal PLoS ONE).

I have noted in a number of my papers on addiction (particularly in a paper I had published in a 2005 issue of the Journal of Substance Use) that although each addiction has several particular and idiosyncratic characteristics, they have more commonalities than differences that may reflect a common etiology of addictive behaviour. Using the ‘components’ model of addiction, within a biopsychosocial framework, I consider online game addiction a specific type of video game addiction that can be categorized as a nonfinancial type of pathological gambling. I developed the components of video game addiction theory by modifying Iain Brown’s earlier addiction criteria. These are:

(1) Salience: This is when video gaming becomes the most important activity in the person’s life and dominates his/her thinking (i.e., preoccupations and cognitive distortions), feelings (i.e., cravings) and behaviour (i.e., deterioration of socialized behaviour);

(2) Mood modification: This is the subjective experience that people report as a consequence of engaging in video game play (i.e. they experience an arousing ‘buzz’ or a ‘high’ or, paradoxically, a tranquillizing and/or distressing feel of ‘escape’ or ‘numbing’).

(3) Tolerance: This is the process whereby increasing amounts of video game play are required to achieve the former effects, meaning that for persons engaged in video game playing, they gradually build up the amount of the time they spend online engaged in the behaviour.

(4) Withdrawal symptoms: These are the unpleasant feeling states or physical effects that occur when video gaming is discontinued or suddenly reduced, for example, the shakes, moodiness, irritability, etc.

(5) Conflict: This refers to the conflicts between the video game player and those around them (i.e., interpersonal conflict), conflicts with other activities (e.g., job, schoolwork, social life, hobbies and interests) or from within the individual themselves (i.e., intrapsychic conflict and/or subjective feelings of loss of control) which are concerned with spending too much time engaged in video game play.

(6) Relapse: This is the tendency for repeated reversions to earlier patterns of video game play to recur and for even the most extreme patterns typical at the height of excessive video game play to be quickly restored after periods of abstinence or control.

John Charlton and Ian Danforth analyzed these six criteria and found that tolerance, mood modification and cognitive salience were indicators of high engagement, while the other components – withdrawal symptoms, conflict, relapse and behavioural salience – played a central role in the development of addiction.

Researchers such as Guy Porter and Vladan Starcevic don’t differentiate between problematic video game use and problematic online game use. They conceptualized problematic video game use as excessive use of one or more video games resulting in a preoccupation with and a loss of control over playing video games, and various negative psychosocial and/or physical consequences. Their criteria for problematic video game use didn’t include other features usually associated with dependence or addiction, such as tolerance and physical symptoms of withdrawal, because in their opinion there is no clear evidence that problem video game use is associated with these phenomena.

Arguably the most well known representative of the internet-based approach is Kimberley Young who developed her theoretical framework for problematic online gaming based on her internet addiction criteria which were based on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders – (Fourth Edition, DSM-IV) criteria for pathological gambling. Her theory states that online game addicts gradually lose control over their game play, that is, they are unable to decrease the amount of time spent playing while immersing themselves increasingly in this particular recreational activity, and eventually develop problems in their real life. The idea that internet/online video game addiction can be assessed by the combination of an internet addiction score and the amount of time spent gaming are also reflective of the internet-based approach.

Integrative approaches try to take into consideration both aforementioned approaches. For instance, a 2010 paper by M.G. Kim and J. Kim in Computers in Human Behavior claimed that neither the first nor the second approach can adequately capture the unique features of online games such as Massively Multiplayer Online Role-Playing Games (MMORPGs), therefore it’s absolutely necessary to create an integrated approach. They argued that “internet users are no more addicted to the internet than alcoholics are addicted to bottles” which means that the internet is just one channel through which people may access whatever content they want (e.g., gambling, shopping, chatting, sex, etc.) and therefore users of the internet may be addicted to the particular content or services that the Internet provides, rather than the channel itself. On the other hand, online games differ from traditional stand-alone games, such as offline video games, in important aspects such as the social dimension or the role-playing dimension that allow interaction with other real players.

Their multidimensional Problematic Online Game Use (POGU) model reflects this integrated approach fairly well. It was theoretically developed on the basis of several studies and theories (such as those by Iain Brown, John Charlton, Ian Danforth, Kimberley Young and myself), and resulted in five underlying dimensions: euphoria, health problems, conflict, failure of self-control, and preference of virtual relationship. A 2012 study I carried out with Zsolt Demetrovics and his team also support the integrative approach and stresses the need to include all types of online games in addiction models in order to make comparisons between genres and gamer populations possible (such as those who play online Real-Time Strategy (RTS) games and online First Person Shooter (FPS) games in addition to the widely researched MMORPG players). According to this model, six dimensions cover the phenomenon of problematic online gaming – preoccupation, overuse, immersion, social isolation, interpersonal conflicts, and withdrawal. Personally, I believe that online game addiction can be defined as one type of behavioural addiction. In fact ‘internet gaming disorder’ has just been included in the appendices of the new DSM-5 in order to encourage research to determine whether this particular condition should be added to the manual as a disorder in the future.

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

Additional input: Orsolya Pápay, Katalin Nagygyörgy and Zsolt Demetrovics

Further reading

Charlton, J. P., & Danforth, I.D.W. (2007). Distinguishing addiction and high engagement in the context of online game playing. Computers in Human Behavior, 23(3), 1531-1548.

Demetrovics, Z., Urbán, R., Nagygyörgy, K., Farkas, J., Griffiths, M.D., Pápay, O. & Oláh, A. (2012). The development of the Problematic Online Gaming Questionnaire (POGQ). PLoS ONE, 7(5): e36417. doi:10.1371/journal.pone.0036417.

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

Han, D. H., Hwang, J. W., & Renshaw, P. F. (2010). Bupropion sustained release treatment decreases craving for video games and cue-induced brain activity in patients with Internet video game addiction. Experimental and Clinical Psychopharmacology, 18, 297-304.

Kim, M.G., & Kim, J. (2010). Cross-validation of reliability, convergent and discriminant validity for the problematic online game use scale. Computers in Human Behavior, 26(3), 389-398.

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

Peters, C. S., & Malesky, L. A. (2008). Problematic usage among highly-engaged players of massively multiplayer online role playing games. Cyberpsychology & Behavior, 11(4), 480-483.

Pontes, H. & Griffiths, M.D. (2014). The assessment of internet gaming disorder in clinical research. Clinical Research and Regulatory Affairs, 31(2-4), 35-48.

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

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

Porter, G., Starcevic, V., Berle, D., & Fenech, P. (2010). Recognizing problem video game use. The Australian and New Zealand Journal of Psychiatry, 44, 120-128.

Van Rooij, A. J., Schoenmakers, T. M., Vermulst, A. A., Van den Eijnden, R. J., & Van de Mheen, D. (2011). Online video game addiction: identification of addicted adolescent gamers. Addiction, 106(1), 205-212.

Young, K. S. (1998a). Caught in the Net: How to recognize the signs of Internet addiction and a winning strategy for recovery. New York: Wiley.

Young, K. S. (1999). Internet addiction: Symptoms, evaluation, and treatment. In L. Vande Creek & T. Jackson (Eds.), Innovations in clinical practice: A source book (pp. 17, 19–31). Sarasota, FL: Professional Resource Press.

Coining it in: Neologisms and ‘New Syndrome’ Syndrome

One of things I am very proud of in my academic career is the coining of the term ‘technological addiction’ back in 1995 (an umbrella term that I invented to describe a number of different person-machine addictions including slot machine addictions, video game addiction, television addiction, etc.). I’m also proud of coining the term ‘aca-media’ (relating to academics like myself that use the media to disseminate our research). A neologism (i.e., the name for a newly coined term) is often (according to Wikipedia) directly attributable to a specific event, person, publication, or period.

In the 1980s and early 1990s, there seemed to be a real upsurge is the naming of ‘new syndromes’ in the medical literature including many relating to excessive use of technology (such as ‘Space Invader’s Wrist’) and other leisure activities (such as ‘Cuber’s Thumb’ relating to excessive use of the Rubik’s Cube) – both of which made their appearance in 1981 issues of the New England Journal of Medicine. Other videogame medical complaints include ‘Pseudovideoma’ (in a 1984 issue of the Journal of Hand Surgery), ‘Pac-Man Phalanx’ (in a 1983 issue of Arthritis and Rheumatism) and ‘Joystick Digit’ (in a 1987 issue of the Journal of the American Medical Association). Another videogame-related medical complaint (in this case an infection), was reported in a 1987 issue of the Western Journal of Medicine by Dr. G.B. Soe and colleagues:

“We wish to focus WJM readers’ attention on another complication associated with video games-one that originally presented as an “infected spider bite. A 17-year-old right-handed boy noted progressive swelling and redness of his left hand seven days before admission. Two days before admission he was given penicillin intramuscularly and oral cephalexin to take at home. The swelling did not subside and the hand became very painful, so he came to the medical center for treatment. On admission his mother reported that she had seen many spiders around the house with a violin pattern on their backs, and that her son had probably been bitten by a spider…After seven days of parenteral antibiotic therapy, the edema, erythema and fever had disappeared and the patient was discharged home. Further questioning revealed that the young man was spending almost all of his time playing his favorite video game, which involved a fighting kung fu character. The patient used his left hand in manipulating a ball-shaped joystick to move the figure up, down, left and right, and his right in operating buttons to kick and jab. Extensive use of the joystick resulted in blisters on his left palm. He rubbed the blisters off, and an infection resulted that progressed to abscess formation. Neuromuscular complications of video games (‘pseudovideoma’, ‘Pac-Man phalanx’, ‘firing-finger syndrome’ and ‘Space Invaders wrist’) have been reported, as well as video game-induced seizures, but we have not come across any reports of an infectious complication of video games. Perhaps video game players should wear gloves to protect their palms, similar to ones worn by golfers and baseball players, who also need to get a firm grip on their respective sticks”.

Another one that I’d never heard of is ‘Nurd Knuckles’ coined by Dr. J.B. Martin in the Canadian Medical Association Journal in 1982:

“I wish to describe a case of painful knuckles associated with the use and manipulation of a new, allegedly therapeutic product, a Nurd. A Nurd is a head 10 cm across with a smiling face and large ears, reminiscent of the character Yoda of ‘Star Wars’. It is made of malleable material that can be stretched, twisted or deformed in any direction, yet with release of tension quickly resumes its original shape without a trace of distortion. A 32-year-old public school teacher presented with painful knuckles of his right hand. His students, perhaps feeling that their teacher was under increased stress during the marking of exams, had given him a Nurd for Christmas, and during a particularly trying day he had found occasion to use it. He repeatedly stretched its ears and twisted its neck without ill effect; however, on punching it he suffered sharp pain of his fourth and fifth metacarpophalangeal joints. On examination the joints were found to be reddened, with point tenderness over the fifth metacarpal head; there was no evidence of deformity. He was advised to stop beating his Nurd, and the pain subsided. While the Nurd is very plastic, yielding to the linear tension of stretching and twisting, it is very resistant to compression. Punching a Nurd does not cause the surface to give way, and, since the force of the blow is returned to the fist, it is conceivable that a fracture might result. Therefore, although stretching and twisting Nurds does not cause any harm, users should be cautioned against punching their Nurd. The Nurd is advertised as being a ‘punchable, stretchable, pushable and likeable alternative to tension, migraine headaches, drug abuse, alcoholism and manic depression’, but these claims are unsubstantiated. A MEDLINE search of the medical literature shows that no retrospective or prospective case control studies or controlled double blind crossover studies have been undertaken. Before the clinical efficacy of the Nurd can be taken seriously in the treatment of this broad spectrum of disease, full clinical trials must be completed. Subjects entering into trials must, however, be duly informed of the hazards of punching Nurds”.

Another one that caught my attention was a new affliction (‘Breaker’s Neck’) caused by the craze of ‘break dancing’ reported by Dr. Bertha Ramirez and her colleagues in a 1984 issue of the Journal of the American Medical Association. (The reason why I say it caught my eye is that I am currently involved in some research on ‘dancing addiction’ with some of my Hungarian colleagues and we have just had a new paper accepted in the journal PLoS ONE concerning the development of our ‘Dancing Motives Inventory’ – see ‘Further Reading’ below).

“To be added to the rapidly growing list of socially acquired injuries, we report a case of traumatic cervical subluxation caused by a new dance technique. This technique, labeled ‘breaking’ by its devotees, involves a modified head stand, in which the dancer, using his arms and hands for balance, spins rapidly on his head, neck, or shoulders to the rhythm of disco music. He then lowers his body to the floor and performs a series of rotational motions using his arms as a fulcrum…A 15-year-old boy was seen in our pediatric emergency room complaining that, on awakening two days previously, he felt a ‘snap’ in his neck, followed by persistent neck stiffness. He reported having ‘danced on his head’ the night prior to this incident. On physical examination, his head was tilted to the left with an inability to flex”.

Engaging in excessive sporting activity has given rise to a number of medical syndromes. One such consequence is ‘Rower’s Rump’ reported by Drs. K Tomecki and J. Mikesell in a 1987 issue of the Journal of the American Academy of Dermatology. In a previous blog I examined addiction to cycling. In the 1980s there were many medical complaints reported as a result of excessive cycling. One such complaint (given the name of ‘Bicycling nipples’) was highlighted by Dr. B. Powell in a 1983 issue of the Journal of the American Medical Association:

“Bicyclists are likely to suffer from a number of maladies, including dysuria, numb penises, and more. During cool or cold weather, another problem, bicyclist’s nipples, may occur. This condition is similar to jogger’s nipples, but it is primarily a thermal injury instead of an irritation secondary to friction, as with the jogger’s complaint. Often the rider is out in the cold weather for some time, and his or her undershirt, jersey, and jacket can become moist from perspiration. Evaporation and the chill of the wind lower the temperature of the nipples. They get downright cold, and they hurt. The pain continues after the ride is over. Indeed, it can continue for several days. The nipples are sore, sensitive to both temperature change and touch”.

After reading this I found out that Dr. Fred Levit had reported a case of ‘Jogger’s Nipples’ in a 1977 issue of the New England Journal of Medicine. All of these related nipple conditions are all examples of fissure of the nipple as they are all caused by friction resulting in soreness, dryness or irritation to, or bleeding of, one or both nipples. The Wikipedia entry also notes that “the condition is also experienced by women who breastfeed, and by surfers who do not wear rash guards”. The article also noted that:

“Jogger’s nipple is caused by friction from the repeated rubbing of a t-shirt or other upper body clothing against the nipples during a prolonged period of exercise. The condition is suffered mainly by runners. Long-distance runners are especially prone, because they are exposed to the friction on the nipple for the greatest period of time. However, it is not only suffered by athletes; the inside of a badge, a logo on normal items of clothing, or breastfeeding can also cause the friction which results in this condition”.

Outside of the leisure sphere, there were two case study reports of ‘Diaper Doer’s Hand’ in a 1987 issue of the journal Clinical Rehabilitation by Dr. J.L. Cosgrove and colleagues:

“Three cases of stenosing tenosynovitis occurred three to six months postpartum. Childcare activities aggravated the symptoms of pain and swelling in both patients. In two cases, a specific method of carrying the child was implicated as the mechanism of injury. Although there was no evidence of generalized inflammatory arthritis, all patients had very low positive titres of anti-nuclear antibodies. While it is likely that tenosynovitis was caused by mechanical factors, the possibility of increased susceptibility to inflammatory disease in the postpartum period cannot be discounted. The patients were successfully treated with a low temperature plastic splint, superficial heat and gentle mobilization”.

All of these new syndromes lead to why I put this article together in the first place. I found this letter in the British Medical Journal by Dr. E.P. Hoare entitled ‘New Syndrome Syndrome’ that I found both funny and poignant:

“Your readers will be familiar with tennis elbow, brazier’s ague, and soap packer’s jig not to mention Achilles’ heel. More recently we have heard of Space Invader’s wrist, jogger’s nipples, and the ultimate futility of Cuber’s thumb. May I point out another occupational disease which I have noticed among patrons of the reading room medical journal correspondence column reader’s neck or, more succinctly, the new syndrome syndrome. Symptoms usually begin with muscular contraction of the eyebrows, hyperventilation, and involuntary utterances, which in severe cases can lead to coprolalia. These may be followed by drowsiness, disorientation, hysterical amblyopia, and double vision (of the deja vu variety). If untreated the condition can result in a chronic pain in the neck. Treatment is 200 ml of gin and tonic stat by mouth and complete rest; music can also be helpful. The long-term prognosis is poor, however, unless journal editors can be persuaded to ban further reports of occupational afflictions or at least print a health warning at the head of their correspondence columns”.

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

Further reading

Behr, J.T. (1984). Pseudovideoma. Journal of Hand Surgery, 9(4), 613.

Cosgrove, J. L., Welch, D. A., Richardson, G. S., & Nicholas, J. J. (1987). Diaper doer’s hand: stenosing tenosynovitis in the postpartum period. Clinical Rehabilitation, 1(3), 219-223.

Gibofsky, A. (1983). Pac‐Man phalanx. Arthritis and Rheumatism, 26(1), 120.

Griffiths, M.D. (1995). Technological addictions. Clinical Psychology Forum, 76, 14-19.

Griffiths, M.D. (1995). Pop psychology and “aca-media”: A reply to Mitchell. The Psychologist: Bulletin of the British Psychological Society, 8, 537-538.

Griffiths, M.D. (2001). A moral obligation in aca-media? The Psychologist: Bulletin of the British Psychological Society, 14, 460.

Hite, P. R., Greene, K. A., Levy, D. I., & Jackimczyk, K. (1993). Injuries resulting from bungee-cord jumping. Annals of emergency medicine, 22(6), 1060-1063.

Hoare, E.P. (1982). Points: New syndrome syndrome. British Medical Journal, 285(6352), 1429.

Levit, F. (1977). Jogger’s nipples. New England Journal of Medicine, 297(20), 1127.

Maraz, A., Király, O., Urbán, R., Griffiths, M.D., Demetrovics, Z. (2015). Why do you dance? Development of the Dance Motivation Inventory (DMI). PLoS ONE, in press.

Martyn, J. B. (1983). Nurd knuckles. Canadian Medical Association Journal, 129(3), 228.

McCowan, T.C. (1981). Space Invader’s wrist. New England Journal of Medicine, 304,1368.

Osterman, A. L., Weinberg, P., & Miller, G. (1987). Joystick digit. Journal of the American Medical Association, 257(6), 782.

Powell, B. (1983). Bicyclist’s nipples. Journal of the American Medical Association, 249(18), 2457-2457.

Ramirez, B., Masella, P. A., Fiscina, B., Lala, V. R., & Edwards, M. D. (1984). Breaker’s neck. Journal of the American Medical Association, 252(24), 3366-3367.

Soe, G.B., Gersten, L. M., Wilkins, J., Patzakis, M. J., & Harvey, J.P. (1987). Infection associated with joystick mimicking a spider bite. Western Journal of Medicine, 146(6), 748.

Tomecki, K. J., & Mikesell, J. F. (1987). Rower’s rump. Journal of the American Academy of Dermatology, 16(4), 890-891.

Torre, P. R., Williams, G. G., Blackwell, T., & Davis, C. P. (1993). Bungee jumper’s foot drop peroneal nerve palsy caused by bungee cord jumping. Annals of emergency medicine, 22(11), 1766-1767.

Waugh, D. (1981). Cuber’s thumb. New England Journal of Medicine, 305, 768.