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I love view: Can Google Glass be addictive?

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

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

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

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

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

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

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Blocked-in syndrome: Another look at Game Transfer Phenomena

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

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

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

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Further reading

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

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

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

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

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

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