OurTherapist Blog

What you need to know about Video Games, The Net, and Addictions

Friday, December 18, 2015

What You Need to Know about Video Games, the Net, and Addictions


This Blog is divided into a few sections; I wanted to start with a couple of typical examples to see if they fit what you are seeing or experiencing and your thoughts about each story.  Subsequent sections get into providing some information about video game and internet addiction and what we know about it.  I believe it is helpful to think of video games as “addictive”, rather than an “addiction”, which is a formal label suggesting a disorder.  While both ways of thinking can be true of different people, the idea is that you don’t need to be an “addict” to get some help to change a behaviour that is causing some problems.  This blog is intended to provide some information and to also be thought provoking.  

Meet John and Steve:

John is in high school and spends 4-5 hours per day playing video games and surfing the net, often looking for information about his favourite games or chatting about it.  He tends to play more on weekends, up to 8 hrs, and when his parents ask him to go out and hang out with friends, do homework, or go somewhere with them he gets agitated.  He would much rather play his games, which are way more fun. He goes to school, but has been sleeping less and less at nights and as a result is often groggy in the mornings and in his early classes.  Last week he missed his first class because he was just too tired.  John is a smart kid, and knows he can get A’s, but he’s getting B’s and a few C’s.  He’s not terribly concerned about it and is getting into conflict with his parents who are blaming everything on his video gaming.  He goes to school, and how he spends his free time is his concern.  His parents just don’t understand because they didn’t grow up with these games and don’t get that all of his friends play about the same amount.  

Steve is a student and started his first term in University living on campus in September.  He loves playing games, and without his parents nagging him found he started staying up most nights playing and missing first some, and then all of his classes.  He likes MMORPG’s, and is in a guild.  He would wake up with gaming on his mind, would get excited, and couldn’t wait till he started playing, advancing, and checking in with his guild.  He feels an attachment and responsibility towards his guild, and if he does not contribute he feel guilty. He tends to play 8-15 hours per day, depending.  He was shocked when he failed his first tests, and started lying to his parents about how he’s doing.  Over time, he started feeling depressed and the only thing that would make him feel great was playing.  He wasn’t drinking or doing drugs like other people, and didn’t see what the problem was.  Unfortunately Steve ended up failing his first term at school.  He decided his parents didn’t need to know.  He’ll just do better next term. 

Are Video Games Addictive?

In the past several years an increasing number of clients, parents, teachers, and therapists have been asking me about video gaming; and whether or not it can be an addiction.  Several colleagues had I have gained some expertise in this area through conducting research that we have presented internationally during the past few years.  This blog summarizes some of my thoughts on this question based on research and clinical experience.  

In General The Sooner Someone Gets Help, The Less Help They Need!

First, the dry update for the professionals: Video gaming is not listed as an addiction in the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) (where we list and define all psychological disorders).  However, Internet Gaming Disorder is listed in section III (conditions warranting more research and experience before being included as a formal disorder).  What that means is that this is not yet considered a formal disorder in psychology, but is being researched and it will most probably be included as a formal diagnosis in the future.  Other countries such as China do consider Video gaming as not only an addiction but a serious concern warranting state action including monitoring and controlling net use and involuntary military-like treatment centres dedicated to video game addiction.  The NY Times had a very interesting video on the Chinese solution which you can see here: 

NY Times China Web Junkies 

I’m certain that this video will create strong emotions in viewers, some of whom will find it quite shocking.  Clearly different countries have very strong thoughts about the label and seriousness of the issue and how to approach it and their ways may not resonate well with our thinking.  

So what’s an addiction anyways?

An addiction can be considered any behaviour which is habitual and hard to break and causes distress or harm to the person engaged in it, whether or not it includes ingesting a drug or substance.  “Harm” can include things like falling behind socially, academically, or occupationally; as well as emotional and even physiological problems. 

People sometimes think of addictions as only relating to abusing a substance and having absolutely no control over it, sort of like you see on TV shows like “intervention”.  We now know that behaviours, like gambling and sex, can be just as addicting as certain drugs and have their own negative consequences. Like any other problem or disorder, addictions also exist on a continuum from mild and barely a concern to severe and quite serious and therefore require different levels of help ranging from a simple advice from a trusted person or professional all the way to long term residential treatments.  So the first barrier to getting help for video gaming is that people often just don’t think it may be a problem and don’t seek help.

Once people think they may need some  help, they then often run into the problem of where to get the help.  I have seen existing treatment programs refuse to help someone struggling with excessive video gaming because it’s not listed as a “disorder”, or simply not know how to help them.  I would agree that people struggling with Video Game or internet problems should have their own separate kinds of treatment rather than being in a traditional addiction program.  Unfortunately such dedicated programs are greatly lacking in North America for Video Gaming and Net addictions.

What Makes Video Games Addictive?

Video games have many elements that make them addictive.  They are very fun and stimulating, they are designed and tested (sometimes by psychologists) to have optimal challenge levels to make people not get bored (if it’s too easy) or give up playing (if it’s too difficult).  In fact many of the reward systems that have proven so successful in making Video Lottery Terminals so addictive are also used in the development of video games.  The Avatars  (your in-game-representation) and gaming environments are so realistic that in game achievements become just as rewarding and “real” to people as real life achievements.  The gamer’s mind can get tricked into thinking that their game achievements are real while they slowly fall behind their peers in real life achievements.  

Game relationships (in guilds, chats, etc..) become real and sometimes take the place of real life relationships. The above make video games an extremely powerful form of entertainment; in fact the industry has now overtaken the movie industry as the most lucrative entertainment format netting billions of dollars per year for the industry.   

This isn’t necessarily bad; I’m all for good entertainment.  However for some people the game time and pattern does become excessive and takes the place of other important things such as school, work, and even social relations with real life family and friends.  This is especially true if the person is already struggling with friendships in the real world due to shyness, anxiety, or poor academic achievement caused by ADHD or just lack of proper motivation and skills. 

The idea that people need to have “disorders” or “diseases” before they get help is an old fashioned and even harmful notion.  This confusion gets in the way of people getting help they need and leads to the “I don’t need to see a psychologist for THAT” reaction.  Luckily most of my clients lose this concern after their first session.  Often gaining good insight into our behaviour is enough to prompt change, but of course sometimes we need more help.  If you have more questions about your own online or game activity or that of a loved ones contact me and I’ll be happy to help.

Anxiety and the Trojan Horse

Monday, September 29, 2014

It’s 2014 and my resolution is to start putting out more information for everyone about various mental health related topics.  To get things started I thought I’d talk about one of the most common emotional problems people struggle with: anxiety!  

Anxiety is caused by a belief that some negative outcome is associated with a future event.  For example, that I’m going to fail my exam next week, or that the lump I’m in my throat means I may have cancer.  Though we often think of anxiety as a “negative” emotion, it’s actually quite useful.  For example I may study really hard for that exam and do well in it, or my anxiety may motivate me to go get checked out and catch a nasty illness early and get the right treatment.  At least that’s the “intent” of anxiety, it’s supposed to motive us to take action to avoid the nasty outcome we fear.  Anxiety (and indeed all emotions) are meant to be helpful.  They give us information about the world in a general way and our job is to make sense of the emotion and come up with solutions to improve things.

But what if the thing I’m worrying about isn’t real, or doesn’t have an easy solution?  What if I have a pattern of thinking that I’m going to fail even if I always do well, or what if that pesky lump in the throat keeps coming back because I’m anxious about having cancer all the time?  In other words, what if the disaster I’m envisioning is illogical and a creation of my mind?  Whereas in the “good” anxiety examples above, I was able to do something and resolve the issue and happily go on with my life, the latter examples have no resolution because I will just come up with new things to worry about faster than I could deal with them.  This is what it means to be suffering from an anxiety disorder; a never ending (and often worsening) cycle of things to worry about.  We sometimes label these thoughts illogical, or give them fancy names like “cognitive distortions”. 

I wanted to talk a bit about why smart, logical people persist in having illogical thoughts that do them harm (or at the very least bother them quite a bit).  Take the person who worries daily about having cancer or heart problems despite constant assurance from Dr.’s that she’s fine.  I recently asked a patient suffering from something similar to this how they’d feel if a friend told them they think they have cancer.  Of course they’d be concerned.  Ah, but what if your friend was assured by Dr.’s that she’s fine, and then she thought she had a heart condition, and then cancer again, etc. etc. My patient had no trouble eventually coming to the conclusion that her friend is being a hypochondriac.   Indeed, we typically can easily identify other people’s illogical beliefs and cognitive distortions, so why do we struggle so much about our own?  

The answer to that question is simple.  It’s because our perceptions and beliefs about things appear real to us and indeed define our reality.  If I truly believed that someone hates me, that belief would be as real to me as my belief that it’s daytime outside.  Our brain is programmed to take our perceptions for granted and not to challenge them (though we are certainly capable of doing so).  In fact, there is no internal way to distinguish a real belief from a false one.  They both appear equally real to the believer.  What’s all this have to do with the Trojan Horse?  Well, we’re getting to that.  

Our minds can certainly make us feel miserable at times, but it it is well intentioned.  Fears or worries serve to protect us, and that’s exactly what the brain does; it tries to protect us by telling us to stay away from the feared object.  This is how cognitive distortions are like the Trojan Horse.  They appear benign and even helpful, so we take them in and accept them, but in reality they are destructive. Unfortunately our brains are not well designed to tell the difference between a “real” vs. an “illogical” belief and treat them both the same.  This is why simply being told to stop worrying about something doesn’t work:  it’s not logical to stop doing something that appears to protect you!  We need tools, taught through therapy, to teach us to separate rational from irrational fears and worries and to begin treating them differently.  Only then do we return the balance to where anxiety can once again become that useful and necessary emotion and not the destructive and debilitating one that it has become.

Copyright: Shervin Vakili

ADHD and the Pressure Valve Principle

Monday, September 22, 2014

ADHD and the Pressure Valve Principle!

George, my imaginary friend, has given me permission to share with you some stories about his life to help illustrate some concepts I want to discuss.  George and I hope that if you see some similarities in your experiences, you’ll gain some understanding about why you’re having that experience.  

A while ago George, (while watching an old episode of X-files with his girlfriend), had a brilliant idea for a topic for his upcoming sociology term paper.  He excitedly told his girlfriend all about it just as Scully was about to solve the case, and jotted the idea on a sticky note, then got up to get some pizza, and decided to call his friend Karen while he watched the rest of the show.  The sticky note was diligently moved from the coffee table to the top of a pile of school papers, which got moved to his desk, and through some odd series of events best left unexplained was last seen walking away stuck under the shoe of a shopper in a nearby shopping mall.  

During the next few weeks, George had several more brilliant ideas for the paper, he even started researching one of his topics in a moment of inspiration, but he forgets where he jotted down his research.  George began feeling a growing sense of dread and anxiety a week before the paper was due, which got worse every day, and finally three days before the due date (after deciding that asking for an extension due to illness was not going to work) a switch went off in his brain.  He went to the library and sat in a cubicle for six hours, completed his literature review, outlined a panicky derived idea, and working 14 hours per day for the next two days, completed his paper.  At the end, he felt exhausted, but elated.  There was a deep sense of accomplishment, strengthened when he received an A-.  That night, George wrote down his idea for a book he wanted to write on a sticky note while making himself a ham and cheese sandwich…

George’s pattern of doing things, which should be instantly recognizable to anyone with ADHD, is what I mean by the pressure valve principal.  George’s mind is almost incapable of starting or completing a project unless he feels a great deal of pressure about that project.  The pressure often gets built up as a result of a fast approaching deadline, or an unhappy boss, or nagging partner, etc.  At times people develop internal sources of pressure, such as a strong need for accomplishment.  


The ADHD mind, when properly motivated, can actually switch from a paralyzing inability to focus and function, into a hyper-focused machine capable of getting a great deal done in a short period of time.  If I graphed most people’s level of activity and output, I may see a relatively flat line, but the graph for the ADHD mind swings up and down like a yoyo.  Let’s look at this pattern more closely to see if George should maintain it or try and change it.

George received a great deal of positive feedback from the above pattern.  He got an A- and he only worked on the project for three days, while most of his friends spent a few weeks working on their paper and got the same grade as George.  George’s friends expressed some disbelief and jealousy about how George could accomplish that paper with only three days effort when they had to work on their project for three weeks.  This makes George feel superior and smart, and made it more likely that he’d do the same thing next time.  The problem is that in life we don’t always have externally set deadlines to help build that pressure.  For example George’s sticky note about writing his book never turned into an actual book, because there was no deadline for the book, and therefore no building pressure.  In fact, his inability to get going on his book and many other projects over time have made George doubt his abilities and have made him feel badly about himself.  While everyone praised him in University, George is now seeing that all the friends he used to feel superior to are now doing better at their jobs than he is, he just doesn’t know why. 

George's problems aren't because he's not smart, he needs tools to help him overcome the pressure principle.  It's never too late!

Copyright: Shervin Vakili