Treating Internet Gaming Disorder - Outback Therapeutic Expeditions

ELVES, DRAGONS & FOMO:

THE RELATIONSHIPS BETWEEN PSYCHOLOGICAL

PREDISPOSITIONS, GAMER CULTURE & SOCIAL MEDIA

JASON CALDER, LMFT, [email protected]

PRESENTATION OVERVIEWPRESENTATION OVERVIEW

• internet gaming disorderinternet gaming disorder•ComorbidityComorbidity•Psychological predispositionsPsychological predispositions•Theories to explain Underlying needsTheories to explain Underlying needs•Basic IGD treatment principlesBasic IGD treatment principles

TERMINOLOGYTERMINOLOGY

Of all the terms used to define this Of all the terms used to define this phenomenon, it is likely that the phrase phenomenon, it is likely that the phrase “Internet Gaming Disorder” will be the one “Internet Gaming Disorder” will be the one to stick since this is the diagnostic label the to stick since this is the diagnostic label the APA has settled upon. Let’s face it. They are APA has settled upon. Let’s face it. They are the 800 pound Gorilla in the room!the 800 pound Gorilla in the room!HTTP://WWW.DSM5.ORG/DOCUMENTS/INTERNET%20GAMING%20DISORDER%20FACT%20SHEET.PDF

MMORPG:MMORPG:THE “HEROIN” OF THE VIDEO GAME WORLDTHE “HEROIN” OF THE VIDEO GAME WORLD

• M: MassivelyM: Massively• M: MultiplayerM: Multiplayer• O: OnlineO: Online• R: RoleR: Role• P: PlayingP: Playing• G: GameG: Game

The Top Seven MMORPGs:The Top Seven MMORPGs:1.1.World of Warcraft (WoW)World of Warcraft (WoW)2.2.Guild Wars 2Guild Wars 23.3.Final Fantasy XIVFinal Fantasy XIV4.4.Elder Scrolls OnlineElder Scrolls Online5.5.Star Wars: The Old RepublicStar Wars: The Old Republic6.6.ArcheAgeArcheAge7.7.RunescapeRunescape

HTTP://MASSIVELYOP.COM/2015/06/11/PERFECT-TEN-THE-TOP-10-HEALTHIEST-LIVE-MMOS/

DOES IGD CONSTITUTE A “TRUE” DOES IGD CONSTITUTE A “TRUE” ADDICTION?ADDICTION?

Yes, it can. The American Society of Addiction Medicine (ASAM):“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.”HTTP://WWW.ASAM.ORG/QUALITY-PRACTICE/DEFINITION-OF-ADDICTION


Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.HTTP://WWW.ASAM.ORG/QUALITY-PRACTICE/DEFINITION-OF-ADDICTION


Numerous brain scan studies show a Numerous brain scan studies show a similarly enlarged ventral striatum in similarly enlarged ventral striatum in the brain scans of substance abusers the brain scans of substance abusers and video game addicts. Their brains and video game addicts. Their brains

look almost identical from a look almost identical from a neurological standpoint.neurological standpoint.


We need to be cautious about throwing the We need to be cautious about throwing the word “addiction” around casually. According to word “addiction” around casually. According to a national Harris Poll survey of 1,178 American a national Harris Poll survey of 1,178 American “gamers” (ages 8-18), only 1in 10 of them, 8.5 “gamers” (ages 8-18), only 1in 10 of them, 8.5 percent, met the criteria for Internet Gaming percent, met the criteria for Internet Gaming Disorder.Disorder.HTTP://WWW.NCBI.NLM.NIH.GOV/PUBMED/19476590

HISTORY OF INTERNET GAMING HISTORY OF INTERNET GAMING DISORDERDISORDER

• 1995: IAD originally proposed in a satirical 1995: IAD originally proposed in a satirical hoax by Ivan Goldberg, M.D.hoax by Ivan Goldberg, M.D.

• 1996: Dr. Kimberly Young draws national 1996: Dr. Kimberly Young draws national attention to “internet addiction”attention to “internet addiction”

• 2006: Europe’s first residential treatment 2006: Europe’s first residential treatment program for compulsive gaming opened in the program for compulsive gaming opened in the Netherlands.Netherlands.


• 2008: South Korea developed diagnostic criteria 2008: South Korea developed diagnostic criteria for this process addictionfor this process addiction

• 2009: reStart retreat center opened near 2009: reStart retreat center opened near Seattle,WASeattle,WA

• 2011: ASAM released that new definition of 2011: ASAM released that new definition of addiction as a chronic brain disorderaddiction as a chronic brain disorder

• 2011: South Korea enacted laws to restrict online 2011: South Korea enacted laws to restrict online gaming amongst minors.gaming amongst minors.


• 2012: the Video Game Addiction Treatment 2012: the Video Game Addiction Treatment Clinic opens in AustraliaClinic opens in Australia

• 2013: Bradford Medical Regional Center 2013: Bradford Medical Regional Center opens a 4 bed inpatient treatment program opens a 4 bed inpatient treatment program for Internet addictionfor Internet addiction

• 2015: Outback Therapeutic Expeditions opens 2015: Outback Therapeutic Expeditions opens their Unplugged programtheir Unplugged program

INTERNET GAMING DISORDER: PROPOSED INTERNET GAMING DISORDER: PROPOSED CRITERIACRITERIARepetitive use of Internet-based games, often with other Repetitive use of Internet-based games, often with other players, that leads to significant issues with functioning. players, that leads to significant issues with functioning. Five of the following criteria must be met within one year:Five of the following criteria must be met within one year:1.1.Preoccupation or obsession with Internet games.Preoccupation or obsession with Internet games.2.2.Withdrawal symptoms when not playing Internet Withdrawal symptoms when not playing Internet games.games.3.3.A build-up of tolerance–more time needs to be spent A build-up of tolerance–more time needs to be spent playing the games.playing the games.4.4.The person has tried to stop or curb playing Internet The person has tried to stop or curb playing Internet games, but has failed to do so.games, but has failed to do so.

INTERNET GAMING DISORDER: PROPOSED INTERNET GAMING DISORDER: PROPOSED CRITERIACRITERIA5.5.The person has had a loss of interest in other life The person has had a loss of interest in other life

activities, such as hobbies.activities, such as hobbies.6.6.A person has had continued overuse of Internet games A person has had continued overuse of Internet games

even with the knowledge of how much they impact a even with the knowledge of how much they impact a person’s life.person’s life.

7.7.The person lied to others about his or her Internet game The person lied to others about his or her Internet game usage.usage.

8.8.The person uses Internet games to relieve anxiety or The person uses Internet games to relieve anxiety or guilt–it’s a way to escape.guilt–it’s a way to escape.

9.9.The person has lost or put at risk an opportunity or The person has lost or put at risk an opportunity or relationship because of Internet games. relationship because of Internet games.

INTERNATIONAL PREVALENCE RATESINTERNATIONAL PREVALENCE RATES• United States: 8.5%, age 8-18 (n = 1178)United States: 8.5%, age 8-18 (n = 1178)• China: 9.8% of teenagers (n = 330)China: 9.8% of teenagers (n = 330)• South Korea: 10.7% of middle and HS students (n = 903)South Korea: 10.7% of middle and HS students (n = 903)• Netherlands: 3%, aged 13-16 (n = ?)Netherlands: 3%, aged 13-16 (n = ?)• Italy: 3.9%, aged 13-22 (n = 1035)Italy: 3.9%, aged 13-22 (n = 1035)• Nigeria: 3.3% of University students (n = 1022)Nigeria: 3.3% of University students (n = 1022)• Spain: 10% of “young students” (n = 493)Spain: 10% of “young students” (n = 493)• United Kingdom: 18.3% of students (n = 371)United Kingdom: 18.3% of students (n = 371)• Greece: 8.2% aged 12 to 18 (n = 2200)Greece: 8.2% aged 12 to 18 (n = 2200)

HTTP://WWW.TECHADDICTION.CA/INTERNET_ADDICTION_STATISTICS.HTML

A ROSE IS A ROSE IS A ROSE?A ROSE IS A ROSE IS A ROSE?

Severity levels with problematic digital media Severity levels with problematic digital media use:use:•Casual UserCasual User•Transitional UserTransitional User•At-Risk UserAt-Risk User•Addicted UserAddicted UserPRIVATE CONSULTATION WITH MELANIE HEMPE AT FAMILIES MANAGING MEDIA

FREQUENT COMORBIDITIES WITH IGDFREQUENT COMORBIDITIES WITH IGD

• AddictionAddiction• ADHDADHD• anxietyanxiety• AUTISM SPECTRUM DISORDERS (social anxiety)AUTISM SPECTRUM DISORDERS (social anxiety)• DepressionDepression• Family dysfunctionFamily dysfunction• Other health problemsOther health problems

COMORBIDITY: OTHER COMORBIDITY: OTHER ADDICTIONSADDICTIONSKimberly Young found in her research that Kimberly Young found in her research that 52% of respondents said that they were 52% of respondents said that they were following recovery programs for other following recovery programs for other addictions. These included alcoholism, addictions. These included alcoholism,

chemical dependency, compulsive chemical dependency, compulsive gambling, or chronic overeating.gambling, or chronic overeating.

YOUNG, K. S. (1998). CAUGHT IN THE NET. NEW YORK: JOHN WILEY

COMORBIDITY: ADHDCOMORBIDITY: ADHD• United States: adolescents with Internet United States: adolescents with Internet addiction had higher ADHD symptoms, addiction had higher ADHD symptoms, depression, social phobia, and hostility. depression, social phobia, and hostility.

• Taiwan: internet addiction was associated Taiwan: internet addiction was associated with a significantly higher rate of ADHD.with a significantly higher rate of ADHD.

J ADOLESC HEALTH. 2007 JUL;41(1):93-8. EPUB 2007 APR 12.

COMORBIDITY: ADHDCOMORBIDITY: ADHD

South Korea: 20% of internet-South Korea: 20% of internet-addicted children and teens addicted children and teens

demonstrated relatively severe demonstrated relatively severe ADHD symptoms.ADHD symptoms.

J ADOLESC HEALTH. 2007 JUL;41(1):93-8. EPUB 2007 APR 12.

COMORBIDITY: ANXIETYCOMORBIDITY: ANXIETY

There is a very strong correlation There is a very strong correlation between Anxiety, Depression, between Anxiety, Depression, ADHD, OCD and addictive ADHD, OCD and addictive technology use.technology use.PSYCHOL ADDICT BEHAV. 2016 MAR;30(2):252-62. DOI: 10.1037/ADB0000160.

COMORBIDITY: ANXIETYCOMORBIDITY: ANXIETY

““The rich get richer and the poor get poorer.” The rich get richer and the poor get poorer.” Only, in this scenario, we’re talking about social Only, in this scenario, we’re talking about social currency. The more a socially anxious individual currency. The more a socially anxious individual isolates, the more their anxiety builds and the isolates, the more their anxiety builds and the

more they feel the need to isolate.more they feel the need to isolate.

PSYCHOL ADDICT BEHAV. 2015 JUN;29(2):473-82. DOI: 10.1037/ADB0000070. EPUB 2015 MAY 4.

COMORBIDITY: AUTISM COMORBIDITY: AUTISM SPECTRUMSPECTRUMChildren with ASD spent approximately 62% more time Children with ASD spent approximately 62% more time watching television and playing video games than in all watching television and playing video games than in all non-screen activities combined. Compared with NT non-screen activities combined. Compared with NT siblings, children with ASD spent more hours per day siblings, children with ASD spent more hours per day playing video games and had higher levels of problematic playing video games and had higher levels of problematic video game use. In contrast, children with ASD spent little video game use. In contrast, children with ASD spent little time using social media or socially interactive video time using social media or socially interactive video games.games.J AUTISM DEV DISORD. 2013 JUN;43(6):1258-71. DOI: 10.1007/S10803-012-1659-9.

HTTP://ONLINELIBRARY.WILEY.COM/DOI/10.1111/ADB.12347/ABSTRACT

•https://www.youtube.com/watch?v=mbdOqxdiSZc

https://www.youtube.com/watch?v=mbdOqxdiSZc



COMORBIDITY: AUTISM COMORBIDITY: AUTISM SPECTRUMSPECTRUM

Dr. Mazurek found an association between Dr. Mazurek found an association between excessive video game use in ASD clients and excessive video game use in ASD clients and

increased oppositional behaviors. Such behaviors increased oppositional behaviors. Such behaviors include arguing, refusing to follow directions and include arguing, refusing to follow directions and

aggression. aggression.

RESEARCH IN AUTISM SPECTRUM DISORDERS. VOLUME 7, ISSUE 2, FEBRUARY 2013, PAGES 316–324

COMORBIDITY: DEPRESSIONCOMORBIDITY: DEPRESSION

Mental Health disorders such as Mental Health disorders such as Depression account for up to 15% of the Depression account for up to 15% of the

variance when comparing those with variance when comparing those with technology dependency and those who technology dependency and those who

do not.do not.PSYCHOL ADDICT BEHAV. 2016 MAR;30(2):252-62. DOI: 10.1037/ADB0000160.

COMORBIDITY: FAMILY DYSFUNCTIONCOMORBIDITY: FAMILY DYSFUNCTION

• Youth with IA reported greater global dissatisfaction with their families; less organized, cohesive and adaptable families; greater inter-parental and parent-child conflict; and perceived their parents as more punitive, and less supportive, warm, and involved compared to non-IA youth

• Compared with non-addicted subjects, subjects with severe IA (9.98%) had lower family functioning

HTTP://DL.ACM.ORG/CITATION.CFM?ID=2565971

COMORBIDITY: OTHER HEALTH COMORBIDITY: OTHER HEALTH PROBLEMSPROBLEMSHealth factor

Those who replied "never"Non-addiction group Addiction group

Headache 28.7% 20.6%Neck-/back pain 25.8% 16.2%Digestive problems 51.4% 40.3%Sleep problems 45.3% 31.2%Sadness 43.1% 22.0%Sleepy in daytime 22.6% 10.4%Palpitations 71.4% 53.5%

HTTP://OGLOBO.GLOBO.COM/SOCIEDADE/TECNOLOGIA/JOGADOR-DE-GAME-DO-GOOGLE-MORRE-APOS-SER-ATROPELADO-NA-TIJUCA-11571559

MEDIA PSYCHOLOGISTSMEDIA PSYCHOLOGISTS

Technologies change. People don’t. Media psychology Technologies change. People don’t. Media psychology delivers the ‘why.’ Success in media design, delivers the ‘why.’ Success in media design, development and messaging is about using psychology, development and messaging is about using psychology, whether you’re creating commercial projects or whether you’re creating commercial projects or advocating for social change. I consult with companies advocating for social change. I consult with companies on a variety of media projects because applying the on a variety of media projects because applying the fundamentals of media psychology gets powerful results.fundamentals of media psychology gets powerful results.

RICHARD BARTLE’S ANALYSIS OF PLAYER RICHARD BARTLE’S ANALYSIS OF PLAYER TYPESTYPES•AchieversAchievers: those seeking a sense of accomplishment: those seeking a sense of accomplishment•SocializersSocializers: those seeking friends and connection: those seeking friends and connection•KillersKillers: those who enjoy inflicting misery upon others: those who enjoy inflicting misery upon others•ExplorersExplorers: the curious minds who explore game : the curious minds who explore game geography or game rulesgeography or game rules

BARTLE, RICHARD (1996) HEARTS, CLUBS, DIAMONDS, SPADES: PLAYERS WHO SUIT MUDS

NICK YEENICK YEE

NICK YEE’S MOTIVATIONAL CLUSTERSNICK YEE’S MOTIVATIONAL CLUSTERS

•AchievementAchievement: focuses on different ways of : focuses on different ways of gaining power within the gamegaining power within the game

•Social InteractionSocial Interaction: about different ways of : about different ways of relating to others within the gamerelating to others within the game

•ImmersionImmersion: about different ways of : about different ways of becoming a part of the storybecoming a part of the story

YEE, NICK (2006) MOTIVATIONS FOR PLAY IN ONLINE GAMES. CYBERPSYCHOLOGY AND BEHAVIOR 9: 772-775

SELF-DETERMINATION SELF-DETERMINATION THEORYTHEORY

•A = AutonomyA = Autonomy•B = BelongingB = Belonging•C = competenceC = competence

UNDERLYING NEED: ACHIEVEMENTUNDERLYING NEED: ACHIEVEMENT


““I learned this about myself: I’m I learned this about myself: I’m incredibly goal-oriented. There’s a incredibly goal-oriented. There’s a maximum level you can achieve in World maximum level you can achieve in World of Warcraft. I achieved it on a Tuesday of Warcraft. I achieved it on a Tuesday and I started the company on a and I started the company on a Wednesday. I remember, it was level 70.”Wednesday. I remember, it was level 70.”

-Robert Hohman, founder of Glassdoor.com-Robert Hohman, founder of Glassdoor.com


“I told myself I’m only going to do these once in a while cause I saw how much time it was consuming. But I would get some awesome gear just as I was about to quit! So then I started doing raids to build up my paladin character.”

-Outback Unplugged student


• “I once played a certain dungeon 80 times over and over until I earned the Rivendare Death Charger Mount! I was hooked! I now have 4 characters at level 100 (the current level cap in WoW). My hunter’s gear level is 715. The max total possible at the time was 745. I played 3-8 hours a day but would sometimes play 12 or more hours per day.”-Outback Unplugged student


“I thought my happiness came from progressing in the game & receiving rare items. So when my parents tried to make me not play the game I got very angry & attacked them.”


UNDERLYING NEED: AUTONOMYUNDERLYING NEED: AUTONOMYTeens who use social media get a small dose of Teens who use social media get a small dose of

autonomy. Is autonomy a normal human need? Of autonomy. Is autonomy a normal human need? Of course, but practicing autonomy on the web with no course, but practicing autonomy on the web with no oversight can often be dangerous for teens. So we oversight can often be dangerous for teens. So we

need to coach parents and teens about safe internet need to coach parents and teens about safe internet practices. But we also need to help them find ways practices. But we also need to help them find ways that they can gain some autonomy through other that they can gain some autonomy through other

means.means.HTTP://RAISINGCHILDREN.NET.AU/ARTICLES/INDEPENDENCE_TEENAGERS.HTML

UNDERLYING NEED: AUTONOMYUNDERLYING NEED: AUTONOMY

Girls who allocated the most time to photo-Girls who allocated the most time to photo-related activities on facebook were more likely related activities on facebook were more likely

to internalize a thin ideal, succumb to self-to internalize a thin ideal, succumb to self-objectification, be dissatisfied with their weight, objectification, be dissatisfied with their weight,

or report having a drive to become thin. or report having a drive to become thin. ll

HTTP://HEALTHLAND.TIME.COM/2013/12/04/HOW-FACEBOOK-CONTRIBUTES-TO-EATING-DISORDERS/

UNDERLYING NEED: AUTONOMYUNDERLYING NEED: AUTONOMY “When I would go to Tanaan Jungle I’d see all these Plebs (from the Latin word Plebian which referred to the peasantry) walking around down on the ground! I’d gotten the flying achievement long before it was even available to everyone!”


HTTP://RAISINGCHILDREN.NET.AU/ARTICLES/INDEPENDENCE_TEENAGERS.HTML

UNDERLYING NEED: AUTONOMYUNDERLYING NEED: AUTONOMYParents can help foster autonomy in many ways. For Parents can help foster autonomy in many ways. For example:example:•Respect their child’s feelings and opinionsRespect their child’s feelings and opinions•Establish clear and fair family rulesEstablish clear and fair family rules •Treat them in a way that’s appropriate for her stageTreat them in a way that’s appropriate for her stage •Help them develop decision-making skillsHelp them develop decision-making skills•Provide safe opportunities for them to exercise Provide safe opportunities for them to exercise independenceindependence

HTTP://RAISINGCHILDREN.NET.AU/ARTICLES/INDEPENDENCE_TEENAGERS.HTML

UNDERLYING NEED: BELONGINGUNDERLYING NEED: BELONGING

Milan, Italy (2009):Milan, Italy (2009):Participants who showed signs of problematic Participants who showed signs of problematic

internet usage utilize dysfunctional coping internet usage utilize dysfunctional coping strategies and show worse interpersonal relations strategies and show worse interpersonal relations than peers who do not show signs of problematic than peers who do not show signs of problematic

internet usage.internet usage.CYBERPSYCHOL BEHAV. 2009 DEC;12(6):681-4. DOI: 10.1089/CPB.2009.0071.


“…“…playing LOL has strengthened our playing LOL has strengthened our relationships with each other. The fact that relationships with each other. The fact that we work together instead of against each we work together instead of against each other is a huge factor. Cooperating and other is a huge factor. Cooperating and communicating with each other is much communicating with each other is much more satisfying than winning every game.”more satisfying than winning every game.”

-Johnathon Goodenow, Student-Johnathon Goodenow, StudentHTTP://PAPYRUS.GREENVILLE.EDU/2016/03/BROTHERHOOD-THROUGH-NERDINESS/


“Gaming was a way to connect with my brother. But I’ve been working on improving how much time I make available for friendships.”

-Outback Unplugged student-Outback Unplugged student

UNDERLYING NEED: BELONGINGUNDERLYING NEED: BELONGINGPlayers of WoW were found to derive social Players of WoW were found to derive social support from playing and higher levels of in-game support from playing and higher levels of in-game social support were associated with fewer social support were associated with fewer negative psychological symptoms. However, WoW negative psychological symptoms. However, WoW players who played for 44 to 82 hours per week players who played for 44 to 82 hours per week had significantly lower levels of offline social had significantly lower levels of offline social support and higher levels of negative symptoms.support and higher levels of negative symptoms.CYBERPSYCHOL BEHAV. 2009 OCT;12(5):563-6. DOI: 10.1089/CPB.2009.0001.


Facebook use was associated with higher Facebook use was associated with higher levels of psychological well-being among levels of psychological well-being among

users that used Facebook for users that used Facebook for maintainingmaintaining current friendships but was negatively current friendships but was negatively

associated with psychological well-being associated with psychological well-being among users that accessed Facebook for among users that accessed Facebook for

makingmaking new friends. new friends.


“It got to a certain point that I had to join a group (in the game) to progress further. I was having some social problems at the time so it was kind of nice to be part of my guild. They were super nice & were actually surprisingly responsible.” -Outback Unplugged student

UNDERLYING NEED: BELONGINGUNDERLYING NEED: BELONGINGOnline gaming is foremost motivated by social Online gaming is foremost motivated by social reasons providing the gamers with a possibility reasons providing the gamers with a possibility

of cooperation and communication. Online of cooperation and communication. Online gaming also provides gamers with an gaming also provides gamers with an

experience in which "flow" can be obtained experience in which "flow" can be obtained and serves as a "hallucination of the real”.and serves as a "hallucination of the real”.

CYBERPSYCHOL BEHAV. 2009 OCT;12(5):557-62. DOI: 10.1089/CPB.2008.0345.


““Social validation is important; a Facebook like is a Social validation is important; a Facebook like is a social signal. It affirms our existence the same way social signal. It affirms our existence the same way that someone nodding at you on the sidewalk does. that someone nodding at you on the sidewalk does. But we’re also just learning to use social tools, But we’re also just learning to use social tools, experimenting to find out what it all means.”experimenting to find out what it all means.”

-Dr. Pamela Rutledge-Dr. Pamela RutledgeHTTP://WWW.CMSWIRE.COM/CMS/CUSTOMER-EXPERIENCE/WHY-SOCIAL-MEDIA-IS-SO-ADDICTIVE-AND-WHY-MARKETERS-SHOULD-CARE-022276.PHP

UNDERLYING NEED: COMPETENCEUNDERLYING NEED: COMPETENCEProblematic cognitions & behaviors often Problematic cognitions & behaviors often intensify IGD:intensify IGD:““I am only good on the internet.”I am only good on the internet.”““I am worthless offline, but online I am I am worthless offline, but online I am someone.”someone.”““The internet is the only place I can feel safe.”The internet is the only place I can feel safe.”““Nobody loves me offline.”Nobody loves me offline.”HTTP://WWW.SCIENCEDIRECT.COM/SCIENCE/ARTICLE/PII/S0272735814000658

https://www.youtube.com/watch?v=gWxLanshXw4




UNDERLYING NEED: COMPETENCEUNDERLYING NEED: COMPETENCE“The formulas we’d have to use to determine

whether I’d be the tank or my pet would be the tank were very mathematical. We’d have to balance our agro with our abilities constantly throughout the battle. I found the numbers-

crunching intellectually stimulating.”Outback Unplugged student

HTTP://WWW.SCIENCEDIRECT.COM/SCIENCE/ARTICLE/PII/S0272735814000658

UNDERLYING NEED: COMPETENCEUNDERLYING NEED: COMPETENCEPreference for Online Social Interaction Preference for Online Social Interaction (POSI): the belief that one is safer, more (POSI): the belief that one is safer, more efficacious, more confident, and more efficacious, more confident, and more confortable with online interactions than face confortable with online interactions than face to face.to face.

PreoccupationPreoccupation: obsessive thought patterns : obsessive thought patterns concerning internet use.concerning internet use.HTTP://WWW.SCIENCEDIRECT.COM/SCIENCE/ARTICLE/PII/S0272735814000658

UNDERLYING NEED: COMPETENCEUNDERLYING NEED: COMPETENCECommon Cognitive Factors Underlying IGD:

1.Beliefs about game reward value and tangibility

2.Maladaptive and inflexible rules about gaming behavior

3.Over-reliance on gaming to meet self-esteem needs, and4.Gaming as a method of gaining social acceptance.

HTTP://WWW.SCIENCEDIRECT.COM/SCIENCE/ARTICLE/PII/S0272735814000658

OTHER UNDERLYING NEEDS: ESCAPISMOTHER UNDERLYING NEEDS: ESCAPISM

41% of MMORPG 41% of MMORPG gamers admit that they gamers admit that they play online to escapeplay online to escape

HTTP://LINK.SPRINGER.COM/ARTICLE/10.1007%2FS11469-009-9202-8

•https://www.youtube.com/watch?v=uwHbOEHrKn4

https://www.youtube.com/watch?v=uwHbOEHrKn4



ONLINE GAMERS UNMASKED ONLINE GAMERS UNMASKED WHAT THEY REALLY LOOK LIKEWHAT THEY REALLY LOOK LIKE

UNDERLYING NEED: ESCAPISMUNDERLYING NEED: ESCAPISM•Participants in attractive avatars became Participants in attractive avatars became friendlier and shared more personal information friendlier and shared more personal information with the virtual stranger in the task than people with the virtual stranger in the task than people who were given an unattractive avatarwho were given an unattractive avatar

•People given taller avatars became more People given taller avatars became more confident than people given shorter onesconfident than people given shorter ones

•People given attractive avatars selected more People given attractive avatars selected more attractive partners in a separate offline task.attractive partners in a separate offline task.

OTHER UNDERLYING NEEDS: IMMERSIONOTHER UNDERLYING NEEDS: IMMERSION

“WoW was appealing at first because it meant I got to spend time with my younger brother. After a while,

however, I started to play it to fulfill a sense of purpose I was lacking in real life. It made me turn from a

confused, struggling high-schooler into a powerful hero that boasted rare items & mighty deeds.”


•https://www.youtube.com/watch?v=nKi8iwQ8ZP8

https://www.youtube.com/watch?v=nKi8iwQ8ZP8



ADDITIONAL TREATMENT PRINCIPLESADDITIONAL TREATMENT PRINCIPLES

•Common MistakesCommon Mistakes•Cris Rowan’s Cris Rowan’s conceptualizationconceptualization

•Do the opposite!Do the opposite!

COMMON THERAPIST MISTAKES COMMON THERAPIST MISTAKES #1#1

Allowing Dungeons & Dragons, Magic: Allowing Dungeons & Dragons, Magic: The Gathering, or similar types of The Gathering, or similar types of

escapist Fantasy while in the therapeutic escapist Fantasy while in the therapeutic program. These only serve as Dopamine program. These only serve as Dopamine

hits and neurological reinforcers. hits and neurological reinforcers.


Teaching gaming moderation rather Teaching gaming moderation rather than abstinence. Treating than abstinence. Treating internetinternet

addiction requires moderation addiction requires moderation principles whereas true principles whereas true gaminggaming addiction requires an abstinence addiction requires an abstinence

approach.approach.

HEALTHIEST RESIDENTIAL STRUCTURE TO HEALTHIEST RESIDENTIAL STRUCTURE TO LEASTLEAST

(WITH REGARD TO IGD)(WITH REGARD TO IGD)1.1. Internet: blocking & monitoring software, titrated in stages based on trustInternet: blocking & monitoring software, titrated in stages based on trust

Video Games: none on campus. Other creative outlets for connection and Video Games: none on campus. Other creative outlets for connection and entertainment are used.entertainment are used.

2.2. Internet: blocking & monitoring software, students have very regular accessInternet: blocking & monitoring software, students have very regular accessVideo Games: if on campus a Wii is preferable. Not used as a behavioral Video Games: if on campus a Wii is preferable. Not used as a behavioral “reward”.“reward”.

3.3. Internet: every student has a laptop or iPad with little oversightInternet: every student has a laptop or iPad with little oversightVideo games: Xbox or PlayStation, used as a reward for positive behaviors.Video games: Xbox or PlayStation, used as a reward for positive behaviors.


Encouraging the client to pursue a Encouraging the client to pursue a career in the gaming industry, career in the gaming industry, white-hat hacking, computer white-hat hacking, computer programming, and so forth.programming, and so forth.

https://www.youtube.com/watch?v=Bf5TgVRGND4




DO THE OPPOSITE!DO THE OPPOSITE!

Status Quo“Comfort Zone”

Disequilibrium“Optimum Learning Zone”

Overwhelmed and/or Unwilling

“Panic Zone”

No Change

Potential for Change

No Change

https://www.youtube.com/watch?v=jrKjNwejhfg



IF YOU’D LIKE A COPY OF THIS IF YOU’D LIKE A COPY OF THIS PRESENTATION OR HAVE QUESTIONS PRESENTATION OR HAVE QUESTIONS

PLEASE EMAIL ME AT:PLEASE EMAIL ME AT:

[email protected]

YOU CAN ALSO REACH ME AT:YOU CAN ALSO REACH ME AT:

(385) 315-9279(385) 315-9279

mailto:[email protected]

Health & Medicine

Treating Internet Gaming Disorder - Outback Therapeutic Expeditions