Australasian Science Magazine

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By Olivia Metcalf

Excessive video gamers have the same physiological disturbances and disrupted thought processes as those addicted to substances and gambling.

Video gaming has become a popular pastime, with 94% of Australian children playing video games regularly. The increasing popularity of video games is partly because the internet has changed the way we play.

Offline video games are typically played against computer-generated characters, have a defined ending, and are played as solo experiences. Online gaming is typically played against other human characters, making them much more social experiences. They also have no defined ending, so the game is less likely to become repetitive or boring.

While most online gamers play for entertainment, relaxation or socialisation, there is growing evidence that a minority of gamers develop an unhealthy relationship with games.

A new area of psychology has been growing since the late 1990s to investigate the ways in which humans interact with technology and how technology affects us. Known as cyberpsychology, this area of research has been investigating the nature of excessive gaming – or more broadly, excessive use of any internet feature.

“Internet addiction” was first described in 1995 – as a joke. Fast forward to 2013, and the American Psychiatric Association is considering formally recognising “internet use disorder”, with subtypes such as excessive online gaming or excessive online gambling, as a mental health disorder.

Cyberpsychologists use terms such as excessive, problematic, pathological or uncontrollable internet use to describe the same behaviour: use of the internet or its related features that results in significant negative consequences, and an inability to cut back or control the behaviour.

Some may think investigating the clinical nature of excessive use of any type of technology is ridiculous or out-of-touch, but the behaviour is a genuine issue. Sceptics argue that frequent or even heavy use of anything does not constitute a problem; they say there is nothing abnormal about using the internet for 12 hours each day – and they are right.

When cyberpsychologists talk about excessive internet use, they don’t just mean hours spent: they mean use of the internet that seriously affects an individual’s life negatively yet, despite these consequences, the person can’t stop. There are no current Australian estimates, but a recent review of prevalence rates estimates that 1–12% of individuals use the internet excessively, depending on how excessive usage is defined.

While excessive internet users can regularly spend 16 hours per day using the internet, they also experience symptoms such as regular loss of sleep, changes to diet, relationship difficulties, damage to real-world social life, loss of income/employment, poorer academic performance, irritability or anxiety when not using the internet, and an inability to cut back or stop internet use. Excessive use is also associated with higher levels of hostility, stress, loneliness, depression, and increased suicidal thoughts.

While research has traditionally focused on excessive internet use, some researchers argue that the problem lies with the feature of the internet being used rather than the internet itself.

The most common type of excessive internet use is online gaming. While we have known for some time that excessive gaming occurs, there remains debate as to whether the behaviour can be considered an addiction.

This debate is part of a bigger question facing addiction research: can a person be addicted to a non-substance activity? Previously we believed that people could only be addicted to substances. While the physical effects of a substance compared to behaviour can obviously differ, decades of research have shown that pathological gamblers are experiencing the same disorder as substance addicts: it is simply the manifestation of the addiction that differs. As a result, pathological gambling, which was previously recognised as an impulse-control disorder, will be classified as an addiction in the next edition of the Diagnostic and Statistical Manual (the “psychologist’s handbook”) produced by the American Psychiatric Association.

While pathological gambling is the only formally recognised “behavioural” addiction, reports of excessive gaming have led to a debate about whether it might also be a behavioural addiction.

Evidence for Addiction

There have been many studies over the past decade in which excessive gamers have reported the same withdrawal, craving and negative consequences found in addiction. However, self-report data from gamers is not sufficient to classify the behaviour. Thus, the past few years have seen a range of experimental research investigating clinical signs of addiction in excessive gamers.

Cue-reactivity is the term used to describe the physiological and behavioural responses to certain cues or stimuli, and it plays a central role in addiction. During the development of an addiction, a person will start responding differently to addiction-related cues, such as the sights, sounds and words relating to an addiction or the paraphernalia used in an addiction. Over time, addiction-related cues become associated with the experience of the drug or activity.

Given that cue-reactivity is so central to addiction, psychologists have set out to investigate whether excessive gamers display cue-reactivity.

In one task of my PhD research, excessive and non-excessive gamers were given two word types: gaming-related words or neutral words, such as book, chair or plate. Gamers were asked to ignore the meaning of the word and focus on the colours the words were presented in.

Excessive gamers took significantly longer to correctly name the colour of gaming words compared with neutral words. In comparison, non-excessive gamers showed no difference in colour naming times, so the effect is not attributable to familiarity with the gaming words.

The longer reaction times that excessive gamers showed for gaming words is attributable to an aspect of cue-reactivity known as attentional bias. The attention system of the human brain has a finite capacity to process information –it simply cannot process every piece of information in our sensory world. Instead, the attention system prioritises information based on the bits that are deemed most important.

For an addict, their attention system considers addiction-related information to be the most important. This means that no matter what addicts might want to pay attention to, such as the colour of certain words, their attention system will effectively override the colour-processing task and focus on the addiction-related cue – the meaning of the word. By the time the attention system has directed its focus back to the primary task, a delay of a few hundred milliseconds has occurred. The same pattern of longer reaction-times to addiction-related words is found across all substance and gambling addictions.

Another study required excessive and non-excessive gamers to recall certain words presented in lists that were presented very rapidly, at around 100 milliseconds per word. Gamers were required to recall two of the 16 words that were located anywhere in the list. These two “target” words were presented in red.

While you can read a word presented at such a short duration, reading the whole list and remembering words becomes a challenging task. Typically, recalling the first target is relatively easy, but if the second target is presented close to the first target in the word list, recall of the second target is poor. This is because the attention system is busy tied up in the processing of the first word. However, if the second target is an addiction-related word, then an addict’s attention system will prioritise the processing of the second target.

The results showed that excessive gamers had better recall of gaming-related second targets compared with neutral targets whereas non-excessive gamers had similar levels of recall for either target type. Evidence such as these attentional bias studies adds to the wealth of self-report evidence that excessive gamers are displaying signs consistent with an addiction.

Why Are People Addicted to Gaming?

We know that excessive gaming is occurring, and we now have some evidence that excessive gamers are displaying signs consistent with addiction. The next, and maybe most important, question is: why is it occurring?

Cue-reactivity research has also provided insight into why excessive gaming occurs and how motivations to game may differ depending on the genre of game played. Two popular genres of games played worldwide are first-person shooter (FPS) games and Massively Multiplayer Online Role-Playing Games (MMORPG).

FPS games are part of the action genre in which gamers control a protagonist from a first-person perspective and use weapons (typically firearms) to navigate a fast-paced, violent game world. Popular titles include Call of Duty and Halo.

In comparison, MMORPGs are part of the action–strategy genre in which gamers create their own avatar and gameplay involves the development and progression of the avatar through exploration, combat, socialisation, skill and wealth acquisition. World of Warcraft is one of the most popular MMORPGs played in Australia.

Excessive FPS gaming is associated with higher impulsivity and more risk-taking behaviour. In comparison, excessive MMORPG gaming is associated with lower impulsivity and higher anxiety.

These findings coincide with further cue-reactivity research we conducted to investigate physiological responses during gaming. Physiological responses, or arousal, are indexed by changes to heart rate, blood pressure and perspiration, and are associated with emotional experiences like excitement, frustration, nervousness and fear.

Our physiological research shows that excessive FPS gamers experience significantly greater arousal during gaming compared with non-excessive gamers. When the game stops, excessive FPS gamers immediately drop off in the high arousal levels they experienced during gaming and reduce back to pre-gaming levels.

In comparison, for some time afterwards the non-excessive gamers remain at comparable levels of increased arousal they experienced during gaming. However, excessive FPS gamers need to return immediately to the game to have the same level of arousal they experienced during gaming.

In stark contrast, excessive MMORPG gamers experienced a significant decrease in physiological arousal during gaming. They also self-reported a reduction in nervousness levels during gaming compared with before gaming. Once excessive MMORPG gamers stopped gaming, their arousal levels increased back to pre-gaming levels.

Therefore, excessive MMORPG use is associated with an effect of arousal reduction, which excessive MMORPG gamers may seek out due to their lower levels of impulsivity and higher levels of anxiety.

Thus there may be two types of excessive gamers: those who are seeking stimulation through higher intensity gaming and experience the games at a more intense level, and those who are seeking avoidance or escapism and play the games to reduce their high emotional state.

Distinctions such as these have also been found in addictions, particularly in pathological gambling, where stimulating forms of gambling such as racetrack or casino gambling have been associated with thrill-seeking and increased arousal, whereas repetitive forms of gambling such as poker machine gambling have been linked to escapist behaviours and arousal reduction.

It remains unclear if these abnormalities in physiological arousal existed before excessive gaming developed, or are an associated feature of excessive gaming, but they are likely to play a significant role in why some gamers become excessive and others don’t.

Future Research

We still have a number of important questions to answer, and more research is needed to determine whether psychologists will formally recognise excessive internet use and its related features as an addiction. Some medical professionals remain adamant that excessive internet or gaming use is not an addiction. The debate that surrounds officially recognition of a disorder is always important, and ultimately will be answered using good-quality research and evidence.

A big concern for many gamers is that the incidence of excessive gaming will negatively affect regular video gamers, either through regulation of video gaming or restricting access to games. Cyberpsychologists are not out to have video games banned or restricted, and the popularity of video games is a testament to their many positive effects as a form of entertainment, relaxation and socialisation. The goal is simply to help the minority of gamers who have lost the ability to control their gaming use and in which gaming has started to control them.