The Kusnacht Practice Podcast #015 Interview with Melissa Nobile, psychologist MSc on the effects of gaming on mental health

Interviews Podcasts Podcast 15 V1

“It’s going to be just all these signs that show that it’s no longer a child or teen wanting or asking to play, but it’s a child or teen needing to play. And that’s where all the difference is going to be.” – Melissa Nobile, psychologist MSc.

The popularity of video games has risen dramatically since the start of the pandemic, with lockdowns and restrictions only increasing the appeal. But while the interest among consumers has multiplied, so too has the development of addictive patterns.

In the latest podcast from The Kusnacht Practice, we are talking with Melissa Nobile – psychologist MSc about the effects of gaming on mental health.

Melissa explores the indiscriminate nature of gaming dependence. The manifestation of combined factors that can lead to an addictive pattern. The obsessive and neglectful behaviours exhibited, as well as advice to parents on methods of early interventions.

Presenter: Hello, we’re here this morning with Melissa Nobile.

Melissa Nobile: Hello.

PR: Melissa is the Psychologist, Operations Coordinator and Project Manager here at The Kusnacht Practice. This morning we will be discussing the effects of gaming on mental health.

With Christmas, the launch of PlayStation Five consoles and millions of people still under restrictions of movement, gaming will be a big feature in many homes over the coming month. But there is conflicting research into the effect of gaming on mental health. Melissa how common are cases of addiction to gaming? And have you seen a rise in the numbers recently?

MN: Yes. And first I’ll start by saying that the reason there’s conflicting research is also because it’s a relatively new area of study in terms of researching the consequences that these games have on people’s mental health. And that’s because, although video games have been around for quite some time, it’s only been a decade or two since they’ve been using neuroscience and the developments in the understanding of the human brain, to create games that really tap into all the pleasure centres and the reward systems of the brain to have consumers spend more and more time playing. So that’s just a short note I wanted to say.

And it is common, in general, to play video games, because you were asking about the cases of addiction; and only a small group of these people playing will develop some form of addictive pattern. I don’t have exact numbers in mind, but I can tell you, from a clinical perspective, in settings that treat addictive patterns in youth, it’s one of the top three problematics that we see, together with cannabis and alcohol dependence.

And since April, yes, there’s also been an increase in these addictions being seen. First, probably because there’s been, in general, an increase in people gaming during the pandemic, without necessarily being addicted. And simply because it was a fun way of entertainment while being isolated. It’s a great strategy for coping with boredom, or stress, or loneliness. Games are also a way to socialise and connect, maybe escape family conflicts at times. So again, only for a subset of people, it’s going to turn into an addiction.

PR: The World Health Organization officially recognises gaming addiction, calling it ‘gaming disorder’, describing it as a pattern of persistent or recurrent gaming behaviour. What kind of symptoms can be seen in an individual who has become too dependent on gaming, in your opinion, Melissa?

MN: Addictions are complex processes. You mentioned there being a pattern of persistent or recurring behaviour, right? It’s actually a little more than that. Usually, the common way we describe it is ‘engaging in a compulsive behaviour despite its harmful consequences’. And these compulsions can reach the point where it takes over the life of someone physically and, usually, mentally as well.

And in gaming, compared to other addictions, the physical component is less present. Although there’s extremes; people who go days and days without sleeping, usually that physical component is not as visible as in other forms of addiction. So what you would see is, the gaming itself, really taking over the life of someone. They’ll have obsessions about it, neglecting certain aspects of their life to gaming, and this element of loss of control over the fact that they’re neglecting the rest of their life usually.

So the problem is not really the gaming, it’s what they’re neglecting for the gaming. And I can tell you from clinical experience, what I’ve seen, the complaints that families usually raise are going to be ‘okay, my child or my teen no longer want to join us for dinner’. And ‘because they’re playing when we raise the issue, it starts a huge conflict in the household.’ It’s families where there’s a lot of tension around the kid or the teen wanting to play these games and not being able to stop.

With children, I know that when the parents try to remove the device, the child can sometimes get so frustrated that there’ll be a little bit of violence. I’ve seen, just recently, a teenager that couldn’t attend the online classes because he was so tempted to be gaming at the same time as the classes were going on, now that the format is online. So he was just really dropping out of school.

It’s going to be just all these signs that show that it’s no longer a child or teen wanting or asking to play, but it’s a child or teen needing to play. And that’s where all the difference is going to be.

PR: I see. And then publication Healthline has also reported an increase in online gaming and gambling during the global pandemic. How can families and individuals help regulate gaming time if there is a concern that it is having a detrimental effect on somebody?

MN: That’s a difficult question. Mostly because I don’t want to oversimplify an answer, just in the span of a podcast because the problem with doing that is that it doesn’t always give sufficient respect for how difficult it is to deal with this situation. But I can give you a few tips to try. Maybe as a first step, especially if you are struggling with a child that’s young enough that you can do this, would be to set boundaries.

So maybe, work as a family and create a planner: on Monday, you can play one hour, from this time to this time. Wednesday, Friday, and Sunday, maybe two hours, etc. And to be really specific, that’s usually something we do in sessions, at the very beginning, when working with children who are becoming dependent on gaming.

It can be installing options on the computer; these timer systems where the computer, after one hour, just closes down, so the game has to stop. And explaining that to the child. And that will also help with the frustration of the child because they know in advance when it ends and the parents don’t have to be in the room. And they don’t have to be the person removing the computer.

If it’s during studies, it can be to block the option to game, because you can choose what programme you’re going to be using on the computer. So those would be the first line interventions and the very first steps. And then if that doesn’t work, definitely recommend seeking professional help, so that we can create a more individualised plan that works for your family.

PR: A recent survey from Oxford University suggests that playing video games can be good for mental health. This is going against all odds, but the survey which is focused on players of Nintendo springtime craze ‘Animal Crossing’, as well as the EA shooting game ‘Plants vs Zombies: The Battle For Neighborville’. It found that people who played more games tended to report greater wellbeing and casted doubts on reports that video gaming can harm mental health.

It stated, “contrary to many fears that excessive game time will lead to addiction and poor mental health, we find a small positive relation between gameplay and wellbeing.” How much should we read into this survey? And why is it so at odds with the WHO position, in your opinion?

MN: This really makes me think, and I just remember this with an author I once read. I can’t remember exactly what he said, but he was trying to conclude whether or not gaming is good or bad for someone is similar to asking someone to conclude whether or not someone’s nutrition is good or bad by just judging how much time someone is spending at the table. It was something in those lines. And for me, that’s the best answer because it just says, basically, that it really depends for lots of people.

It’s a fun, educational activity. A social activity, that helps connect with friends, with family, and just a different form of entertainment, and not a problem at all. And there have been signs that it can help regulate emotions. In these games, you’re doing a lot of multitasking. So I really don’t want to be demonising these games, they have loads of great things about them.

And just like for lots of different other things the reality is just complex, because, for a small group of people, for a variety of reasons, they lose control over their behaviour with gaming. Quite similarly to substance misuse, where lots of people can just enjoy a glass of wine in the evening, but for a minority of people, for some reason, It’s more difficult to do that.

And it’s really the same with gaming. So it’s all about that feeling of loss of control at the end of the day, and how much it’s impacting the day to day life. But it’s not a problem If it’s all in moderation and part of just a happy, fun life.

PR: It’s difficult to determine whether the disorder is its own clinical entity or a manifestation of other underlying psychiatric disorders. Is it usually associated with other mental health issues? And if so, which ones, in your opinion?

MN: Regarding the first part of the question, what we call gaming disorder. It’s the manifestation of a combination of biological, psychological, and social factors that lead someone to, one point in their life, have this difficult relationship with gaming. And we’re all somewhere on a continuum. I know in a previous podcast I had talked about this for eating disorders as well. We all have a certain relationship to food, or here to gaming. And then, for some people, they’re just somewhere on the continuum where it reaches a certain threshold, where it creates sufficient problems that we’re going to say, okay, this is more of a disordered pattern.

So there’s not a region of the brain, in terms of a clinical entity, that’s responsible for gaming addiction that some people would have, and some people wouldn’t. It’s not a qualitative difference, It’s more of a quantitative difference on this continuum, with how well people are handling their time gaming.

I said earlier, it’s going to be social factors that are going to contribute to more problems, biological, psychological. So the social factors would be, for example, someone who’s having a difficult time, maybe at school; being bullied. Or someone feeling isolated, lonely, difficulties in the families. All of those factors will be contributing to whether or not gaming could become a difficulty.

The psychological factors are going to be, maybe someone with more, let’s say a more impulsive temperament or lower self control. The biological factors are going to be, maybe, someone with a brain that’s more sensitive to rewards than someone else, bearing in mind that these games are really designed to tap into all these parts of the brain that will give pleasure. And we all have different brains, some are more sensitive to that than others.

So when we put all of these factors together, it’s going to just, for some people, when all blended together, heighten the probability of developing an addiction to gaming. And it’s usually associated with anxiety. That’s what I’ve seen quite frequently, or sleep difficulties, and sometimes a depressive mood simply because of this feeling of having lost control over gaming.

And as I mentioned earlier, all this neglect of the other parts of the life is going to have consequences on someone’s mental health and create tension, again, in the family etc. And it will be this vicious cycle that people get stuck in where this then increases the gaming etc. And it’s just a cycle that goes on and on and on. Hence, if you’re listening, it’s good to know that there’s help out there and a way to get out of it

PR: Going further into this, which age group and demographic seem to be the most affected? And what kind of treatment do you recommend for those who are suffering from gaming disorder?

MN: Anybody can suffer from gaming disorder, that’s the first thing to say. And there does seem to be a tendency for it to affect more young adults, and usually men. When I say young adults, I mean, late teenagers until 25. 15 to 25, I’d say, is the group that we see the most in clinics. But again, I’ve seen children aged 7, 8, 9 struggling with gaming. And I’ve seen women aged 60 to 70. So it’s not limited to anybody at all. And in terms of, I think you asked about a geographical area, It’s really seen in many countries. I mean, it’s not limited to a certain part of the world. I know that, quite recently, in South Korea they named it a public crisis. So it’s really everywhere.

And the treatment, I’d say, it’s mostly psychotherapy, that’s going to be the first line treatment and intervention to help with gaming disorder. And more than the approach that the provider is using, I’d say, make sure, and I’d really encourage you to find someone who has experience in treating this because, and this is how we started the podcast, It’s quite a recent area of research. It’s only been a decade or two since we’ve been seeing more and more of this in clinics, so not all professionals have the training to treat this. So ask around, see if the provider has experience in this before committing to a session. I think that would be my best tip to give to families or individuals who are listening.

PR: We were here with Melissa today. Thank you very much Melissa for being on this Q&A today. We are going to be back online fairly soon to discuss more topics. Again, thank you, Melissa.

MN: Thank you for having me.