Internet Gaming: Wat is a MMORPG WoW. Warm-Up. Warm-Up. What do you think a gamer is? What do you think is too much time spent talking to friends?

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1 Internet Gaming: Wat is a MMORPG WoW Presented By Ryan Andrusky, Dr. Shervin Vakili and Dan Biggs October 8, Warm-Up Understanding personal biases is important in working with any population How professionals frame an issue can in turn effect the relationship and therapeutic course 2 Warm-Up What do you think a gamer is? What do you think is too much time spent talking to friends? Is gaming a waste of time? 3 1

2 Warm-Up If you could have special power what power would that be? In a week what is the maximum amount of time a person should spend gaming? Do you think gaming has benefits? 4 Goals of Workshop Introduce Gaming Discuss Pros and Cons of Gaming Ideas Regarding Treatment Options 5 Types of Games Online and Off-line Wii, PS3 s, Xbox 360 s & PC s Shooters, RPGs, Strategy Games MMO s 6 2

3 MMORPG s Massive Multiplayer Online Role Playing Games Online Develop a Character Complex Social Environments Complex Reward Systems Limitless (7650 quests in WoW as of Nov. 2008) 7 Character Development Character development can be a very personal process Allow a person to experience themselves in an alternative world 8 Character Development In RPG s Complicated Process Race Class Skills Attributes 9 3

4 Character Development Alliance (Pro Man Kind) Human Night Elf Gnome Dwarf Draenei Horde (Opposes Man Kind) Troll Tauren Orc Undead Blood Elf 10 Character Development 11 Character Development Base Stat Strength Agility Stamina Intellect Spirit Total Blood Elves Draenei Dwarf Gnome Human Night Elf Orc Tauren Troll Undead

5 Character Development Users can also customize the appearance of their character 13 Character Development Great deal is invested time in developing characters and strengthening them Characters level up Get new skills Collect new and more powerful weapons 14 Character Development 15 5

6 Rewards Multiple reward systems Primary quests Achievement points and leader boards Skill and level advancements Equipment, money Mini-quests and social quests Defeating challenging enemies Multiple rewards schedules Limitless (A lot of games have no natural endpoint) 16 Limitless No natural endpoint New expansions More quests More items More levels More terrain Quests that can only be completed as teams 17 The WORLD of Warcraft Populated Human players and computer based characters Common ground between players Friendships and teams Multiple social opportunities Guilds Taverns Buy, selling and trading (auction house) 18 6

7 MMORPG s Recap Personalized Characters Multiple Rewards Populated Immersive Limitless 19 Who Plays 2008 Gaming revenues topped $21bn in the U.S. WoW - 11,500,000 active subscribed users* (December 2008, EverQuest - 400,000 active subscribed users* (D. Tom, 2003) Average user age 31 years old* ( 5% Serious role playing ( 20 Who Plays Mental Health Learning Difficulties ADHD Depression/Dysthymic Personality Disorders Social Anxiety Disorder Antisocial Personality Disorder Lonely Adults Social Problems Substance Use Disorders Schizotypal Personality Disorder Bipolar Disorders Schizophrenia Addiction Issues Females Ko, Yen, Chen, Chen &Yen, 2008 Recupero, 2008 Willoughby, 2008 Young, Young,

8 Benefits of MMORPG s Possible Double Edged Sword 22 Benefits - Social Complex and rich social environment Medium may be more comfortable for certain individuals to socialize Multiple forms of communication International Smyth, 2007 Young, Benefits - Social Complex and rich social environment Emotional safety Connection and belonging Common language Highly invested in the community Smyth, Young,2009 8

9 Benefits - Social Team work and connection People feel a real sense of responsibility Some quests require teams People feel appreciated for their characters skills and abilities Teams reach exciting goals Smyth, Young,2009 Social status Benefits - Social Increased social mobility Dynamic set classes, ranks and roles Praise and recognition based on; Time playing Title, level, equipment Leadership of guilds, poises Ability in game (tanking, healing, dps) Competitions and leadership boards Smyth, Young,2009 Benefits - Empowerment Control Provide a sense of mastery Sense of exceptional abilities and skills Increase in confidence through therapeutic role play Sense of personal agency in influencing outcomes and the environment Freedom Freedom to choose direction and outcomes Freedom to take risks Delfabbro, Recupero,

10 Possible Risks and Benefits Online role-playing also allowed Mr. A the opportunity to explore real and threatening aspects of himself but in an environment where consequences were not real. He would integrate violent and altruistic aspects of who he was through trying on different identities (Sara E. Allison, M.D., Lisa von Wahlde, L.M.S.W., Tamra Shockley, M.S., and Glen O. Gabbard, M.D: The Development of the Self in the Era of the Internet and Role-Playing Fantasy Games. American Journal of Psychiatry 2006: 384) 28 Benefit - Stress Role in mitigating stress Online resource Social support (teams, friends ) Sense of efficacy Provides an escape from stressful life event and negative feelings Allows an individual to experience a sense of being resource rich and mobile Ko, Yen, Chen, Chen &Yen, 2008 Smyth 2007 Recupero, 2008 Willoughby, 2008 Young, Young, 2009 Benefit - Stress Role in mitigating stress Emotional outlets Ability to experience a more positive sense of self Enjoyment Risk of becoming primary coping mechanism Ko, Yen, Chen, Chen &Yen, 2008 Smyth 2007 Recupero, Willoughby, 2008; Young, 2007 &

11 Situation Addressed Stressful Event Sense of Efficacy Mitigating Activity Personal Resources Mental and Physical Health Factors Environmental and Social Factors 31 Situation Addressed Stressful Event Efficacy Joy Escape In Game Personal Resources Mental and Physical Health Factors Environmental and Social Factors 32 Stressful Event Sense of Efficacy in Game Escape Supports Resources Time Escaping Online Social Engagement External Rewards Stress Personal Resources Mental and Physical Health Factors Environmental and Social Factors 33 11

12 Consequence of Excessive Gaming Neglect of work or school Reduced time reading Less physically active/decline in health Worse quality of sleep/sleeping habits Negative impact on eating habits Reduced face to face socializing Increased feelings of isolation depression Considerable impact of time lost Smyth J, Young, 2007 Possible Risks of Gaming Lack of motivation to pursue goals to outside of the virtual world Increased social anxiety Reduce opportunities of expansion of real world identity and self Increased violence and hostility* Desensitization to (virtual) violence Ko, Yen, Chen, Chen &Yen, Young, 2007 Bottom Line Excessive video game playing is multifactorial Less social and economic resources in non-virtual world may increase risk of excessive gaming 36 12

13 Possible Treatment Options Warning There are no established best practices for treating excessive video game playing Warning There are no established definitive definition for excessive, problematic, or addiction regarding to video game playing 37 Possible Treatment Options Comprehensive Assessment Explore and address factors associated with excessive gaming Mental health concerns Family dynamics Peer dynamics Scholastic issues Benefits and consequences of gaming Allison, Wahlde, Tamra Shockley,& Glen, 2006 Recupero, Young, 2007 Young 2009 Possible Treatment Options Early Interventions Stop It often does not work Avoid arguing It reinforces resistance to change May reinforce belief of there are online friends and offline people Develop discrepancies 39 13

14 Possible Treatment Options Early Interventions Build awareness of gaming Ability to reduce or stop playing Schedules Tracking forms Emotions associated with gaming 40 Possible Treatment Options Identify and address underlying issues Cognitive Behavioral Treatment -Time management -Moderating use of computers -Teach self-care Allison, Wahlde, Tamra Shockley,& Glen, 2006 Recupero, Young, 2007 Young 2009 Possible Treatment Options Identify and address underlying issues Cognitive Behavioral Treatment -Relapse Preventions Associated emotional states and situations Alternative coping mechanisms Allison, Wahlde, Tamra Shockley,& Glen, 2006 Recupero, Young, 2007 Young

15 Possible Treatment Options Empowerment Assess if empowerment is associated with playing Lack of real world control and mastery is a risk factor for excessive game play Develop strategies for addressing control and mastery outside of the game 43 Possible Treatment Options Social Acknowledge the significance of online community Help client develop new emotional/social supports Access previous supports Support groups Hobby groups Sport teams Family therapy (positive recognition, boundaries, etc.) 44 Possible Treatment Options Social Assess for interpersonal issues Unaddressed mental health concerns Communication skill may need to be addressed Identifying previous psychic-injury that maybe affecting client (i.e. unaddressed abuse, bullying or abandonment) 45 15

16 Possible Treatment Options Reward Systems Community Reinforcement /Contingency Management Develop a set of reward systems Reduced gaming Abstinence from gaming Rewards should be negotiated Address multiple life areas family 46 Possible Treatment Options Behavioral Address location of computer or console Make the computer less accessible Monitor play-time Set a play schedule Use timers Avoid purchasing games with higher time commitments Limitless games Games with multiple quests (non-linear) Online games 47 Possible Treatment Options Final Thought Patient may experience multiple losses when quitting a game Clients have personal relationship their characters, community and gaming system Gaming maybe a primary coping mechanism Connections and friendships maybe severed Huge investments of time maybe lost 48 16

17 Smyth J, 2009 Final Thought MMORPG s create a compelling, immersive and socially rich environment. As many more people become immersed in virtual societies, it is important to examine the costs and benefits of partaking in such worlds. 49 MMORPG s Thank you for your time!! 50 Questions/Discussion 51 17

18 Thank you for your participation For information about Alberta Health Services Telelearning Events: (403) Initiatives Telemental Health Current Learning Sessions 52 18