Yasser Khazaal

Why do you play World of Warcraft? An in-depth exploration of self-reported motivations to play online and in-game behaviours in the virtual world of Azeroth

Massively multiplayer online role-playing games (MMORPGs) are video games in which players create an avatar that evolves and interacts with other avatars in a persistent virtual world. Motivations to play MMORPGs are heterogeneous (e.g. achievement, socialisation, immersion in virtual worlds). This study investigates in detail the relationships between self-reported motives and actual in-game behaviours. We recruited a sample of 690 World of Warcraft players (the most popular MMORPG) who agreed to have their avatar monitored for 8months. Participants completed an initial online survey about their motives to play. Their actual in-game behaviours were measured through the games official database (the Armory website). Results showed specific associations between motives and in-game behaviours. Moreover, longitudinal analyses revealed that teamwork- and competition-oriented motives are the most accurate predictors of fast progression in the game. In addition, although specific associations exist between problematic use and certain motives (e.g. advancement, escapism), longitudinal analyses showed that high involvement in the game is not necessarily associated with a negative impact upon daily living.

Psychological predictors of problematic involvement in massively multiplayer online role-playing games: illustration in a sample of male cybercafé players

Background: Massively Multiplayer Online Role-Playing Games (MMORPGs) are video games in which a large number of players interact with one another in a persistent virtual world. MMORPGs can become problematic and result in negative outcomes in daily living (e.g. loss of control on gaming behaviors, compromised social and individual quality of life). The aim of the present study is to investigate psychological predictors of problematic involvement in MMORPGs. Sampling and Methods: Fifty-four males who played MMORPGs regularly were recruited in cybercafés and screened using the UPPS Impulsive Behavior Scale (which assesses 4 facets of impulsivity) and the Motivation to Play Online Questionnaire (which assesses personal motives to play online). Negative consequences due to excessive time spent on the Internet were assessed with the Internet Addiction Test. Results: Multiple regression analysis showed that problematic use of MMORPGs is significantly predicted by: (1) high urgency (b = 0.45), and (2) a motivation to play for immersion (b = 0.35). Conclusion: This study showed that, for certain individuals (who are characterized by a proneness to act rashly in emotional contexts and motivated to play to be immersed in a virtual world), involvement in MMORPGs can become problematic and engender tangible negative consequences in daily life.

How can we conceptualize behavioural addiction without pathologizing common behaviours

Following the recent changes to the diagnostic category for addictive disorders in DSM-5, it is urgent to clarify what constitutes behavioural addiction to have a clear direction for future research and classification. However, in the years following the release of DSM-5, an expanding body of research has increasingly classified engagement in a wide range of common behaviours and leisure activities as possible behavioural addiction. If this expansion does not end, both the relevance and the credibility of the field of addictive disorders might be questioned, which may prompt a dismissive appraisal of the new DSM-5 subcategory for behavioural addiction. We propose an operational definition of behavioural addiction together with a number of exclusion criteria, to avoid pathologizing common behaviours and provide a common ground for further research. The definition and its exclusion criteria are clarified and justified by illustrating how these address a number of theoretical and methodological shortcomings that result from existing conceptualizations. We invite other researchers to extend our definition under an Open Science Foundation framework.

Motivations to Play Specifically Predict Excessive Involvement in Massively Multiplayer Online Role-Playing Games: Evidence from an Online Survey

Background: Several studies have linked massively multiplayer online role-playing games (MMORPGs) with possible problematic usage or internet addiction. Aims: The main goal of the present study was to assess links between motivations to play in MMORPGs and addictive involvement in such types of games. Methods: A total of 696 gamers responded to an online survey. Results and Conclusion: Five distinct motivations to play were identified in gamers: achievement, socializing, immersion, relaxing and escaping. Multiple regression analysis revealed that addictive MMORPG use patterns are predicted by achievement, escapism and socializing motives. Gender was also a significant predictor of problematic involvement in MMORPGs. Moreover, addictive MMORPG use positively correlated with the weekly time devoted to playing MMORPGs.

Problematic involvement in online games

ADV=advancement (MPOGQ); SOC=socializing (MPOGQ); RP=role-play (MPOGQ); ESC=escapism (MPOGQ); URG=urgency (UPPS-P); LPR=lack of premeditation (UPPS-P); LPE=lack of perseverance (UPPS-P); SS=sensation seeking (UPPS-P); SE=self-esteem (SISE). Dashed lines refer to mean Z-scores of the entire sample. Bold lines refer to mean Z-scores for each specific cluster.Display Omitted The current study identified distinct subtypes of online gamers.The study combines self-report measures and ecological data (in-game behaviors).Cluster comparison revealed that problematic online gaming is a heterogeneous disorder.Problematic online gamer subtypes exist and individualized treatment is favored. Playing online games can become problematic and engender adverse consequences. Several psychological factors have been shown to influence the development and the maintenance of this problematic behavior, including impulsivity traits, motives to play (immersion, achievement, social affiliation), and self-esteem. The aim of the current study is to determine whether reliable subtypes of problematic online gamers can be identified. A sample of 1057 online gamers was recruited. Validated questionnaires were used to measure established psychological risk factors (impulsivity, motives to play, self-esteem) and potential consequences of playing (addiction symptoms, positive and negative affect). Actual in-game behaviors were also monitored. Five reliable clusters of gamers were identified (three problematic and two nonproblematic clusters). Cluster comparison revealed that the psychological factors considered are differentially involved in problematic online gaming. At the theoretical level, the results emphasized that problem online gaming depends on a wide range of psychological factors. At the clinical level, the diversity of psychological profiles shown supports the development of personalized (custom-made) interventions targeting specific psychological mechanisms. Overall, our findings suggest that conceptualizing the problematic use of massively multiplayer online role-playing games as behavioral addiction is too restrictive and might result in the simplification of heterogeneous and multi-determined problematic behaviors.

Does Self-Selection Affect Samples’ Representativeness in Online Surveys? An Investigation in Online Video Game Research

Background The number of medical studies performed through online surveys has increased dramatically in recent years. Despite their numerous advantages (eg, sample size, facilitated access to individuals presenting stigmatizing issues), selection bias may exist in online surveys. However, evidence on the representativeness of self-selected samples in online studies is patchy. Objective Our objective was to explore the representativeness of a self-selected sample of online gamers using online players’ virtual characters (avatars). Methods All avatars belonged to individuals playing World of Warcraft (WoW), currently the most widely used online game. Avatars’ characteristics were defined using various games’ scores, reported on the WoW’s official website, and two self-selected samples from previous studies were compared with a randomly selected sample of avatars. Results We used scores linked to 1240 avatars (762 from the self-selected samples and 478 from the random sample). The two self-selected samples of avatars had higher scores on most of the assessed variables (except for guild membership and exploration). Furthermore, some guilds were overrepresented in the self-selected samples. Conclusions Our results suggest that more proficient players or players more involved in the game may be more likely to participate in online surveys. Caution is needed in the interpretation of studies based on online surveys that used a self-selection recruitment procedure. Epidemiological evidence on the reduced representativeness of sample of online surveys is warranted.

HON Label and DISCERN as Content Quality Indicators of Health-Related Websites

Content quality indicators are warranted in order to help patients and consumers to judge the content quality of health-related on-line information. The aim of the present study is to evaluate web-based information on health topics and to assess particular content quality indicators like HON (Health on the Net) and DISCERN. The present study is based on the analysis of data issued from six previous studies which assessed with a standardized tool the general and content quality (evidence-based health information) of health-related websites. Keywords related to Social phobia, bipolar disorders, pathological gambling as well as cannabis, alcohol and cocaine addiction were entered into popular World Wide Web search engines. Websites were assessed with a standardized proforma designed to rate sites on the basis of accountability, presentation, interactivity, readability and content quality (evidence-based information). “Health on the Net” (HON) quality label, and DISCERN scale scores were used to verify their efficiency as quality indicators. Of 874 websites identified, 388 were included. Despite an observed association with higher content quality scores, the HON label fails to predict good content quality websites when used in a multiple regression. Sensibility and specificity of a DISCERN score >40 in the detection of good content quality websites were, respectively, 0.45 and 0.96. The DISCERN is a potential quality indicator with a relatively high specificity. Further developments in this domain are warranted in order to facilitate the identification of high-quality information on the web by patients.

Trait gambling cognitions predict near-miss experiences and persistence in laboratory slot machine gambling.

Near-miss outcomes (i.e., unsuccessful outcomes close to the jackpot) have been shown to promote gambling persistence. Although there have been recent advances in understanding the neurobiological responses to gambling near-misses, the psychological mechanisms involved in these events remain unclear. The goal of this study was to explore whether trait-related gambling cognitions (e.g., beliefs that certain skills or rituals may help to win in games of chance) influence behavioural and subjective responses during laboratory gambling. Eighty-four individuals, who gambled at least monthly, performed a simplified slot machine task that delivered win, near-miss, and full-miss outcomes across 30 mandatory trials followed by a persistence phase in extinction. Participants completed the Gambling-Related Cognitions Scale (GRCS; Raylu & Oei, 2004), as well as measures of disordered gambling (South Oaks Gambling Screen [SOGS]; Lesieur & Blume, 1987) and social desirability bias (DS-36; Tournois, Mesnil, & Kop, 2000). Skill-oriented gambling cognitions (illusion of control, fostered by internal factors such as reappraisal of losses, or perceived outcome sequences), but not ritual-oriented gambling cognitions (illusion of control fostered by external factors such as luck or superstitions), predicted higher subjective ratings of desire to play after near-miss outcomes. In contrast, perceived lack of self-control predicted persistence on the slot machine task. These data indicate that the motivational impact of near-miss outcomes is related to specific gambling cognitions pertaining to skill acquisition, supporting the idea that gambling near-misses foster the illusion of control.

Maximizing the Impact of e-Therapy and Serious Gaming: Time for a Paradigm Shift.

Internet interventions for mental health, including serious games, online programs, and apps, hold promise for increasing access to evidence-based treatments and prevention. Many such interventions have been shown to be effective and acceptable in trials; however, uptake and adherence outside of trials is seldom reported, and where it is, adherence at least, generally appears to be underwhelming. In response, an international Collaboration On Maximizing the impact of E-Therapy and Serious Gaming (COMETS) was formed. In this perspectives’ paper, we call for a paradigm shift to increase the impact of internet interventions toward the ultimate goal of improved population mental health. We propose four pillars for change: (1) increased focus on user-centered approaches, including both user-centered design of programs and greater individualization within programs, with the latter perhaps utilizing increased modularization; (2) Increased emphasis on engagement utilizing processes such as gaming, gamification, telepresence, and persuasive technology; (3) Increased collaboration in program development, testing, and data sharing, across both sectors and regions, in order to achieve higher quality, more sustainable outcomes with greater reach; and (4) Rapid testing and implementation, including the measurement of reach, engagement, and effectiveness, and timely implementation. We suggest it is time for researchers, clinicians, developers, and end-users to collaborate on these aspects in order to maximize the impact of e-therapies and serious gaming.

Characteristics and treatment response of self-identified problematic Internet users in a behavioral addiction outpatient clinic

Aims: Controversies remain about the validity of the diagnosis of problematic Internet use. This might be due in part to the lack of longitudinal naturalistic studies that have followed a cohort of patients who self-identify as having Internet-related problems. Methods: This retrospective study included 57 patients who consulted the Geneva Addiction Outpatient Clinic from January 1, 2007, to January 1, 2010. Patients underwent an initial clinical psychiatric evaluation that included collection of data on socio-demographics, method of referral, specific Internet usage, psychiatric diagnosis, and Internet Addiction Test (IAT) and Clinical Global Impression Scale (CGI) scores. Treatment consisted of individual psychotherapeutic sessions. Results: Of these patients, 98% were male and 37% were 18 years or younger. Most patients were online gamers (46% playing massively multiplayer online role-playing games). The mean IAT score was 52.9 (range 20–90). Sixty-eight percent of patients had a co-morbid psychiatric diagnosis, with social phobia being the most prevalent (17.8%). Patients who remained in treatment (dropout rate 24%) showed an overall improvement of symptoms: 38.6% showed significant or average improvement on their CGI score, 26.3% showed minimal improvement, and 14% showed no change. Conclusions: Our results support the hypothesis that there are specific types of Internet use, with online gaming mainly affecting young male patients. As Internet addiction is not yet an official diagnosis, better instruments are needed to screen patients and to avoid false-negative and false-positive diagnoses. Successful care should integrate the treatment of co-morbid symptoms and involve families and relatives in the therapeutic process.