compulsive and pathological media- and internet use in ... · „male“ behaviour in adolesence...

Compulsive and pathological media- and internet use in children and

adolescents

Auf Wiedersehen lieber Patrick!

16.3.2012

Phenomenological subtypes (Young,1997; Beard, 2001; Griffiths, 2008;Wölfling, 2009)

ONLINE GAMING preoccupation with different online-games, mainly related to MMORPG´s (Massively Multiplayer Online Role-Playing Games)

ONLINE GAMBLING

preoccupation with different gambling sites (poker and further card-games, online-casinos, online betting)

INFORMATION SEEKING

excessively surfing the Internet for the gathering of irrelevant and superfluous information that doesn´t affect one´s life or interests directly

ONLINE COMMUNITIES

Pre-occupation with communication-based platforms (social networks; chats; message boards)

ONLINE PORNOGRAPHY

preoccupation with pornographic offers; excessively researching for pornographic material

ONLINE SHOPPING excessive and uncontrolled buying of (superfluous) items

Worldwide Internet users/100 inhabitants

Daily use Onliners vs. six months-offliners

International data of prevalence (Wölfling, 2011)

Is there really a new clash of generations?

Who globalises whom? „Digital natives vs. Digital immigrants“ ? Welcome „silver surfer“ !

(post- moderne) Medienkritik 1.0

Marshall McLuhan 1956

Joseph Weizenbaum 1976

Neil Postman 1984

In the fields near amsterdam 1790

Cyper-philosophy and media criticism 2.0

Jaron Lanier: Gadget, 2010

N. Christakis & J. Fowler: Social networks, 2010

Nicholas Carr: Shallows, 2009

Hartmut Rosa: Beschleunigung, 2005

Thomas Friedman: The world is flat, 2004

Thomas Raab: Wir sind online, wo seid ihr?, 2010

Miriam Meckel: Next, 2011

Sherry Turkle: alone together, 2011

In the streets of Luxor (Egypt) 2011

contextual factors facilitating excessive e-media-use („Triple A“, Shotton, 1991; Cooper, 1998)

Accessibility

Affordability

Anonymity

«Mobile Boost»

60% of mobile phone

users surf daily in the

internet

pragmatic terminology and typology (te Wildt, 2009; Wölfling, 2009, Petry, 2003)

Pathological internet use (Davis, 2001; Kratzer, 2006)

Internet and media addiction

Internet and media dependency

«Gamer/Gambler»

«Chatter»

«Surfer«

DSM-5 Development

Experimental Design – visual cues

computer game-associated and non-computer game-associated cues

Cue-reactivity in PIU

Virtual or real danger ? The gender perspective

© Blizzard: WoW tcg

Adolescent development is demanding

Accepting of body changes sexual identity Peer relations Emotional independence Preparing work-life Preparing family-life Social responsibility Ethical system

Technology and its

content relaxes immediately…

Top 10 games of female german adolescents (n=21.509)

Daten aus KfN Schülerbefragung 2007/2008; bearbeitet durch Ines Bodmer

Social role games as a Substitute

Everyday-life as role play

Very popular

SIMS, Bus, second life, Farm

Re-start any time

Web 2.0, daily use of social networks (JAMES-Study, Swisscom 2010)

three clicks further at Schülerinnen-VZ…

„male“ behaviour in adolesence

Risc behaviour

Sensation seeking

novelty seeking

Testing boundaries

Attachment new defined

Playing with extremes

Acting out

Old man, have you been at the Intel extreme masters in Hanovers Cebit 2012? No?

Top 10 games of male german adolescents (n = 22.620)

Daten aus KfN Schülerbefragung 2007/2008; bearbeitet durch Ines Bodmer

online gaming -MMORPG (Massive Multiplayer Online Role Play Game)

Risc factors for addiction in childhood (5-11y.) (Loxley et al., 2004, Jordan u. Sack, 2008)

Early school problems

Conduct disorder

Aggression

Intensive relations to elderly peers in early adolescence

(Erhart et al., 2007; Weichold et al., 2008)

What do gamers achieve? The reward issue (Caplan, 1998; Shaw u. Black, 2008; Möller, 2008, Wölfling u. Beutel, 2009)

Social reward

Transfer of reward in „real“ life by peer-interaction

Several Identities in distinct Subcultures

Simulation of competition without consequences

Cultivation of aggressive cognitive patterns

cognitive coordination capability increased

What do gamers achieve? the self-therapy-hypothesis (nach Krausz, 2004, modifiziert von Bilke u. Spitzcok, 2009)

Therapy of mental disorder Therapist decides Peer-criticism cultural Stigma control at therapist Side effects uncontrollable

dysfunctionality at beginning and transitions

„Self-therapy“

Against adults

Peer-Integration

Identity in Subculture

Side effectsControllable

dysfunctionality in the end

Conflicts in

autonomy

Electronic media change the individual communication patterns (Weinberg, 1996; Cooper u. Sportolari, 1997; Wan u. Chiou, 2005; Lanier, 2009)

individual secrets are lifted much easier

reduced fear of being mobbed (Avatar…)

Cyber-mobbing is very present in networks

physical and intellectual aspects less relevant for

interactional and sexual attractivity

Communication by a „blink“

Communication exclusively in social networks

Clinical diagnostics in PIU

media history / structured interview

media changes

family history of PIU

functionality of PIU

unusual use of media due to age and sex/gender

isolation instead of networks

psychosexual development

Coping with aggression and interpersonal conflicts

Dependency has to be diagnosed clinically (Beard, 2005; Ha et al., 2006; Huang et al., 2007;Böning, 2008; Bilke, 2008)

Three or more criteria fulfilled in the last six months:

compulsive need to play , surf, chat or gamble

severely reduced control over time and intensity

evident somatic craving

tolerance increased

severely reduced social interactions „offline“

constant behaviour accepting the damage

Premorbid factors of addicted persons-retrospective (Caplan, 1998; Shaw u. Black, 2008; Möller, 2008, Wölfling u. Beutel, 2009, Bilke et al., 2011)

Fear to miss something

Time perception altered

Tasks and themes are never ending

Aggression bound to certain topics

OCD-like symptoms

Untreated ADHD

Asperger-syndrome

Three crucial handicaps in the „brave new world“ (Nielsen, 2005)

Insufficient reading capacities

Insufficient strategies in searching

Reduced patience

www.ltv.se

Multitasking as a developmental risk (Ophir, Nass u. Wagner, 2009)

increases distractability

reduces working memory

differentiation figure/backgound decreases

fast reaction to „false alarm“

„der zum Scheitern verurteilte Versuch des

Menschen, selbst zum Computer zu werden“ (Schirrmacher, 2009)

Co-dependeny in adolescence (modified Rennert, 2005)

over-involvement vs. Lack of responsibility

Illusion of (technical and / or financial ) control

shame and grief

Problems with self-esteem

Supressed emotions

Joint progressive loss of reality

Joint virtual online-life

Psychiatric disorder

Übergeordnetes Behandlungsziel Abstinenz; adäquate Lösung

alterspezifischer Entwicklungs-aufgaben

Teilziele dauerhafter Verzicht auf die

konsumierte Substanz (Abstinenz); Reduzierung des Substanzkonsums als Zwischenziel

Klärung bahnender Mechanismen des Cravings und der Rückfall-gefährdung

Überwindung des suchtbezogen eingeengten Denkens und Handelns

Reduzierung der Häufigkeit und Schwere von Rückfällen

Behandlung der komorbiden psychischen Störungen entlang der Leitlinien der jeweiligen Diagnose-gruppen

Somatic disorder

Ziel Bei kardiovaskulären Störungen,

chronischen Infektionen (Hepatitis C, HIV etc.), Leberfunktions-störungen sowie Störungen im ophtalmologischen und HNO-Bereich ist eine medizinische Behandlung dieser Störungen als Weiterführung der Akutbehandlung und im Sinne einer Sekundärprophylaxe angezeigt.

Post acute treatment in addictions (german guidelines, 2009)

therapeutic interventions (from Wölfling et al., 2010)

Therapy phases (Wölfling et al., 2011)

Phase 1: „Abstinence“(Bilke et al., 2011)

Developmental psychiatry

Multiaxial Diagnostics

Therapy planning

Ressources of the family

other addictions

Functionality of behaviour

Media oriented assessment

E-Media history

E-Media diary

Content of games

Intensity of games

Functionality of behaviour

Phase 2: „prosocial computer/media use“ (Wölfling, 2010,Bilke et al., 2011)

Developmental psychiatry

Adjusting of therapy

Family interventions

Individual therapy

Pharmacological therapy

Media oriented intervention

Media history in detail

Content and meaning of games

Understanding intensity

Change functionality

peer–to-peer-approach

Phase 3: social and academic reintegration

Developmental psychiatry

sustained therapy

family counselling

pharmacotherapy

school integration

Media oriented intervention

media competence

Game content changed

Intensity understood

Functionality changed

Klinische Forschungsansätze - Ausblick (Shaw u. Black, 2008, Bilke u. Spitzcok, 2009; Petersen et al., 2009, Wölfling , 2011)

Validierung von Untersuchungsinstrumenten

Entwicklungsverläufe

Typisierung und Definition

Komorbiditäten

Familienaspekte

Biologische Aspekte integrieren

Evaluation von Therapieprogrammen

Danke für Ihre Aufmerksamkeit !

www.doktor-bilke-hentsch.ch