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