Research Proposal (not technically artistic)

[Feodor]

I. Introduction

Modern society has come to center more and more around the Internet and its many uses. With the click of a button, people can communicate, research staggering amounts of information, shop, listen to music, watch movies, and play games with or against other players across the world. But there is a downside as well, for as Kim (2007) stated in a paper regarding treatment of teenagers in Korea, “Along with all the benefits the Internet brings, problems of excessive Internet use are becoming apparent.” Thus, the last activity, online gaming within virtual worlds, has become the center of increasing amount of attention over the last decade, both from clinical and media representatives. (Grusser, Thalemann, & Griffiths, 2007) While there are many activities on the Internet that are seen as falling under the board umbrella of Internet Addiction, such as online gambling, participation in chat rooms, and compulsive use or online pornography, online gaming seems the most common and recognized by the popular consciousness. Based on their studies in Taiwan, Wan and Chiou (2006) asserted that “Online games have become one of the most addictive activities on the Internet.” Furthermore, the problem is only expected to get worse instead of better. Internet usage has been on an ever increasing upward slope, and along with that internet and online gaming addiction has followed suit. The trend is so fast, in fact, that as a few years ago, internet usage has been estimated to have tripled compared to even three years earlier (Kim, 2007).

On the bright side, now that the problem has begun to receive the attention it needs, there is an increasing effort to development productive treatment options for patients with Internet or Online Gaming addictions. There is also a great need for new and existing counselors alike to be more aware of the signs of Internet addiction, as well as emerging treatment methods, especially as this problem will become more and more an issue as times goes by (Kim, 2007). Beyond merely the issue of increasing Internet usage, there is also the consideration that the majority of people being diagnosed with Internet addiction are college age or younger (Wan & Chiou, 2006). It is assumed that the younger population of this particular behavior will also add to its prevalence and longevity in modern society.

Most treatment to date has followed on the footsteps of other addictions treatment, mainly behavioral approaches similar to those used to treat alcoholism, drug addiction, and pathological gambling. There are therapists though that feel there is need for a new treatment for this phenomena as it differs in important ways from other addictive behavior (Shaffer, Hall, & Bilt, 2000). While these treatments have shown positive results, there is an element here that might have been overlooked. Specifically, there seems to be little validity granted to these persons for their online worlds and online personas. Unlike many other addictions, the online communities and activities that internet games can offer can be sources of strength and growth, both personally and socially. Thus, the premature writing off of that experience might actually be harmful to the client suffering from mixed or lost identity issues, and low self-esteem that might be interfering with their “real life” social activities. This study proposes that a more humanistic, experiential model of treatment that centers more on validation and empathy toward the client’s online affiliations might be more productive.

For the purpose of this study, the independent variable being examined would be the manner of treatment. Mainly, a comparison of traditional behavior approaches versus more client-centered humanistic validation, whether the treatment includes a total denial of the alternate virtual worlds’ validity (including the person’s community, accomplishments, and motivations there in) or an acceptance of this other world as a significant and not-wholly-detrimental part of the patient’s life. The difference in results of the treatment would be measured by testing the client’s sense of self esteem and self concept after receiving one or the other treatment.

It is expected that clients with online gaming addiction issues who’s other lives in virtual worlds are approached respectfully and with validation with have a greater chance of increasing their sense of self-esteem and stability of identity than those who’s virtual identity and world is denied. Furthermore, this study has obvious direct implications for the counseling field, as it is directly assessing one manner of treatment against another for a very specific, but growing problem that is confronting the ever-modernizing world.

In summary, the problem of internet or online gaming addiction is a growing concern that warrants more attention. While there are clinical examinations of both the problem and possible treatments, there is much room for further study. Specifically in the manner of treatment, there is reason to believe that the traditional behavioral model of addictions therapy will fall short and miss a crucial element. Toward this end, this study proposes an alternate treatment based more on the experiential, humanistic model where the client will be validated for the attempts at a personal and social identity formation within the virtual space. This different approach should bolster the client, increasing self-esteem, which can then be used as a base for further social exploration outside the virtual world.

[Feodor]

II. Literature Review

As stated in the introduction, Internet addiction and specifically online gaming or virtual world addiction is starting to receive a great deal of attention, both from clinicians and the general populace. It is agreed upon that something is going on, some new phenomena that holds ramifications for the social, mental, and physical health fields. The fact that online games have become so common has led some parts of the world to label it a public health threat (Chuang, 2006). Unfortunately, much of the agreement ends there and the questions begin. For starters, there is the very basic question of whether or not there really is such a thing as Internet or online gaming addiction. For instance, on one side of the argument there is the research of Shaffer, Hall, and Bilt (2000) who proposed that while there is a current trend in labeling behavior as addiction in our society, but the move to do is usually more media induced than clinically studied. The very term addiction, they argue, is something that is defined differently by various sources. Further, they claim specifically that labeling excessive time spent online or in a virtual world an “addiction” is almost certainly premature, as there are likely many other explanations that must be explored first. On the other side of the argument is Kimberly Young (2004), who is often referenced by other researches for her efforts to very specifically define and lay out clinical criteria for making a diagnosis of Internet addiction. For Young, it is a fairly large umbrella term that covers addictions to multiple forms of Internet usage, such as chat rooms, instant messaging, email, online games, etc., basically anything that involves being plugged in to the social networking aspect of the Internet. It’s also worthwhile to note that Young isn’t alone, and has made headway in her crusade. An editorial was written by Dr. Jerald Block (2008) just last year for the American Journal of Psychiatry proposing that Internet Addiction be considered for the DSM-V, citing studies done in Korea, China, and the United States.

Of course, there’s plenty of room in between these two extreme sides and the shades of grey are full of various opinions from different researchers. For example, in the study by Chumbley and Griffiths (2006), it was found that there are quite a few factors within the game itself that lead to repetitious and extended play. Though studying responses to various types of games, they found that characteristics such as challenge, pacing, competition, and perceptions of reward and punishment were all correlated to a players desire to continue to play a game. This focus of the type of game itself, instead of on the player solely, is a novel approach to the situation. Game persistence taken in this light clouds the idea of online gaming addiction being purely pathological. Instead, Chumbley and Griffiths present evidence that these games could be habit forming by design, inducing an affective state of frustration and desire to overcome challenges, and have less to do with the mental, emotional, and social traits of the player.

On the opposite side of the spectrum, there are some that argue that it is not the behavior itself that needs to be examined, but the players’ personality. In studying players of the massive online game, World of Warcraft, Peters and Malesky (2008) also troubled the idea of Internet or online gaming addiction, stating instead that they preferred the term problematic usage. They posit that idea that the excessive use of the online game should be viewed as a symptom rather than the whole of the problem. In their survey study, they found that many players with high rates of time logged into the game reported problems in their personal lives, including social anxiety and interpersonal issues. This moderately strengthened correlation suggests the possibility that there are underlying personality traits that players may possess well before starting to engage in excessive game play that could predispose them to problematic usage. While it is often taken for granted that the excessive play leads to the interpersonal issues, Peters and Malesky suggest that it might be the other way around, and that these underlying issues should receive more attention than they do. This idea is further supported by various researchers, including Block (2008) in his DSM-V proposal on Internet addiction, reporting that such addictive behavior shows a high comorbidity with other diagnoses. According to Block, it was as high as 86% of cases.

Beyond questions of whether or not there is such a thing as Internet addiction, and exactly what causes it, there is also debate over the manner of treatment, which is something this proposal hopes to add to. It’s important first to consider what the traditional treatments and interventions have been though. In an effort to develop treatment initially, there has been a move to associate online gaming and Internet addiction with other, classic forms of addiction, mainly alcoholism, substance abuse, and pathological gambling (Salguero & Moran, 2002). Of these three, it has been further and further associated with the gambling, as both behaviors are seen as an impulse control problem, as opposed to alcohol and drugs which are a substance based addiction (Young, 2004). Nevertheless, the use of treatments designed around the behavioral model for drug and alcohol addiction have been used, and continue to be used. This includes a very behavioral approach on the onset, limiting or entirely eliminating the addicts pattern and rate of game play. Commonly, this is done alongside the encouragement and formation of other hobbies and activities, often social activities to replace the socialization that occurs within the online gaming world (Chiu, Lee, & Huang 2004). Also in line with the traditional methods for substance abuse treatment, group counseling and programs similar to Alcoholic Anonymous have been used with some success. Jong-Un Kim (2007, 2008) has written two separate studies about running Reality Therapy groups to treat Internet addiction in Korea. Both group studies revolved around sharply decreasing or ceasing the online game play while promoting social skills training to increase self-esteem and self-awareness in a group counseling setting.

Along with the traditional behavioral approaches, there has also been a recent push toward more cognitive treatment plans as well. Such treatment models look less toward the pattern of behavior, and instead into the mental functioning and faulty thought processes that lead to such behavior. For instance, in their examination of the computer game addiction and aggression, Grusser, Thalemann, and Griffiths (2007) end up arguing that a cognitive treatment based on increasing the player’s self-observation skills would probably be effective. They suggest that game playing might be less an addiction, and more a faulty coping mechanism to deal with disappointment and pain in day to day life. Thus, if a client was to be more aware of this negative coping mechanism, the desire to play excessively would fall away on its own, replaced by more productive coping. Along the same lines, Lee and LaRose (2007) see the issue as more cognitively based as well, though they posit the instead of addiction, excessive game play is due to a faulty self-regulation mechanism in the part of the player. They suggest that this lack of self-regulation has to do with the experience of “flow state” when playing the game, that is, that there is a sense of complete immersion that allows for the game player to lose their sense of self, time, and other worries outside the game. Lee and LaRose (2007) also point out that the vast majority of gamers are able to reinstate their sense of self-regulation naturally, without the encouragement or need of an outside regulatory source. Thus, not only do they trouble the idea of addiction itself, but also leave room for treatments that are not behavioral in nature, but rather rely on the client to fix themselves once a change of perception has occurred.

None of the above is meant is to suggest that there are not serious concerns with excessive online gaming. There most certainly are. It is well documented that excessive online gaming and time spent in virtual worlds is positively correlated with depression and social anxiety (Kim, 2007). It has also been shown that excessive playing of these games hinders academic performance and decreases the likelihood of the player having healthy, positive interpersonal relationships (Wan & Chiou, 2006). However, it is also acknowledged that MMOs, Massively Multiplayer Online games, are a different beast, and while these negative consequences do occur, that is not the whole picture. Online games do offer a social networking aspect that changes the dynamic when considering possibly pathology and treatment (Lee and LaRose, 2007). As Joshua Smyth (2007, p.717) put so eloquently, “MMORPGs represent a different gaming experience with different consequences than other types of video games and appear to post both unique risks and benefits from their use.”

There are two major characteristics that set MMOs apart from other video games and warrant attention when considering treatment. First, there is the fact that in these types of online games, the player actually creates a persona within the game, a character that he or she has control over and develops according to personal wishes and choices. Lewis, Weber, and Bowman (2008) studied this particular aspect of online games, considering it an important enough variable to name character attachment. They studied how this sense of attachment between player and online character actually correlated with game enjoyment and a desire to play, indeed with video game addiction as a whole. Character attachment was also shown to be a mediating force between the self-esteem of the player and the time spent playing. The data they gathered showed that those players with lower character attachment had a stronger negative correlation between self esteem and time played than those with lower attachment.

The other, arguably more important, difference that sets MMOs apart from other games is the social aspect of playing online with other players. This single aspect has huge implications across the board. One of the reasons Internet gaming has such a large draw as compared to other games is the very widely developed social tools and possibilities built in. Unlike many other types of games that are played individually, or in small groups of players in the same room, online games are played by thousands of players at any one time from around the world, all of whom one has the ability to interact with. Cole and Griffiths (2007, p.575) put it particularly well in their study, describing how “Research suggests that the game-play within these virtual worlds is enhanced because players use them as traditional games as well as arenas in which to explore new relationships, new places, and themselves.” In fact, some research has suggested that it is the social interaction itself, with the actual game-play as a far second, that draws people into MMOs in the first place. Joshua Smyth (2007) reached that very conclusion at the end of his study, suggesting that social interaction was the core component driving online game usage. It is also often hypothesized that many of these players are seeking a surrogate social experience in lieu of successful social interaction in their day to day life (Lo, Wang, & Fang, 2005).

It is exactly that last idea that might be most important to this particular research proposal. There seems to be a sort of “chicken and egg” type disagreement when it comes to assigning order of causation to excessive online gaming and poor social or interpersonal relationships outside of the game. Some studies clearly want to show that the gaming leads to the social isolation and avoidance of “real life” interaction with people (Lo et al., 2005). Others, though, suggest the opposite relationship, that preexisting poor social skills or unsuccessful attempts at interpersonal relationships leads to the retreat into a safer virtual world (Wan and Chiou, 2006). In all likelihood, the two aspects have a cyclical relationship that feed off each other, with neither being clearly the cause or effect.

The problem comes in when researchers only see the draw to social interaction within MMO’s virtual worlds as a sign of negative development on the part of the player. Instead, this desire to participate in a social environment (even a virtual one) can be taken as a sign of a healthy desire for interpersonal relationships that should be supported and applauded rather than criticized as pathological. While it is true that the social bonds formed in this virtual worlds might be acting as a surrogate for interpersonal relationships outside of the game, they are no less real to the player or client. Instead of seeing these attempts at interpersonal learning and experimenting as merely an avoidance of face to face relations, there is evidence to suggest that these indeed might be attempts to practice skills that can later be used in a non-virtual setting (Smyth, 2007).

In point of fact, there is a great deal of a positive potential in the social interactions that takes place in an MMO game (Cole & Griffiths, 2007). For instance, players in an online virtual world have very little choice but to interact with each other, the games are very frequently built around that very idea. But more so, the games also require specific positive interaction for the completion of in game goals. More frequently than not, players are required to team together and work collaboratively to accomplish the goals of the game. This manner of teaming up teaches players to depend on one other, and promotes the formation of more lasting bonds. Players are encouraged to form larger social networks, usually referred to as Guilds, who’s members regularly work together in game, share conversation, and rely on each other for support. In Cole and Griffiths (2007) study, players also expressed feeling more themselves in their virtual environment, as they weren’t being judged by their appeared, age, gender or ethnicity. The MMO provides the players with a safe environment to explore social interaction, which often can lead to interaction outside the game. In that same study, 42.8% of players reported meeting their online friends outside of the game and building further on the relationship started in virtual space. Smyth (2007) also suggests similar ideas, that the social interaction that takes place in these online games might actually help players develop social and emotional regulation skills.

As a final point, it should be noted that using online video games as a supplement or aid in therapy is not an idea without precedent. Wilkinson, Ang, and Goh (2008) researched that exact subject, and found that online games provided a significant benefit to therapy with specific populations and presenting problems. In particular, they found that when treating children, the elderly, client’s with autism, or those suffering from anxiety disorders, online video games were able to elicit therapeutic benefits. Along the lines of this proposal, they end their research report by stating that MMOs “with an online chat component, provide a limitless platform for social interaction that could be incorporated as part of the intervention program” (Wilkinson, Ang, Goh, 2008, p.378).

To conclude, there are still more questions than answers when dealing with the diagnosis and treatment of online gaming or MMO addiction. While traditional behavioral approaches to understanding and treating the excessive gaming has shown positive results, there is reason to believe that these model of understand might be missing something. In particular, the vast social networks that are formed in these games and the deeply personal investment that players have in their online personas should be examined as spring boards for therapy instead of evidence for pathology. There are many useful aspects to the social interaction that goes on in these games which therapists could use to redirect toward interpersonal growth outside the game, but only after understanding these players and their motivations for investing so much in a virtual life.

[Feodor]

III. Method

Participants will be taken from a population of young adults and adults seeking treatment for online video game and computer game addiction, specifically those that involve a virtual simulated world, through the cooperation of 5 local counseling agencies. Both men and women will be accepted, as long as they are over the age of 16. The approximate size of the sample will be 40 people, 20 for each style of treatment being tested. They will be drawn from the eligible population by means of stratified random sampling, being first divided by gender. The gender categorization is important because there is very likely to be a much larger percentage of men than woman seeking treatment for this addiction, and thus it would be important to make sure that each gender was represented in each group. All participants will be required to read and sign a statement of informed consent prior to admission into treatment, with parents or guardians signing for those who are still under the age of 18.

The dependent variables being measured are the clients’ self-esteem and self-concept after receiving one of the two forms of treatment being offered. In regards to the self-concept variable, the Tennessee Self-Concept Scale will be used for evaluation purposes. This test was authored by William H. Fitts in 1965 and was designed to summarize an individual’s sense of self-worth, as well as to present an indication of the individual’s self-image, in so much as if it is realistic or not and deviant or not. The test breaks down self-concept into five external categories (moral-ethical, social, personal, physical, and family) and three internal aspects (identity, behavior, and self-satisfaction), with the cross over and relationship between these offering an idea of self-concept as a whole. The test is set up as a 100 item, 5 point Likert scale response, ranging from “Completely Disagree” to “Completely Agree.” After being taken, the Likert responses are assigned a value based on the individual’s level of agreement, and scores are generated for each of the 8 aspects of self-concept, both internal and external, as well as a total, overall score. Reliability for this test measures from .60 to .90. (Marsh & Richards, 1988)

While self-esteem is somewhat accounted for by the Tennessee Self-Concept Scale, it is deemed important enough to this study to have another, separate test given concentrated specifically on it. For measurements of self-esteem, the Rosenberg Self-Esteem Scale will be used. This instrument was authored by Dr. Morris Rosenberg originally in 1965. While it has undergone some changes in scoring, the 10 items the client responds to remain the same. It is used now as a Likert scaled test to measure either a positive or negative orientation toward the self. After completion, each item is given a score based on the response to the usual 4 point Likert scale, usually between 0 and 3. These number values are then totaled to produce a score between 0 and 30, with 30 being the highest possible measure of self-esteem. Reliability for this test is quite high, typically ranging from .82 to .88. (http://www.bsos.umd.edu/socy/Research/rosenberg.htm, n.d.)

Most of the researcher’s interaction with the sample groups will occur after treatment. All the data gathering, in particular, cannot occur until after the full treatment program has been completed by each group, as the treatment style itself is what is being tested. Thus, after the members of the sample have completed the course of counseling, the researcher will then (probably at the close of the last session) administer to the client the two scales that will be used to measure self-esteem and self-concept. Prior to the treatment, the researcher would need more interaction with the counselors who would be administering the interventions than with the sample itself. The counselors would have to be coached on the different forms of intervention, and would probably be used to administer the statement of informed consent to the participants as well.

The two courses of counseling treatment would be similar in many regards, both following a somewhat usual treatment plan for addictions counseling. Obviously the first step therein is to work with the client on an admission that a problem exists in their life. Early counseling would revolve around helping the client to come to terms with the fact that their addiction or obsession is leading to poor functioning behaviors in their life, likely the loss of personal relationships, the abandonment of responsibilities to work, school, home life, and the deterioration of self care. Both would also involved a great deal of help in the middle and late stages of counseling with establishing and practicing social skills and life skills, as well as enhancing the ability of the client to recognize and avoid relapse.

Obviously though, there will be differences. The comparison group will receive the more tried and true form of addictions counseling, which in terms of this addiction, would involved a great deal of reality testing. The client would be encouraged consistently to “kill off” his virtual identity in favor of building a stronger sense of identity in the real world. A great deal of the counselor’s role would be to help the client establish clear distinctions in their life between the fantasy world and the real world, as well as their persona as a character versus a person in the world. Also, the client would be expected to make a more complete divorce from the virtual world and character in which he or she was previously participating. The virtual life would be reinforced as inauthentic, a true figment of imagination and fantasy, that has no bearing on real life.

On the other hand, the experiment group would receive counseling that did not paint this virtual world and existence in a negative light. Instead, this group’s counseling would revolve more around redefining the limitations of this other life without a denial of its validity and possibly positive uses to the client. Quite the contrary, this counseling’s early steps would be an examination of what positive feedback or reinforcement the client felt they were getting from this virtual life that was lacking in their day to day. The client’s online persona would be seen as serving an important function in their life, an attempt at fulfillment that isn’t without merit. More so, as these online experiences are usually somewhat social in nature, they would be used as a springboard for the growth or use of some of the same social skills in the client’s day to day. Ultimately, their virtual world and character would be used as a tool to help the client find that fulfillment in other ways and from the people around them. It would not be expected that the client had to completely discontinue their gaming habits, but merely find a place for them in their life without letting it dominate that life.

This proposal is for an experimental, comparison treatment design. The data would be a multivariate analysis, and would use two independent t-tests for statistical analysis of each tests measure of the dependent variables. I expect that those clients who receive the experimental treatment will show higher levels of self-esteem and self-concept, as the virtual reality they have attached themselves to is not being challenged and discarded, but rather validated and used as a springboard for broader aspirations in their day to day life.

[ccc beck]

Nice work Feo.

[akona]

Not a bad paper. A few grammatical/word usage errors, but nothing to bother with.

[Feodor]

Yeah, I don't proof read. That's one of my biggest academic flaws. Always has been, even when I was still in my undergrad. And for English no less!