One of the first things I (KH) often hear in therapy is the accusation that a partner is “addicted” to the Internet. We believe this is a way to distance rather than confront the problem. More often than not, the people in the room are not addicted to the computer. Yet such words are used as a weapon against each other. When we talk about “addiction,” what are we really saying? On the flipside, because of the nature of my (MLCT) clinical consultations—which focus on gender, sexual, erotic, and relational diversity (GSERD)—people I work with are at times very into sexual technologies (sextech), but may have partners who are afraid of the technology (technophobic) and thus are weary of such practices. But what is technophobia and how much of an issue is it really?
Out-of-control technology behaviors have many characteristics of a behavioral addiction. Such behaviors are often conceptualized as being a form of one of two diagnoses in mental health—either a form of an “addictive” disorder or a form of impulse control disorder (Spada, 2014). When considered an “addiction,” commonly referenced criteria include Internet use that is interfering with one’s vocation or personal life (Spada, 2014). Ross (2006) offered a conceptualization of problematic Internet use among five criteria. These criteria include:
Whether it is characterized by time online or the specific activities, the presence or absence of physical symptoms (which are more common in addiction than in infidelity), and the presence or absence of addictive properties such as speed and potency of information, or connection factors that play a part in maintaining the behavior. Another conceptualization is offered by Ross and associates who conceptualize Internet addiction as having an impact on five major domains: “causing problems in everyday life; a sense of lack of control; feeling bad about sexual use of the Internet (dysphoria); a subjective awareness that things have reached the point of lack of control and addiction; and seriousness, a sense that this addiction requires professional intervention or treatment.”
(p. 460)
In addition, out-of-control technology-related behaviors (Braun-Harvey & Vigorito, 201 6; Twist & McArthur, 2017) seem to be associated with time spent online (Odacı & Kalkan, 2010). The more time spent online, the more likely one is to indicate problematic usage. Further, Internet “addiction” is viewed to have similar characteristics to other addiction categories, including withdrawal, conflict when asked to limit use, tolerance, relapse, changes in mood, loss of interest in previously pleasurable activities, and using the Internet for mood management (Sussman, Harper, Stahl, & Weigle, 2018).
Unfortunately, there is a great deal of incongruence in both the terminology and the criteria. For example, phrases such as “Internet addiction,” “problematic Internet use,” “compulsive Internet use,” “Internet compulsion disorder,” and “pathological Internet use” are used synonymously and interchangeably (Billieux & Starcevic, 2017). In fact, the American Psychiatric Association (APA, 2013) in the Diagnostic Statistical Manual of Mental Disorders (DSM)-5 claims that Internet gaming disorder is synonymous with Internet “addiction” and Internet use disorder (American Psychiatric Association, 2013; Billieux & Starcevic, 2017), which, when considering the vast difference in those terms, is irresponsible. This makes the classification of Internet “addiction” (and consequently, treatment) fraught with conceptual and definitional issues (Ryding & Kaye, 2018). Moreover, with no clear definition of what are healthy technology-related behaviors and usage, it makes it virtually impossible to determine what are out-of-control, pathological, addictive, and/or phobic technology-related behaviors.
According to the Merriam-Webster Dictionary (n.d.), “technophobia” was first cited in 1947, and is defined as the fear or dislike of technology or complex devices, especially those of an advanced nature. There is disagreement as to whether this fear is irrational or justified in nature (Osiceanu, 2015). In the United States, such feelings and behaviors around technology started to first be observed during the Industrial Revolution, and have since been observed around the world across various societies.
Prominent computer educator, professor, and research psychologist Dr. Larry Rosen (1993) has identified and described three main types of technophobes: (1) uncomfortable users, who are slightly anxious about technology due to their lack of knowledge and information, (2) cognitive computerphobes, who appear non-anxious with technology, but who, internally, experience negative cognitions and distortions in relation to their technological engagement, and (3) anxious computerphobes, who experience classic anxiety signs and symptoms when engaged with technology.
In terms of the prevalence of technophobia, there is data that exists going back almost 30 years now. In a survey study of 3,392 first-year university students across 23 countries conducted between 1992 and 1994, Weil and Rosen (1995) found that 82% of Indian students, 58% of Japanese students, 53% of Mexican students, and 29% of US students reported high levels of technophobic fears. Moving forward, each year, beginning in 2014, a research team (Bader, Day, and Gordon) at Champman University has conducted a comprehensive, nationwide study of the fears of US persons. Their findings the first year were that of the 1,500 participants, technophobia was not one of the biggest fears, but rather that forms of technophobia (i.e., online identity theft, and government and corporate surveillance of Internet activity) were some of the top five things held as worries or concerns by people (Ledbetter, 2014). The following year, of the 1,541 random US sample of participants, Bader, Day, and Gordon found that technophobia (i.e., artificial intelligence, robots, and cyber-terrorism) was in the top five fears of people (Ledbetter, 2015). When participants were asked to rate their level of fear on a scale of 1 (not afraid) to 4 (very afraid), technophobia received the second highest average fear score—2.07; human-made disaster, with an average fear score of 2.15, was the only fear ranked higher (Ledbetter, 2015). By 2016, 2017, and 2018, however, technophobia was not ranked even in the top ten biggest fears of US participants (Wilkinson College, 2016, 2017, 2018).
The data has also shown that fear of US persons in general appears to be on the rise (Wilkinson College, 2018). Bader, Day, and Gordon speculate on this change, stating that in the era of the current US presidency (Donald Trump and administration), other fears have grown significantly more critical like fears for the environment, healthcare, government corruption, and shrinking wealth and thus have replaced technophobic fears (Wilkinson College, 2018). I (MLCT) would agree with this idea—that people have more important things to fear than technology, but I would also attribute such a decrease in technophobia to the growing everyday use of technology across US generations and overall populations.
Technophobia can and does have a major impact on the quality of life for individuals and relational systems (Brosnan & Thorpe, 2006; Nimrod, 2018; Osiceanu, 2015). For example, there is great difficulty in maximizing one’s academic and employment opportunities at earlier and middle lifespan stages if one suffers from technophobia (Brosnan & Thorpe, 2006). In the later lifespan stage, those who experience technophobia often have fewer resources to cope with their declining health and losses of loved ones (Nimrod, 2018). Technophobia is therefore considered a threat to one’s well-being across the lifespan (Nimrod, 2018).
Other negative effects of technophobia include poorer school performance, threats to job security, decreased happiness, and difficulty accessing one’s social relationships/friendships (Nimrod, 2018). Negative relational system effects can include lack of partners met through online dating, decreased chances to relationally grow through digisexual engagements, less opportunity to develop attachment relationships via technology, decreased experiences with shared technology-based leisure activities with family and friends, and less opportunity to soothe one’s anxieties and insecurities (and those of others) via digital attachments (otherwise known as digiattachments; Twist, 2018).
Some scholars have gone so far as to posit that technology usage is as important as literacy, and thus, the educational system needs to weight the importance of technological literacy equivalent to that of literacy around reading, writing, and mathematics (Osiceanua, 2015). Therefore, technophobia needs to be acknowledged as a problem, and steps need to be taken to reduce it across educational, employment, and home settings (Osiceanua, 2015).
Out-of-control technology-related behaviors have also been tied to a host of negative consequences (Eleuteri, Saladino, & Verrastro, 2017). For example, low motivation in students is associated with a lack of key aspects that would create success for one in academics, including intrinsic motivation, and the ability to master a task (Reed & Reay, 2015). Outside of academics, out-of-control technology usage is comorbid with somato-form disorders, suicidal ideation, sleep problems (as discussed in Chapter 1), immune system problems, anxiety symptoms, and conditions such as obsessive-compulsive disorder (Kim et al., 2016; Moretta & Guodo, 2018; Reed, Romano, Re, Roaro, Osborne, Viganò, & Truzoli, 2017; Shaw & Black, 2008; Stavropoulos, Gentile, & Motti-Stefanidi, 2016; Sussman et al., 2018; Taylor, Koerber, Parker, & Maitland, 2014; Tuzun Mutluer, Yener Orum, & Sertcelik, 2017).
There are also physiological responses after using the Internet for those who fit a profile of out-of-control pathological users—including increased heart rate and systolic blood pressure, increased sense of anxiety (either as an interpretation of the individual of the increased heart rate and blood pressure, or preceding the physiological changes), and depressed mood (Reed et al., 2017). This finding is further supported by research in neuro-biology, which has uncovered impairment in the brain centers that regulate motivation, reward, memory, and cognitive control (Park, Han, & Roh, 2017). Like any construct in psychology, however, the relationship may be influenced by third variables. In the case of Internet “addiction,” the anxiety and negative psychological outcomes are affected by one’s coping style—the more negative your style, the more likely your computer use is problematic (Tang, Yu, Du, Ma, Zhang, & Wang, 2014). In fact, the ability to escape one’s offline life is a major contributor to the development of Facebook “Addiction” Disorder (FAD), for instance (Brailovskaia, Rohmann, Bierhoff, & Margraf, 2018). Moreover, researchers using a German-based sample demonstrated that the personality trait of narcissism and negative mental health issues like depression, anxiety, and stress symptoms are positively related to the experiencing of FAD (Brailovskaia, Margraf, & Reed, 2017). Furthermore, this research seems to indicate that narcissistic people may be specifically at greater risk for developing FAD (Brailovskaia et al., 2017). Of course, because the findings are correlational in nature, it may also be the case that the experiencing of FAD puts people at greater risk for furthering their own narcissistic tendencies.
Out-of-control technology usage is also tied to psychiatric conditions— namely, substance abuse, mood disorders, and other impulse control disorders such as gambling (Kawabe, 2016; Ko, Yen, Yen, Chen, & Chen, 2012; Spada, 2014). Disorders that have demonstrated some association to out-of-control technology usage include major depression (Moreno, Jelenchick, & Breland, 2015), persistent depressive disorder (previously known as dysthymic disorder; Bernardi & Pallanti, 2009), generalized anxiety (Coyne, Padilla-Walker, Stockdale, & Day, 2011), and bipolar disorder (Tang & Koh, 2017). There has also been research substantiating co-occurrence with attention-deficit hyperactivity disorder (ADHD; Finlay & Furnell, 2014; Wu, Chang, & Tzang, 2014). Further research has tied alexithymia (the inability to identify emotions) and the experience of trauma to increased susceptibility to Internet “addiction” (Sussman et al., 2018; Taylor et al., 2014).
In children and adolescents, the criteria for determining if Internet use is problematic may be expanded to include using the Internet as a way to self-regulate, but doing so in a way that is maladaptive (Cole & Hooley, 2013; Haagsma, Caplan, Peters, & Pieterse, 2013; Kardefelt-Winther, 2014a; Oktan, 2011). Both cognitive and behavioral manifestations point to someone who cannot adequately regulate their emotions. Cognitively, an inability to self-regulate is characterized by obsessional thinking. The behavioral manifestation, then, is compulsive behavior (Caplan, 2010). In addition, the compulsion to use the Internet is fueled by an inability to feel that one has autonomy and mastery in their offline world (Casale, Lecchi, & Fioravanti, 2014). Family factors associated with Internet addiction in teens include poor communication (particularly about Internet use), parental drinking, family dysfunction, and family dissatisfaction (Lam, 2017).
The cognitive-behavioral theory of pathological Internet use (Caplan, 2002) states that pathological use arrests a variety of areas of one’s functioning—emotional, cognitive, and behavioral. These effects can be observed both online and offline. For example, disruption in emotional functioning might be characterized by greater depression symptoms, anxiety symptoms, and sensitivity in interpersonal interactions (Alavi, Maracy, Jannatifard, & Eslami, 2011; Bodhi & Kaur, 2017; Caplan, Williams, & Yee, 2009; Chou et al., 2017; Ha et al., 2007). The association to depressive symptoms, according to Davis’s (2001) model, suggests that individuals who are more likely to engage in pathological Internet use are those who have a predisposition to maladaptive cognitions, of which there are two types. One type—thoughts about the self—is those thoughts where the individual already has a pattern of rumination and this rumination extends to them thinking about their Internet use (Davis, 2001). Maladaptive cognitions held by the individual extend to ruminating about the evaluation of their offline interactions and their comparison to online interactions. For example, due to negative self-thoughts inspired by low self-esteem, an individual may convince themselves that they are more successful in interpersonal interactions online and may see themselves as unsuccessful offline, thus reinforcing their maladaptive cognitions (Davis, 2001). The other type is thoughts about the world, and, in the case of pathological Internet use, refers to when an individual holds global thoughts about the Internet such as “the Internet is the only place I am safe to be myself.” In either case, the maladaptive cognitions further contribute to a dependence on the Internet and become self-reinforcing (Davis, 2001).
Additionally, in the cognitive-behavioral theory of pathological Internet use, the use is a multi-dimensional construct (Davis, 2001). This means that problematic use affects many areas of one’s well-being. Pathological use is separated into two categories—specific problematic usage (SPIU) and generalized pathological usage (GPIU). SPIU refers to using the Internet to engage in certain activities in problematic ways, including online gambling, day trading, etc. (Caplan, 2002). These would be activities that could be done outside of the Internet and, without the advent of the Internet, would be accomplished in another way. GPIU, on the other hand, is more directly related to problems with technology’s social communication components—that is, without the Internet, the person would not necessarily express problems related to communication (Davis, 2001). Sussman et al. (2018) claim individuals with anxiety in attachment and social interactions with others may be predisposed to Internet addiction, as the lack of anxiety to talk online may, without intention behind it, turn into a dependence as this is the only comfortable way to express oneself.
These categories are reminiscent of Al Cooper’s categories of Internet cybersex users—at-risk, recreational, and compulsive users. At-risk users (Cooper, Putnam, Planchon, & Boies, 1999) are those users who would not have a problem with pornography and the Internet without the presence of the Internet. Cavaglion and Rashty (2010) describe the process of the at-risk user developing problems as beginning with a slow decline in the quantity and quality of interactions with others, including an eventual decline in work performance. A second type of user is defined as recreational (Cooper et al., 1999). This means the Internet provides a way to seek out cybersexual activities or facilitates the viewing of pornography, but the person uses this strictly for entertainment value and is in no way addicted to either the Internet or the sexual activity. This type can be the most difficult for couples to understand because a partner’s usage might be recreational, but because of its sexual nature, it may be classified by their partner as being an addiction or compulsion problem, thus complicating the treatment process from the beginning. A third type of user is known as the compulsive user. Implications for couples where one partner is a compulsive user include a decrease in the amount of sex desired by the compulsive individual toward their partner (Schneider, 2000), a decrease in one’s sense of sexual desirability, a reduced frequency in sexual interaction, and a decrease in sexual satisfaction (Bergner & Bridges, 2002; Bridges, Bergner, & Hesson-McInnis, 2003).
One final model that examines the complexities of Internet addiction and Internet gaming disorder is that which classifies such addiction as a spectrum disorder (Billieux & Starcevic, 2017). This view builds on previous research that identifies problematic gaming and problematic Internet usage as two very distinct phenomena (Király et al., 2014). Further, there are differences in motivation to engage in gaming and other online behaviors: for example, some motivations may be escapism, and other motivations may be excessive fantasizing, as in the case of cybersex (Billieux & Starcevic, 2017).
One of the aspects commonly associated with those who use the Internet is its association to loneliness. The research early in the field of Internet users sought to explore what type of personality was associated with using the Internet. The prevailing hypothesis in the late 1990s and very early 2000s was the Internet had limited power and impact in our lives, and its users were afraid to interact with others—those with social pho-bias, who preferred a certain level of isolation, or who were socially inept (Ceyhan & Ceyhan, 2008; Ghassemzadeh, Shahraray, & Moradi, 2008). In fact, one of the key criteria for the definition of pathological Internet use, according to Davis (2001), is the perception that the Internet is one’s only friend. Simsek, Akca, and Simsek (2015) have tied loneliness to a sense of hopelessness, which, in the case of out-of-control technology-related behaviors, becomes a reinforcer for becoming more dependent on using the Internet to manage the feelings of hopelessness and isolation.
As more and more people have been using the Internet, it is clear that it is no longer the case that “only the lonely” are the ones using the Internet— it is everyone. Researchers then started turning their questions to whether Internet usage leads to more isolation, and potentially more loneliness (Kraut et al., 1998). This can be a very serious consequence. Brain scans reveal that remaining in a socially isolated state can induce certain changes in the brain (Cacioppo, Capitanio, Cacioppo, Hinshaw, & Albarracín, 2014). Heavy use of the Internet has also been found to increase depression and social isolation, despite the connectivity (see, for example, Puri & Sharma, 2016; Yao & Zhong, 2014). But is the Internet socially isolating, or are isolation and loneliness a precursor to Internet usage? The time one spends online away from others may not be time spent socially isolated if they are in fact engaging with others online. And in fact, that is what many seem to use the Internet for—social connections (Amichai-Hamburger, & Vinitzky, 2010; Zheng, Spears, Luptak, & Wilby, 2015). This contention might underlie why other researchers such as Takahira, Ando, and Sakamoto (2008) have found the opposite—that there is no impact to the perception of loneliness due to Internet usage. Further, in at least one study the Internet has been shown to improve quality of life, but can either increase or decrease loneliness to get there (Khalaila & Vitman-Schorr, 2018). In addition, the usual suspects that tend to contribute to Internet overuse (escapism, loneliness, and social anxiety) tend to lose their statistical significance when taking stress into account (Kardefelt-Winther, 2014b). Casale and Fioravanti (2011) noted that generalized pathological Internet use, as compared to specific pathological Internet use, seemed to be the one type predicted by a student’s level of loneliness, but was not the type predicted by depression or self-esteem.
The Problem Behavior Theory has been applied to exploring young people’s Internet use. Moving outside of the traditional models that associate certain personality characteristics such as loneliness and social anxiety with increased computer usage, the Problem Behavior Theory (Ko et al., 2008) takes an ecological approach. This theory posits that there are variables outside one’s personality that create a fertile bed for the growth of Internet use problems—notably, behaviors and the environment. Both protective and risk factors serve to inhibit the development of problematic Internet use or accelerate it. For example, parental attitudes and behaviors may contribute to a youth being more likely to develop problematic usage (risk factor) or less likely (protective factor) (Lam & Wong, 2015). Finally, this model is a circular model: personality factors may influence environmental factors, which may in turn influence behaviors, and so on. This model has some support, as certain contextual factors such as support, bonding, work stress, religion, and style of parenting seem to be factors in the development and maintenance of Internet addiction (Lopez-Fernandez, 2015).
Sextech is technology that is designed to enhance and innovate all areas of human sexuality and the human sexual experience (Gallop, 2015). In relation to sextech, some people are participating in digisexual activities, while others are adopting a full on digisexual identity (McArthur & Twist, 2017). Yet, some people see sexual participation and engagement with technology as a problem, like a technology or sexual “addiction” (Twist & McArthur, 2017).
Again, acting out sexual behaviors share many of the characteristics of a behavioral addiction. Yet, sexual “addiction” was not included in the DSM-5 (APA, 2013) due to lack of sufficient empirical evidence, and related controversy among many in the medical and sexological fields. In addition, the term “sex addiction” is now regarded as pejorative, and viewed as condemning by many clinicians, and a few national governing bodies like the American Association of Sexuality Educators, Counselors, and Therapists (AASECT, 2016). AASECT (2016) recommend that its members not engage in practices that condemn or pathologize what appear to be consensual sexual activities and behaviors (e.g., engagement with online and offline pornography, frequent sexual self- or partnered-activity, etc.). Additionally, a review of the literature suggests that there is no evidence-based treatment for sex “addiction”; relatedly it is not considered a psychiatric diagnostic category, and by extension it is not something that needs to be “treated” (AASECT, 2016; Derbyshire & Grant, 2015).
Regardless of the term that is used to describe out-of-control sexual behaviors (OCSB), “sexual addiction/hypersexual disorder” is commonly used as an umbrella construct to encompass various types of problematic behaviors, including excessive masturbation, cybersex, pornography use, sexual behavior with consenting adults, telephone sex, strip club visitation, and other behaviors (Karila et al., 2014, p. 1). Furthermore, OCSB often leads to non-consensual non-monogamy and/or sexual promiscuity and interferes in one’s sexual relationships.
One of the most common queries asked about OCSB is whether it is a distinct behavior that is qualitatively different from what is the norm, but in ways that are problematic, or if it is a problem on the extreme end of the “normal” range of sexual behaviors (Bancroft & Vukadinovic, 2004). In addressing this query, Braun-Harvey and Vigorito (201 6) posit that OCSB can be either/or or both/and, because their way of seeing OCSB is tied to how a specific person envisions their own behavior. They suggest OCSB is a sexual health problem only if the sexual urges, thoughts, or behaviors feel out-of-control to that specific person (Braun-Harvey & Vigorito, 201 6). To elaborate, a problem with sexual health means a problem with one’s state of physical, mental, emotional, and social well-being in relation to sexuality, and sexual health is not merely the absence of dysfunction, disease, or infirmity (World Health Organization; WHO, 2010).
For a person to be sexually healthy it requires a respectful and positive approach to sexuality and sexual relationships, and the possibility of having pleasurable and safer sexual experiences that are free from discrimination, coercion, and violence. For a person to attain and maintain sexual health, rather than struggle with OCSB, the sexual rights of all persons must be respected, protected, and fulfilled (WHO, 2010). When individuals do struggle with OCSB, some of the ways it may serve a purpose in their lives is to provide them with the illusion of such behaviors serving as a mechanism for controlling their anxiety, stress, isolation, and/or solitude (Rathus, Greene, & Nevid, 2006). Although OCSB may seem to have these benefits, in reality often such behaviors are accompanied by feelings of low self-esteem, remorse, and fear of being found out in relation to their behaviors (Rathus et al., 2006). More often than not despite any of these adverse consequences, the person struggling with OCSB will continue their behavior (Rathus et al., 2006). OCSB might best be clinically explored as a lifestyle choice, or as an aspect of other relational and/or psychological issues (Braun-Harvey & Vigorito, 2016).
When one pairs OCSB with technology, matters become even more complex. For instance, concerns related to technology have yet to be diagnosable by the APA. Yet, people can and often do struggle with excessive, out-of-control, and potentially “addictive” technology issues and their effects on relationships (Hertlein & Blumer, 2013). Unfortunately, up until recently, these kinds of problems have been practically invisible in the mental and relational health community. With the rapid spread of technology, however, more people are now being adversely affected and becoming aware that technology can have both positive and negative effects on individuals and their relational systems. As detailed in this chapter, some of the various technological media that people experience issues with include, but are not limited to: video and online gaming, smartphones, and the Internet. Technology is also the medium needed to support outof-control behaviors related to online pornography, video sex chats, and a range of other digisexual activities (Aaron, 2016; Delboy, 2015). Because of the current and ongoing lack of awareness on the part of clinicians toward better understanding and treatment of problems related to sextech or digisexuality, expanded assessment is necessary for clinicians to effectively attend to sextech-based behaviors (Blumer, Hertlein, Smith, & Allen, 2014). An assessment through which to do this is a focused genogram, more specifically one focused on sex and technology (Blumer & Hertlein, 2015; DeMaria, Weeks, & Twist, 2017; Hertlein & Blumer, 2013).
Online video gaming is now considered a mainstream activity in everyday life. As noted in Chapter 1, the sheer number of people participating in online gaming is growing at an astonishing rate. Couples and families have to make decisions about how this entity will play a part their lives. In 2011, I (KH) went to a large online gaming conference to recruit participants for a study on online gaming and relationships. As I handed out my advertisements for the survey, the conference attendees asked what I was researching. I responded I was interested to find out the ways in which gaming added to and complicated couple relationships. This reply was usually met with a story about how they or someone they knew was in a relationship where online gaming contributed substantially to the relationship’s disillusion or success. For those who shared, it seemed there was not a middle ground—online gaming seemed to have one effect on the relationship or the opposite. The information I received at the conference lent support to what some research had already found: just over a third of couples disagree about whether online gaming is acceptable in their relationships (Helsper & Whitty, 2010). Certainly, the information mentioned in this paragraph was acquired from casual conversations soliciting research participants, and thus, it would not be appropriate to draw any scientific conclusions. But one theme became apparent: the impact of gaming on online relationships was also on the minds of the gamers attending the conference, not just the lone family researcher present.
Online video games are just one area in which couples may choose to participate independently and collectively, as well as with each other or with other people. Online video games refer to video games couples play interactively and online role-playing games. In some ways, online gaming can be helpful to couple relationships. It provides a safe place for the exploration of social interactions. For example, in some of the games that allow for text-based communication to other players, users can present their written text in a way that would present them most favorably. Other ways where games may be beneficial is in assisting people in developing relationships outside of a reliance on physical attributes because the users are generally only able to see one another’s avatars (or characters) instead of the gamer. There may also be a sense of togetherness that is generated when playing with a partner or family members (Greitemeyer, Traut-Mattausch, & Osswald, 2012).
There is also some evidence to suggest that couple relationships are helped by online gaming because to be successful in the games, one has to be able to navigate social situations to collaborate with others in order to accomplish tasks in the game (Hertlein & Hawkins, 2012). Part of the way a gamer successfully navigates these social interactions is through developing a heightened understanding around gender roles. In online gaming, an avatar may or may not represent the characteristics of its owner. Additionally, the gender gap in an online role-playing game might disappear altogether since women can adopt masculine characters and vice versa. In some ways, the online world may provide a more equal playing field, or the notion of cisgender genders might break down altogether as more gender diverse options become available to users. Another benefit is the exposure to others who are geographically distant with the same or similar interests. Finally, those who participate in online fantasy games may have higher levels of creativity and the ability to fantasize outside of the gaming realm—namely within their physical relationship with a partner (Hawkins & Hertlein, 2013; Hertlein & Hawkins, 2012).
Despite the benefits of online gaming in relationships, massively multiplayer online role-playing games (MMORPGs) have become vulnerable to attack because of their association with addiction characteristics, issues of player versus partner loyalty, number of hours spent on the game in one sitting, and one’s willingness to pay for the service (Lu & Wang, 2008). One study cites problematic Internet behavior as a presenting problem in clinical practice (Mitchell, Becker-Blease, & Finkelhor, 2005), one element of which is online gaming.
One of the issues is around the elements of online gaming considered collective play. According to Zhong (2011): “Frequent participation in collective actions increases the chance of social interactions. However, it is unavoidable that sometimes online social interactions are accompanied with selfish, deceptive or ulterior motivations” (p. 2353). In this way, one may observe a partner interacting with others with increasing frequency and may develop suspicion around a partner’s motives. It may also be the case that one’s motives are trusted by a partner, but there is not the same assumption of good intent of the other gamer’s motives.
Another relational challenge may be the ability to… well, relate. A meta-analytic review of video games found, independent of culture and gender, that engagement in violent video games is associated with increased aggressive behavior, increased aggressive thoughts, and lower levels of empathy (Anderson et al., 2008; Anderson et al., 2010). For example, after one year of playing violent video games, best friends were more likely to be aggressive to one another, even if they played together. This effect, however, was true for teen boys, but not for teen girls (Verheijen, Burk, Stoltz, Van den Berg, & Cillessen, 2018). Even playing games with profanity is associated with an increase in aggression levels (Ivory & Kaestle, 2013). In addition, the presence of online gaming addiction is associated with more problems with relationships with classmates, fewer friends, and less perceived family harmony (Wang, Chan, Sai-Yin, Wong, & Ho, 2014). With couple relationships, the implications of online gaming and addiction may be more profound. Those who participate in MMORPGs may play upwards of 22 hours per week (Yee, 2006). They also report having fewer friends and going out less frequently (Achab et al., 2011), but also increased social capital as a consequence of building relationships within the game (Zhang, & Kaufman, 2015). Couples are also aware of the negative impact participating in MMORPGs has on their relationship. According to researchers, for couples with one gamer, as well as couples where more than one partner games, partners report lower marital satisfaction, because they go to bed at different times. In addition, every couple in the study reported arguing over gaming issues and tied these arguments to reduced marital satisfaction, with those couples who had only one person gaming reporting lower satisfaction than in the relationships where more than one partner engaged in gaming (Ahlstrom, Lundberg, Zabriskie, Eggett, & Lindsay, 2012).
In a qualitative investigation specifically related to the experience of women whose husbands play World of Warcraft (a popular MMORPG), the researchers were interested in the relational issues that emerge as a consequence of partner gaming (Lianekhammy & Van De Venne, 2015). In the interviews about their experiences, the women discussed the impact to their family, their relationship, their feelings associated with the issues related to gaming, and their coping strategies. With regard to the family issues, commonly reported issues included conflict with finances, how the gaming affected the husband’s job, lack of responsibility in the home including with children, and a change in the husband’s behavior. Impacts on the relationship included wanting more attention for the non-gaming spouse, attention desired for the children, and a feeling that the priority was the video gaming, not the relationship (Lianekhammy & Van De Venne, 2015). Feelings expressed by the World of Warcraft “widows” included feeling hopeless, “fed up,” angry, and distrustful of their partner. In fact, one of the coping mechanisms was mentioning divorce (Lianekhammy & Van De Venne, 2015).
The challenges associated with online video gaming could be explained by social presence theory (Short, Williams, & Christie, 1976). This theory posits that people who share experiences together are more likely than others to feel closer to one another because of the immediacy in their interaction. For example, Uma and Amar, a heterosexual, upper-class couple who both came from large families of East Indian descent, and whose marriage had been arranged by their families, came to therapy for relational enhancement. When the therapist inquired as to the development of their relationship over time, Amar cited that Uma was generally the first one who responded to his emails and he, in turn, responded to her quickly. They experienced each other as being reliable in their communication, more so than most others in their lives, and felt that the two of them immediately shared a bond characterized by mutual respect and shared family values.
The structure of online video gaming really makes social presence theory relevant. Online video gaming is characterized by (a) a specific number of challenges that have to be overcome in a game in order to be successful in progressing through the game’s levels, and (b) the accomplishment of such tasks primarily through working in a group—an embedded opportunity for social interaction. Issues emerge when the online gamer is participating in online gaming and developing immediacy and intimacy with someone else and not providing those things to a partner. The net result may be the gamer being accused of spending more time and energy and having more positive feelings for online relations than for a primary partner. This can be even more problematic when one considers that the online associations for which the immediacy and intimacy may be developing are ones that may involve the player developing a romantic interest.
A highly developed sense of fantasy was previously classified as something online gaming may contribute to the positive nature of relationship. In some cases, however, when online video games are utilized as a strategy to avoid the tension and stress in one’s offline life, it may interfere with creative problem solving, flexibility, and other issues, setting couples up to present with issues related to online gaming in treatment (Mitchell & Wells, 2007).
Online gaming addiction is more subtle and embedded in a couple’s dynamics than it sounds. How do you know if you have a problem? It is not just the interference with activities. It is the time spent, and protection of the game over all other things, etc. The commonly stereotypic impression of online gaming addiction is that this individual does not bathe/shower, has no friends, is isolated, and spends all of their waking moments on the game playing. This is not an accurate representation. It looks more mundane than that and can really be discerned based on one’s reaction to taking the game away—not even from them, but from someone else.
For example, Alan and Janet, a white, heteorsexual, middle-class couple, presented to therapy with me (KH) for issues around online gaming. Alan has always played games, much to the chagrin of his wife, Janet, who always assumed he would grow out of it. There had been several times in the marriage when she had requested that he spend time with her (for example, staying in bed on Sunday mornings), but he always seemed to make time for his online friends (he elected to play with his gaming friends Sunday mornings instead), and her requests would go unanswered. In fact, he began to say things like “I have to keep that time open to play with my family” while his wife and son would sit downstairs, without him. Alan would engage in episodic barbs at his wife about the lack of sex, but seemed oblivious to the fact that his decision-making regarding her unmet needs and his decision to play games with strangers in favor of time with his wife had anything to do with unmet sexual needs. Further, because of Alan’s work as an online instructor, he was tied to the computer at all times. Though he asserted that he only played with his friends Tuesday night, Saturday morning, and Sunday night (leaving his family to work around his schedule), he was actually tied to the computer more often. This might involve him playing games, and it also involved watching other people play video games—staring at a screen showing YouTube videos of people (young boys) playing computer games. These events would take place all day or all weekend, so Alan would abdicate his family in favor of these games as well.
At one point, Alan’s son Joseph (age 9) started doing poorly in school. Janet suspended the video games until such time as Joseph brought up his grades. Once he lost his video games at home, Joseph was reprimanded and punished in school for using the Internet to look up video game music. The family hit a boiling point. Janet, having had enough of the games from both her husband’s standpoint and her son’s, told Joseph that he could no longer play video games the rest of the year and only when his report card came back with As and Bs would he be allowed to play again.
While both Alan and Janet agreed that Joseph was a totally different kid without the video games, Alan’s inability to handle a consequence of no video games threatened his ability to relate to and work with his son to enjoy their relationship and help him to improve his grades. Alan, likely feeling threatened and ashamed that his own gaming behavior had contributed to the problems his son was having, cut himself off from the school problem in the family. Rather than change his behavior to be a role model for his son, Alan angrily told Janet and Joseph that he would no longer help with homework. He continued to spend every night in his office playing video games or watching other people play video games and left Janet to do the heavy lifting—hold down a full time job as a business executive, do all the homework with her son, etc. In fact, on nights when Janet was late at work or had meetings, Alan still refused to review Joseph’s homework, thus setting him up for failure. When confronted by Janet about the fact that she was doing everything, he said, “I thought we agreed to give up and he was on his own.” She replied that perhaps he was going to give up, but she would not since Joseph was only 9 years old and needed their guidance.
The salient elements of out-of-control online gaming behaviors in this case were: unmet needs; preference for spending time online instead of with Janet and Joseph; constant staring at a digital device through dinners, family recreation time, while driving, and in bed; anger at another personal interruption of computer games; and even watching others play computer games in favor of housework. In addition, Alan ended up needing glasses because he was no longer able to see distance given that his eyes had been negatively impacted by staring at a screen. Alan, aware that his eyes were changing, did nothing to remedy the situation. It was more important to stare at a screen than protect his own health. The way in which these actions affected the relationship included the following: both partners experiencing unmet sexual and emotional needs, resentment for the non-gamer toward the gaming partner for not being a satisfactory participant in the parenting and household responsibilities, lack of sleep for both partners, negative impacts to both partners’ physical health, and providing a poor role model for a child around responsible ways to communicate and engage in leisure activity, and overall negative impacts to the relational system as a whole.
As we, and other scholars, have identified technophobia as a significant area of concern, it is important to give brief attention to what can be done about it. For instance, to address technophobia, many work environments offer support to employees to reduce anxiety-based technology issues (Osiceanua, 2015). Moreover, as those experiencing technophobia commonly have symptoms similar to people struggling from other kinds of phobias, the application of clinical treatments can also be effective in helping people manage or combat technophobia (Brosnan & Thorpe, 2006; Rosen, Sears, & Weil, 1993; Weil, Rosen, & Wugalter, 1990). For instance, technophobia has been successfully treated using systematic desensitization (Rosen et al., 1993). More recently, clinical research has found that when those experiencing technophobia are taught relaxation techniques to apply as a coping strategy, their technology-related anxiety is reduced, and their confidence with using technology is improved (Brosnan & Thorpe, 2006). In another more recent clinical study involving 89 Europe and US based university students, Brosnan and Thorpe (2006) found that even when just a single anxiety intervention session was conducted anxiety levels in the treatment group were significantly reduced when compared to the non-treatment/control group.
Addressing video gaming issues comes from various frameworks and solutions. Because the etiology of problematic video gaming is multifaceted (Davis, 2001; Ko et al., 2008; Lam & Wong, 2015), the solutions also need to be multifaceted. Based on the diathesis-stress hypothesis, Davis (2001) considers pathological Internet usage as having both proximal and distal components. Proximal components are those that are an obvious link to problematic Internet usage, such as maladaptive cognitions (about both the self and the world), the social context of the Internet user (the presence of social support), and an inability to appropriately express oneself or regulate one’s emotions (Haagsma et al., 2013). Distal causes may be an underlying level of pathology, an event that triggers the user, and potentially the presence of the Internet itself.
Parents/care providers can play a key role in assisting their children with moderating their Internet usage and avoiding some of the negative outcomes associated with Internet dependence. While many parents/providers may believe that it is their active monitoring of their children’s Internet use that prevents them from falling victim to some of the negative consequences of such usage, the research actually supports using more strategies that rely on engaging technology to assist in the monitoring (Benrazavi, Teimouri, & Griffiths, 2015; Lee & Chae, 2007). This requires that parents/providers become more knowledgeable about the media to be able to use it to its utmost effectiveness.
Another important component is monitoring peer influences online. There is no question that children need their online activities monitored; however, in cases where parents/providers are not adequately monitoring, peer influences and affiliation can lead the youth toward a potentially deviant peer group, thus increasing the likelihood of developing out-of-control technology-related behaviors (Ding, Li, Zhou, Dong, & Luo, 2017).
Parents/providers also have to manage their own computer usage and be able to talk to their children about excessive Internet usage (Lam, 2017). Research by Lam and Wong (2015) found that those adolescents classified as moderate to severe problematic Internet users were three times more likely (in comparison to adolescents classified with normal Internet use) to have parents who were moderate to severe problematic users of the Internet themselves. In addition, parents can role model appropriate technology usage by being involved cooperatively in games. This does two things: first, it provides them a way to be able to continually monitor their children’s online game-playing behavior. Second, as much as violent video gaming is associated with aggressive thoughts and behavior as mentioned earlier, (Anderson et al., 2008; Anderson et al., 2010), this increased aggression is somewhat mitigated when games are played cooperatively (Greitemeyer, Traut-Mattausch, & Osswald, 2012; Velez, Greitemeyer, Whitaker, Ewoldsen, & Bushman, 2016). Again, this is more than playing the games at the same time, in parallel; this means engaging in a task together during the game and being on the same team to accomplish a goal.
In cases where relational systems present with out-of-control technology-related issues, therapists can work with families to monitor and create a family plan using the IMPROVE tool (Tam, 2017). This acronym reflects a plan that, while geared more broadly toward excessive Internet use, can also be applied to video gaming issues in families. The first item is the I nternet inventory, whereby the parent takes an inventory of the types of Internet use and the time their youth is using the Internet. The next item is M onitor Over Time, which refers to parental monitoring of the youth’s Internet use, with particular attention to changes in patterns of Internet use. For example, a youth might increase the amount of time on social media or decrease game-playing time when the newness of a game wears off, and a parent needs to understand the baseline and be aware of the circumstances around changes in that pattern (Tam, 2017). P arenting Factors refer to how parents use their own technology to model appropriate behavior, and involve a parent’s adopting a style that encourages rewards for appropriate Internet use. R eal-World Activities ask parents to continually involve their children in offline activities, environments, and experiences. O ther Mental Health Conditions include the presence of some of the conditions commonly co-occurring with out-of-control technology-related behaviors discussed earlier in this chapter, such as depression, anxiety, and events such as socioeconomic deprivation. V ulnerability Factors include attending to both external (such as major life events and trauma) and intrapsychic factors (like a narcissistic personality, low self-esteem, and a tendency to procrastinate) (Tam, 2017). Finally, E xtra Help involves inviting other professionals into the picture to address the technology-related issue, including a pediatrician, psychologist, psychiatrist, and/or school counselor (Tam, 2017).
As aforementioned, the negative impact of violent video gaming can include impairments in one’s ability to develop and express empathy, which may have significant and cascading implications for successful social interactions and prosocial behavior. To that end, assisting those who play to focus on strategies to improve the quality of their social relationships as well as moving them toward increasing positive emotions are key (Khazaei, Khazaei, & Ghanbari-H, 2017). Specific components of this IMPROVE program include focusing on assisting the individual with nurturing positive emotions, developing an ability to process maladaptive or negative emotions, and teaching forgiveness, hope, gratitude, satisfaction, and optimism (Khazaei et al., 2017).
Coping strategies suggested by partners in the Lianekhammy and Van De Venne (2015) study included joining in on the gaming, support from the community of people who also struggle with technology-related issues, recognition of the out-of-control component when appropriate, and reliance on the emoticons and electronic gestures they may receive from a partner (Lianekhammy & Van De Venne, 2015). Further, there has been some evidence that the strategies proposed by Hertlein and Hawkins (2012) could apply in these cases (Lianekhammy & Van De Venne, 2015). Such strategies include: increasing the use of fantasy to augment the relationship, inviting one’s partner into the shared activity and working in a cooperative fashion (Hertlein & Hawkins, 2012), and developing clear expectations and appropriate communication patterns for addressing the lack of responsibility regarding the technology-related issues perceived by partners of people with the identifiable technology use issue.
While not common problems, issues such as technophobia, out-of-control sextech behaviors, and out-of-control video and online gaming can significantly affect a couple and family system. Some of these issues need to be addressed and managed individually, whereas others may be able to be addressed in a therapeutic relational context. As technology and the Internet continue to evolve, this list may grow. We need to continue to understand the intrapersonal and interpersonal mechanisms that contribute to the development and maintenance of such issues, which may potentially decrease any negative impact and potentially decrease the incidence of such issues.
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