Safeguarding Podcast – Porn Stars in Superhero Suits & Internet Gaming Disorder with Michiel Smit

Welcome to another edition of the SafeToNet Foundation’s safeguarding podcast with Neil Fairbrother, exploring the law, culture and technology of safeguarding children online.

In this Safeguarding Podcast with neuroscientist Michiel Smit we explore Internet Gaming Disorder (IGD). We discuss what it is, the impact it has on different brain structures such as the Reward Network especially within the developing adolescent brain, how addiction in general works, purposefully addictive game design and compare IGD with cocaine usage.

There’s a lightly edited transcript below for those that can’t use podcasts or for those that simply prefer to read.

Neil Fairbrother

At this time of year, millions of games will have been given as presents to children. According to Grand View Research, the global video game market was valued in 2019 at $150 billion and the mobile device segment led the market with a share of over 35% and the entire market is expected to grow at a compound annual growth rate of nearly 13% over the next seven years. Internet based gaming today represents about one third of the market, but companies are witnessing a COVID-19 surge in the number of users and a spike in the number of hours users spend to play online games. All of which raises the perennial question: are computer games bad for children?

To help guide us through a complex answer to this simple question is neuroscientist, gaming researcher and author Michiel Smit. Welcome to the podcast, Michiel.

Michiel Smit

Thank you.

Neil Fairbrother

Could you give us a brief resumé so our listeners from around the world have an appreciation of your experience and expertise?

Michiel Smit

Yes, of course. I was born in the same year that the [Berlin] Wall fell in 1989 and that was also the year the Gameboy was born. So it was a very eventful year and I had an amazing childhood there with video games being inserted into the equation at the age of five. And that was a great relationship. Just a lot of fun, but something flipped when I went to secondary school and after secondary school, I went on to study mostly like political science and physics, but then I kind of converged those two directions into neurobiology.

Currently I’m finishing some research, a systematic review on the resting state fMRI imaging in Internet Gaming Disorder. And I’m working on a second book because in 2018 I published a book on my experience as a teenaged video game addict. From 12 to 19 was a pretty hardcore video game addict. I luckily got out of there. And then I thought, that was 10 years back, I felt like, yeah, the world really needs a book about this because it’s a far more pernicious territory than we often realize. And the world ought to know.

Neil Fairbrother

So first of all your book, you mentioned it’s about Internet Gaming Disorder. So two questions there. What’s your book called and what is Internet Gaming Disorder?

Michiel Smit

Yeah, so the book is called GameBoy!. It’s not out in English yet. That was on the menu, but publishing world is not an easy world. And the research on Internet Gaming Disorder is about like players who play so excessively that it is now categorized as an addiction and that means that they have lost control over their game play despite adverse consequences. They give up many of life’s other domains in favour of playing as much video games as they can. They basically classify according mostly to DSM5 criteria for gambling addiction, but they borrow quite a bit from other more traditional addictions. They classify as being addicted to video games. And then we put these people into brain scans and I’m collecting now all the data from last 15 years of brain imaging research in resting state, in these gamers who play excessively.

Neil Fairbrother

Okay. Now you said just a moment ago and indeed in a recent webinar that, as a child, a young child, your relationship with gaming was perfectly normal and very healthy, but it flipped when you transitioned from primary school to secondary school. What happened there? What caused the change in your relationship with online gaming at that point?

Michiel Smit

Yeah, so the biggest flip was the transition from primary to secondary school. I was very active, let’s say in class, I had many different friends. But I was never really the one that got picked first in making a football or a soccer team. I was not really on the list of the girls who, when they made these lists of like, which boy do you like best? And I was sometimes I was number five on the list.

So when I was 11 and I went to secondary school, I thought like, ah, this is really my moment to shine this time. I want to be picked first in soccer matches. And I want to just be noticed by the girls. And so I went to secondary school and I went to a school where I didn’t know anyone because I kind of wanted to start with a blank slate.

And I was a young student, I was a year early. So I was 11 when I entered secondary school, which is early in the Netherlands. I was very excited to be noticed and I was a bit too much of a child. So I actually, I got teased pretty early on, quite severely, like people thought for a few weeks in the new school environment, they thought like, is this guy actually like a pretty cool dude? Or is he just, and then like, you know, like almost as an emperor with his thumb, should the gladiator die or may he live? The thumb slowly went down.

In Dutch, my name, you can rhyme it with everything. My name rhymes with like imbecile, like Michiel and imbecile rhymes in the Netherlands, Michiel paedophile, Michiel necrophile, like all these pretty bad names for an 11 year old. That was really harsh. And so I got teased a lot and yeah, the thing is that with teasing, no one who teases really notices how bad it is because only the one who’s being teased receives the sum of all the teasing.

So I went back from school, feeling utterly depressed, and like, I felt like I just lost control over life. I, the first time in my life, I felt many emotions I’d never known. I’d never been teased. I’d never been so scared. I’d never been ostracized. So I went back from school, every day, feeling the lowest I’ve ever felt.

And then of course, entering a video game became a very different experience from that angle. All of a sudden, it wasn’t just for fun, just playing a game and then going outside with some friends. No, it was becoming like a place where I could find my strength again, where I could find my reassurance again, that I was capable of having some control in the world. And so that was of course not a healthy development. I stopped playing for fun and I started to play to take pain away, to numb pain, and to reaffirm in a way that I was actually good.

Neil Fairbrother

You mentioned that your book Gameboy! isn’t available in English. However, we do have some of your research available in English and in it, you say that the World Health Organization (WHO) has recently included Hazardous Gaming and Gaming Disorder in the 11th revision of the International Classification of Diseases. So is Internet Gaming Disorder, or IGD, a disease?

Michiel Smit

That’s a very tricky one because there’s a huge difference between disorder and disease and in the neurobiology field of addictions, there’s a pretty hefty fight going on between the disease versus the disorder camps. I’d say maybe not a disease, but definitely a disorder.

Neil Fairbrother

Okay. We’re going to discuss some fairly complex areas in relation to the brain and the brain structure and how it all works and how gaming impacts different areas of the brain. You’ve mentioned just a short moment ago that you were looking at the “resting state imagery” of brains. What do you mean by resting state imagery? What exactly is that?

Michiel Smit

So what is interesting about the resting state is that we use brain scanners that we’ve always basically used, the fMRs, functional Magnetic Resonance Imaging. These make use of the magnetic signal coming from the iron in blood, so we get a proxy of blood flow. So when neurons are active, they use more oxygen, they attract more blood. They make the arteries around them vasodilate. And so the active areas in your brain, they receive more blood and we can detect that with an fMRI and we see a signal like, Hey, more blood is being used or more oxygen, probably more activity.

We’ve used this in neuroscience for decades. And then in the late eighties, I believe early nineties, what researchers were starting to pick up is that during task-based fMRI, so if I put you in a scanner and I ask you to connect dots on a grid, or to watch certain stimuli or certain pictures, that every time a participant or subject is involved in a task, they saw that there was a deactivation in a number of regions in the brain, and it was very reliable and it was also across different tasks. And that didn’t really make sense because why would the same region sort of deactivate when I’m doing, I don’t know, a colour matching task versus emotional recognition task versus a maze task?

And so they started to see that being involved in a task at the activates a certain region a bit, which then became the Default Mode Network, which was the network that is active most when you’re not doing anything, when you’re just gazing into life, basically, you’re not paying attention to any particular thing. You’re not actively exerting control over your own psyche. You’re just being, and that then became the Default Mode Network. And the resting state MRI is doing a brain scan by asking participants to not be involved in any effortful or any conscious task-oriented activity. So just sit in a scanner with your eyes open or closed and do nothing basically.

Neil Fairbrother

Okay. Two of the structures in the brain that I think almost everyone will be familiar with is the left and right side of the brain. Does addiction, whether traditional addiction to drugs or Internet Gaming Disorder manifest itself more in one side of the brain than the other, is there a left right brain bias?

Michiel Smit

In traditional addictions there’s a little bit of that. We’ve tried to determine if that is also replicable in our research and we do see it like the left side, it seems to be slightly more involved. It wasn’t a huge difference. We found almost 50 findings in the left side of the brain. We found 38 in the right side of the brain, but we’re not at the level yet where we can confidently say what this exactly means or how we should interpret this.

Neil Fairbrother

I think when you are analysing the brain scans, you’re looking for what you call “perturbations”. What are these perturbations?

Michiel Smit

So we’re looking at perturbations between healthy controls and people who have been classified with IGD. And so both the healthy control and the person with Video Game Addiction they entered the brain scanner with the same question of just sitting there and do nothing and the perturbations I talk about in the research are the average differences between these two groups. So how is the functional connectivity of the brain in some healthy control versus someone with internet gaming disorder?

You can do that in many different ways. You can look at the functional connectivity from one seed region that you look at. You zoom in on a particular region that you want to know, how is this region functionally connected to other regions? Functional connectivity in this sense is like, if this one region here fires or shows more activity, do other regions also increase their activity in accord, is there a correlation between the activity?

You need to have very sophisticated statistical instruments to really detect that kind of correlation. It’s not like sort of a click clear-cut, like bleep-bleep you know? There’s many, many signals to detect. And the perturbations then are the differences between how the brain of a gaming addict is functionally, differently, active from that of a healthy control.

Neil Fairbrother

The brain is an incredibly complex organ and some people say that it’s the most complex construct in the known universe. You’ve touched on one network, the Default Mode Network but you’ve also found a network of networks that are related to traditional addiction and which are also related to Internet Gaming Disorder. One of those is the Memory Network. I think most people are familiar with the concept of memory and can probably guess what the Memory Network might be, but could you explain very succinctly what the Memory Network is?

Michiel Smit

It’s nice that you start with the Memory Network because there’s one big caveat with the Memory Network, which is that it shows quite strong diurnal rhythms. So the activity of the Memory Network by default changes throughout a day and I have not seen the research on Internet Gaming Disorder, the resting state research, explicitly take that into account.

So the memory network is comprised of the Hippocampus, the pair of Hippocampal Gyrus, and the Inferior Temporal Gyrus, which are all sub-cortical structures pertaining to the Limbic system. There might be other structures that are also involved because there there’s no discreet, really not really discrete networks in the brain. I mean, everything is in contact with almost everything else via certain hubs, but these are some hubs of the Memory Network and they underly your capacity for forming memories, be it explicit memories or episodic memories or memories about valence.

So if we look at the particular difference in the Memory Network of people with Internet Gaming Disorder, we see that the Memory Network decreases its resting state functional connectivity with two structures mostly in the Default Mode Network, namely the Temporal Parietal Junction and the Posterior Cingulate Cortex, which are two main structures of the Default Mode Network.

We see a lessened communication between these areas, which is interesting because also in the Default Mode Network in itself we see decreased self-connectivity in people with Internet Gaming Disorder. And the Default Mode Network is also very involved with self-referential thought, so kind of keeping a continuous sense of self, you know, updating your own person from moment to moment, keeping it online.

We see disturbances in the Default Mode Network in many psychiatric disorders, but we also see some of these disturbances in addictions and also in Internet Gaming Disorder and that is a salient observation. It points towards a brain in which your memory and your self-referential kind of what you know about yourself, basically what you’ve gathered your entire life and that has been embedded in your neural structures, that that plays a less strong role in the Default Mode Network and you updating yourself from moment to moment in accordance to your memories and your experiences.

Neil Fairbrother

So this is a negative impact on how you are able to view yourself. Is that what you’re saying?

Michiel Smit

Yes, and we’re only at the beginning of really understanding what all these differences mean and sometimes a decrease is not necessarily a bad thing or an increase is not necessarily a good thing, but it is something that we also see in other psychiatric disorders such as depression. It’s a difference, but that we also see between normal people that game normally, or don’t have a problem with video games and people that play excessively.

It’s maybe important to also mention that for Internet Gaming Disorder, you do need to game like dozens of hours a week you know, like five to 10 hours a day before you really classify as having Internet Gaming Disorder.

So all these effects that we’re talking about do not necessarily arise when you play an hour or two or sometimes three a day. There are huge differences in the way you interact with video games and the effects they will have on your brain. So your listeners shouldn’t be too spooked by all the things we’re talking about, because…

Neil Fairbrother

Yes, this is looking at the extreme case, right?

Michiel Smit

Yeah, pretty extreme, but there’s another problem there and that is that it’s really hard to get the most extreme cases into the lab. Because they’re so extreme, they’re playing video games all the time. So there’s actually a really big problem with researching video game addiction, both also from a psychological and epidemiological point of view, because it’s really hard to incorporate the more extreme cases as they’re in their virtual worlds, you know, away and they’re hard to reach.

Neil Fairbrother

Okay. So very quickly then another network that you’ve looked at is the Sensory Network, what is the Sensory Network?

Michiel Smit

Yeah. So the Sensory Network is basically the network that processes all your sensory input that you get. So the things you hear, the auditory system, the things you feel, tactile, the things you see. And this network is obviously one of the big networks that we also incorporated in researching Internet Gaming Disorder, because of course gaming itself is a very sensory rich experience, especially visually and auditory. You’re getting a lot of input.

We saw some differences in the Sensory Network, but not too much. It’s one of the networks that seem to be least impacted, though the impact that we saw was interesting. We saw that it was slightly more connected to the Reward Network.

Neil Fairbrother

So you mentioned just then the Reward Network, what is the Reward Network?

Michiel Smit

So the Reward Network is a very important network because in life there’s an infinite amount of things we could do at any moment. And how do we choose what we do? For a large part it depends on the activity in the Reward Network, because certain things are better or more rewarding for us and other things are less so. The Reward Network is basically the basis of our valence-based activity which is quite a lot.

Neil Fairbrother

Okay. Now, when you say “valence based activity”, what do you mean by that?

Michiel Smit

Well, I mean that we choose things that we think will be most rewarding and I mean that in the broadest possible way, like the spouse you choose. It’s like beauty is rewarding, but also affection, touch, is something rewarding. Social approval is something rewarding, but also things like food and drink. Those are all rewarding things that kind of shape the way we behave in the world and the Reward System is trying to optimize our fitness and our wellbeing in the world by acting as a radar for where we will find meaning and find reward.

Now, the problem with the reward system is that it’s quite old. I mean bees have a rudimentary reward system, and it has evolved over tens of millions of years. So it’s really good and we’ve got a very advanced version of it in the animal kingdom, but it’s definitely not flawless.

I’m spending a bit more time the award system because it’s the system that underlies addiction, mostly. What all addictions have in common, be it substance abuse or a behavioural addiction like gambling or gaming, they all hijack the activity in the Reward System. Substance abuse does this by the substance you take forcing dopamine, which is basically the currency in the reward system that it uses to assign valence, but it forces the dopamine to kind of flow out almost like a fire hose, to spray out of whatever you’re doing at that moment.

Cocaine is the easiest way to envision this. When someone snorts cocaine, you know, casually, then the cocaine is a stimulant and it forces the dopamine to be released in the reward system. So you get a huge peak in the dopaminergic activity within the reward system, which for the brain is a signal like, wow, what I’m doing right now, this feels amazing! Give me more of this because this is really relevant!

So traditional drugs can hijack the reward system and give the user of feeling that they’re doing something highly significant. I mean, that’s basically just the signal that has been evolved for the brain to learn like, Hey, more of this please! And that starts a whole cascade of processes like enhanced neuro-plasticity, more synaptic outgrowth, building of habits, sensitisation. The whole circus starts to spin around this sort of really high dopamine signal. So the reward system of course is central to understanding Internet Gaming Disorder, because the big question is: “Can games also hijack the reward system in such a way that it becomes pathological?”

What’s pathological about traditional drugs is that they activate the reward system beyond the normal activation. So instead of let’s say that, you know eating a chocolate bar is more rewarding than eating a carrot. The carrot maybe activate your reward system 10%, the chocolate bar may activate your reward system like 40%. And then the highest natural reward that you would encounter in your life would be to make love to the one you love, the person you love. And let’s say that we put that at a 100%.

That’s 100% of the reward system. You’re having your amazing romantic moment with the person you love and you can imagine like the feelings that go through you and then a large part of that is the reward system.

But now picture that you take alcohol or any drug into the equation. What those substances do is that they artificially force dopamine output in the reward system. So you could actually push the reward system to like 150%, 200%, 250% or 300%. If you smoke crack cocaine, you push the gas pedal on your reward system hard. So imagine how that feels, using drug at that point feels, to your brain and to your being, it feels like this is the absolute best I’ve ever been through and we’ve got to find more of this because this is significant. This is important.

And so of course, different drugs elicit those feelings in indifferent intensities. But over time, when you keep returning to a drug, you learn how good the using for you is, and you start building this habit and you start developing an addiction basically. And the nasty thing about substances is by its chemical structure, it forces dopamine out, it never disappoints. It will always force dopamine out. So your brain will always pick up a signal like, Hey, this was pretty good. This was better than expected, you have to find more of this.

Now the question is, can games do the same thing? And what we see already in the previous millennia, like 1989, there was a seminal research done about a little like a 2D tank game with a positron emission tomography, which is a different imaging tool. And they used radioactive tracers. You can’t really do that kind of research that easily anymore because it involves radioactive tracers so there’s more ethical concerns there, but they already saw it back then.

This is 22 years ago that playing a simple 2D game could boost dopaminergic levels in the reward system to levels comparable to injecting amphetamines, which of course are very addictive. So already video games of 22 years ago were as potent as injecting amphetamines in eliciting responses from the reward system. And that is the basic neurobiology behind addiction and video game addiction and, yes, apparently video games do have this potential.

Neil Fairbrother

Okay. So we’re almost through the network of networks that you’ve been exploring, and I know that this is a very complex area and you can’t possibly answer in the time we have with all the detail perhaps that you might like, but another network that you have looked at is the Executive Control Network. Very quickly, Michiel, what is this network?

Michiel Smit

It’s like the newest instrument in our brain. It is very involved in inhibition of the subcortical structure. So inhibition of impulses in planning, in execution of plans. And what we see in Internet Gaming Disorder is that it shows a reduced functional connectivity, this network, and this is correlated with the functional conductivity within the Reward Network.

So you see that the Executive Network becomes less strongly interconnected and the Reward Network becomes more strongly interconnected. And these are correlated in people who suffer from video game addiction.

So that paints the image of someone who’s less capable of controlling himself, of planning, and who feels a stronger urge for reward and for craving video games in this case, which fits in very neatly with the gaming behaviour getting out of control and people losing control over their video game play. And then this is something you also see in more traditional addictions.

Neil Fairbrother

The penultimate network was the Salience Network. What is the Salience Network? I think it’s to do with detecting and filtering stimuli, is that correct?

Michiel Smit

The Salience Network works in conjunction with the Reward Network and where the Reward Network is sort of the radar and the instrument that measures how good something is for you, the Salience Network make sure that you keep your attention on the things that are valuable to you or do things that might be threatening to you so that you have your attention where it’s most needed, be it like for reward or for averting something negative to happen.

And yeah, we also see some differences in the Salience Network of people with Internet Gaming Disorder, and which is again a higher self-connectivity, which is interesting because that seems to suggest that they’re feeling a feeling within themselves like the anticipation of games, like the craving for video games. It comes from within. It’s not so much connected to the sensory network, something external, it’s something that in the resting state is sort of a closed loop within itself, which might be indicative of craving and anticipation of playing.

And also you see the Salience Network shows reduced conductivity with the Executive Control Network that we just talked about, which may indicate that the Executive Control Network is less well capable of regulating the Salience Network, which echoes the same point that the craving and the drive to satisfy and to game becomes stronger whereas the top down control becomes weaker.

Neil Fairbrother

Okay. And the final network that you’ve looked at is something called the Interoceptive Network. What is the Interoceptive Network?

Michiel Smit

On a personal note, I find the Interoceptive Network most interesting because when I was a video gaming addict myself, what I noticed was that I lost connection with myself, with my body, with my feelings. So you can imagine that if you come out of school and you game because your life is out of your control and it hurts. And you kind of drown these emotions in a bath of just video game epic gameplay, that you don’t really listen to the signals of your body. You’re tranquilizing, you’re numbing.

I was a video game addict for about seven years. What I noticed when I came out of that was that I was very, very poor at noticing what my body was actually telling me, feeling, just basically feeling what was relevant to me, feeling what I needed. I definitely, from a personal perspective, noticed that my Interoceptive Network was completely haywire after seven years of excessive video gameplay.

So the Interoceptive Network consists mostly of the insula, the insula is part of the brain region that is involved with proprioception or feeling yourself. And you can see how all these networks work together, because you need to kind of feel yourself, also for the Reward Network, to feel how good something is. They work together, the Salience network works together with these two networks to keep these feelings and the importance to keep them in your attention, your conscious attention and unconscious attention. And so in this the Interoceptive Network, we also see quite some differences between people with Internet Gaming Disorder and healthy controls.

Neil Fairbrother

Okay, now you started your deep involvement with computer games and internet gaming as a young adolescent. And I think most people will be familiar with the idea that the adolescent brain is a developing brain. The adult brain is very different in structure from the child brain and that period of adolescence, which starts around the age of 10, just sort of pre-prepubescent up to the mid-twenties and many, many players of these games will be young adolescents. Are we at a stage where we can say whether the adolescent brain, the developing brain, is impacted adversely or indeed beneficially by these computer games?

Michiel Smit

So that really depends on the amount of gameplay. I think playing an hour or two a day can probably be either neutral or maybe even beneficial for a developing brain, though I wouldn’t play two hours every day. I think that you’re probably already pushing it. But some kids, I mean, the average is like many hours a day now in the West, and especially in some Asian countries. So we’re on average already, I think, in the red zone. And if you start playing like five to 10 hours a day, then you’re definitely deep into the red zone. This becomes definitely problematic also for your development of your brain.

And the reason why adolescents are so sensitive has to do with these networks that we talked about, because when you’re young, these networks of networks aren’t fully developed yet, especially like the insulation, like the myelin, the white matter, that’s around the axons of the neurons, that kind of facilitate communication, quick communication. These are not mature at all yet.

And this is the ripening of the brain and especially the Executive Control Network that we talked about. In adolescents this is definitely far from finished and that makes them also less capable of inhibiting impulses, of planning, of executing a plan. And so you have a brain of an adolescent that is less good at this kind of self-control being targeted by a hyper-advanced billion dollar product being video games.

I mean, on the other side of your screen, of your glass slab, there is basically a supercomputer and a whole team of psychologists and storytellers and developers that have built the most perfect experience for you to experience with many elements that are predictably targeting your Reward Network, and that are trying to grab your attention.

And as an adolescent, you’re less good at fighting back and pulling back and winning the battle for your attention. So your attention is more easily grabbed by anything, but especially by things that are particularly targeting you. And so that’s one of the things that happens.

And then the other thing is that the Reward Network again is more active in adolescence. So you have a more strong dopaminergic signal, you’re more sensitive to reward and to also anti-reward like punishment, basically. So the addiction also develops more easily in that time period. And then there’s the fact that you, as a person, you’re well less developed as a whole. So I think one of the most important things about gaming addiction is the balance between different live domains.

So let’s say if you are a child who does whatever sport, you play some instrument, and you have a group of friends that you see on a few times a week, and you’re doing okay in school. And your family doesn’t have to be a perfect family but doesn’t suffer too severe drawbacks. Then you can probably play four hours of video games every now and then without much problem because your life’s in balance and you are growing along different lines into life, you’re growing, you’re developing yourself as a student, you’re developing yourself as a sportsman. You’re developing yourself maybe as a musician, as a friend, as a part of a family. And if those developmental trajectories are okay, that offers a lot of counterbalance to developing Internet Gaming Disorder.

The problem is that you may lose this balance without noticing, you know, like people who slowly do become video game addicts, they often don’t tell their parents or their environment. They don’t even really notice because they’re kids. I didn’t notice as a kid what was happening. I mean, I noticed something was off and I was playing too many video games and it had probably restrained and limited my performance in other areas of my life. But as a 12, 13, 14, 15 year old, you don’t really understand, so you can’t really ring a bell, but it does, it can happen.

Neil Fairbrother

We do have Game Rating systems such as PEGI and the like. Are they particularly effective?

Michiel Smit

They’re made more to detect adult content and content that is suited for your developmental age.

Neil Fairbrother

Right. So do we need to have some kind of robust Age Verification system in place, do you think?

Michiel Smit

Well, yeah, definitely, absolutely new one, because for example take, Fortnite or League of Legends, these video game companies, they’re very consciously developing their video games, they’re always being on the edge of what is still permissible. And if you play League of Legends, for example, many of the characters in there, they’re like dressed like porn stars in superhero suits and outfits, especially female ones. They’re basically a video game epic hero porn stars.

I don’t want to sound a Protestant pastor or anything like, “Oh, this is horrible”, but that’s not coincidental. It’s not that these developers thought, “Oh, this just looks nice. Let’s make it this way”. It’s not only League of Legends, it’s many video games. I mean, you see it in Unreal Tournament, you see it in Fortnite, you see it in basically almost any game, Apex Legend in various degrees. A teenage boy will be very sensitive to those kinds of stimuli. And there is a very subtle tug of war between our regulations and these kinds of stimuli.

So PEGI is quite outdated and we definitely need new tools and these tools should also look at way more elements than just is something adult content? Is it not too aggressive? Because now of course we’re all aware of Loot Boxes, does it contain gambling elements? But there’s more things like does it have too much time pressure elements added into it? What’s the overall stimulation of a world that you enter? Because I conceptualize video games as super-stimulation structures and what they do basically is they bundle over 20 to 30 different elements that are all stimulating in their own regard, and they bundle them all together into one experience thereby just massively stimulating your dopaminergic system to the level that I think it can probably mirror the usage of cocaine.

Maybe not the highest dose, but like 22 years ago, we were at the level of games being able to stimulate your Reward System to the level of amphetamines. I think now we’re definitely at the place where some of the most advanced games, they can stimulate your Reward System in a similar manner as cocaine.

Now, of course, cocaine may be way worse because there’s also really a substance that’s in your brain and it has also biochemical effects. And of course with video games it’s just light entering your retina. So there’s definitely some upsides to video game addiction over maybe substance abuse, because you don’t take a substance. There’s also drawbacks again, because you do spend five to 10 hours a day in a chair in a world that’s totally different from the real world, from reality.

Neil Fairbrother

Okay. So well one final question, Michael, if I may, because we are extremely short time now. Are video games bad for children?

Michiel Smit

Yeah. A large part of them are, definitely not all of them. There’s huge variety in video game companies, not all of them are bad players, but the most commercial ones do have just a market motive. They want to earn money. They earn money by capturing the attention of your child for as long as they can and capture the attention and then motivate the child to make in-game purchases.

For example, there’s many children now who have more money on in-game clothing than they have in real life clothing. You need to have a pretty strong bond with a video game to have such a skewed investment ratio between video games and real life. But this is what video games like the commercial ones do. They want to make a strong as possible connection with a gamer, often a young person in order to earn as much money from them.

And there’s also a lot of research that shows that addicted video game players spend way more than non-addictive video game players. If you’re in a competitive environment where the attention is the thing you compete for, and you use all the state of the art tools to capture this attention, then in a competitive setting, you will start to develop more and more attention grabbing and addictive products and video games.

So if your child, or client, is playing like some of the more popular and commercial video games, then you bet that there is a strong, negative influence being exerted over the child from the other end of the screen. And you do want to pay very close attention to what kind of relationship this child is developing with video games. And you want to intervene as best you can and of course proper intervention, finding a balance and the autonomy of the child and everything are super important topics.

And the most important thing I would say is, can you have a good bond with the child? As a parent or as a therapist, can you be a model figure maybe for that child to show them how they can be strong in reality, because that’s what many of these kids are looking for in video games, a sense of competence, of connection, of autonomy, of strength and “epicness”. They don’t want to give that up and you have to address those needs.

Neil Fairbrother

Okay, Michiel we are going to have to leave it there, I’m afraid we’re absolutely out of time. Thank you so much for that totally, totally fascinating and absorbing topic and I only wish we had more time available to us to go into even more detail, but there we are. Good luck with your research. Good luck with your new book. When will that be available do you think?

Michiel Smit

Hopefully summer next year [2021] would be nice.

Neil Fairbrother

Okay. Well, let’s look forward to seeing that, Michiel, thank you so much.

Michiel Smit

You’re very welcome. And greetings from the Netherlands to the UK and all around the world.