There’s No Place like Phone

Noel Bell Channel 5 newsThe sixth annual Deloitte report There’s No Place like Phone, which analyses the mobile usage habits of more than 4,000 UK consumers, was released today.

The report was covered widely across the national media. Channel 5 News covered the story on their main news and spoke to consumers, journalists and myself about the issue. See below for the embedded link to the news item (I spoke briefly at 1:03).

The UK public has never been more ‘addicted’ to smartphones, according to the survey. The report uses June 2016 as a foundation to claim that four out of five UK adults (81%) have a smartphone. This percentage rises to 90% when the 18-24 year olds cohort is reviewed.

The key findings of the report are:

  • Nearly 50% of the age group 18-24 check their device in the middle of the night.
  • The adoption rate of 4G usage has more than doubled in the past 12 months (up from from 25% to 54%).
  • 31% of those smartphone users surveyed did not make any traditional voice calls in a given week. (This contrasts with 25% in 2015, and just 4% in 2012).
  • The majority of those who participated have downloaded 20 or fewer apps.

The word ‘addiction’ is difficult for many clinicians in the medical world. Strictly speaking it is a misnomer to call even heavy smartphone usage an addiction. Psychiatrists recognise Gambling Disorder as the only behavioural (non-substance related) addiction. Their bible is the Diagnostic Statistical Manual (DSM), the American Psychiatric Association (APA) diagnostic tool, currently in its 5th iteration, and does not include smartphone usage as a problem. Internet Gaming Disorder is, though, listed in section 3 of DSM-5 as “conditions for further study”. However, in common with other behavioural problems like sex addiction, counsellors and therapists have lots of anecdotal evidence that alludes to a growing problem of preoccupation and obsession.

If you think you have a behavioural problem with your smartphone take a look at whether you identify with some of the points to consider in the need for digital detox and how to set boundaries around your engagement with technology.

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Digital detox from smartphone addiction

ofcom-logoThe latest Ofcom research into internet usage informs us that fifteen million UK internet users have taken steps to ‘digitally detox’ in an attempt to establish a more healthy balance between technology and ‘real life’. The Communications Market 2016 (August) is Ofcom’s thirteenth annual Communications Market report.  The key findings from the latest report found that roughly one in three of adult internet users has specifically sought a period of time offline. For those unfamiliar with Ofcom, they are the communications regulator in the UK (similar to the Federal Communications Commision in the USA).

Noel Bell ITV Good Morning BritainITV’s Good Morning Britain featured the story in their edition yesterday and invited me onto the show to talk about addiction to smartphones and digital detox. They also invited a family who had undertaken an experiment of having dinner but only communicating by messaging around the dinner table as an attempt to understand how we miss out on social cues by engaging exclusively by electronic means.

I am often asked what constitutes addiction.  For me, addiction is a serious bad habit, can be highly condensed, reinforced and consolidated across many neural networks. Fear is a huge factor in all addictions and every addiction has a stress factor. Addiction can be present when you are doing something repeatedly and negative effects start to occur in other areas of your life. You find it very difficult to cut down the activity when you seek to regulate the behaviour. But according to the medical view, Gambling disorder is the only behavioural (non-substance related) addiction, as it’s the only one included in the Diagnostic Statistical Manual (DSM), currently in its 5th iteration.  DSM is how psychiatrists diagnose ‘mental disorders’. As an aside, pathological gambling had long been considered by the American Psychiatric Association to be an ‘impulse control disorder’, rather than an addiction. Internet gaming disorder (psychiatrists just love to pathologize with words like disorder, don’t they?) is, however, listed in section 3 of DSM-5 as “conditions for further study”. So, presumably there may be room for smartphone addiction in future iterations of the Manual.

How do you know if you have a problem with mobile devices?

Here are a few general questions you could explore about your relationship with your smartphone:

  • Do you use your smartphone more than you are comfortable with?
  • Do you panic when there is no cell coverage or wifi connection?
  • Do you neglect social interaction with friends and family by spending excessive amounts of time on your device?
  • Do you use your smartphone to gamble and spend more time (and money) than you had planned?
  • Do you sext with strangers and regret it afterwards?
  • Have you been the victim of revenge porn?
  • Do you compulsively use adult chat rooms, even when you don’t want to?
  • Do you start to feel lonely or depressed as a result of excessive engagement with social media?
  • Do you bring your phone to bed?
  • Do you feel increasingly stressed from feeling the need to answer work emails beyond the contracted work hours?
  • Is your sleep disturbed from excessive smartphone usage?
  • Do you spend excessive time on dating apps?
  • Do you lose interest in having sex with your partner?

You may have a problem if you are finding it more difficult to concentrate on daily tasks at home or at work, if you are concealing the amount of time spent on mobile devices, if you have a fear of missing out (FoMo) and have a sense of dread or panic if you leave your phone at home. Common withdrawal symptoms from smartphone addiction are anger/irritability, restlessness, sleep problems, difficulty concentrating and craving access to your device.

Treatment options

We all need to use online services from statutory services so a complete abstinence based approach is problematical. Indeed we need to be online to progress in careers and to connect with people. However, we can take steps to reduce our reliance on our devices. We can try to set goals for device-free times. We can set our phones to airplane mode during the day and especially at night. We can try to avoid reading work emails beyond certain times,as well as turning devices off two hours before sleep so we comply with sleep hygiene requirements.

If you think you have a problem, you could also consider not bringing mobile devices to bed and removing social media apps from phones. Maybe you could try to refrain from the constant checking of social media updates. See how you cope. If you begin to feel empty, moody and depressed as a result of putting in boundaries you could be experiencing a form of withdrawal.

Considering doing these steps might tell you all you need to know. How does it feel to potentially implement some of these suggestions? Does it seem reasonable or do these suggestions fill you with dread?

Seeing a therapist can be useful to motivate you to set boundaries with your mobile device usage and to address problem behaviour. You could explore what is behind your intense need to feel connected and learn to cope better with everyday anxiety. Therapy could be a means of building your coping skills to better help you to deal with boredom, rejections, loneliness and worry. There can, of course, be underlying issues with depression which might be worth exploring so it may be appropriate to go and see your GP too.

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When your financial trading becomes an addiction

financial tradingThere are more and more people these days dabbling with online trading as a result of greater access to online trading platforms . This can often be as a sideline to the day job or as a new way of seeking to earn a living. Indeed, there are increasingly more and more people trading financial instruments as their main daily activity as a result of the restructuring within the finance sector following the financial crisis.   Online subscriptions to news wire services as well as financial tv channels can help to keep you as up to date as the professional trader in the great trading floors in the City of London.

So, when does financial trading become a problem?  See my article on financial trading and gambling addiction.

Put simply, your trading is problematical if it is causing damage to your quality of life. The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, currently in its fifth iteration (DSM-5), provides a diagnoses list to reflect the whole person, not separating mental disorders from physical and general medical conditions. DSM-5, released in 2013, placed “Gambling Disorder” in “Substance-Related and Addictive Disorders”, under “Non-Substance-Related Disorders”.  See the criteria for gambling Disorder.

 

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Worried about your gambling habits?

Gambling disorderClick here for my published article on ‘gambling disorder‘, the new classification in DSM5, the fifth iteration of the Diagnostic and Statistical Manual of Mental Disorders used by the American Psychiatric Association (APA).  The DSM5 Task Group decided to list ‘Gambling disorder’ as the sole condition in a new category on behavioural addictions, which can be found in the Addictive Disorders chapter of the manual.

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Dr Patrick Carnes on sex addiction

In this interview Dr Patrick Carnes chats to Joe Polish, founder of the Genius Network about sex addiction, neuroscience and the most effective treatment for addictive behaviours.  I have listened to this interview, usually as an mp3 file on my phone, many times and always seem to learn something new each time I listen to it. I believe that Dr Carnes is a legend and a visionary, given that he was talking about sex addiction as an illness in the early 1980s, when the definition of addiction in psychiatry was typically restricted to chemical dependence. These days there are more enlightened practitioners in the therapy field who acknowledge the real impact of behavioural addictions such as gambling and internet sex addiction.

This interview, as well as Dr Carne’s extensive publications, could be, perhaps should be, a staple diet on every psychology and psychotherapy course reading list in every discipline and modality. Essentially, Dr Carnes has long maintained that sexual addiction, like food addiction, develops in the brain through the bypassing of the executive functioning (the pre-frontal cortex) as the reward centres get flooded by the stimuli, in similar ways to the effects of cocaine usage. In the interview he articulates his ideas on attachment theory as possible causes of addiction and points to the dangers of the proliferation of cybersex activities through the internet, particularly for teenagers.

That is not to say that there is not still a lively debate about the evidence for what can be called an addiction. Darrel Regier, who was co-chair of the DSM task force which investigated the evidence to support revised classifications, maintained that there was insufficient evidence to reclassify sex as an addiction for the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).  Regier maintained that the reward circuitry in the brain was not operative in the same way for sex as in (substance) addictive areas.

As yet there might not be the clinical evidence needed to justify the addiction term, for sexual addiction, but it could be argued that there is overwhelming anecdotal evidence about the problem. It is clear we need to fund more research into the problem, but it becomes very political very quickly, when we start thinking of web filters, censorship, impacts on economies (just think of Romania and the number of webcam models and the income stream) and actually who will fund the research.

Ten Types of Sex Addiction in “Don’t Call It Love” by Dr Patrick Carnes.

Click here to listen to my interview with Paula Hall.

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DSM 5: Schizophrenia Spectrum and Other Psychotic Disorders

DSM5 SchizophreniaIt seemed appropriate that I recently attended a DSM 5 seminar entitled Schizophrenia Spectrum and Other Psychotic Disorders, given that the recent World Mental Health Day centred on the theme ‘Living with Schizophrenia’.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook developed by the American Psychiatric Association (APA) and is used by psychiatrists and other health care professionals as a diagnostic tool for the management of people with mental disorders.  It was first devised in 1952, (and merely as an aside, it classified homosexuality as a mental disorder until 1974). It is currently in its 5th iteration (released in May 2013) hence the term DSM 5 guidelines. However, it is worth noting that ICD-10, which uses the WHO criteria, is used more frequently in the UK.

The psychotic disorders in DSM-5 are:

  • Schizophrenia;
  • Schizoaffective Disorder;
  • Delusional Disorder;
  • Brief Psychotic Disorder;
  • Catatonia.

Each person with psychosis will have different problems and the symptoms may include hallucinations, delusions, thought disorder and lack of insight. People can often believe they are going mad when they suffering from stress. However, ‘Psychosis’ is when your thoughts are so disturbed that you lose touch with reality. When this happens, this type of problem can be severe and distressing and can potentially be life limiting.

Schizophrenia

DSM 5 has removed the following schizophrenia subtypes: paranoid, disorganized, catatonic, undifferentiated, and residual type because of their “limited diagnostic stability, low reliability, and poor validity,” according to the APA.

What is new in DSM 5? Two Criterion A symptoms are now required for any diagnosis of schizophrenia.  The second change was the requirement for a person to now have at least one of three “positive” symptoms of schizophrenia: Hallucinations, Delusions, Disorganized speech. The APA believes that this helps increase the reliability of a schizophrenia diagnosis.

The incidence of schizophrenia  occurs in males and females but typically appears earlier in men with peak onset between the ages of 20-28 for men and 26-32 for women. The lifetime prevalence is 1%. The prevalence of schizophrenia varies around the world.

Causes – Genetics

Twin studies have shown that if one identical twin has schizophrenia, their twin has roughly a 40 to 65 % chance of developing the disorder. It is unlikely that there is one exclusive gene for schizophrenia, there are probably a number of genes for a variety of characteristics (e.g. schizotypal personality, enlarged ventricles, childhood neuroticism etc.) which increase the risk of schizophrenia.

One in ten people with schizophrenia have a parent with the illness. However, “Genome scans”, are unlikely to offer a comprehensive assessment of a person’s risk for developing a mental disorder like schizophrenia.

Psychiatric academics seem to agree that whether or not schizophrenia manifests itself depends on the result of a conglomeration of these factors, both genetic and environmental in origin (Sullivan et al., 2003).

Causes – Environment

The debate about the causes of schizophrenia have progressed since the 1960s when schizophrenogenic parents were viewed as the cause of the illness in their children.  That does not mean that early environment is not still important.  Indeed, according to scientists, the risk for schizophrenia appears to begin as early as the first trimester in pregnancy. This can emanate from  exposure to influenza associated with increased risk of later developing schizophrenia (Brown et al., 2004). There are other prenatal factors in the second and third trimesters which include respiratory infections, maternal rubella, low socioeconomic status, maternal deprivation resulting from war or famine, being born in an urban setting and obstetric complications. Also, those born in Winter/early Spring (in Northern Hemisphere) appear to have an increased risk compared to those born in the Autumn.

Children of migrants appear to have an increased risk of psychosis, however the increased risk is not shared in the population of origin.

References: (Dohrenwend et al., 1992; Lewis and Murray, 1987; Marcelis et al., 1999; Susser et al., 1996; Torrey et al., 1997).

Causes – Neurobiology

Scientists have speculated that an imbalance in chemical reactions of the brain involving the neurotransmitters dopamine, glutamate and serotonin, and possibly others, play a role in the development of schizophrenia. They are unsure why this should be the case and more research is needed to help explain how it develops.

Causes – Substance abuse

It is difficult to find research that states that substance abuse causes schizophrenia. However, people who have schizophrenia often abuse alcohol or drugs. Indeed, they may have particularly bad reactions to certain drugs.

Heavy cannabis intake at 18 years of age is associated with increased risk of later psychosis. There also appears to be a dose dependent relationship as well as a connection between the use of cannabis and relapse. It may be fair to state that substance abuse can be a trigger to the onset of the illness, as is stress, for those that are susceptible to the condition.

Psychological Treatment for Schizophrenia

Perhaps the greatest block to care is the stigma of mental health diagnosis and then the barriers to care in the system, once they are diagnosed.  It will perhaps take more than a party conference speech by Nick Clegg MP to address these issues.  NICE guidelines suggest a course of CBT for both first episode and relapse prevention.  I was wondering about the transpersonal aspects of schizophrenia: might patients be wrongly diagnosed if undergoing a spiritual emergency? Professor Grof, a transpersonal proponent, has stated in the past that some form of transpersonal experiences can seem like psychotic episodes, such as undergoing a spiritual emergency. However, he also states clearly that psychosis is still quite pathological especially when the subject of psychosis loses all objectivity and becomes truly paranoid.

I learned a lot on the course. It is estimated that GPs see 95% of mental health problems in the UK, as GPs are the gatekeepers to the secondary care services. The most frequent psychiatric disorders in general practice are depression, anxiety and somatoform disorders.    I was left wondering about the powerful impact of psychiatrists who falsely diagnose schizophrenia because of their racist beliefs or because they simply fail to account for cultural norms and values.  Perhaps we need to rethink our whole attitude to mental health care service provision and this will entail a significant political shift so that mental health care provision starts to receive greater funding in the healthcare system.

Resources:

Key facts about Schizophrenia
Support for those living with Schizophrenia
Schizophrenia World
The National Spirituality and mental health Forum
Recovery Colleges

 

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