Written evidence submitted by The Reward Foundation

 

 

 

Note to Committee on Inquiry into Immersive and Addictive Technologies for Department of Digital, Culture, Media and Sport

 

Executive Summary

Introduction

Written Evidence submitted by Mary Sharpe, Advocate, Chief Executive of The Reward Foundation, a Scottish educational charity (SC044948) that makes the research about internet addictions, especially compulsive sexual behaviour, accessible to a wide audience. We have been accredited by the Royal College of General Practitioners to run 1-day workshops for professionals on the impact of internet pornography on mental and physical health. We also teach in schools about neuroplasticity and problematic use of the internet and run digital detoxes to make pupils aware of their digital behaviour and its effects.

Background – Why internet pornography is relevant to the term of reference on tackling digital and gaming addiction

 

Although pornography is not mentioned directly in the Committee’s terms of reference, it would be a relevant starting point for understanding the other internet addictions and their impact on the adolescent brain. For some users, digital pornography is a clear form of digital addiction in its own right. Arguments to support this view are set out in Neuroscience of Internet Pornography Addiction: A Review and Update (Love et al 2015).

When teaching about digital addiction to healthcare, legal and educational professionals, I usually begin by showing two these short videos. The first is a 4-minute TED talk called “The Demise of Guys” by Stanford social psychology Professor Philip Zimbardo which looks at “arousal addiction”. I then follow with “The Great Porn Experiment”, a 16-minute TEDx talk by former science teacher Gary Wilson, answering the challenge set down by Zimbardo.

Issue 1: What are they and how do they differ from other forms?

 

  1. Understanding the role of internet pornography is important for four key reasons.

 

  1. First is because the porn industry is diversifying in ways that are relevant to your research question. See this article.

 

  1. Second is because the brain evolved circuits in the reward system to drive us towards sex. Sex is nature’s number one priority once puberty starts. Behaviours connected to it trigger the highest levels of dopamine (anticipation of reward) and natural opioids (feeling of euphoria/pleasure) amongst other neurochemicals that encourage us to seek it out, engage with it and repeat it. Orgasm is the most powerful ‘natural’ reward we can achieve. It produces a level of brain stimulation/reward equivalent to a hit of cocaine. Other natural/normal rewards include food, bonding, novelty and achievement. They all promote survival.

 

  1. Artificial substances of abuse like heroin, cocaine, nicotine, alcohol and the like, highjack the brain’s reward pathways that evolved for natural rewards. We did

not evolve to pursue alcohol or heroin.

  1. Technological processes and behaviours such as gaming, gambling, porn and social media all utilise the brain’s same reward system. Environmental cues from technological rewards trigger high levels of the go-get-it neurochemical dopamine that anticipates reward and pleasure. Bingeing on these activities is leading to addiction-like brain changes in increasing numbers of users, especially adolescents.

 

  1. I draw this to the Committee’s attention to illustrate that fierce lobbying by the relevant multi-billion dollar industries has resulted in a delay in recognising the addictive nature and mental health impacts of internet products.

 

  1. The World Health Organization in the recently published International Classification of Diseases revision 11 (ICD-11) recognised gaming and gambling as disorders due to addictive behaviours as well as impulse control disorders.

 

  1. Out of control pornography use and sex were categorised as “Compulsive sexual behaviour disorder” (CSBD) only in the impulse control category, as had been the case with gambling when it was first classified. However, world leading neuroscientists believe that CSBD would have been better classified under both parent categories (link here). The slide shown here is from our teaching materials highlighting the scientists’ key argument.

 

 

  1. Experts say powerful lobbying by interested industries were responsible for this restricted classification. This link lists 41 neuroscience-based studies (MRI, fMRI, EEG, neuropsychological, hormonal) supporting the addiction model related to pornography.

 

10.  See also the following: Not Playing Around: Gaming Disorder in the International Classification of Diseases (ICD-11) by King and Potenza (2018).  This paper notes that:

10.1.1.  “Cross-overs between gaming and other potentially addictive behaviors (e.g., online pornography viewing) should also be noted [24], particularly given the prevalence of pornography viewing (including among adolescents), problematic pornography use, and the inclusion of compulsive sexual behavior disorder (6C72) in ICD-11 [25].”

 

  1. It cites another piece published by Daniel King in 2018 Comment on the global gaming industry's statement on ICD‐11 gaming disorder: a corporate strategy to disregard harm and deflect social responsibility?  Here's an excerpt:

 

“The gaming industry's corporate strategy involves the pursuit of economic gain from gaming products and services. This strategy is aided by promoting the view that all gaming, without exception, enhances people's quality of life. The industry's statement demonstrates this by: (1) extolling the value and popularity of gaming in absolute terms, without any comment on the risks or harms associated with excessive gaming involvement; (2) drawing a false equivalence between the benefits of educational software and commercial video games in general and ignoring research evidence that finds certain benefits to be negligible 7; and (3) selectively referring to academics who appear to support the industry's position while ignoring these same authors’ acknowledgement in the quoted article that ‘there are some people whose play of video games is related to life problems’ 8.”

 

  1. The third reason to understand pornography’s role is because pornography has always been at the forefront of developing new technologies – photography; VHS; mobile devices and immersive technology such as VR. Recent research by Simon and Greitemeyer (2019) about the impact of immersion on the perception of pornography, stated,

 

“Results showed that viewing pornographic video material via VR technology had a stronger effect on psychophysiological reactions as well as subjective experience than using the conventional desktop display.”

 

  1. Experts say that the use of immersive technology will cause addiction-related brain changes to develop more quickly than conventional technology. Many users recovering from internet addiction confirm this too.
  2. The added challenge is that most young people, especially men, tend to engage in a range of technology-based activities for instance, alternating between online gaming and porn or gambling over the course of an evening. Co-morbidity of addiction is extremely common with a user more likely to take up other addictive activities or substances as the brain desensitizes to the current level of stimulation. When a person experiences a numbed pleasure response, he/she will seek a high in other ways from other substances and behaviours, especially via a smartphone, to stave off boredom or withdrawal symptoms.

 

  1. The fourth reason relates to what we hear directly from young people and their experience of the internet. I have been teaching in schools in Scotland and England for the past 6 years. We provide evidence-based lessons in 2 areas: digital detoxes and lessons on the health impact of the internet pornography on the adolescent brain.

 

  1. Included in the 2-part lesson for a digital detox is a 14-question survey. We ask children to assess the time they spend online for matters other than school work; the apps, games and social media used; how it affects work, sleep, stress levels, relationships etc. There is also a comment section. Pupils state variously that they wish parents would give them better boundaries; teachers give them less online homework; that their friends wouldn’t expect them to be connected at all times via smartphones. Many reported feeling stressed, anxious and depressed. Social anxiety is very common.

 

  1. Speaking to final year pupils in Edinburgh in mid-January 2019, pupils asked about virtual reality and pornography, and about the effect of pornography featured in videogames and social media. The world of internet entertainment is seamless for young people. This why it is important to understand pornography use as part of the discussion about immersive technologies. 

 

Issue 2. Role of Design

 

  1. In the 1990’s psychology Professor BJ Fogg from Stanford University set up the “Persuasive Design Technology Lab”. He is one of the instigators of the so-called “attention economy” that offers products for free in return for a user’s attention and from which personal data can be harvested, shared or sold to third companies for profit and other sales purposes. See this opinion piece by Richard Freed on The Tech Industry’s War on Kids. The co-founder of Instagram, with 1 billion users worldwide, was a student of Professor Fogg’s.

 

  1. Fogg used research about human behavioural psychology and neuroscience, specifically how to increase dopamine in the brain’s reward centre, to hook users unconsciously to make them keep using their products. The more dopamine sent to the reward centre, the more important (for survival) a given activity or substance appears/feels to the user. Every reward in a game, every hyper-stimulating streaming porn video, every ‘like’ in social media or intermittent reward in gambling stimulates dopamine in the reward centre. Technology companies since the mid 1990’s have used and improved his persuasive design techniques of likes, rewards and other tricks to keep users coming back for more.

 

  1. Porn sites use a tube-site format of short streaming videos with new ones ready to appear when the last one finishes, tailored by algorithm to match a user’s desires based on previous use. These YouTube-type interfaces hook a user’s attention unconsciously and increasingly over time, leading to a trance-like state of interest and interaction. By comparison, television is a passive medium and does not hook users in the same way.

 

  1. These internet products induce a ‘supernormal’ version of natural rewards: our brain responds more powerfully to junk food than plain fare; to the intermittent chance of winning ever-escalating online rewards in gaming, gambling, social media and hyper-stimulating, ever-novel, edgier porn videos. Porn becomes more stimulating and (momentarily) more satisfying activity than real partners for increasing numbers of users.

 

  1. Pornography has a particularly high potential for generating either compulsive use or full addiction because of the way it is used. Nearly all pornography viewing sessions are accompanied by masturbation to orgasm, creating a positive feedback loop that encourages further pornography viewing. Pornhub alone supplies about 7 million hardcore video pornography sessions per day in the UK for a population of 64 million. Twenty years ago, this supply of potentially addictive material did not exist. It is also important to note that a behavioural addiction to pornography takes time to incubate. Every brain is unique so negative health, legal or social impacts develop at different rates.

 

Issue 3. Addictive use of social media

 

  1. The neuroscience research has been the most important source of understanding for the internet’s impact on mental and physical health in users. The fMRI brain scans show physical changes to the grey matter and functional connectivity in the brain as a result of even ‘moderate’ use of the internet.

 

 

 

  1. Experts believe that virtual reality will only accelerate the rate at which addiction-related brain changes will take place to the detriment of users, especially adolescents, because of the vulnerability of their brain during adolescent development. This is the view too of many people on internet pornography-recovery websites.

 

  1. Adolescents are the most vulnerable to mental health disorders and addiction. These tend to start in the early adolescent years and often cause problems for many years to come, putting a huge burden on the NHS. There are three main reasons for this:
  1. Levels of the signalling neurochemical dopamine produced in response to stimulating cues and triggers in the environment (social media, gaming etc.)
  2. immaturity of the thinking brain (frontal cortex) and dominance of impulsive/emotional brain leading more risk-taking behaviour with less foresight about consequences and
  3. the pruning process associated with brain maturation that preserves only the most-used circuits and clears away the less-used ones

 

  1. For evolutionary reasons that push adolescents to take risks and learn the skills necessary for adulthood, the adolescent brain produces more dopamine and is more sensitive to it than an adult or child. More dopamine in the reward centre means a potential reward appears more valuable to a person and will drive attainment of it. The more dopamine sent to the reward centre in response to a given cue or trigger, the stronger the brain pathway becomes to help a person repeat the action and reinforce the behaviour. Over time this can become problematic, even an addictive, out-of-control behaviour for some.

 

  1. Dopamine is produced mainly in the reward system which links the emotional and thinking parts of the brain. The reward system has both a wanting circuit (driven by dopamine) and a liking circuit (driven by natural opioids) that are closely related. Dopamine is what drives desire, wanting or anticipation of pleasure and the behaviour to achieve a reward. Natural rewards that the brain evolved to promote survival are: food; bonding; sex; novelty; achievement. The ‘wanting’ circuit is stronger than the ‘liking’ circuit keeping people on the hunt for the next opportunity. The reward system also alerts us to pain or danger and drives avoidance behaviour. Seeking short term hedonic pleasure is a way to avoid the effort of homework!

 

  1. During adolescence the emotional, impulsive brain is stronger than the thinking, reflective brain. The circuits between them only slowly integrate over that time so that by the age of 25 the brain is mature. However, that process of integration and learning can be stalled by addiction where key brain circuits do not connect effectively and grey matter shrinks or increases in an unbalanced way. For instance, too much grey matter in the amygdala (alarm system) leads to heightened anxiety; too little grey matter in the frontal cortex and with it reduced connectivity to the emotional brain means that a person can’t control impulsive behaviour. Inability to control behaviour despite negative consequences is a hallmark of addiction. 

 

  1. I hope the Committee will invite representation from psychiatrists who are involved in the neuroscience research of internet addictions and work with patients in a clinical setting. Dr Henrietta Bowden-Jones from Imperial College London and Dr Valerie Voon from the University of Cambridge are two such experts.

 

Issue 4. How might that be managed?

 

  1. Having monitored the rise of internet addiction for the past 10 years since the advent of broadband and mobile devices, we have learned a great deal from young and older people who have recovered from compulsive use of internet pornography and gaming. By far the most successful approach to dealing with their out of control behaviour, which many had not recognised, was learning about neuroplasticity. In other words, how vulnerable the adolescent brain is to hyperstimulation by chronic overuse of interactive technology.

 

  1. Whilst the environment and levels of free, anonymous and accessible hyper stimulation from digital sources have increased immeasurably in the past 10 years, our hunter-gatherer brains have not evolved in that time to cope with the tsunami of activities that basically overstimulate the brain. High levels of stress, depression, anxiety and addiction have been the result for increasing numbers of consumers.

 

  1. Teaching people about neuroplasticity can help them understand the impact of interactive technology and give them agency to take control of their levels of use. It is easier to control demand through education about health impacts than try to stem supply.

 

  1. In addition to improving the capacity of consumers to be able to cope better with online entertainment, there is an important potential role for Government to encourage more ethical and user-friendly behaviour by the large-scale providers of internet services, especially services with a high propensity to lead some users towards behavioural addictions.

 

Issue 5. Are extra measures needed to protect children from these forms of addiction? What can be learned from other countries.

 

  1. The extra measures required are to ensure that every school teaches children at different stages of learning and development about neuroplasticity and the vulnerability of adolescent brain to all kinds of mental and physical health disorders and addiction especially related to online activities. This will help pupils and parents take responsibility for their own behaviour in regard to internet products, as well as junk food and alcohol and drugs. This could help cut the burden on the NHS and judicial system, improve productivity, creativity and healthy relationships.

 

  1. We are piloting lesson plans in this area for primary and secondary schools and are receiving a lot of interest from US, Finland, Netherlands, Estonia, the Republic of Ireland, Australia and elsewhere.

 

Recommendations

 

  1. To teach all school pupils about neuroplasticity and the adolescent brain. This would highlight the brain’s strengths but also its vulnerability to mental health disorders and addictions. By teaching this from late primary school through to the end of secondary school would allow for age appropriate learning, help pupils take control of their own behaviour and build resilience to addiction. Knowledge is key. This will have a knock-on effect of getting the message through to the wider family too.

 

 

January 2019