Going back to gaming

In August this year the Department of Health published a report on the mental health and wellbeing of children and adolescents (parents of 4-17 year olds and young people aged 11-17). Putting aside the significant limitation that the 18-25 age group was not included, it provides a good snapshot of young people’s health. Depressingly not a lot has changed in terms of the rates of mental health problems and disorders which have remained about the same.

Within the highlights section a summary reports on ‘behaviours that could put them at risk’. Interestingly, internet use and electronic gaming was reported alongside bullying, problem eating, and substance use, implying that this activity is inherently problematic. In fact, only 4% of 11 to 17 year olds have highly problematic internet use or electronic gaming (compared with 34% who had been bullied and 18% who had drunk alcohol).

I’ve enjoyed gaming in the past, without transforming into regular or ongoing use (perhaps because it lost the battle with the well-established love of reading books for preferred leisure time activity). That said, my family was certainly an early adopter of technology and gaming. Indeed my brother ended up becoming games programmer.  My dad was an engineer and inherently interested in computers and we soon had an Apple II. We were soon playing those wonderful early games like Castle Wolfenstein and Dino Eggs – and even before this we played the simple but oddly enjoyable pong (yes, I am officially old!).

Apple II: CC Maciej Janiec @ flickr http://tinyurl.com/nrdro7w

Apple II: CC Maciej Janiec @ flickr http://tinyurl.com/nrdro7w

On the weekend I unpacked my Wii and discovered that the last time I’d played was in 2010! I’ve spent a few hours over the last couple of days playing Super Mario Galaxy. I was curious to know if I would enjoy it as much as I did previously, or whether there was something inherently ‘youth’ about it that would mean it wouldn’t engage me like it once did. This wasn’t the case and I found myself totally absorbed and enjoying it. What did surprise me was that I experienced a flow state that was analogous to that I experience while horse-riding. The sense of being totally absorbed in the task, learning skills and a sense of mastery was wonderful.

There have been many alarmist reports about the negative effects of gaming (addiction, violence). In fact, there is also good evidence to suggest that there are many creative, social and emotional benefits from playing video games. And it’s great to see that there is a more complex and mature discussion about video games emerging, for example Play Write.  The next challenge is to enable health practitioners (including GPs) to be able to discuss video game use with young people in order to identify and understand use that does and does not facilitate health and wellbeing.




What horseriding has taught me about doing a PhD

At about the same time I started my PhD I also started taking horse-riding lessons. Every weekend I travel out to the the gorgeous Yarra Ranges outside Melbourne for a couple of hours of peace and beauty. It’s been immensely rewarding and satisfying, and a real privilege to get to know these majestic animals and be taught by some excellent supportive teachers. Apart from the many health benefits it’s made me reflect that, in many ways, a PhD is a lot like riding a horse (bear with me):

It can be scary: Horses are big, powerful and can be unpredictable. This can be scary, particularly for new and inexperienced riders. While I understood undertaking the PhD would be a big commitment, it was only after a few months in that I realised the complexity and challenge of it (and got a little freaked out!). I also don’t think I appreciated what an emotional rollercoaster it would be.

Autumn riding by reindi @ flickr

Autumn riding by reindi @ flickr

You need to turn up and be present: With horse-riding you absolutely need to be in the moment; focused on the task at hand, otherwise there’s a good chance you will be putting the safety of yourself, the horse and others at risk. This is not just for during the actual lesson itself but from the time you groom and saddle your horse, through to unsaddling,  and turning out into the paddock. In the PhD there are just so many distractions and opportunities to procrastinate that sometimes you don’t know where to start and how to focus (harder than it sounds!). Using things like the pomodoro technique is a good start. Breaking things down into manageable chunks can make all the difference!

It’s about partnership: Before I started having lessons, oddly, I thought horse-riding was mostly about me learning a new skill. This is true in part, however it’s actually so much more. At the risk of going all horse-whisperer on you, it’s about the connection between horse and rider, and understanding how to form a partnership with the horse so you are working together towards set goals, rather than simply cajoling/pushing/pulling the way. The PhD can be a very solitary journey but there are partnership opportunities throughout – with supervisors, other PhD students, with reference groups who might form different types of partnerships, etc. These people can walk some of the journey with you.

Persistence (or sticking at it when things get tough): Learning to horse-ride can be a bit like learning to play a new (albeit living and breathing) instrument. One week everything just comes together and you feel so elated, but other weeks things just don’t click, both you and the horse get flustered, and you can’t seem to do anything right. But you persist and end up still getting so much out of the lesson despite (because of!) the frustration. Persistence in the face of boredom, confusion, frustration, the unknown (etc!) has got to be one of the top three traits required for a PhD – at least for me.

Learning by doing: If nothing else, horse-riding can be learning through doing; practising something again and again until it comes together. There is something very freeing in being able to do that. With the PhD I often put a lot of pressure on myself to get something right the first time, when in fact the PhD is an apprenticeship and as much about learning to do research as much as doing it (though I don’t think this is emphasised enough).

Celebrating the little wins: It’s such a wonderful feeling in horse-riding when something you have been working on for weeks comes together, even relatively small things. Last week I managed to transition from walk to sitting trot (a bit harder than the usual walk to rising trot as it requires more control of your body and the horse). With the PhD seeing the little wins (finishing coding a section of data, for instance) within the bigger picture need to be regularly recognised and celebrated!

Remember to breathe: It’s amazing how often I have to remind myself to breathe during my lesson. I’ve got so caught up in adjusting my technique or learning to do something that I’ve been holding my breathe. Apart from the fact that breathing is, well, kinda necessary, the horse quickly picks up on the tensions that it causes in the body, getting in the way of learning. With the PhD, finding the space to breathe and unwind is so important.

I used to cringe a little when reading posts that used metaphor to describe the PhD experience (or anything!). I’m not sure why, perhaps I thought it trivialised it. Now, I’m glad that I see this can be a valuable way of deepening the understanding of the experience.

Should GPs be screening for problem gambling in young poeple?

A few weeks ago I felt quite happy (smug even!) at reaching a mini-milestone for the development of my health risk screening app: I delivered the final set of questions for the app (to be filled out by young people prior to their doctor’s appointment) to the software developers.

The questions are based on the Home, Education/employment, Eating, peer Activities, Drugs, Sexuality, Suicide/depression and Safety (HEEADSSS) approach to assess for psychosocial health in young people (more info here). As part of the process of transforming the quite lengthy interview guidelines into a brief questionnaire, I adapted a recently developed e-heeadsss tool for headspace centres and consulted with young people and general practitioners (GPs). And I felt pretty good about the final list being a representative and appropriately youth (and GP)-friendly!

Gambling was not an issue that had been included or suggested nor did it occur to me either. However, listening to a recent Background Briefing podcast investigating problem sports betting among young males has made me look further into the issue. The podcast makes for sobering listening, detailing the insidious tactics betting companies undertake to ‘groom’ their customers.

As an Australian Rules football fan, who’s seen betting advertising increasingly saturate the experience of watching it via television, radio and even at the ground (there is no escape!) this wasn’t a massive surprise. That said, the amount of money lost by the young men was breath-taking, losses that they may never be able to repay.

What the investigation did not really explore in much depth was the incidence and whether there are any health effects to problem gambling.

In terms of the incidence, the Problem Gambling Research and Treatment Centre report that young people are at higher risk of problem gambling compared with adults. A median of 73% of young people have gambled during the past year, with 4-8% falling into pathological gambling (which is 2-4 times the rate of the adult population). An additional 10-15% are at risk of problem gambling.

Apart from the obvious financial stress and problems, the report outlines how problem gambling is also associated with a range of psychosocial problems. Youth problem gambling is associated with anxiety, depression and suicide ideation. It is also associated with substance use, physical violence, and poor academic achievement. The additional problem with gambling is that it is often hidden and people don’t seek treatment.

So it would suggest that GPs are actually ideally positioned to screen for this and make referrals to appropriate support.  And including it in my app would be a very good idea.