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Therapeutic work and the ‘reward circuit’

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Neurosciences have always been of great interest to me and it is with pleasure that I read this or that article on different fields, enriching my understanding of a particular phenomenon or striving for an ever greater openness of mind.

What is even more interesting is to try to find cross-overs between the world of neuroscience and my therapeutic practice. It turns out that the use of video games as a therapeutic mediator precisely facilitated these crossings, of which here is an example :

I was using Minecraft with a young client to help him build his self-confidence, supporting him in his ability to follow through on his building idea while constantly distracted by multiple elements of the game. I therefore acted to ensure that the Minecraft sessions worked on his distractibility by specifically using elements of the game (staying in Survival mode to avoid getting lost in the Creative mode inventory for example) and interventions (always benevolent in the therapeutic context) on my part to help this framing (‘this is not your objective’, ‘you are moving away from your task’, ‘stay focused on your first idea’, etc.). Without realising it, I had put in place a whole procedure to help him progress in his ability to inhibit elements peripheral to his task that could overwhelm him if he allowed his attention to diverge. Thanks to a better capacity for inhibition, his attention to the tasks to be accomplished, his learning capacities as well as his successes will be improved. The therapeutic goal of self-confidence is achieved by developing better capacities to face the situations encountered (problems to be solved, various learnings) and confidence is then built according to the lived experiences. The therapeutic environment provides support in the face of difficulties, sending positive signs of recognition, and such framing allowed this client to discover these capacities in himself and to be able to use them.

So reading neuroscience articles and using video games are more than relevant to my therapeutic practice, so that I can best help the people who come to see me.

But it turns out that video games have always generated heated debate. For many years it was the question of the violence that video games would provoke that fuelled these debates; but recently another debate has emerged: that of the supposed addiction that the practice of video games can cause.

To give my position on this subject, I hold onto the idea that video games do not create addiction, preferring to speak of excessive or problematic practice. This allows me to always see this practice as being a symptom to be understood and analysed in the functioning of my clients. Therefore, I remain centred on them rather than on the subject of ‘video game-addiction’ and do not miss valuable psychological insights. I will not develop my position further here because this is not the subject of this article.

With this new debate, the notion of the famous dopamine reward circuit appeared, that is ubiquitous in explaining how video games and screens in general turn us into ‘addicts’. So what we read and hear regularly is the idea that the tasks we perform produce rewards that stimulate our brain by releasing dopamine, and the individual then finds him or herself trapped in repeatedly and unconsciously performing these tasks to receive these rewards over and over and the neurological response that accompanies it …

Like here for example: ‘These devices activate the reward system very quickly. The brain is constantly receiving stimuli and rewards that activate high-dose dopamine neural networks, which can create the onset of addiction.’

There is no question of me debating or explaining this neurological functioning because I have no competence to claim to be able to do this. My reading and my interest in the field do not replace the lack of training and professional experience; I rely on the opinions and explanations of my colleagues in the field of neuropsychology, who recommend in particular reading Mark Humphries ‘The Crimes against dopamine’ (https://medium.com/the-spike/the-crimes-against-dopamine-b82b082d5f3d). But this has prompted me want to give a therapist’s perspective on this issue, describing the therapeutic work that can be achieved with a client.

Thus, by dint of reading articles evoking the equation ‘addiction-video game-reward circuit’, I began to question my vision of the clinical psychologist and therapist. This article offers an opportunity to better formalise and explain my professional position on these issues.

What can therapists do with all of this? They will ask themselves questions that those who believe that video games create addiction through neuroscience devices do not ask themselves, and will not make sure to remove the bad object more or less quickly.

Not going down this path opens up other fields of investigation that may consider whether the use of video games is a way for individuals to use a device to fight against what is causing them pain: it’s like a psychic crutch, or like an antidepressant.

Would it be dangerous for clients to abruptly withdraw from something that is helping them to maintain some semblance of balance? The therapeutic work is there to support them: to understand this balance, what it is made up of, what it struggles against and why it generates so many negative elements for the individual.

So among the questions that will emerge in relation to the client are, for example:

  • what game is being played?
  • how long and at what time of the day?
  • in what way?
  • for what (un)conscious purpose(s)?
  • generating what feelings and emotions?

… and all this is constantly entwined with the client’s life story and experiences. An activity which occupies a client at this point is something very precious because in fact there is a lot to discover, much therapeutic material to collect! So for me it doesn’t make sense to cast all this aside.

In my clinical practice, if the client chooses a game which will constitute a psychological crutch, it is not because he or she is addicted to it neurologically speaking, it is because the act of playing ‘this game and in this way’ is a product of its meaning in relation to who the client is as an individual at a specific time. There is therefore an element of ‘choice’ even if it is unconscious (‘choice’ that we find in an article by Pickard, H., Ahmed, S. & Foddy, B. (2015). Alternative Models of Addiction. Frontiers in Psychiatry. 6. 20.10.3389/fpsyt.2015.00020).

But how does the gamer take pleasure in a behaviour that can generate so much inconvenience if we no longer talk about dopamine and the reward circuit? The fact that these actions validate one or more psychological beliefs may be sufficient: the individual produces acts which reinforce a belief, which in turn reinforces the behaviour which leads to this result. The therapeutic work will consist in bringing to light these false beliefs and allowing the client to access those which correspond to his or her real functioning. It takes time (a lot sometimes) and a very good therapeutic alliance to reach the end of this work. As the false beliefs appear and the client’s functioning emerges, he or she will be able to act increasingly on the problematic gaming behaviour, a bit like communicating vessels whose resources pass from one system to the next.

In this article, I wanted to shed more light on the therapeutic work in which our clients have been engaged, for some over several years, as a way to allow another perspective on this question to be heard, to show more concretely how some psychologists work with this media on these issues.

These individuals suffer a lot from the beliefs that surround video games, from those who demonise this activity and discredit their users, sometimes through ignorance and incomprehension. So let’s bring a little compassion and kindness to this subject.

The listening skills and knowledge on the use of video games that I have developed in my clinical practice are invaluable assets in helping clients with problematic video game use.

This post is also available in: Français Español

About Bruno BERTHIER

Psychologue Clinicien en libéral Diplômé en 2001 de l'Ecole de Psychologue Praticiens

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