"The definition of success also is socio-emotional growth and emotional intelligence and in-person social connection."

~ Alex Basche

Alex Basche is a psychotherapist (LMFT) based in the SF Bay Area (ie: the heart of Silicon Valley). He works mainly with adolescents and young adults, specializing in the treatment of tech-related behavioral addictions such as gaming, social media, pornography, online gambling & shopping in addition to substance use disorders. 

In this episode we discuss how to bridge online gaming with offline tabletop games as a way to ease kids into in person socializing, the concept of Game Transfer Phenomena (a condition in which gamers can experience auditory and visual hallucinations) and much more.

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Show Transcript

Hillary Wilkinson: (00:00)

My guest today is a psychotherapist based in the San Francisco Bay Area. He works mainly with adolescents and young adults, and specializes in the treatment of tech related behavioral addictions. These include both gaming and social media. He played a pivotal role in co-founding California's first in-network outpatient program dedicated to addressing technology related addictions in adolescents. I have so many questions. I'm so glad you are here to chat with us. Welcome to Healthy Screen Habits, Alex Basche.

Alex Basche: (01:07)

Thank you so much, Hilary. It's great to be here. Appreciate the opportunity.

Hillary Wilkinson: (01:11)

For sure. So, Alex, not only are you an expert in the field of tech related behavioral addictions, you also work in Menlo Park. So for those listeners who are not in California you may not realize that Menlo Park is basically the heart of Silicon Valley. Menlo Park is the home to headquarters of Google Meta for formerly known as Facebook, and on their city profile homepage list themselves as the capital of venture capital. It's funny because what we Yeah, I know. It's funny 'cause what we hear again and again, Alex, is that the execs of Silicon Valley don't let their kids have tech, and yet you have enough clientele that you are based there. So I'm, I'm like, Hmm. So what is that? Like ?

Alex Basche: (02:10)

That's funny. Yeah. That's a, that's, that's a first for me. I, that was something, um, I wasn't aware of because you, you wouldn't know it at least from what, what I think, uh, many of us in, in the field have seen. 'cause it, it, it's, um, it

Hillary Wilkinson: (02:26)

Wouldn't know what, wouldn't know which part.

Alex Basche: (02:30)

You wouldn't know that they were not letting their kids have tech because truly, I mean, also having grown up in this area, my, you know, my dad's worked in tech, um, my, my entire life as well. So it, it's just something that I've kind of just been steeped in for most of my life. And, uh, all the, the, the major kind of tech industry founders and pioneers, investors, et cetera, you know, they, they get into this, uh, obviously it's, it's lucrative, but also there's a lot of, uh, stock, so to speak, that's placed in innovation and on ingenuity and, and really being, uh, the person who moves fast and breaks things. Um, and so there's the, the cutting edge tech is something that often finds its way back home. You know, they bring it back from the office, Hey, you know, you should play with this new thing that we just got.

Alex Basche: (03:25)

So these are also kids that are getting introduced often to technology before it's even hit the market, or sometimes it's even, uh, in testing. So they, they're often very savvy. And, you know, one of the challenges that I often encounter with people that work in tech and and whose kids or teens or young adults are seeing me is that there's this kind of dichotomy where, you know, these people have spent their entire career, again, just kind of living in the wonders of technology and ingenuity and, and innovation. And yet their own children, right, of course, are struggling with the, the dark side of, of this innovation and the dark side of this technology. And, and so it, I find often that part of, uh, treatment involves also kind of like helping parents come to terms with that, helping them sort of process and, and find, okay, maybe there's a middle ground. Maybe it's not all bad, but maybe it's not all good, right? Like, you know, there's that, that, um, saying that Google had, which is, uh, “don't be evil.”  And so the, the goal of course is, hey, how do we find this balance, uh, walk this middle path right? Between, uh, the wonders of technology, but also not allowing it to kind of control us. We wanna be the ones in control who can hit that power button if we want to. 

Hillary Wilkinson: (04:46)

Yeah. I feel like that's what we're all struggling with, right? I mean, because really we, I we just struggle with being tech intentional, you know? I mean, it's like we, we love technology, but we were having a tricky time getting it to stay in its lane and not impinge upon our human relationships. So I think we're getting better at it. I do, I don't know, maybe I'm, you know, a Pollyanna, but I feel like, I feel like as awareness builds and as I, I've worked with more and more parents, I feel like we're getting much better with maintaining intentionality,

Alex Basche: (05:33)

Truly. Yeah, it's definitely, I think the pandemic was a big wake up call for a lot of us. And, you know, there was a time where it was very, uh, black or white. It was, you know, it's gaming is evil. It's gonna take over your life or social media is gonna destroy your self-esteem. And, and then on the other side it's like, no, this is like how I express myself or how I connect with my friends. Like, like, you just don't get it. Right. So starting to, to see that also kind of awakening happen with parents too, that, oh, there's a way to do this that is, you know, safe, that's sane, that's age appropriate, and that also doesn't equate, you know, um, like hating the, hating the player and hating the game. So that, that's something that I often talk with parents about, which is that, hey, if, if you just kind of walk around the house demonizing the games that your kid's playing, you know, this is wrapped up in their identity. So you're, you're also kind of right it in turn hating the player

Hillary Wilkinson: (06:37)

And Right.

Alex Basche: (06:38)

Obviously that's not the message you wanna send to your kids, of course

Hillary Wilkinson: (06:41)

Mm-hmm. . So finding a,

Alex Basche: (06:43)

A way to, to have that balance is of course very key. Um, but it, it's also hard, right? It's hard to be a teenager these days. And I think, you know, it's, it's something sometimes is claimed, uh, with every generation that, “oh, it's so hard these days.” But

Hillary Wilkinson: (06:58)

Right.

Alex Basche: (06:58)

It's safe to say, you know, being Gen Z and, and being such digital natives, it, it can be a real struggle to, to think of it in terms of finding that moderation and particularly, you know, in the Bay Area, right? With these teens who grew up seeing their parents wildly successful, right? Like just at the, the forefront of this huge, you know, bajillion dollar industry to, to not model their idea of success on, oh, if I get X grades, that means that I will have y outcome. And so anything else I do, as long as I get the numbers that, or the letters that say, I know what I know is okay, so I can stay up all night gaming and then waltz in the school, get an A on this test and go home and binge on it all over again. And that's okay.

Hillary Wilkinson: (07:51)

Right? So

Alex Basche: (07:52)

Learning that, you know, the definition of success also is socio-emotional growth and emotional intelligence and in-person social connection.

Hillary Wilkinson: (08:01)

So we almost need to kind of widen and deepen the definition of success as we approach our kids, and show them models of well-rounded, loving, caring individuals. It's not just numbers based, it's not, you know, whether that be income or likes or scores or et cetera.

Alex Basche: (08:28)

Yeah, yeah, exactly. I think that there's just so much pressure, and I know it's not just here in the Bay Area, just in talking to other colleagues, uh, across the country really internationally, there's just so much more of this sort of scarcity mentality, right? It's harder to get into college, it's even harder to get into, you know, what people think of as though this is the top school.

Hillary Wilkinson: (08:51)

Mm-hmm. .

Alex Basche: (08:52)

 So there's this, this sort of, um, survivalist mentality of, you know, I gotta just like scrape and fight and get every last point, every last accolade. And it's, I think, honestly part of why we're seeing such high rates of, of mental health disorders developing and such high rates of depression and suicidality and substance use among the first generation. So, you know, it's like, who, who, between that and the environment and, and everything else going on in the world, who wouldn't wanna escape into a digital realm?

Hillary Wilkinson: (09:25)

Right? And a lot of times I feel like what we see is that, um, when we're talking with kids, like tech is a little bit of like gasoline on a fire of a preexisting concern, you know, like it's an accelerant of angst. M  y question to you as a mental health professional is like, what role do co-occurring conditions play with tech-related behavioral addictions? Do you see a correlation?

Alex Basche: (10:05)

Oh, most definitely. I mean, I, I think that the classic example has been, uh, social phobia or what we used to call social anxiety. Uh, that's really, uh, in that top five of most prevalent co-occurring disorders. And again, you know, someone who, for example, has social anxiety or, or, you know, even is on the autism spectrum, the idea of being able to form lasting social connections online where you're not having to read people's, you know, nonverbal cues. You're not having to, to interact on a three-dimensional level and in which case, like the playing field doesn't feel as level

Hillary Wilkinson: (10:47)

Mm-hmm. ,

Alex Basche: (10:48)

It, it's really, it's actually quite helpful. And so it's, again, going back to that idea of balance, there's plenty of ways that, that some of these, uh, folks who are, are so into, you know, gaming, social media, et cetera, are really getting their needs met. We think about like what some of the motivating factors are being able to develop like a community and connection is really invaluable. So it, it's, I think also important to recognize that some of these folks who, who do have some of these co-occurring disorders, they are actually finding really clever and wonderful ways of getting those needs met. Um, and that the motivation is actually quite benign. It's not a, it's not always just a desire to numb or to escape or avoid, 

Alex Basche: (11:35)

So think anxiety is a big one. A D H D is, is really the most prevalent. Um, that's when we see a lot. And again, when it's just the way that someone's brain is wired, it, it's very easy to get stuck in that sort of shame spiral of you're not spending enough time doing your homework. All you wanna do is game what's wrong with you? They use the “A” word, you're addicted. And really it's like, Hey, this is just how their brain's wired. So why are, why are, you know, why are we, uh, levying all this shame on the, on the teenager? 'cause again, being a teen is hard enough. Maybe there's a way to find that balance that is, is more positive, more strength-based.

Alex Basche: (12:20)

Just as you said, it's otherwise it's just kind of pouring fuel on the fire.

Hillary Wilkinson: (12:24)

You mentioned finding these communities online, which I 100% understand can be completely beneficial and, you know, finding people you connect with and all of that. Um, do you find that the online communities are as strong? Do people get the same amount of emotional feedback is from in-person relationships versus their online communities?

Alex Basche: (13:02)

Yeah, it's a good question. I think, you know, there's definitely been some research that shows, you know, as, as we might expect, you know, certainly it's not the same. And it's, it wouldn't be fair, I think to, to equate those two.

Hillary Wilkinson: (13:14)

Mm-hmm.

Alex Basche: (13:15)

Uh, I, I usually like to think of it more as something that's supplemental that like, hey, this, this person has, uh, you know, found that they've now been able to have these sorts of social connections they hadn't had before and they struggled to form. And so in some ways it's kind of like the training wheels of, of creating social connection in community.

Hillary Wilkinson: (13:38)

I've never even thought of it that way. Yeah.

Alex Basche: (13:40)

Yeah. So it's like, hey, so it's not that it's a bad thing. We all need training wheels, right? Where everyone starts, you know, from that same place, but at some point they gotta come off. And it doesn't mean you need to, to throw those relationships away or discount them, but it does mean that, okay, let's take it to the next level. And one of the ways that I've been, uh, trying to help, uh, some people do that is getting them into tabletop gaming. So like, Dungeons and Dragons, Pathfinder, Settlers of Catan.

Hillary Wilkinson: (14:10)

Totally. Like we have game room, um, like game rooms. I think they're called like in the, in the community where they have just like a whole wall of various board games or, and like you're talking about, like what you're ta Sorry, I didn't mean to interrupt you, but I No, please. I, the same communities that I see, like drawn towards those Dungeons and Dragons are, are a lot of the kids that I see also whom, you know, just from the, just from the outside, I'm, I would, I would put them in the heavy, heavy gamer category, , you know? Yeah. But I think that's absolutely, yeah. I love how that is a very real life, um, ease into something. So if you have a child who is, you know, finding their only connections to be online gaming or within that community, you can seek to forge, seek other relationships by maybe getting them into a local gaming league of tabletop gaming.

Alex Basche: (15:19)

Definitely. And, and, and even taking it a step further, you know, there's, um, there's now accreditations. You can get in what's called a therapeutic dungeon master, basically like in, in a game like Dungeons and Dragons, which of course is the, the OG uh, tabletop, uh, there's one person who is kind of the one that is the world builder, right?

Hillary Wilkinson: (15:48)

And

Alex Basche: (15:48)

They're the ones that kind of guide everyone through, and that's the DM or the, the Dungeon Master. So as a therapist, you can get an accreditation where you're trained in how to really utilize that sort of world and those game mechanics to create kind of like a, a a kind of, to create a therapeutic environment and to help people

Hillary Wilkinson: (16:12)

Like a social group? Is it, would it be akin to a social group?

Alex Basche: (16:17)

Yeah, but there, there's more. There's a, there's more of a clinical layer to it. And so it's, okay, so here are these people, right? For example, like social anxiety, we're gonna work on developing pro-social communication skills, and I'm gonna integrate that into this round of, you know, gameplay or this scenario, uh, that, that we're playing together.

Hillary Wilkinson: (16:38)

Brilliant.

Alex Basche: (16:40)

Yeah. Truly. Yeah.

Hillary Wilkinson: (16:41)

 I love that!,

Alex Basche: (16:42)

It's fantastic.

Hillary Wilkinson: (16:43)

Yeah. So next we're gonna talk about game transfer phenomena, but first we have to take a break.

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Hillary Wilkinson:   I'm speaking with Alex Basche a licensed marriage and family therapist, and C M A T candidate who specializes in the treatment of tech related behavioral addictions. So, Alex, I have to ask, what is C M A T ? I

Alex Basche: (18:24)

So that's, um, so basically there's different levels of, uh, certification for behavioral addictions. So there's a CSAT, which is like a certified sex addiction therapist. And right now what I'm pursuing is a CMAT, which is like multiple addictions and

Hillary Wilkinson: (18:43)

Oh, okay. Gotcha.

Alex Basche: (18:45)

Trying to just see how many, uh, different acronyms I can collect, because honestly, it was kind of hard finding, uh, accreditations and certifications for behavioral addictions because with substance use disorders, there's, there's a ton.

Hillary Wilkinson: (19:01)

Mm. Um, and

Alex Basche: (19:02)

I'd gotten that when I was in Oregon, a CADC, A Certified Alcohol and Drug counselor. But of course it doesn't transfer to California. So, you know, just playing with that, uh, bureaucracy a little bit. Certainly.

Hillary Wilkinson: (19:13)

Gotcha. Okay. So thank you for, thank you for, uh, clearing that up, . Of course, of course. One of your areas is of expertise is game transfer phenomena, which is also known as G T P.   I only became aware of G T P after reading Glow Kids. And can you define what is game transfer phenomena and like, how does it impact people's functioning and like, just give us the whole lowdown.

Alex Basche: (19:54)

Yeah. So it, it, G T P is, um, basically this, this neurological phenomena that happens. It's based on like sensory perceptions, uh, or, or behaviors, behavior changes or, um, mental process changes, which happens as a result of like a, a digital trigger or stimulation. So, um, what that often can look like is, uh, like an auditory hallucination. So if, uh, we see this in some ways actually happen with nurses a lot, where they're listening to the beeping of a machine, like a heart rate monitor, and then they, they go home and they can still hear the beeping, even though, obviously right? They're, they're nowhere near the monitor. Uh, for, for gamers often it's, you know, they're, every time they, uh, you know, attack in their game, it plays like a certain, uh, music. And then when they turn the game off, they get into bed, they close their eyes, they can hear the music faintly playing. And so it's this, this interesting phenomena that, uh, isn't really well understood. Um, it's been happening pretty much since the advent of, uh, really the digital life that we know, uh, even used to be called the Tetris Effect.

Hillary Wilkinson: (21:13)

Yeah, that was my intro to it. Yeah. And can you explain that?

Alex Basche: (21:18)

Yeah. So it, it was originally called that because, uh, people that were playing Tetris were, were having this sort of phenomena and it was really just considered something that was, uh, just like, oh, yeah, that just happens because you're playing the game. Um, and, and so it was really thought first to have just been, uh, local localized really to that one population. And, and thus wasn't really well researched or studied. I had stumbled upon it because I was really curious about the effects of, um, 'cause I used to do a lot of work with substance abuse of, uh, post hallucinogen perception disorder, and, uh, which is also known as, um, like people that have, uh, taken like a lot of hard drugs like hallucinogen, and then they, they have, um, flashbacks or other, other phenomena, uh, even though the substance is no longer in their system. And so I was pointed towards, uh, this, this wonderful, brilliant professor, um, Angelico Ari, and she is kind of the, um, I wouldn't say the, the founder, but she's really the, the world expert on G T P. And so we've been, uh, coordinating, uh, across the oceans because she's based in Europe, uh, the past couple of years on, on a number of research projects.

Hillary Wilkinson: (22:35)

Okay. So how I, I understand that it, so, um, with the Tetris effect. People would continue in their periphery to see like the falling blocks. Yeah. For anybody who doesn't know Tetris isn't familiar with Tetris. Tetris was very early stage video game in which you lined up blocks to come and, you know, create complete horizontal lines at which it would, you know, blink or whatever, and you'd collect your points and that row would evaporate and you'd go about trying to fit puzzle pieces together. So in my understanding, people would continue to kind of see these falling blocks on like out of the sides of their eyes. Um, so you've talked mm-hmm. And then you've talked about the auditory, the hallucinations, like how I don't, I, I guess what I'm asking is like, how does it impact people's 

Alex Basche: (23:39)

Yeah.

Hillary Wilkinson: (23:40)

day-to-day Life. Like, I, I, I'm like, so, you know, I many's the day I've walked around, you know, singing, you know, some earworm or another , you know? Yes, exactly. So I'm like, how is it, how is it different? Why, why, why should we care? Is what I'm asking?

Alex Basche: (23:57)

Yes. That is often the question, um, truly right? Because it's like, oh, that's interesting, that's neat. Why, why do I care?

Hillary Wilkinson: (24:04)

Yeah. Yeah. So

Alex Basche: (24:06)

The answer is, uh, and this is something that we've been working a lot on recently, is, you know, the clinical application is something that I think I can best, uh, summarize just with a, a short anecdote. And I was working with, uh, one teenager who had been in and out, unfortunately, at the hospital. And, um, they had, uh, found that they were being prescribed a number of anti-psychotic medications. And the reason was because they were suspected of, of having, uh, schizophrenia or something, something similar. But it turned out it was, um, there was something else going on, but the symptoms they were getting these medications for turned out to be Game Transfer Phenomena. Now, the prescribing doctor, the hospital, no one had really heard of it, and no one had really made that connection because of course, right? It's not a very well known phenomena.

Alex Basche: (25:02)

But once I started meeting with them and presented, uh, you know, this hypothesis to the prescriber, they almost immediately leapt into action and started weaning them off. And a lot of their difficult behaviors, uh, went away. It turned out to be more of a situational thing, and they didn't need to be on all these, you know, heavy, heavy, serious antipsychotic drugs. So when we, we talk about, you know, why should we care? It's because sometimes this can be misdiagnosed as, you know, something, uh, such as, you know, this case for schizophrenia or something like it. But also because if we can separate that out, then we can see, okay, well, some of these behaviors you're engaging in are probably because, you know, okay, you're playing too much. But also, it, it's maybe when you're playing, so if you're gaming late into the night, and this is really disrupting your sleep, and you're entering into what's called like a, a having like a hypnagogic sort of a state, which is that that kind of, um, dawn between sleep and wakefulness. Mm-hmm. And it's starting to really, um, interrupt, right? The, the sleep process. Maybe we need to move when you're gaming back. So I've been really interested in looking at those sort of clinical applications. And really also it's kind of an indicator of, okay, for whatever reason, the, the, the lines between reality and fantasy right in the digital world are getting a bit more blurred

Hillary Wilkinson: (26:40)

For sure.

Alex Basche: (26:40)

And we need to investigate why that is. Is it something to do with your brain or when you're playing, how you're playing, how much things like that.

Hillary Wilkinson: (26:49)

How, how can someone determine, I'm thinking if you're a parent who's concerned, or if you're someone yourself who is a gamer and concerned, how can someone determine if they have a bad habit versus a like, full on gaming or tech addiction?

Alex Basche: (27:17)

Yeah. Thankfully, there's a lot of great skills and assessments, um, that we use to help determine that. Uh, there's, like, for people that aren't, um, struggling with gaming specifically, there's like the internet addiction test. Um, the IAT, there's the internet gaming disorder test.

Alex Basche: (27:38)

The, the problematic online gaming questionnaire. There, there's a number of them that, you know, are pretty self-explanatory and are, are, a lot of them are self-reporting. So you can even just go online and Google any of those names and it'll come up with a P D F. Okay. But really, like, when we're thinking about how much of this is an issue we're looking at, uh, really the, the criteria, right? The definitions. So are we seeing changes in mood? Are we seeing symptoms, um, of anxiety, anger, irritability that happen when you're not allowed to play? Is there a lot of conflict? Has this become the most important activity in your life? So you're not even prioritizing things like your own self-care, hygiene, eating, sleeping.

Alex Basche: (28:30)

Is there a lot of binging behavior? So you're playing for five plus hours, three plus hours a day in a row, and then isolation, right? So as it seemed like social, familial, intimate relationships are kind of falling by the wayside. Um, so it's, it's so much less about the number of hours. There's no magic number, and it's so much more about how has it affecting your life than what's the quality of the content that you're consuming.

Hillary Wilkinson: (29:01)

Hmm. Okay. Those

Alex Basche: (29:03)

Are really the big ones.

Hillary Wilkinson: (29:04)

Got you, got you. And I, um, yeah, thank you for giving the, the resources that if people are concerned, they can go ahead and have a look. So when we come back, I am going to ask Alex for his healthy screen habit. 

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Hillary Wilkinson:

We are back. I'm talking with Alex Basche, founder of Reset From Tech, a mental health practice in Silicon Valley that treats people struggling with tech overuse. So Alex, on every episode of the Healthy Screen Habits podcast, I ask each guest for a healthy screen habit. This is a tip or takeaway that our listeners can put into practice in their own home. Do you have one?

Alex Basche: (30:02)

I do. So it may come as no surprise, but mine is related to, uh, the use of digital screens. Uh, so there's been plenty of research, uh, that shows that blue light, which is, uh, a form of light that we know is ample in the sun and also in our screens, that it suppresses melatonin production. And that's, uh, one of those sleep inducing hormones that's pretty critical to our sleep quality and quantity. So what if there was a way to filter out the blue light from our screens? Well, some of you may know that there is. And what you can do basically, is to look at your smartphone, your laptop monitors, smart TVs. Most of these devices we use each day do have a way to do that, to filter out that blue light. So what you wanna do is, um, look at basically setting this up and seeing if there's a way to schedule it so that it goes off by around seven or 8:00 PM each night. And it doesn't necessarily mean you have to turn your device off, it just means that you enable that night mode, the blue light filter, whatever it might be called. And again, if you can schedule it automatically and you don't even think about it, uh, anyone who's struggling with eye strain, digital eye strain, this will also reduce that too. So it's one of those things that's really easy to do, doesn't cost you anything, it will just kind of make your quality of life a lot better and

Hillary Wilkinson: (31:30)

Increase your sleep potentially.

Alex Basche: (31:32)

Exactly.

Hillary Wilkinson: (31:33)

. Okay. As always, you can find a complete transcript of this show and a link to reset from blah, blah blah, and a link to the reset from tech website. Let me say that again, and a link to the Reset From Tech website by going to healthy screen habits.org. Click the podcast button and scroll down to find this episode. Alex, thank you so much for sharing What a fraction of what, you know, this has been a fascinating conversation.

Alex Basche: (32:07)

Oh, thank you so much, Hillary. I appreciate the chance to talk.