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Endorsements

‘The editorial team and contributors’ knowledge and understanding of

the broad intersections of cyberpsychology research is second-to-none,
given their years of experience teaching and writing about the impact of
technology on human behaviour. This is a must have book for those start-
ing to learn about, or wanting to keep pace with, the multi-disciplinary
field of cyberpsychology’.
Dr Andrew J. Campbell, Associate Professor of
Cyberpsychology, The University of Sydney, Australia

‘The second edition of An Introduction to Cyberpsychology offers a compre-

hensive and thought-provoking critical analysis of a range of contempo-
rary topics in this ever-evolving field. With supporting online resources,
this is an essential read for interested scholars and students across a range
of disciplinary areas, not least in psychology. Highly recommend’.
Neil Coulson, Professor of Health Psychology,
University of Nottingham, UK

‘The second edition of An Introduction to Cyberpsychology shares the

most-up-to-date research on contemporary issues in cyberpsychology
in accessible, easy-to-understand language. It is thorough and considers
the multiple ways in which human behaviour shapes and is shaped by
digital technology across all facets of life from developmental ages (youth
and older age), work, education, sport, and interpersonal and romantic
relationships. Chapters are written by leaders in the field and the online
learning activities would enhance any cyberpsychology curriculum. I’m
looking forward to using this in my own classrooms!’
Dr Melanie Keep, Director of Academic
Education, Sydney School of Health Sciences, Faculty
of Medicine and Health, The University of Sydney

‘This book provides a comprehensive overview of cyberpsychology. It

applies evidence-based literature from psychology and related disci-
plines to explore the impact of online technologies on a diverse range
of topics including but not limited to health, education, social iden-
tity, consumer behaviour, and the workplace. In doing so it provides an


CHAPTER 

invaluable resource for students, instructors, policymakers, and any other

stakeholders with an interest in the increasingly important discipline of
cyberpsychology. The supplementary online resources provided that can
be accessed by students are engaging and will provide a deeper under-
standing of the issues that the book discusses’.
Prof. John McAlaney, University of
Bournemouth, UK

‘As technology progresses, the importance of cyberpsychology as an

essential part of the wider psychology curriculum becomes more appar-
ent. This book acts as an excellent introduction to the field, providing
an in-depth overview of all the subject has to offer. Through interac-
tive discussion questions and additional reading lists, the book provides
a valuable and accessible resource for students and anyone intrigued to
find out more about our digital behaviours. An essential addition to the
existing literature, with contributions from leading experts in the field.
A great read!’
Dr Lisa Orchard, Senior Lecturer in Psychology,
University of Wolverhampton, UK

‘The new edition of An Introduction to Cyberpsychology by Irene Connolly,

Marion Palmer, Hannah Barton, and Gráinne Kirwan demystifies the rel-
atively new field of cyberpsychology. Moreover, it communicates the nuts
and bolts of strategies from several up-to-date approaches for studying
digital technologies. The companion website provides informative sup-
plementary materials that are easy to follow. This is an important addi-
tion to the cyberpsychology literature’.
Thomas D. Parsons, PhD, Grace Center
Professor for Innovation in Clinical Education,
Simulation Science, and Immersive Technology,
Director: Computational Neuropsychology and
Simulation (CNS) Lab, Arizona State University, USA

‘The second edition of An Introduction to Cyberpsychology is a valuable and

much needed addition to the field. A must-read for those who are new to
cyberpsychology as well as those who are looking to update their under-
standings. An Introduction to Cyberpsychology covers diverse topics at the
forefront of cyberpsychology, which are highly applicable to life in the
digital age. Importantly, An Introduction to Cyberpsychology provides read-
ers with the building blocks to develop a nuanced and critical under-
standing of key issues in cyberpsychology’.
Dr Catherine Talbot, Senior Lecturer in
Psychology, Bournemouth University, UK
 CHAPTER 

‘An Introduction to Cyberpsychology does an amazing job of covering the

current state of cyberpsychology and how its basic premises extend inter-
disciplinarily in both positive and potentially destructive ways. In addi-
tion to including many opportunities for the reader to think critically
about this growing applied discipline within psychology, the editors and
chapter authors have included many resources and relevant references
that allow for extending the utility of the textbook outside of the very
pages they appear on. As a cyberpsychological researcher and an aca-
demic teaching cyberpsychology at the graduate level, I found the focus
on conducting online research particularly well-suited to my students’
needs, with several of the other chapters uniquely capturing the essence
of what I want all of my first-year students to be aware of’.
Dr Scott Debb, Associate Professor,
CyberPsychology Research and Program Coordinator,
Norfolk State University, USA
AN INTRODUCTION TO
CYBERPSYCHOLOGY
An Introduction to Cyberpsychology provides a comprehensive introduction to
this rapidly growing discipline. Fully updated in its second edition, the book
encourages students to critically evaluate the psychology of online interactions
and to develop appropriate research methodologies to complete their own work
in this field.
The book examines cyberpsychology and online research methodologies,
social psychology in an online context, practical applications of cyberpsychol-
ogy, and the psychological aspects of other technologies. This new edition has
been carefully updated to include additional coverage of:

● Expanded content relating to major developments in the field and new

content on gaming and screentime
● A new chapter examining the relationship between older adults and
technology
● Cyberpsychology in focus feature boxes in each chapter that examine top-
ics in depth
● Interviews with professionals working in fields relating to cyberpsychology

Each chapter includes key terms and a glossary, content summaries, discussion
questions, and recommended reading to guide further study.
Supported by extensive online resources for students and instructors, this
authoritative book is an essential core text for undergraduate modules in
cyberpsychology, and an ideal primer for students of postgraduate programs in
cyberpsychology.
To view the additional student and instructor resources for this book, please
visit bpscoretextbooks​.routledge​.​com

Gráinne Kirwan is a Lecturer in Psychology at Dún Laoghaire Institute of Art,

Design and Technology, Ireland.

Irene Connolly is Lecturer in Developmental and Educational Psychology at

Dún Laoghaire Institute of Art, Design and Technology, Ireland.

Hannah Barton is a Lecturer in Psychology at Dún Laoghaire Institute of Art,

Design and Technology, Ireland.

Marion Palmer is the former Head of the Department of Technology and

Psychology at Dún Laoghaire Institute of Art, Design and Technology, Ireland.
CHAPTER 

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 CHAPTER 

AN INTRODUCTION TO
CYBERPSYCHOLOGY

2nd Edition

EDITED BY GRÁINNE KIRWAN,

IRENE CONNOLLY, HANNAH BARTON AND
MARION PALMER
CHAPTER 

Designed cover image: © Getty

Second edition published 2024

by Routledge
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and by Routledge
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© 2024 selection and editorial matter, Gráinne Kirwan, Irene Connolly, Hannah Barton, and
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First edition published by Routledge 2016

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Names: Kirwan, Grainne, 1978- editor. | Connolly, Irene, editor. |
Barton, Hannah (College teacher), editor.
Title: An introduction to cyberpsychology / [edited by] Gráinne Kirwan,
Irene Connolly, Hannah Barton and Marion Palmer.
Description: Second edition. | Abingdon, Oxon ; New York, NY : Routledge,
2023. | First edition published by Routledge 2016. |
Includes bibliographical references and index. |
Identifiers: LCCN 2023026232 (print) | LCCN 2023026233 (ebook) |
ISBN 9780367636418 (hardback) | ISBN 9780367552299 (paperback) |
ISBN 9781003092513 (ebook) | ISBN 9781032603520
Subjects: LCSH: Cyberspace–Psychological aspects. |
Virtual reality–Psychological aspects. | Telematics–Social aspects.
Classification: LCC HM1017 .I58 2023 (print) | LCC HM1017 (ebook) |
DDC 303.48/34–dc23/eng/20230902
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ISBN: 978-0-367-55229-9 (pbk)
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DOI: 10.4324/9781003092513

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Contents

List of Figures and Table xxiii

Notes on Contributors xxv
Foreword xxix
Acknowledgements xxxi

PART 1: INTRODUCTION 1

Interview 1: Cyberpsychology in Professional Practice 3

1 Introduction to Cyberpsychology 5
Gráinne Kirwan
Chapter Overview 5
Key Terms 5
Cyberpsychology: A Brief Synopsis 5
Cyberpsychology Journals, Conferences, and Research Groups 12
Aims and Structure of the Book 12
Part 1: Introduction 13
Part 2: Human Interactions Online 13
Part 3: Applied Cyberpsychology 14
Part 4: Psychology and Technology 15
Conclusion 15
Activity 15
Discussion Questions 16
Recommended Reading List 16
Glossary 17
References 17

2 Conducting Online Research 21

Brendan Rooney
Chapter Overview 21
Key Terms 21
Introduction: Good Research 21
The Internet and Research 22
Secondary Research Online 22
Primary Research Online 23
xi


CHAPTER  C o n t e n t s

Observation 23
Interviews, Questionnaires, and Experiments 24
Considerations for Online Data Collection 25
Internet Research Ethics 28
Conclusion 29
Activity 29
Discussion Questions 30
Recommended Reading List 30
Glossary 31
References 31

PART 2: HUMAN INTERACTION ONLINE 37

Interview 2: Cyberpsychology in Professional Practice 39

3 Computer-Mediated Communication and Online Media 43
Gráinne Kirwan
Chapter Overview 43
Key Terms 43
Communication Tools Online 44
A Very Short History of Computer-Mediated Communication 45
Language and Online Communication 46
Paralanguage 47
Acronyms and Abbreviations 47
Emojis/Graphic Accents/Smileys/Emoticons 48
Communication Theories 49
Hyperpersonal Communication 49
The SIDE Model 50
The Shannon–Weaver Mathematical Model 50
Rules Theory/Co-Ordinated Management of Meaning (CMM) 51
Herb Clark’s Grounding Theory 52
Other Theories of Communication 52
Related Concepts 53
Conclusion 53
Activity 54
Discussion Questions 54
Recommended Reading List 54
Glossary 55
References 56

xii
 C o n t e n t s CHAPTER 

4 Self and Identity in Cyberspace 59

Irene Connolly
Chapter Overview 59
Key Terms 59
Online Behaviour Theories 61
Equalisation Hypothesis 61
Social Identity Model of Deindividuation Effects (SIDE) Theory (Leary
and Kowalski, 1990) 62
Impression Management 63
The Role of Anonymity in Impression Management 63
Lying or Impression Management? 64
Broadcasters and Communicators 65
Identifiable Online Environments 66
Identity and Self in Anonymous versus Identifiable Online
Environments 66
Conclusion 68
Activity 68
Discussion Questions 68
Recommended Reading List 68
Glossary 69
References 69

5 The Dark Side of the Internet 75

Hannah Barton and Derek A. Laffan
Chapter Overview 75
Key Terms 75
The Internet and Trolling 76
Why Do the Trolls Do It? 77
How Do Trolls Operate? 78
Prejudice and Stereotyping Online 79
Stereotyping 79
Effects of Online Ostracism and Prejudice 80
How Can We Reduce Prejudice Online? 80
Sexual Harassment Online 81
Cyberstalking 82
Griefing, Toxic Gamer Cultures, and Dark Participation 83
Conclusion 84
Activity 84
Discussion Questions 85
Recommended Reading List 85

xiii
CHAPTER  C o n t e n t s

Glossary 86
References 86

6 Love and Relationships Online 91

Nicola Fox Hamilton
Chapter Overview 91
Key Terms 91
Seeking Love Online 91
Meeting Online: Where, Who, and Why? 92
What Motivates People to Find Romance Online? 92
Experiences and Outcomes 93
Online Dating Profiles 94
CMC and Its Effect on Online Romance 95
Self-Presentation and Deception in Online Dating 96
What Makes a Dating Profile Attractive? 96
Shifting Modalities: Moving Offline 97
Maintaining Relationships Online 98
Jealousy, Surveillance, and Infidelity 98
Breaking up 100
Conclusion 101
Activity 101
Discussion Questions 102
Recommended Reading List 102
Glossary 103
References 103

7 Attention and Distraction Online 109

John Greaney and Emma Mathias
Chapter Overview 109
Key Terms 109
Studying in a Multitasking Environment 109
Using Technology while Studying at Home 109
Using Technology during Class Time 110
How Do High Multitaskers Compare to Light Multitaskers? 111
Ability to Ignore Irrelevant Information 111
Working Memory Capacity 111
Skill in Switching from One Thing to Another 112
Effects of Habitual Multitasking 112
Impact on Depth of Learning 112
Why Do People Multitask? 113

xiv
 C o n t e n t s CHAPTER 

Attention 114
Alerting and Orienting 114
Executive Control and Attention Network Test 115
Training Attention Using Mindfulness and Meditation 115
Developing Self-Control 116
The Marshmallow Test: Self-Control and Delayed Gratification 116
A Digital Marshmallow Test: The Academic Diligence Task 116
Strategies for Improving Focus and Handling Distraction 117
Turning Study into a Game 117
Technology Breaks 117
Setting up an Intention to Wait to Check Technology 118
Using Technology to Block Distractions 118
Listening to Music 118
Taking a Break from Media: Walking outside in Natural Environment 118
Value of Time Unplugged 119
Conclusion 119
Activities 120
Discussion Questions 120
Recommended Reading List 120
Glossary 121
References 121

8 The Dynamics of Groups Online 125

Olivia A. Hurley
Chapter Overview 125
Key Terms 125
Introduction 125
Groups: What, How, and Why 126
Online Groups v Offline Groups 129
Reliance on Online Group Membership: Risks/Rewards 130
How Do People Behave in Online Groups? 130
Specific Features of Group Dynamics (Cohesion, Identity, Capital,
Groupthink, Social Loafing) 132
Future Directions for Research in Online Groups 134
Conclusion 134
Activity 134
Discussion Questions 134
Recommended Reading List 135
Glossary 135
References 135

xv
CHAPTER  C o n t e n t s

9 Persuasion and Compliance in Cyberspace 139

Hannah Barton
Chapter Overview 139
Key Terms 139
What Is Social Influence? 139
Compliance 140
Obedience and Authority 142
Replication Online of Milgram’s Electric Shock Experiments 142
Conformity 143
Persuasion 145
The Yale Model of Persuasive Communication 146
The Elaboration Likelihood Model (ELM) 146
Captology 147
Conclusion 148
Activity 149
Discussion Questions 149
Recommended Reading List 149
Glossary 150
References 150

10 Privacy and Trust Online 153

Gráinne Kirwan
Chapter Overview 153
Key Terms 153
Sharing Information Online 154
Deciding What Information to Share 156
Cognitive Psychology and Decision Making 157
Communication Privacy Management 158
Social Spheres and Space 159
Paradoxes, Trade-offs, and Gaps 160
Removing Our Data Online 161
Conclusion 162
Activity 163
Discussion Questions 163
Recommended Reading List 163
Glossary 164
References 165

xvi
 C o n t e n t s CHAPTER 

PART 3: APPLIED CYBERPSYCHOLOGY 169

Interview 3: Cyberpsychology in Professional Practice 171

11 Forensic Cyberpsychology 175
Gráinne Kirwan
Chapter Overview 175
Key Terms 175
Cybercrime 176
Categorising Cybercrime 179
Forensic Psychology: An Overview 180
Research Topics in Forensic Psychology 181
Theories of Crime 183
Conclusion 186
Activity 186
Discussion Questions 186
Recommended Reading List 187
Glossary 188
References 188

12 Cyberpsychology and Psychopathology 191

Cliona Flood and Audrey Stenson
Chapter Overview 191
Key Terms 191
What Is Psychopathology? 191
What Is the Range of Internet-Based Disorders? 193
Internet Gaming 194
Social Networking 195
Nomophobia and Mobile Phone Usage 195
Pathological Internet Usage 196
Treatment Options 197
Using Technology to Support Recovery and the Treatment of
Poor Mental Health 198
Conclusion 200
Activity 200
Discussion Questions 201
Recommended Reading List 201
Glossary 202
References 202

xvii
CHAPTER  C o n t e n t s

13 Sport and Health Cyberpsychology 207

Olivia A. Hurley
Chapter Overview 207
Key Terms 207
Introduction to Sport Cyberpsychology 207
Athletes’ Technology Use 208
Wearable Technologies: Activity, Sleep, and Psychological States 210
Sport Psychology Consultants’ Technology Use 211
Athletes’ Social Media (SM) Use 212
Health Cyberpsychology 213
Technology and Health 214
Health Information Searching Online: Benefits and Risks 214
Conclusion 215
Activity 216
Discussion Questions 216
Recommended Reading List 216
Glossary 216
References 217

14 The Online Workplace 223

Cliona Flood and Audrey Stenson
Chapter Overview 223
Key Terms 223
Organisations Today: The Online Workplace 224
What about Today? 224
The Challenges Technology Poses for Today’s Workplaces 225
It’s a New World: The Virtual Environment 227
Virtual Teams 228
The Challenges That Technology Poses for Modern People 228
The Darker Side of Technology 229
The Challenges for the Future of Work 231
Back to the Future? 232
Conclusion 232
Activity 233
Discussion Questions 233
Recommended Reading List 233
Glossary 234
References 234

xviii
 C o n t e n t s CHAPTER 

15 The Internet as an Educational Space 239

Marion Palmer
Chapter Overview 239
Key Terms 239
The Internet and Its Impact on Learning 240
Learning Using the Internet 242
Interrogating Learning and the Internet 245
Future Trends 247
Conclusion 249
Activity 249
Discussion Questions 249
Recommended Reading List 250
Glossary 250
References 252

16 Consumer Cyberpsychology and Online Marketing 255

Nicola Fox Hamilton
Chapter Overview 255
Key Terms 255
Who Shops Online? 255
The Factors Affecting Online Shopping Acceptance 256
Motivation for Shopping Online 258
Consumer–Brand Relationships 259
eLoyalty and Retention of Customers 260
Decision-Making and Purchase Satisfaction 262
Persuasion 263
The Impact of Design on Persuasion 264
Conclusion 265
Activity 265
Discussion Questions 265
Recommended Reading List 266
Glossary 266
References 267

17 Young People and the Internet 271

Irene Connolly
Chapter Overview 271
Key Terms 271
The Positive Role of Technology 272
Gaming 274

xix
CHAPTER  C o n t e n t s

Cyberbullying 276
Psychological Effects of Cybervictimisation 278
Tackling Cyberbullying 278
Conclusion 279
Activity 280
Discussion Questions 280
Recommended Reading List 280
Glossary 281
References 281

18 Older Adults in the Digital Age 287

Liam Challenor
Chapter Overview 287
Key Terms 287
Technology Adoption 287
Technology for Communication 289
Digital inclusion 290
Positive Impacts of Technology on Older Adults 291
Negative Impacts of Technology on Older Adults 294
Online Scams 295
Conclusion 296
Activity 296
Discussion Questions 296
Recommended Reading List 297
Glossary 298
References 298

PART 4: PSYCHOLOGY AND TECHNOLOGY 301

Interview 4: Cyberpsychology in Professional Practice 303

19 Human–Computer Interaction 305
Andrew Errity
Chapter Overview 305
Key Terms 305
Introduction 305
Who Is Involved? 307
The Origins of Human–Computer Interaction 307
The Current State of the Field 309
Human–Computer Interaction in Practice 310

xx
 C o n t e n t s CHAPTER 

Gathering Requirements 311

Designing and Prototyping 313
Evaluation 315
Cyberpsychology and Human–Computer Interaction 316
Conclusion 317
Activity 318
Discussion Questions 318
Recommended Reading List 318
Glossary 319
References 320

20 Gaming 323
David Hayes, Andrew Errity, Brendan Rooney, and
Conall Tunney
Chapter Overview 323
Key Terms 323
An Introduction to Video Gaming 323
Introduction 323
What Are Video Games? 324
The Evolution of Video Games 324
What Types of Games Are There? 325
The Psychology of Video Gaming 327
The Negative Aspects of Computer Gaming 330
Conclusion 333
Activity 333
Discussion Questions 333
Recommended Reading List 334
Glossary 334
References 335

21 Psychological Applications of Virtual and

Augmented/Mixed Reality 339
Gráinne Kirwan
Chapter Overview 339
Key Terms 339
Virtual Reality Equipment 340
Head Mounted Displays 340
Other Virtual Reality Equipment 341
Mixed Reality and Augmented Reality 343

xxi
CHAPTER  C o n t e n t s

Presence 343
Virtual Reality as a Treatment Tool 344
Anxiety Disorders 345
Addictions and Eating Disorders 345
Virtual Reality as a Diagnostic Tool: Paranoia and Attention Deficit
Hyperactivity Disorder 346
Virtual Reality as Pain Management 347
Virtual Reality in Psychological Research 348
Conclusion 350
Activity 350
Discussion Questions 350
Recommended Reading List 350
Glossary 351
References 352

22 The Psychology of Artificial Intelligence 357

Gráinne Kirwan
Chapter Overview 357
Key Terms 357
Defining and Testing Artificial Intelligence 358
Social Robotics 359
Applications of Artificial Intelligence 361
Cognitive Psychology 361
Gaming 362
Customer Services and User Interfaces 363
Psychotherapy 363
Companionship 364
Artificial Intelligence in the Future 366
Conclusion 366
Activity 367
Discussion Questions 367
Recommended Reading List 367
Glossary 368
References 368

Glossary 373
Index 383

xxii
List of Figures and Table

Figures
6.1 Technology can bring couples together or create
distance between them 99
11.1 While copyright infringement is not a recent
development, analogue media such as video
cassettes, audio cassettes, and vinyl records were
more difficult to copy than modern digital files 178
11.2 Internet offences which have pre-existing offline
equivalents have sometimes been referred to as
“old wine in new bottles” 180
17.1 Time on technology 272
17.2 Gaming in action 276
19.1 A process for designing interactive experiences 311
19.2 An example of a low-fidelity prototype for a mobile
social networking app 315
21.1 Virtual reality head mounted display 340
21.2 Gesture recognition in virtual reality 342
21.3 Virtual cafe scenario with a variety of settings 349
22.1 Searle’s “Chinese room argument” is a critique of
the validity of the Turing test as a measure of
artificial intelligence 359
22.2 Young children frequently give their toys
personalities and ascribe human-like characteristics
to them 360

Table
20.1 Video game genres 326

xxiii


Notes on Contributors

Hannah Barton holds an MA in Psychology from University College Cork

and is a previous coordinator of the MSc in Cyberpsychology. She has
been lecturing in personality and social psychology in IADT for over
20 years, teaching on both the BSc (Hons) in Applied Psychology and
the MSc in Cyberpsychology degrees. Her research has included altru-
ism and positive psychology, mobile learning (podcasting), and group
dynamics in both online and offline settings.

Liam Challenor, PhD, is a chartered psychologist accredited by the

Psychological Society of Ireland and Psychology Lecturer in IADT. He
lectures undergraduate and postgraduate students on research meth-
ods and statistics, cyberpsychology, persuasion, and cybersecurity and
computer-mediated communication. Dr Challenor’s research interests
focus on technology and its impact on human behaviour and wellbeing.
This includes misinformation, cybersecurity, social media use, cyberbul-
lying, and their impact in workplace and educational settings. ORCID
iD: 0000-0002-1974-9535.

Irene Connolly, PhD, is a Lecturer of Developmental and Educational

Psychology at Dún Laoghaire Institute of Art, Design and Technology
(IADT) and a member of the Psychological Society of Ireland. Irene holds
a PhD in Educational Psychology from Trinity College Dublin, special-
ising in the area of bullying. Her research has focused on areas such
as bullying, cyberbullying, and online learning. She is also a research
fellow with the National Anti-Bullying Research and Resource Centre,
Dublin City University (DCU). ORCID iD: 0000-0001-7843-7657.

Andrew Errity, PhD, is a Senior Lecturer and Head of Department of

Technology and Psychology at IADT. This department includes the
complementary disciplines of computing, design, and psychology. He
is a graduate of Dublin City University, having been awarded both a
BSc (Hons) in Computer Applications [Computer Science] and a PhD
in Speech Signal Processing. His areas of expertise and research inter-
ests include software development, UX design, human–computer
interaction, and spoken dialogue systems. He has actively taught, super-
vised, reviewed, published, and consulted in these areas. ORCID iD:
0000-0002-4041-1408.

xxv


CHAPTER  N o t e s o n C o n t r i b u t o r s

Cliona Flood holds an MSc in Work and Organisational Psychology

from Dublin City University and a BSc in Psychology from the Open
University and has studied counselling and psychotherapy with Dublin
Business School. Cliona also holds a postgraduate diploma in teaching
and learning awarded by Athlone Institute of Technology. Cliona lec-
tures on the Psychology programme at IADT and is currently a PhD can-
didate with Lancaster University. Her research is related to how images
in presentation technologies enhance teaching and learning. ORCID
iD: 0000-0003-3925-9629.

Nicola Fox Hamilton, PhD, holds an MSc in Cyberpsychology from IADT

and a PhD from the University of Wolverhampton. Her research
examines the connection between language, personality, culture and
attraction, and the consistency of expression of personality in online
platforms. Nicola was founding secretary of the Psychological Society
of Ireland’s Special Interest Group for Media, Art and Cyberpsychology.
ORCID iD: 0000-0002-6334-704X.

John Greaney, PhD, is a Lecturer in Applied Psychology at IADT. He holds

a BSc (Hons) in Mathematics and Psychology and a PhD in Psychology,
and has worked for the Royal National Institute for the Blind, Hewlett
Packard Labs, and Frontend. He has held lectureships at the Universities
of Birmingham and Manchester, and is an associate fellow of the British
Psychological Society.

David Hayes is a PhD candidate in the School of Psychology, University

College Dublin. His research focuses on conceptualising the psychologi-
cal experience of video game entertainment and, through this, he has
developed the Integrated Gameplay Entertainment Model – a compre-
hensive and validated account of the player experience. David has also
lectured on video game effects at both undergraduate and postgraduate
level and has most recently published a systematic scoping review on the
use of gamification and serious games for addressing pollution. ORCID
iD: 0000-0003-0484-4182.

Olivia A. Hurley, PhD, holds a BSc (Hons), an MSc, and a PhD in Psychology
from University College Dublin (UCD). She is a lecturer on the BSc
(Hons) Applied Psychology programme at the Institute of Art, Design
and Technology (IADT, Dún Laoghaire). She is also a guest lecturer in
RCSI and UCD. Olivia is a chartered psychologist with the Psychological
Society of Ireland (PSI). She is also one of Sport Ireland’s Approved Sport
Psychology Consultants. Olivia has published numerous academic
papers and book chapters, as well as speaking at national and interna-
tional conferences. She is a frequent guest on various media outlets.
Her first solo book, Sport Cyberpsychology, was published by Routledge in
2018. ORCID iD: 0000-0003-1357-3951.

xxvi
 N o t e s o n C o n t r i b u t o r s CHAPTER 

Gráinne Kirwan, PhD, is a chartered psychologist with the British

Psychological Society and a Lecturer in Psychology in IADT. She
teaches on both the BSc (Hons) in Applied Psychology and the MSc
in Cyberpsychology. Gráinne holds a PhD in Criminology as well as
an MSc in Applied Forensic Psychology, a Postgraduate Certificate in
Third Level Learning and Teaching, and an MLitt in Psychology. She has
co-authored two books on forensic cyberpsychology with Dr Andrew
Power: Cybercrime (Cambridge University Press, 2013) and The Psychology
of Cybercrime (IGI Global, 2012) as well as co-editing Cyberpsychology and
New Media (Psychology Press, 2014). ORCID iD: 0000-0001-6011-5510.

Derek A. Laffan currently works as a researcher in the Dublin City University

Anti-Bullying Centre and teaches on the MSc Cyberpsychology pro-
gramme in Dún Laoghaire Institute of Art, Design, and Technology. He
has published peer-reviewed research related to cyberpsychology across
areas such as digital gaming, adolescent wellbeing, online schooling dur-
ing the COVID-19 lockdown, anti-cyberbullying, and K-Pop fandom.
Derek sits on the committee of the Special Interest Group for Media, the
Arts, and Cyberpsychology (SIGMAC) at the Psychological Society of
Ireland. ORCID iD: 0000-0002-5780-1840.

Emma Mathias, PhD, is a Lecturer in Applied Psychology in the Institute

of Art, Design, and Technology (IADT) and an Occasional Lecturer in
the School of Politics and International Relations, University College
Dublin (UCD). Emma teaches a cognitive psychology module to second-
year undergraduate students in IADT and a module on the application
of psychology to IT. Emma’s PhD research focused on the interactions
between culture and mental health using qualitative research methods.
She is currently working on a project to develop an ethical toolkit for
use by researchers across disciplines such as business, psychology, and
design.

Marion Palmer, PhD, is a higher education consultant. She retired as Head

of the Department of Technology and Psychology at Dún Laoghaire
Institute of Art, Design and Technology, Ireland, in 2016. Marion worked
on the MSc in Cyberpsychology with a particular focus on learning in
cyberspace. She researched teaching in Irish Institutes of Technology
for a doctorate in education from Queen’s University Belfast and was
a national Award of Teaching Excellence winner in 2011. Marion is
a member of the Board of the National Forum for the Enhancement
of Teaching and Learning, (www​.teachingandlearning​.ie). ORCID iD:
0000-0003-0678-9025.

Brendan Rooney, PhD, is an Assistant Professor in the UCD School of

Psychology and Director of the Media and Entertainment Psychology
Lab. He previously held appointments at Columbia University, the Dún

xxvii
CHAPTER  N o t e s o n C o n t r i b u t o r s

Laoghaire Institute of Art, Design and Technology, and the National

College of Art and Design. Brendan’s research interests include social
cognition, (visual) perception, and how cognitive and emotional pro-
cesses interact in the context of media, arts, and entertainment. Through
his research and teaching, he has worked in a number of interdiscipli-
nary and international research teams, with creative and entertainment
industry experts (such as animators, filmmakers, and designers), philos-
ophers, computer scientists and engineers, film and humanities schol-
ars, and cognitive neuroscientists. Brendan founded the Psychological
Society of Ireland’s Special Interest Group for Media, the Arts and
Cyberpsychology, and he is a member and fellow of the Society for the
Cognitive Studies of the Moving Image (www​.scsmi​-online​.org). ORCID
iD: 0000-0001-9842-1492.

Audrey Stenson, PhD, holds a PhD from the University of Wolverhampton

in Psychology. She holds an MSc in Cyberpsychology from IADT, an
MA in Psychoanalysis by Clinical Specialisation from Dublin Business
School, and a BSc in Information Systems from Trinity College Dublin.
She is currently a graduate member of the British Psychological Society.
In addition to this, Audrey has over ten years of industry experi-
ence in software development and project management roles. She is
a lecturer in the field of business, technology, information systems,
project management, psychoanalysis, and psychology. ORCID iD:
0000-0002-3388-9868.

Conall Tunney, PhD, completed a PhD by research at University College

Dublin in the area of technology for well-being. He works on the Pesky
Gnats project, which designs and develops technology-based cogni-
tive behavioural therapy interventions for children who are experienc-
ing anxiety or low mood. His research uses mixed methods, including
systematic reviews and meta-analyses, qualitative focus groups, and
randomised controlled trials. He has also lectured at IADT on the psy-
chology of new media and entertainment and on gaming and media
psychology. Conall maintains a clinical focus in psychology with a
part-time post as an assistant psychologist at the Children’s University
Hospital, Temple Street, Dublin. ORCID iD: 0000-0002-9667-5832.

xxviii
Foreword

It is a great honour to be able to provide a foreword for the second edition of

An Introduction to Cyberpsychology. This is especially humbling for me as I was
also the invited guest to launch the first edition of the book back in 2016. It
is great to see the positive reception that this book has brought about, and
what a useful resource it continues to be for students, researchers, and enthu-
siasts of cyberpsychology. This is a resource I include on my own reading list
for students on my specialist cyberpsychology course, as it serves as a helpful
introduction for those new to this field to navigate the common topic areas and
issues in this field.
Even since the book’s first release in 2016, the landscape and opportunities
for cyberpsychology have somewhat advanced. The COVID-19 pandemic has
undoubtedly cast cyberpsychology further into public discourse, and helped
us recognise the far-reaching value of internet-enabled technology and online
environments for supporting our work, play, socialising, leisure, business, edu-
cation, and health, to name a few. The technology innovation landscape also
continues to evolve, with proposals for a more inter-connected Metaverse infra-
structure where the boundaries between online and offline become increas-
ingly even more blurred.
All these advancements present opportunities for cyberpsychology to take
a front seat in exploring the digitally connected human experience and how
this operates on an individual and societal level. This may relate to our identity
experiences – how we express our identity through our online behaviours and
digital traces; our social experiences – the nature of our social connections on
social media; or our thinking experiences – how human decision-making may
be enriched or compromised by algorithms. These are all fascinating areas of
the human experience which cyberpsychology is well-positioned to help us
further explore.
This book has consolidated a wide range of topics from prominent schol-
ars in the field, to provide a comprehensive introduction to cyberpsychology.
This includes topics which cover key theoretical areas as well as many applied
avenues of the field. I welcome the inclusion of a new chapter on “older adults
in the digital age” which goes some way to represent key issues for understand-
ing older users’ psychological experiences of using technology and the inter-
net. The chapter authors present the ideas in an accessible and engaging way,
whilst also integrating the academic bases which underpin their assertions.
Each chapter includes some useful thinking activities and features boxes to
help readers apply their learning.

xxix


CHAPTER  F o r e w o r d

The last 15 years or so of my career have been dedicated to advancing the

field of cyberpsychology. I have been heavily involved in advancing the reputa-
tion of the field both nationally and internationally, largely through leading
on the development of a specialised section for cyberpsychology in the British
Psychology Society. I have engaged widely in thought-leadership, and devel-
oped an array of methods to encourage a more external-facing role of cyberpsy-
chology for informing public debate, increasing public awareness of evidence,
supporting practitioners and researchers, and working with policy-makers.
Alongside this, I readily apply cyberpsychology in the services delivered by
my company The CyberDoctor® to support businesses in maximising their
online communications and marketing. I am a huge advocate for the value of
cyberpsychology in society and am always encouraged to learn of key texts
such as An Introduction to Cyberpsychology which are written in a way which is
accessible to wide audiences.
I am sure that the success of An Introduction to Cyberpsychology will continue
to be realised through the publication of its second edition. The authors and
editors have done a tremendous job (again) of helping the reader navigate this
wide-ranging and fascinating field.
Dr Linda K. Kaye
Past Chair of BPS Cyberpsychology Section
Associate Head of Psychology, Edge Hill University

xxx
Acknowledgements

As an editorial team, we are very grateful to all of those who helped us at each
stage of the book’s development. In particular, we would like to extend our
gratitude to Eleanor Taylor, Tori Sharpe, Emilie Coin, Andrew Corrigan, and
the production team at Taylor & Francis/Routledge for their enthusiasm for this
project, their guidance, and the many cheerful answers that they provided to
our queries.
We would like to thank Dr Linda Kaye of Edge Hill University for kindly
writing the Foreword for this edition, and for launching the first edition of this
textbook. Our appreciation also goes to our esteemed colleagues who wrote
endorsements for the book at very short notice, and to those who shared their
real-life experience of the practical aspects of psychology in the interviews at
even shorter notice. A special word of thanks to Dr Nicola Fox Hamilton who
provided advice and professional insight on the cover design, and to Dr Andrew
Errity, our Head of Department, who supported our work on this edition.
We would also like to thank each of the chapter authors. Their expertise in
their respective fields and their dedication to teaching combine to form chap-
ters that are rich in content and full of engaging pedagogic material. We know
that the preparation of these chapters required a great deal of time, effort, and
patience, and we appreciate the authors’ adherence to our schedule and quick
responses to our requests, despite so many conflicting demands on their time.
While textbooks such as this can be read by people from many backgrounds,
they are primarily developed with students in mind. Over the years, our own
students on both the MSc in Cyberpsychology and our undergraduate pro-
grammes have helped us to develop our ideas, push beyond our perceived capa-
bilities, and view online behaviour in new ways. We hope that this textbook
will help future generations of students to become as excited about online
interaction as they have made us.
We would also like to make some individual acknowledgements.
From Irene: To my husband Tom, to my children Lauren, Jamie, and Tom,
and to my parents, Ita and Michael, a huge thank you for everything you do. To
my fantastic colleagues, each of you is simply brilliant.
From Marion: To my co-editors, thank you for all the work over the years. It’s
been a privilege to work with you. To my fellow authors, thank you for a valu-
able book. Last but not least thanks to Peter for the unending support.
From Hannah: To Ashling for being you, and to my friends and colleagues
for unlimited patience, good humour, and endless cat jokes.

xxxi


CHAPTER  A c k n o w l e d g e m e n t s

From Gráinne: To my mother, Marie Kirwan, for decades of encouragement

in all things academic. To Glen, for infinite patience – again. Most of all, to
Ben, for being the wonderful person that you are and for making me smile and
laugh every single day.

xxxii
PART 1
Introduction


Cyberpsychology
in Professional
Practice
Interview 1

Itayi Viriri has been the Senior Regional Media and Communications Officer
and Spokesperson for the International Organization for Migration (IOM-UN
Migration) Asia-Pacific for the past three years. Prior to that he worked for an
additional three years as Head of IOM Global Online Communications.

What are your main responsibilities and/or daily activities in this

post?
As head of media and communications covering IOM’s vast Asia Pacific region
which covers countries from Afghanistan to Vanuatu, I oversee and manage the
regional office’s digital/online platforms and advise our chiefs of mission on
media aspects. I am also the senior spokesperson meaning that I deal with all
media requests pertaining to migration and related topics.

When did you first become interested in cyberpsychology, and how

did you develop this interest into part of your career path?
I first became interested in cyberpsychology in the early 2000s just as social
media channels started gaining prominence. Of course, back then I didn’t know
this was “cyberpsychology” but as someone keenly interested in social media,
especially how it is utilised in journalism (my initial tertiary qualification and

DOI: 10.4324/9781003092513-2
CHAPTER  C y b e r p s y c h o l o g y i n P r o f e s s i o n a l P r ac t i c e

first profession), I grabbed the opportunity when it came up to combine my

personal and career interests and affirm them with some sound academic basis
and foundation. The MSc in Cyberpsychology at IADT provided exactly that.

What cyberpsychological knowledge is of most relevance to your

current role?
I would definitely say aspects that focus on understanding which message fits
best with which medium and audience. This understanding helps ensure that
our external communications are fit for purpose.

Are there any theories in cyberpsychology which you find applica-

ble to your work? If so, which one(s), and how are they relevant to
your responsibilities in your role?
Any theory that brings me to closer understanding the nuances of human–
computer interaction, especially in these sometimes fraught times in the digital
space, is applicable to my current work, particularly when it applies to tack-
ling disinformation (I co-wrote a chapter on this, for IOM’s flagship World
Migration Report 2022).

What do you think are the most important real-world applica-

tions of cyberpsychology?
As a trained journalist and now a media practitioner, the best real-world appli-
cation of cyberpsychology is understanding the what, when, where, why, and
how human beings utilise social and traditional media.

Is there anything else that you’d like to add about cyberpsychol-

ogy in your professional life?
First of all, it was an honour and privilege to be part of the very first cohort of
the MSc in Cyberpsychology and for years I have enjoyed and sometimes even
revelled in explaining to curious family, friends, and even strangers who were
curious as to what cyberpsychology entailed. Cyberpsychology has featured
significantly in my professional life particularly when I was previously IOM’s
head of global online communications, managing teams running and operat-
ing IOM’s extensive digital platforms around the world.

Itayi Viriri
Bangkok, Thailand

4
 Introduction to
1 Cyberpsychology
Gráinne Kirwan

Chapter Overview
Cyberpsychology is a relatively new field within applied psychology, although
there is now a growing library of research and scholarship examining the topic.
As an area of study, it assesses how we interact with others using technology,
how we can develop technology to best fit our requirements, and how our
behaviour and psychological states are influenced by technology. The most
commonly studied technology in cyberpsychology research is the Internet,
although the area considers human interactions with many devices which may
not necessarily be online, including mobile computing, games consoles, vir-
tual reality, and artificial intelligence. This chapter provides a brief overview of
some areas of research in cyberpsychology, including a short introduction to
each of the chapters that follow.

Key Terms
Cyberpsychology “is a scientific inter-disciplinary domain that focuses on
the psychological phenomena which emerge as a result of the human interac-
tion with digital technology, particularly the Internet” (British Psychological
Society, n.d., Title section). It examines how we interact with others using tech-
nology, how our behaviour is influenced by technology, how technology can
be developed to best suit our needs, and how our psychological states can be
affected by technologies. Much research in cyberpsychology has been driven
by the Internet, and in particular the advent of social media. However, other
technologies have also been closely examined, including gaming (both online
and offline), mobile computing, artificial intelligence, virtual reality,
and augmented reality.

Cyberpsychology: A Brief Synopsis

Psychology as a discipline does not stand still for long. It changes and adjusts
as new research, theories, and developments arise, and it aims to face new
advances while challenging concepts that were previously widely accepted.

DOI: 10.4324/9781003092513-3
CHAPTER 1 GRÁINNE KIRWAN

It is not surprising that the advances in technologies, especially those over

the past quarter of a century, have drawn the interest of so many academics
and practitioners in the area. Probably the most significant change in human
behaviour and interaction in the past two decades has been the rise in popular-
ity of the Internet (in a general sense) and social media and online interac-
tions (in a more specific sense). It is unsurprising that psychologists have not
only embraced these technologies as methods of improving general well-being
but have also been drawn to examine how these technologies can impact our
behaviour and our relationships with others. The research of psychologists in
this field complements the research of other social scientists across the globe
who also examine online interactions.
Cyberpsychology is a broad topic, and it encompasses many aspects of
research, some of which have been in existence for some time, and some of
which are more recent. Generally, cyberpsychology encompasses three main
aspects. First, it assesses how we interact with others using technology. This has
been of particular interest since the advent of social media technologies, but
our interactions with others have been affected by technologies for a consid-
erably longer period of time through the use of communication mechanisms
such as email and websites. To consider this for a moment, think about one of
the people that you communicate with the most often. Now imagine under
what circumstances you might talk to them in person, or when you might call
them, or send them a direct message on social media, or tag them in a post on
social media. What would be different about your communications with them
in each of these contexts? Also, take a moment and think about if you know
someone who you communicate with online fairly regularly, but have never
met offline (for example, through online gaming). What is your impression of
that person? Do you think that this might change if you met them offline now?
Do you think that you might have a different impression of them if you had
met them offline in the first instance, and only later started communicating
with them online?
A second aspect of cyberpsychology considers how we can develop technol-
ogy to best fit our requirements and desires. Some attributes of this type of
cyberpsychology often come under the heading of human–computer inter-
action, although this is also considered as an entire specialism in itself. One
example of advances in this area involves programming the recording of pro-
grammes from television channels. Up until fairly recently this was a complex
affair – blank video cassettes needed to be purchased and placed in the video
cassette recorder (VCR), the store-bought television guide magazine needed to
be consulted to determine the start time, end time, day, and channel that a
programme was on, the VCR clock needed to be checked to ensure that it was
accurate, the appropriate option within the VCR’s menu needed to be identi-
fied, and all the date, time, and channel details needed to be inputted correctly.
An error at any stage, a power outage, or a change in the scheduled time of
the programme meant that the recording would fail. Now, most digital televi-
sion providers include all the necessary hardware, including storage space, and
allow users to select a programme from the on-screen listings and record an
6
 I n t r o d u c t i o n t o C y b e r p s y c h o l o g y CHAPTER 1

entire season of the programme with a single button press. Changes in run-
ning schedule are no longer a problem as the system can compensate for it. The
almost ubiquitous nature of “on demand” and “catch-up” services now adds an
extra layer of ease, as the viewer no longer needs to even be aware of the pro-
gramme in advance of it airing to watch it in its entirety. And watching entire
series on streaming services is even easier. The interaction between the human
and the computer has become considerably easier and less prone to error.
Of course, there are many other ways in which research in human–
computer interaction makes our daily lives easier – we only need to briefly
look at a computer’s operating system, or the difference in mobile phones over
the past 15 years, to identify such improvements. Another key example is the
touchscreen – this technology was very rare before the advent of smartphones,
but has become a common feature of daily life. Interacting with a computer in
this way requires a different set of skills from using other interface methods,
such as keyboards. One of the goals of human–computer interaction includes
determining which interface methods are the most appropriate for a given
situation, realising that one approach does not answer all problems.
The third key aspect of cyberpsychology examines how our behaviour and
psychological states can be affected by technologies. Again, there are many
examples of this, but one that many will have experienced is a distorted sense of
time when using technologies, particularly when gaming. This phenomenon is
one of several characteristics of a “flow” state, as identified by Csikszentmihalyi
(1990), and applied to interactions with technology by many researchers (see,
for example, Kaye et al., 2018). Of course, technology can affect us in many
other ways as well. For example, theorists and researchers have identified the
aspects of online communication that can result in our feeling closer to others
whom we are interacting with online (see, for example, Walther’s hyperper-
sonal model, 1996, 2007, which is discussed in more detail in Chapter 3). This
may result in our disclosing our innermost thoughts in what might be unsuit-
ably public settings. Others have identified some core psychological reasons
why it is easier for some people to be hostile or harassing online (see, for exam-
ple, Lee & Jin, 2019; Suler, 2004, 2015). These disruptive behaviours are evident
through a variety of online actions, such as cyberbullying, trolling, and flam-
ing. A deeper understanding of these psychological principles can help us to
advise Internet users of safer and more appropriate behaviour online – simply
being aware of why we might engage in certain activities can often give us the
tools we need to make wiser decisions regarding our online interactions. It can
also provide us with the skills to manage such behaviours should we find our-
selves on the receiving end of a hostile communication.
Much research in cyberpsychology also examines how we manage the
impressions that others form of us based on our online personae, and the roles
of anonymity and self-disclosure in this area (see, for example, Fullwood, 2019;
Joinson et al., 2007; Joinson et al., 2010). In some online fora (such as online
gaming) we have the opportunity to create entirely new personas, even choos-
ing to act as a different gender from our own if we wish. In others, such as
many social media platforms, we will normally adopt our own persona – we
7
CHAPTER 1 GRÁINNE KIRWAN

use our own name and photograph, and we will generally include our offline
friends as our primary contacts (although many factors can influence what we
present on these platforms; see, for example, the discussion by Keep et al., 2019,
on image sharing on social networking sites; that by Talbot et al., 2022, which
examines identity management by LGBTQ+ individuals on social media; and
the research by Chadwick and Fullwood, 2018, which explores the use of social
networking by those with intellectual disabilities). In these settings we do not
tend to use pretence or change much about ourselves, although there are many
individual differences which can affect how and why we use such platforms
(Orchard et al., 2014). However, we will tend to present ourselves in a more
positive light than we normally would – we emphasise the good things that
happen to us, and the exciting activities that we engage in, without focusing
on the more mundane or negative aspects of our lives. As such, on social media,
our impression management is usually relatively minimal, but we still put a
positive spin on our communications.
Another time when we might engage in very careful impression manage-
ment is if we are considering seeking a romantic partner using an online dat-
ing application. While once these applications involved the completion of a
relatively simple profile, as technology has advanced, these applications have
become more complex in some cases (including the possibilities of multiple
photographs, video messages, and many more). But in other cases the technol-
ogy has simplified – smartphone dating applications often show a minimal pro-
file along with a single image, and the user can decide whether or not they are
interested in the individual with a simple swipe to the left or the right. While
online dating has resulted in countless romantic relationships and marriages,
there are many risks involved, and care must be taken (see Buchanan & Whitty,
2014, for a description of some of these risks).
The Internet has also become a rich territory for research in linguistics.
While abbreviations and acronyms are not new, the frequency of use in mod-
ern times and the rate at which new instances are noted have resulted in these
becoming a much more prevalent aspect of modern parlance. Similarly, the
use of emoji (and previously, emoticons/smileys) is of particular interest – the
development of new methods of communicating emotion and mood when the
primary methods by which these are normally communicated (facial expres-
sion and tone of voice) are absent (see, for example, Fullwood et al., 2013; Jones
et al., 2020). The presence of an emoji can completely change the meaning of a
sentence, so their importance in modern linguistics must not be ignored.
Much research has also examined “applied” cyberpsychology. This refers to
any application of our online behaviours to other aspects of our daily lives. For
example, technologies allow us to stay in touch with our workplace, even when
we cannot be there. Being geographically distant from our workplace no longer
means that we cannot immediately respond to any matters that require our
attention. While many workplaces offered some individuals the opportunity
to work remotely for many years, the extent of the possibilities of remote work-
ing became evident in March 2020, as significant proportions of the planet’s

8
 I n t r o d u c t i o n t o C y b e r p s y c h o l o g y CHAPTER 1

population switched to working from home at very short notice due to the
COVID-19 pandemic. The ability to work from home using such technologies
meant that many (but far from all) services and organisations continued to
function, to some extent or another, while keeping their employees in a safer
environment. Of course, there are negative aspects to this as well – we may feel
pressure to respond to emails throughout the night, or at weekends, resulting
in negative effects on our home and family lives, and in the long term, poten-
tially negative effects on our health. That said, cyberpsychology can also have
positive effects on our health – we now have access to more information on
well-being, medicine, and healthy living than ever before. This, coupled with
support from others online who might be facing the same health problems
as ourselves (see, for example, Coulson, 2019), can greatly enhance resilience
and resources for an individual facing a worrying situation. Of course, seek-
ing such support and information can also hold risks – such as distinguishing
between useful and irrelevant (or even harmful) information, knowing who to
trust with our personal details, and even the unnecessary escalation of worry.
Using insights from both psychology generally and cyberpsychology specifi-
cally can help users to make good decisions regarding their online behaviours
so that their online actions can be beneficial to them while avoiding harmful
consequences.
Another important aspect of online life is our increased tendency to use the
Internet to purchase goods and services, or to manage our financial arrange-
ments. Trust is particularly important in understanding consumer behaviour
online. A thorough understanding of how and why we trust, and what features
might cause us to lose trust, is essential in building a consumer base and ensur-
ing the continuance of online commerce. The affordances of technology also
allow online retailers to provide each consumer with the technological equiva-
lent of a personal shopper – artificially intelligent interfaces that compare your
prior purchases and viewing behaviour to all those who have gone before you,
and, using this information, suggest the next product that you are likely to
desire, even though you never knew of its existence. These personalised recom-
mendations can result in increased revenue for the retailer, a more interesting
experience for the consumer, and a healthier long-term prospect for econo-
mies. Similarly, the impact of influencers online can determine what purchases
we make, but also how we respond to and behave in a variety of situations (see
Chapter 9).
The very nature of technology has also been harnessed by psychologists
to improve well-being. We can see this in particular with regard to gaming –
terms like serious games, gameful design, and gamification all refer to methods
by which game elements and gaming principles can be applied to help people
and organisations to reach goals, while also adding some entertainment value.
Many of these draw from other areas of psychology, such as positive psychol-
ogy and learning theories. One of the key tasks in cyberpsychology is deter-
mining when our online behaviour is fundamentally similar to our offline
behaviour (in which case, we can draw from the vast literature in psychology

9
CHAPTER 1 GRÁINNE KIRWAN

as a whole), but also determining when online behaviour differs significantly

from our offline responses (in which case, new theories may need to be devel-
oped and new research conducted to fully understand the ways in which the
technology has changed us).
Unfortunately, along with the good that technology brings, there are also
negative aspects. When the American Psychiatric Association (2013) updated
their Diagnostic and Statistical Manual (DSM) to the fifth edition, they included
“Internet gaming disorder” as a phenomenon which requires further research.
This was retained by the association in the text-revision to the fifth edition
(DSM-5-TR), where it is listed as a “condition for further study” (American
Psychiatric Association, 2022, pp. 913–15). The World Health Organisation
(WHO, 2018) also includes “gaming disorder” in the 11th revision of the
International Classification of Diseases (ICD-11) as a “disorder due to addic-
tive behaviours”. Similar to other behavioural control problems, the diagnoses
for these conditions are primarily based on the impact that the behaviour has
on the individual’s life (rather than the actual number of hours spent playing
games). So, if an individual plays video games to the extent that they experi-
ence tolerance and withdrawal, they relapse if they try to stop playing, they
have pervasive thoughts about playing, or their playing impacts on their fam-
ily, work, or education, then it may be something that needs professional atten-
tion. Similar concerns have been raised about the potential problematic use
of smartphones and the Internet generally, and some studies have explored
perceptions of smartphone over-reliance (see, for example, Conroy et al., 2022).
It is not without a certain degree of irony that someone with such problems
can seek help online – Internet-mediated therapy is offered by an increasing
number of practitioners, especially since the COVID-19 pandemic commenced,
although the benefits of online platforms for therapeutic interventions had
been explored prior to the pandemic (see, for example, Campbell et al., 2019).
Such therapy offers advantages for both clients and therapists, including ease
of access and increased confidentiality.
Another fear that has arisen with the proliferation of our daily interac-
tions with technology is cybercrime victimisation. There are many dangers
online for all users, although understandably we pay particular attention to
the Internet activity of children and adolescents who can be at particular risk
of sexual exploitation (Merdian et al., 2021; Quayle & Koukopoulos, 2019).
Cyberpsychology can provide insights into why some individuals who would
never engage in criminal activity offline might be attracted to such behaviours
online (Kirwan, 2019; Kirwan & Power, 2013). Researching this field can pro-
vide insights into the tactics used by offenders to ensnare their victims and
the aspects of human behaviour which can make us more vulnerable to such
attacks (see, for example, McAlaney & Hills, 2020). Finally, we can also design
educational programmes to help users to protect themselves and their loved
ones against victimisation.
Part of such protection involves the consideration of the careful mainte-
nance of our privacy. Much recent research in cyberpsychology examines how

10
 I n t r o d u c t i o n t o C y b e r p s y c h o l o g y CHAPTER 1

and why we share information with others (Joinson et al., 2011; Kirwan, 2015;
Paine et al., 2007; Vasalou et al., 2015), or the management of our online secu-
rity (see, for example, Debb et al., 2020; Hadlington, 2017). This becomes even
more important as we carry an increasing amount of personal data with us in
the form of mobile devices. These mobile devices may also result in our sharing
information about ourselves unwittingly – such as our previous or current loca-
tions. The more that we use technology and share information about ourselves,
the more we risk. However, the benefits of such sharing often outweigh the
potential risks for many, and some authors (for example, Finkelhor et al., 2021)
have suggested that teaching privacy as a strategy for children’s online safety
may be problematic.
As mentioned, cyberpsychology examines technologies other than the
Internet. This includes common activities, such as gaming, and less common
activities, such as the use of virtual reality, augmented reality, and robotics.
But the use of these technologies is increasing as they become more affordable,
and as larger companies take more of an interest in creating consumer-level
versions. Also of interest in cyberpsychology is human behaviour when inter-
acting with artificial intelligence, whether or not it is coupled with a robotic
device. There is an increase in the use of artificially intelligent chatbots as a
frontline in customer service, as well as understanding the potential use of arti-
ficially intelligent robots as caregivers and companions. Of course, we interact
with some forms of artificial intelligence much more regularly, such as the arti-
ficial intelligence within certain websites, and that which controls non-player
characters in games. While human interaction with robots is still at an early
stage, it is the role of cyberpsychology research to determine how we can aid a
transition into greater levels of interaction when necessary.

FEATURE BOX: THINKING CRITICALLY ABOUT

CYBERPSYCHOLOGY IN THE NEWS
Many aspects of cyberpsychological research are fascinating to a wide range of people,
including those with no previous psychological knowledge or training. Because of this, news
reports frequently include items relating to cyberpsychology, and often enlist a researcher
or practitioner in the field to provide insights into our behaviours with technology. The qual-
ity of these insights, and the expertise of the researcher or practitioner, can vary greatly.
Additionally, some media sources are keen to present their item in a way which gathers as
many viewers/listeners/readers as possible, and this may include the use of sensationalist
headlines and/or pieces which are focused towards fear-mongering, regardless of whether
or not that induced fear is a valid one. When reviewing content in cyberpsychology, espe-
cially that prepared for a general audience, always consider carefully the empirical evidence
relating to the subject, and attempt to determine if a balanced perspective of the relevant
research is being presented.

11
CHAPTER 1 GRÁINNE KIRWAN

Cyberpsychology Journals, Conferences,

and Research Groups

While cyberpsychology is a relatively new field, there are many resources avail-
able for students and scholars to further their knowledge of this important area.
Several journals focus primarily on cyberpsychology, or welcome papers with
such a focus. These include Technology, Mind, and Behavior; Media Psychology;
Social Media and Society; Cyberpsychology, Behavior, and Social Networking (pre-
viously Cyberpsychology and Behavior); Computers in Human Behavior; Journal
of Computer-Mediated Communication; Behaviour & Information Technology;
New Media & Society; Human-Computer Interaction; Interacting with Computers;
International Journal of Human-Computer Studies; Virtual Reality; and Games for
Health, among many more.
Similarly, there are many academic conferences which focus on or include
cyberpsychological research, including the BPS Cyberpsychology Section con-
ference, the APA Technology, Mind & Society conference, the Cyberpsychology,
Cybertherapy & Social Networking Conference (organised by the International
Association of CyberPsychology, Training & Rehabilitation – iACToR), the Social
Networking in Cyberspace Conference (organised by the Cyberpsychology
Research at the University of Wolverhampton research group), and the Internet
Research Conference (organised by the Association of Internet Researchers).
There are also other excellent research and professional groups inter-
nationally, such as the British Psychological Society “Cyberpsychology
Section”, the Oxford Internet Institute at the University of Oxford, the
Cyberpsychology Research at the University of Wolverhampton (CRUW)
group, the Cyberpsychology Research Group at the University of Sydney, and
the Research Centre for Virtual Environments and Behavior at the University
of California Santa Barbara, among many others. Finally, if you would like to
consider a structured academic programme within this area, there are various
options, including the MSc in Social Science of the Internet (at the Oxford
Internet Institute) and numerous undergraduate and postgraduate programmes
in cyberpsychology at a variety of higher education institutions (for exam-
ple, the Dun Laoghaire Institute of Art, Design and Technology in Ireland;
the University of Wolverhampton; Bournemouth University; Norfolk State
University; and many others).

Aims and Structure of the Book

This book aims to provide readers with an introduction to the field of cyberpsy-
chology, with a particular focus on applied aspects of the field. It is designed
to encourage readers to critically evaluate the psychology of online interac-
tions and to develop appropriate research methodologies to complete their own
research in this field. The book may be used as a core text for undergraduate

12
Other documents randomly have
different content
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PHLEBOTOMUS FEVER 355 Duration of Treatment in cases

of Sandfly Fever. Force from which derived. No. of cases. Total
number of days under treatment. Average number of days under
treatment. Salonika Mesopotamia 120 1,880 1,873 21,995 15-6 11-7
Total 2,000 23,868 11-9 There is little doubt that the most valuable
drug is opium, especially if given early. Its efficiency was shown in
Mesopotamia and has been demonstrated in India and the Sudan. A
full dose (30 drops) of liquid extract of opium administered at the
outset will be found to afford great relief. Failing this, the tincture
may be given, also in a full dose. Aspirin and the salicylates in fairly
large doses often afford comfort, and pyramidon has been found to
assuage pain. Myalgia is benefited by the application of hot
sandbags. Tonics are indicated during convalescence. Quinine is
useless and may aggravate the symptoms. It is advisable to apply
tincture of iodine to sandfly bites. It allays irritation and lessens the
risks of sepsis. With regard to preventive measures, cases treated in
infected areas in hospital should be kept under fine-mesh nets
during the first forty-eight hours of fever to prevent the risk of
others becoming infected. A sandfly net should have a mesh of
twenty-two holes to the linear inch. Unless the material of which it is
composed is very fine such a net is oppressive in a hot climate.
Sandfly nets were, however, used with marked success in
Macedonia, were not found too hot and, apart from the prevention
of infection, enabled the men to sleep in comfort. Those living in
infected areas, and especially newcomers, should use fine-mesh nets
if at all possible. It is important to see that there are no flies inside
the net before using it at night. They should be looked for in the
angles formed by the top and sides of the net. It has been stated
that sandflies do not fly high, and Higgins, who records an outbreak
of the fever from an island in the Eastern Mediterranean, found that
moving men from the ground floor of a building to a lobby on the
first floor was a very effective preventive measure. Repellents
smeared on the skin may be tried. Of these the vermijelli preparation
containing some oil of citronella is one of the most useful. Hewlett
strongly recommends oil
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356 MEDICAL HISTORY OF THE WAR of cassia, a good

formula being oil of cassia, one part ; brown oil of camphor, two
parts ; vaseline, lanoline or salad oil, 4-5 parts. Eucalyptus oil alone
or combined with the oils of anise and turpentine may be employed,
a suitable prescription being : — Ol. anisi "^ Ol. eucalypti >aa Tl\iii
Ol. terebinth J Lanolini 5i. M. ft. ung. ,A lump of camphor may be
taken to bed, as the flies dislike its odour. Tobacco smoke keeps
them away to some extent, and electric fans, especially if depending
from the ceiling, are excellent deterrents. Lights in tents and
bedrooms at night attract the flies. In the case of billets and houses
generally, heavy furniture should stand well out from the walls, as
the insects are apt to hide behind cupboards and sideboards.
Frequent cleaning, dusting and removal of hangings help to get rid
of them, as do whitewashing and free ventilation. When it can be
managed camps should be placed on highlying sites exposed to the
wind and should be well away and upwind from horse-lines.
Breeding places in the neighbourhood of drinking-water fountains
should be avoided after dark. The following general measures should
also be adopted. Where possible, ruined walls, masonry, heaps of
rubble and stones, and old damp latrines, which harbour the larvae,
should be removed. When this cannot be done all crevices should be
filled up by pointing the walls, if of stone or brick, or plastering them
smoothly if of mud, as, for example, in the case of trenches and
dug-outs. Where such breeding places are limited it may be possible
to make advantageous use of some form of flame as, for example, a
powerful painter's lamp or the Lucal Comet Heater. Rat-holes and
ant-holes should be stopped. Vegetation about these places should
be cleared away and kept down. Cracks in the ground, and
especially in black cotton soil, should be filled up, or, if this is
impossible, treated with kerosene oil. Cultivation and systematic
watering prevent cracks from re-forming. Measures should also be
taken to capture the flies. For this purpose biscuit boxes blackened
on the inside and placed in dark corners of the room are useful.
Austen recommends that sheets of " tangle-foot " with lights in front
of them should be affixed to the walls. These sheets should be
slightly warmed before use. Fumigation with sulphur may be
employed and spraying with 1 per cent, formalin has been
recommended.
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PHLEBOTOMUS FEVER 357 Adelmann Birt Brack Castellan!

Delmege & Staddon Graham Hartley Higgins Legendre Megaw
Sarrailhe Weinberg BIBLIOGRAPHY. Beitrag zur Kenntnis des
Pappatacifiebers Phlebotomus Fever Pappatacimiicken und
Pappatacierkrankungen Notes on Tropical Diseases met with in the
Balkanic and Adriatic Zones Clinical Notes on Phlebotomus Fever
Sand-fly Fever in Chitral (N. India) Notes on an Outbreak of
Phlebotomus Fever Note on Cases of Phlebotomus Fever at an Island
in the Eastern Mediterranean. Sur 1'existence dans La Somme du
Phlebotomus papatasii. Scop. Sandfly Fever and its Relationship to
Dengue Dengue et Fievre de trois jours Pappatacifieber und
Influenza. Archiv fur Schiffsu n d Tropenhygiene, 1919. Vol. xxiii, p.
81. B.M.J. 1915. Vol. ii, p. 168. Archiv fur Schiffsund Tropenhygiene,
1917. Vol. xxi, p. 381. Jl. of Trop. Med. & Hyg. 1917. Vol. xx, p. 170.
B.M.J. 1918. Vol i, p. 396. B.M.J. 1915. Vol. ii, p. 169. Jl. of R.A.M.C.
1918. Vol.xxxi, p. 317. B.M.J. 1916. Vol. i, p. 166. Comptes Rendus
de la Societe de Biologic, 1916. Vol. Ixxix, p. 25. Ind.Med. Gaz.
1919. Vol. liv, p. 241. Bulletin de la Societe de Pathologic Exotique,
1916. Vol. ix, p. 778. Archiv fur Schiffsund Tropenhygiene, 1919. Vol.
xxiii, p. 331.
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CHAPTER XVI. TRENCH FEVER. npRENCH fever is an

infectious disease characterized by J_ febrile periods which tend to
recur at regular intervals, by local pains, by an erythematous rash,
and by enlargement of the spleen. It was first noticed in the British
troops in Flanders by Graham in the summer of 1915, in Salonika by
Hurst in the latter part of the same year, in French troops in France
in 1916, and about the same time in Italy. It occurred in the German
and Austrian Armies, but most of the accounts given of it there,
under the names of " Wolhynian fever," " five days' fever," " Polish,
Russian intermittent, or Meuse fever," and " His- Werner disease,"
evidently confuse it with other diseases, and are not of great value
as clinical records. It has also been termed "shin fever," " gaiter-pain
fever," and " trench shin." It differs from any disease known to
medicine before the war. Allusions to a quintan fever by ancient and
mediaeval writers are too vague for identification. The name " trench
fever " was first used by Hunt and Rankin. McNee, Renshaw and
Brunt were the first to prove its infectious character by injection of a
patient's blood into the vein of a healthy man. The clinical features
of the disease were studied, and the louse was early suspected to be
the vehicle, but nothing was certainly known until in 1917 the
Medical Investigation Committee commenced work in France, and
the War Office Trench Fever Committee in England. The American
Research Committee co-operated with the former and carried out
the experimental part of the work done in France, and regular
communication was kept up between the groups of workers. The
disease was recognized in Flanders, France, Macedonia and Italy and
in the German and Austrian Armies. It is not therefore much affected
by climate or soil. All Europeans and races originally European are
subject to it. It was in no army so carefully studied as in the British,
but as it is easily confused with other diseases the statistical returns
give no exact idea of its prevalence even in the British, still less in
other armies. Age has apparently no influence. In France patients
were of all ages up to 43, and in England volunteers of 70 seemed
as susceptible as younger men. There was no effect traceable 358
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TRENCH FEVER 359 to food or drink. It was rightly named

trench fever, for it originated in the front area, and for a long time
was hardly noticed to arise at the base. Hospital officers, nurses and
orderlies caught it, and later when officers and other ranks were
sent from the front to army schools they brought the infection into
the back areas. It is impossible to give with any accuracy the rate of
incidence among the troops. The name trench fever was not
sanctioned until 1917, and the fever was not made notifiable till
1918, by which time it was much less common. In July 1918, Colonel
Soltau reported that for the preceding 12 months the total
admissions for all forms of sickness into the clearing stations of the
Second Army were 106,247, of which 15,392 cases were diagnosed
as pyrexia of uncertain origin. 5,244 , , trench fever. 4,755 635 2,535
2,587 , myalgia. , rheumatism. , debility. , cardiac (nearly all
disordered action of the heart). Those who could fully examine the
cases received as pyrexia of uncertain origin were satisfied that the
bulk of them and many also of myalgia and rheumatism were really
trench fever. Without pretending to exactness, experience justifies
the statement that 15,000 to 20,000 of the 26,026 cases diagnosed
as P.U.O., trench fever, myalgia or rheumatism, were probably cases
of trench fever. This is confirmed by the accurate observations in
four base hospitals at Boulogne by Lewis, Thursfield, Jex-Blake, and
Foster, who received 1,241 cases labelled pyrexia of uncertain origin,
trench fever, or myalgia, and found that 822 or 66 per cent, were
true trench fever. The 26,026 cases above mentioned would with the
same ratio produce 17,350 cases of trench fever which would thus
form 16 per cent, of the total sickness. In addition trench fever was
probably responsible for a considerable number of the 5,000 chronic
cases. The importance of the disease may be gathered from the
following estimates. The average evacuation for sickness, as distinct
from the result of wounds, from armies to base in France was 0-6
per cent, of the strength weekly. During the worst year of trench
fever, 1917, the percentage figure for this disease, at, say, 15 per
cent, of 0-6 per cent., would be somewhere about -09 per cent. ;
that is an army of 1,000,000 would lose in a year by evacuation to
the base at least 45,000 casualties from trench fever. Of these
casualties, as is shown below, 80 per cent, would lose on the
average 60 days in hospitals or depots, and at least three months in
all off duty ; and of
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360 MEDICAL HISTORY OF THE WAR the remaining 9,000

more than 2,000 would be incapacitated for a period of over six
months. There were no deaths, but the total loss of man-power
resulting from this apparently new disease was a very heavy drain
on the army. Mtiology. When first recognized clinically in the spring
of 1915, the disease, from its general symptomatology, was
suspected to belong to the enteric group of fevers, possibly modified
by preventive inoculation. Much of the early work on aetiology was
therefore directed to proving or disproving this theory, until evidence
that the disease was a separate and complete entity was gradually
collected. All cultures from the blood, stools and urine were
negative, while the fact that B. paratyphosus A and B had not then
been introduced into the preventive vaccine made the agglutination
reactions simple in their interpretation. The experimental work of
McNee, Renshaw and Brunt, showing that the blood was infective,
was strongly against the enteric theory, and the proof was finally
completed by the work of the American Committee. Since the early
experimental work demonstrated that the virus circulated in the
peripheral blood, long search was made in blood films for a parasite,
either intra or extra-corpuscular, without result. These examinations
of films, moreover, did not reveal anything of diagnostic or
prognostic significance for the clinical pathology of the disease. Later
work has all tended to show that the virus circulating in the blood
belongs to the " filter-passing " group, and is therefore ultra-
microscopic. Observations on the possible nature of the virus
contained in the excreta of infected lice are dealt with below. It has
also been shown that the virus circulates free in the plasma during
the illness. The body louse was early suspected to be the means of
transmission of the infection, and complete proof that this is the
case has been afforded by the experiments of the British and
American Committees. Both committees are agreed that the blood of
an infected man, and the faeces of an infected louse, can be used to
infect a new host, while the American workers have also shown that
in some cases the urinary sediment and sputum may contain the
virus. There is a point of difference in the findings of the two
committees which merits attention. Whereas the American
Committee hold that the disease can be transferred from man to
man by the simple bite of the louse, the British Committee believe
that the mere bite is insufficient, that the virus is only present
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TRENCH FEVER 361 in the faeces of the infected insect,

and that a bite, scratch, or abrasion of any kind, is of equal
importance as a point of entrance of the infection when
.contaminated with infected lice excreta. On this latter view Byam
has brought forward evidence to show that a louse must have bitten
a case of trench fever five to eight days previously before its faeces
become actively infective. In work on the faeces of infected lice,
Arkwright has fully confirmed the observations of da Rocha Lima on
the almost invariable presence of so-called " Rickettsia bodies " in
the excreta of insects which have fed on patients suffering from
trench fever. These bodies, originally found by Ricketts (1909) in the
tick which transmits the disease known as Rocky Mountain spotted
fever, and later by Ricketts and Wilder in the excreta from lice on
cases of typhus fever, are of very small size. The following criteria
are given by Arkwright, Bacot and Duncan for their recognition :—
(1) Minute size — smaller than M. melitensis or B. influenza .—
usually about 0-3 x 0-3 or 0-3 x 0-5mm. (2) Irregularity in shape —
round, oval, diplococcal, or bacillary with stained poles. (3)
Occurrence in very large numbers, or even in masses, especially in
flakes of solid material in the excreta. (4) Well-stained appearance
when coloured by Giemsa's stain, the colour being purple like that of
the nucleus of a leucocyte. These bodies appear to be in some way
closely connected with the virus, but their exact relationship to the
aetiology of trench fever is so far uncertain. The remaining points of
importance in the aetiology of the disease which have been clearly
established concern the powers of resistance of the virus and the
period of infectivity of cases of trench fever to lice, and therefore to
other men. It was established by the American Committee that the
virus " resists a temperature of 60°C. moist heat for thirty minutes
and is fully virulent after such treatment, but is killed by a
temperature of 70°C. moist heat for thirty minutes. Obviously,
therefore, a temperature of 55°C. for thirty minutes, which destroys
the louse (Pediculus humanus) and its ova, does not suffice to
destroy the virus of trench fever which may be present on the
underclothing of trench fever patients." With regard to the period of
infectivity of sufferers from trench fever, Byam has published
observations on chronic cases which show that the virus may still be
present in the blood for a very long time after the onset. He gives
two
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362 MEDICAL HISTORY OF THE WAR instances in which

lice were infected and transmitted the disease to a new host by
feeding on chronic cases who had been first taken ill nine and fifteen
months previously and had subsequently remained in hospital in
England. No fatal case of the disease is known to have occurred.
Observations on morbid changes produced in the tissues by the virus
are therefore not available. The experiments of the War Office
Committee and of the American Medical Research Committee show
that when conveyed by intravenous injection of infected blood or
plasma, or by inoculation of the faeces of infected lice on to the
scarified skin, the period of incubation is as a rule from five to nine
days, but when transmitted by the living louse the incubation period
is from fourteen to over thirty days when estimated from the time
the lice are placed upon the subject. Symptoms. Prodromal
symptoms are rare, and are confined to slight headache or malaise.
The onset is usually rapid or even sudden, but in a few cases more
gradual. There is shivering or chilliness, and the temperature rises
rapidly. At the same time there is in all cases severe headache, and
in many sudden weakness or dizziness. Vomiting occurs in about a
third of the cases on the first day ; anorexia is universal. A common
history is that the patient was awaked in the night by violent
headache, and in the morning was unfit for duty, or that at some
time in the day he was seized with pain in the head and fell down as
if in a faint. On admission the patient is prostrated, looks ill and is
lethargic. He complains of pain in the forehead and in the back,
movement of the eyes is painful and there is slight nystagmus on
looking outwards. Within a day or two the characteristic rash usually
appears, the spleen is felt below the ribs, and there are pains in the
limbs. The tongue is coated on the dorsum with a brown or yellow
fur, but clean on the tip and edges. The throat is sometimes
congested and a dry cough then occurs. The rash consists of small
rosy spots, which are usually round, but sometimes of irregular
outline, are effaced by pressure, and are level with the surface of
the skin. They come out, like the spots of enteric, in successive
crops, and, like them, occur chiefly on the chest and abdomen. They
have once or twice been found on the back. But they differ from
enteric spots in that they are rather redder than the typical pink
enteric spot, have a more indefinite margin, and
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TRENCH FEVER 363 do not project. They last from twelve

to thirty hours, whereas the enteric spot lasts two or three days.
Their number may vary from a single spot to many hundreds. The
rash occurs as a rule with fever, and, when the case is of a regular
type and relapses can be distinguished, the spots usually appear a
few hours before the fever. In a small minority of instances spots are
seen on afebrile days. The rash has been seen on the first day, and
as late as the thirty-fourth. The pains vary greatly in situation,
duration, character and intensity. There is no pain that can be
considered distinctive. Their persistence, sometimes for weeks, is,
however, peculiar to trench fever. The commonest sites of pain at
the onset are the head, back and legs. The most constant of all
pains is frontal headache. This is practically invariable at the onset,
and is often very persistent. Headache is felt in the morning,
sometimes for weeks after other pains have disappeared. Pain in the
head is sometimes substituted for the word headache by the patient,
and probably represents a different kind of pain. It is sometimes felt
in other parts of the head than the forehead. Occasionally pain and
stiffness in the nape of the neck occur at the onset simulating
cerebro-spinal fever. In a few cases this pain has been so severe that
the diagnosis was uncertain until lumbar puncture was performed.
Pain in the chest is not infrequent. It is sometimes felt on one side
alone, either in the upper or the lower half. In the latter case the left
hypochondrium is a far more frequent site than the right, and the
pain is connected with enlargement of the spleen. Occasionally it is
felt round the lower ribs on both sides. Some cases have complained
of pain in the right iliac fossa very suggestive of appendicitis. The
distinction is usually not difficult to recognize. The iliac pain in trench
fever is felt when the skin is even lightly touched, and is not
increased by deeper pressure. There is not the rigidity characteristic
of appendicitis, and there is no tumour to be felt. Pain in the back,
of an aching kind, sometimes referred to the flanks rather than the
loins, is the most common of all pains except headache. It lasts
almost as long as headache, coming and going for many weeks. The
lower limbs are far more commonly painful than the upper. In order
of frequency the shins and thighs are the most often attacked, next
the knees and calf-muscles, and then the hips and ankles. Now and
again the instep or the sole of the foot is the seat of pain. Shin pains
are about as
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364 MEDICAL HISTORY OF THE WAR frequent as backache

and occur in about two-thirds of the cases. The arms are much less
frequent sites of pain. Almost every part of them has, however, been
attacked — shoulders, upper arms, elbows, forearms, and wrists —
in the series of cases observed. The pains are referred to different
structures. The shin pains are referred to the bones themselves,
sometimes to definite parts such as the central part of the bone, or
the posterior surface. Pains in the calves, in the thighs, and in the
upper arms are referred to the muscles in those situations, and
sometimes to particular muscles such as the deltoid or biceps. Pains
K 23 4 5 67 8 9 10 11 1213 14 15 16 17 18 19 20 21 2223 242526
CHART I. — Patient aged 19. Regular form of pulse-rate (light line)
rising and falling with temperature (heavy line). round the knees are
referred to places outside the joint. They are not felt to be within the
joint itself. Muscles to which pain is referred, such as the calves or
the thigh muscles, are usually tender when squeezed, and there is
tenderness round the outside of the knee-joint, especially, it has
seemed, at the site of tendinous attachments. These pains
interchange. They will be felt one day in the shin bones, another day
in the calves, and a third day in the back. There is no division to be
made between cases with bone pains and cases with muscle pains.
Nor is there any variety of the disease that can be called shin fever.
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TRENCH FEVER 365 There is occasionally superficial

tenderness of the skin, in ill-defined areas, and occasionally the site
of tenderness is in areas of the trunk corresponding to the zone
supplied by one or perhaps two of the dorsal or lumbar nerves. The
character of the pain varies. It is sometimes aching, sometimes
boring, and sometimes shooting, in the same patient. The boring
pain is commonly in the shins, but these may also ache. Shooting
pains are generally felt in the length of the limb. The intensity of the
pain varies also. Many patients are kept awake by it, as it is
commonly worse at night. A very few patients have no severe pain.
Pains usually disappear in a fortnight, but in some cases last much
longer. The fever reaches its highest point, 102° or 103° F. on the 46
47 48 49 50 51 52 53 54 55 56 57 CHART II. first, or sometimes on
the second day, but from this its course is extremely variable. In
some cases it follows the typically relapsing form which first drew
attention to the disease. In such cases the peaks of the chart occur
usually at intervals of five, or less commonly four, six, even up to
eight days. There is a tendency for the highest point to become
lower and for the interval to increase as the disease progresses. As
many as seven relapses have been seen. In other cases the
relapsing character is less distinct, and in some the fever is quite
irregular and may last thus almost six weeks, or after beginning by
one or two relapses may later become irregular and continuous.
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366 MEDICAL HISTORY OF THE WAR Even when the

temperature is not above 99° F. it is common for the daily variation
to be much greater than the normal. There is often a difference of
two degrees between the morning and evening level for many days
together, as in Chart II. The American experiments showed that
these types do not breed true, that any type may in the next
generation produce any other, and that trench fever includes them
all. In the early stage the pulse commonly varies with the
temperature, as shown in Chart I, rising to over 100 at the acme and
falling to normal in the interval. Sometimes a rise in the pulse-rate
may be the only evidence on the chart of a relapse. At a later stage,
while in a few cases rates below 60 are seen, it is more common for
the pulse to become rapid. Sometimes tachycardia develops
gradually, in other cases, as in Chart II, suddenly with palpitation
and even dyspnoea. This is more common if patients get up early,
but occurs also while they are in bed. It was not seen in the
American volunteers who were carefully selected and had not
undergone arduous duty. With tachycardia the heart's apex beat
sometimes shifts outwards even to an inch outside the nipple line,
and a systolic bruit may be heard for a few days. Praecordial pain
has been noticed, but there is no evidence that endocarditis ever
develops. The systolic blood-pressure shows a slight tendency to rise
as the disease progresses. Some have reported that the febrile
stages are marked by polymorphonuclear leucocytosis, and the
afebrile periods by an increase of the mononuclears. But Perkins and
Urwick, who made daily counts in many acute cases, showed that
polymorphs, mononuclears and lymphocytes all tended to increase in
the febrile periods, while the period of convalescence was marked by
a gradual rise in lymphocytes. A rise in polymorphs has been found
to occur during the few days preceding the onset. The symptoms
connected with the eyes are pain, made worse on movement, and
referred to the back of the eyeball, conjunctivitis or " pink eye/' and
nystagmus on looking outwards, which is probably due to muscular
weakness. The spleen is usually — in 85 per cent, of the
experimental cases — palpable at some period of the disease. In
about a third of the cases it is felt on the first day, but in some not
until much later. The condition may persist for as long as five weeks,
but usually disappears in a fortnight. It may reappear again, showing
that the organ probably remains enlarged in the interval though not
enough to be palpable. There is no special affection of the gastro-
intestinal system. The appetite returns after the first few days.
Occasionally
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TRENCH FEVER 367 the original symptoms recur in the

relapse. A slight temporary albuminuria is sometimes found as in
other fevers, but no cases of true nephritis were noticed. In some
patients in the early stage a few rales may be heard. Otherwise the
lungs are not affected. It has become evident that in a large
proportion of the cases of trench fever invalided home there is a
tendency to advance through a subacute towards a chronic
condition, with symptoms of disordered action of the heart, and also
in some cases neurasthenia. The symptoms met with may be
summarised as follows, in the order of their importance : — (1)
Exhaustion ; (2) giddiness and fainting ; (3) headache ; (4)
breathlessness on exertion ; (5) pain; (6) irritability; (7) lassitude;
(8) sweating; (9) coldness of the extremities ; (10) palpitation and
cardiac irregularity; (11) fever. Physical activity is not a necessary
factor in the causation of disordered action of the heart, as many
cases develop the condition while lying in bed. Tachycardia, however,
is usually of vasomotor type, the " sleeping pulse rate " approaching
normal, as pointed out by Harris. In the later subacute stage or
transitional stage of the disease the patient presents a well-defined
clinical picture. Throbbing headache is complained of, the face is
flushed, the pupils dilated, the skin warm, profuse sweating occurs
on slight exertion, marked tremor is present. Sometimes constant
nausea is felt and fainting frequently occurs. When the chronic
stage, or stage of disordered action of the heart has been
established this extreme instability of the nervous system is less well
marked. The patient no longer tends to swing from states of
excitement to states of collapse. Another and different clinical
picture is met with, corresponding to the entity which has acquired
the title of " neurasthenia," qualified by some with the words " of
vasomotor type." No matter what name may be given to it, it will be
found that there occur brisk reflexes, coldness and blueness of the
extremities, irritability of temper, inability to fix attention for long
periods, and exhaustion after sustained effort far in excess of that
evoked by the same effort in healthy men. Breathlessness on
exertion, palpitation, praecordial pain and giddiness are features of
both subacute and chronic conditions. The temperature in these
chronic cases varies considerably ; definite fever waves lasting from
a few hours to several days occur at irregular intervals, which
frequently are to be measured in months. Most cases show an
increased daily
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