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Authors: Lijuan Shi, Yuanyuan Wang, Hui Yu, Amanda Wilson, Stephanie Cook, Zhizhou Duan, Ke Peng, Zhishan Hu, Jianjun Ou, Suqian Duan, Yuan Yang, Jiayu Ge, Hongyan Wang, Li Chen, Kaihong Zhao and Runsen Chen

Abstract

Background

The aim of this study was to investigate the mechanisms of Internet gaming disorder (IGD) and the associated interaction effects of childhood trauma, depression and anxiety in college students.

Methods

Participants were enrolled full-time as freshmen at a University in the Hunan province, China. All participants reported their socio-demographic characteristics and undertook a standardized assessment on childhood trauma, anxiety, depression and IGD. The effect of childhood trauma on university students' internet gaming behaviour mediated by anxiety and depression was analysed using structural equation modelling (SEM) using R 3.6.1.

Results

In total, 922 freshmen participated in the study, with an approximately even male-to-female ratio. A mediation model with anxiety and depression as the mediators between childhood trauma and internet gaming behaviour allowing anxiety and depression to be correlated was tested using SEM. The SEM analysis revealed that a standardised total effect of childhood trauma on Internet gaming was 0.18, (Z = 5.60, 95% CI [0.02, 0.05], P < 0.001), with the direct effects of childhood trauma on Internet gaming being 0.11 (Z = 3.41, 95% CI [0.01, 0.03], P = 0.001), and the indirect effects being 0.02 (Z = 2.32, 95% CI [0.00, 0.01], P = 0.020) in the pathway of childhood trauma-depression-internet gaming; and 0.05 (Z = 3.67, 95% CI [0.00, 0.02], P < 0.001) in the pathway of childhood trauma-anxiety-Internet gaming. In addition, the two mediators anxiety and depression were significantly correlated (r = 0.50, Z = 13.54, 95% CI [3.50, 5.05], P < 0.001).

Conclusions

The study revealed that childhood trauma had a significant impact on adolescents' Internet gaming behaviours among college students. Anxiety and depression both significantly mediated the relationship between childhood trauma and internet gaming and augmented its negative influence. Discussion of the need to understand the subtypes of childhood traumatic experience in relationship to addictive behaviours is included.

Open access
Authors: Hideki Nakayama, Fumihiko Ueno, Satoko Mihara, Takashi Kitayuguchi and Susumu Higuchi

Abstract

Background and aims

An important proportion of infants and adolescents in Japan are using Internet-equipped devices, including smartphones, tablets, and game consoles. However, the relationship between the risk of IA and the age at initial habitual Internet use remains unknown. We aimed to investigate this relationship among adolescents.

Methods

We surveyed 1,775 subjects in seven public junior high schools in Kanagawa prefecture, Japan, in November 2017. Students were asked to complete the Young's Diagnostic Questionnaire (YDQ), which captured information regarding gender, school grade, night sleep, age at which they first started using the Internet at least once weekly, Internet usage situation, and Internet use time for purposes other than study. Data from subjects who reported experience of weekly Internet use were analyzed.

Results

Junior high school students who were younger at initial weekly Internet use tended to have problematic Internet use (PIU) and to spend more time on Internet activities. In particular, initial weekly Internet use before the age of five in boys was associated with a significantly increased risk of PIU (YDQ ≥ 5), with an odds ratio of 14.955, compared with initial weekly Internet use after the age of 12. Smartphone ownership significantly increased the risk of PIU compared with no ownership among the total population and among girls.

Discussion and Conclusions

Junior high school male students displayed a robust relationship between initial weekly Internet use and PIU, whereas junior high school female students displayed a particularly strong relationship between smartphone ownership and PIU. Therefore, longitudinal IA preventive education from an early age is necessary.

Open access

Abstract

Background and aims

Individuals with problematic hypersexual behavior (PHB) are unable to control their sexual cravings, regardless of other situational factors. This inability to control cravings is a common trait in patients with neurological pathologies related to response inhibition. Until recently, however, it was unclear whether individuals with PHB have decreased inhibition and altered neural responses in the brain regions associated with inhibition compared to healthy control individuals, especially in the presence of distracting sexual stimuli. In this study, we examined the neural and psychological underpinnings of inhibition in individuals with PHB.

Methods

Thirty individuals with PHB and 30 healthy subjects underwent functional magnetic resonance imaging while performing a modified go/no-go task with neutral or sexual backgrounds used as distractors.

Results

Individuals with PHB showed poorer response inhibition than healthy subjects, especially when sexual distractors were present. Further, compared to healthy control subjects, individuals with PHB showed decreased activation in the right inferior frontal gyrus (IFG) and reduced functional connectivity between the IFG and the pre-supplementary motor area (preSMA) when response inhibition was required. Finally, the reduced activation and connectivity were more pronounced in the presence of sexual distractors than in the presence of neutral distractors.

Discussion

These findings suggest that individuals with PHB show reduced ability to inhibit responses that might be related to lower IFG activation and IFG-preSMA connectivity during response inhibition. Our results provide insights into the neurobiological underpinnings of poor response inhibition in individuals with PHB.

Open access
Authors: Roser Granero, Susana Valero-Solis, Fernando Fernández-Aranda, Mónica Gómez-Peña, Laura Moragas, Teresa Mena-Moreno, Amparo del Pino-Gutierrez, Ester Codina, Virginia Martín-Romera, Gemma Casalé, Zaida Agüera, Isabel Baenas-Soto, Eduardo Valenciano-Mendoza, Bernat Mora-Maltas, Isabel Sánchez, María Lozano-Madrid, José M. Menchón and Susana Jiménez Murcia

Abstract

Background and aims

The significant increase in the prevalence of gambling disorder (GD) among young adults in recent years has attracted interest in determining therapeutic efficiency in this sector of the population. The aim of this work was to estimate the response trajectories of gambling severity during the six-month follow-up after a cognitive behavioral therapy (CBT) program in young adult patients and to identify the main variables associated with each trajectory.

Methods

The sample included n = 192 patients, aged 19–35 years old, seeking treatment for GD. Response trajectories were identified through latent class growth analysis.

Results

Three trajectories emerged: T1 (n = 118, 61.5%), composed of patients with severe GD at pre-treatment and good evolution to recovery; T2 (n = 62, 32.3%), with patients with moderate-high GD affectation at baseline and good evolution to recovery; and T3 (n = 12, 6.3%), with participants with severe baseline GD severity and poor evolution after CBT (Abbott, 2019). The highest risk of poor therapeutic outcomes was related to lower social index positions, high emotional distress, high scores in harm avoidance and low scores in self-directedness.

Discussion and conclusions

Differences in the response trajectories at short-term follow-up after CBT reveal heterogeneity in the samples including young and young-adult GD patients. Patients' phenotype at baseline should be considered when developing efficient, person-centered intervention programs, which should comprise strategies aimed at increasing emotional regulation capacities, self-esteem and self-efficacy, with the aim of avoiding relapses in the medium-long term after therapy.

Open access
Authors: Gal Levi, Chen Cohen, Sigal Kaliche, Sagit Sharaabi, Koby Cohen, Dana Tzur-Bitan and Aviv Weinstein

Abstract

Background and aims

Compulsive sexual behavior is characterized by extensive sexual behavior and unsuccessful efforts to control excessive sexual behavior. The aim of the studies was to investigate compulsivity, anxiety and depression and impulsivity and problematic online sexual activities among adult males and females who use the Internet for finding sexual partners and using online pornography.

Methods

Study 1- 177 participants including 143 women M = 32.79 years (SD = 9.52), and 32 men M = 30.18 years (SD = 10.79). The Sexual Addiction Screening Test (SAST), the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Spielberger Trait-State Anxiety Inventory (STAI-T STAI-S) and Beck Depression Inventory (BDI). Study 2- 139 participants including 98 women M = 24 years (SD = 5) and 41 men M = 25 years (SD = 4). The impulsivity questionnaire (BIS/BAS), Problematic online sexual activities (s-IAT-sex) and Sexual Addiction Screening Test (SAST).

Results

Study 1- Multiple regression analysis has indicated that a model which included BDI, Y-BOCS, and STAI scores contributed to the variance of sexual addiction rates, and explained 33.3% of the variance. Study 2- Multiple regression analysis indicated that BIS/BAS and s-IAT scores contributed to the variance of sexual addiction rates, and explained 33% of the variance.

Discussion and conclusions

Obsessive-compulsive symptoms contributed to sexual addiction among individuals who use the Internet for finding sexual partners. Impulsivity and problematic online sexual activity contributed to ratings of sex addiction. These studies support the argument that sex addiction lies on the impulsive-compulsive scale and could be classified as a behavioral addiction.

Open access
Authors: Kun Qin, Feifei Zhang, Taolin Chen, Lei Li, Wenbin Li, Xueling Suo, Du Lei, Graham J. Kemp and Qiyong Gong

Abstract

Background and aims

Numerous studies on behavioral addictions (BAs) have reported gray matter (GM) alterations in multiple brain regions by using voxel-based morphometry (VBM). However, findings are poorly replicated and it remains elusive whether distinct addictive behaviors are underpinned by shared abnormalities. In this meta-analysis, we integrated VBM studies on different BAs to investigate common GM abnormalities in individuals with BAs.

Methods

We performed a systematic search up to January 2019 in several databases for VBM studies investigating GM differences between individuals with BAs and healthy controls. The reference lists of included studies and high-quality reviews were investigated manually. Anisotropic effect-size signed differential mapping was applied in this meta-analysis.

Results

Twenty studies including 505 individuals with BAs and 564 healthy controls met the inclusion criteria. Compared with healthy controls, individuals with BAs showed GM atrophy in the left anterior cingulate (extending to the left medial superior frontal gyrus and bilateral orbitofrontal gyrus), right putamen and right supplementary motor area. Subgroup analysis found heterogeneity in gender and subtypes of BAs. Meta-regression revealed that GM decreases in the left anterior cingulate and right supplementary motor area were positively correlated with addictive severity. Higher impulsivity was associated with smaller volume of the left anterior cingulate.

Discussion and conclusions

Our findings on BAs were mainly derived from internet gaming disorder (IGD) and pathological gambling (PG) studies, preliminarily suggesting that GM atrophy in the prefrontal and striatal areas might be a common structural biomarker of BAs.

Open access
Authors: Haoran Meng, Hongjian Cao, Ruining Hao, Nan Zhou, Yue Liang, Lulu Wu, Lianjiang Jiang, Rongzi Ma, Beilei Li, Linyuan Deng, Zhong Lin, Xiuyun Lin and Jintao Zhang

Abstract

Background and aims

Previous studies on smartphone use motivation (SUM) and problematic smartphone use (PSU) have been limited in the utilization of regional samples of emerging adults (e.g., college students) and also in the foci on the direct association between SUM and PSU. To address such gaps, using data from a large, national representative sample of Chinese young adolescents and their parents this study examined the associations between adolescents' various types of SUM and their PSU, and also tested the potential mediating roles of smartphone use time (SUT) that adolescents spent on various activities in such associations.

Methods

A nationwide representative sample of 8,261 Chinese adolescents (M age = 12.86 years old, SD = 1.76; 42.6% females) and their parents (49% mothers) participated in this survey study.

Results

Instrumental SUM (i.e., to expand knowledge or acquire information) was associated negatively with PSU via longer SUT spent on learning and shorter SUT spent on entertainment and communication. Self-expression SUM (i.e., to gain acceptance and recognition of others by maintaining or improving self-images) was associated with longer SUT spent on both learning and entertainment, which, in turn, predicted lower and higher levels of PSU, respectively. Last, hedonic SUM (i.e., to gain pleasure) was associated positively with PSU via longer SUT spent on entertainment and communication.

Discussion

These findings contribute to the literature by adding greater specificity in our understanding of the implications of SUM and SUT in the etiology of PSU during the critical life stage of adolescence in a Chinese cultural context.

Open access
Authors: Martina Goslar, Max Leibetseder, Hannah M. Muench, Stefan G. Hofmann and Anton-Rupert Laireiter

Abstract

Background and aims

Internet addiction, sex addiction and compulsive buying are common behavioral problems, which share similarities with gambling disorder and substance use disorders. However, little is known about the efficacy of their treatments. The objective of this meta-analysis was to examine the efficacy of the treatments of such problem behaviors, and to draw parallels to gambling disorder and substance use disorders in terms of treatment response.

Methods

Literature search yielded 91 studies totaling 3,531 participants to provide a comprehensive evaluation of the short-term and long-term efficacy of psychological, pharmacological and combined treatments for internet addiction, sex addiction, and compulsive buying.

Results

Psychological, pharmacological, and combined treatments were associated with robust pre-post improvements in the global severity of internet addiction (Hedges's g: 1.51, 1.13, and 2.51, respectively) and sex addiction (Hedges's g: 1.09, 1.21, and 1.91, respectively). For compulsive buying, psychological and pharmacological treatments were also associated with a large-sized pre-post reduction in global severity (Hedges's g: 1.00 and 1.52, respectively). The controlled pre-post and within-group pre-follow-up effect sizes were in the similar range, with few exceptions. Moderator analyses suggest that psychological interventions are effective for reducing compulsive behaviors, especially when delivered face-to-face and conducted over extended periods of time. Combinations of cognitive-behavioral approaches with medications showed an advantage over monotherapies.

Discussion and Conclusions

The results suggest that treatments for common behavioral addictions are effective in the short term, similar to those implemented for gambling disorder and substance use disorders, but more rigorous clinical trials are needed.

Open access

Abstract

Background and aims

There is a considerable amount of research on the psychological antecedents and outcomes of gaming disorder. Although many studies have examined various personality traits or motivations as predictors in isolation, fewer studies have investigated the mediations between personality traits and motivations. Furthermore, the analyzed personality traits have been limited to a few core concepts, with the Big Five personality traits being a standard model in this context. However, more recently the dark triad of personality traits (Machiavellianism, narcissism, and psychopathy) has been found to be associated with various forms of problematic online behavior and usage, such as online gambling, yet little is known about gaming disorder. The current study examines the relationship of these dark personality traits to gaming disorder with three gaming motivations (achievement, social, and escapism) as mediators.

Method

The study uses an online survey of 1,502 German digital game users.

Results

Results indicate a fully mediated association for narcissism via escapism and partial mediation associations for Machiavellianism and psychopathy. Direct effects on gaming disorder were observed for Machiavellianism and psychopathy. Indirect effects by psychopathy were observed via escapism and social motivation, by narcissism via escapism, and by Machiavellianism via social motivation.

Discussion and conclusions

These findings contribute to the theoretical understanding of the mediation of gaming motivations and the dark triad personality traits' importance for gaming disorder.

Open access
Authors: Ji-Won Chun, Chang-Hyun Park, Jin-Young Kim, Jihye Choi, Hyun Cho, Dong Jin Jung, Kook-Jin Ahn, Jung-Seok Choi, Dai-Jin Kim and In Young Choi

Abstract

Background and aims

Although the Internet has provided convenience and efficiency in many areas of everyday life, problems stemming from Internet use have also been identified, such as Internet gaming disorder (IGD). Internet addiction, which includes IGD, can be viewed as a behavioral addiction or impulse control disorder. This study investigated the altered functional and effective connectivity of the core brain networks in individuals with IGD compared to healthy controls (HCs).

Methods

Forty-five adults with IGD and 45 HCs were included in this study. To examine the brain networks related to personality traits that influence problematic online gaming, the left and right central executive network (CEN) and the salience network (SN) were included in the analysis. Also, to examine changes in major brain network topographies, we analyzed the default mode network (DMN).

Results

IGD participants showed lower functional connectivity between the dorsal lateral prefrontal cortex (DLPFC) and other regions in the CEN than HC participants during resting state. Also, IGD participants revealed reduced functional connectivity between the dorsal anterior cingulate cortex and other regions in the SN and lower functional connectivity in the medial prefrontal cortex of the anterior DMN. Notably, in IGD individuals but not HC individuals, there was a positive correlation between IGD severity and effective connectivity and a positive correlation between reward sensitivity and effective connectivity within the ventral striatum of the SN.

Conclusions

Problematic online gaming was associated with neurofunctional alterations, impairing the capacity of core brain networks.

Open access