This commentary proposes an integrative approach of theoretical and empirical considerations when developing policy responses to Internet-gaming disorder and when evaluating their efficacy. It complements the overview by Király et al. (2018) about preventive and treatment programs by referring to a lack of inclusion of internal factors, such as individual aspects and cognitions, and missing empirical evidence. This commentary claims the integration of current research addressing individual predisposing and maintaining factors in order to evaluate existing programs and to enhance the exchange between actors including policy. This integrative approach has the potential to develop successful preventive strategies, which could be implemented realistically and socially responsible.
Diminished control over a specific behavior is a core characteristic in addictive behaviors such as problematic Internet-pornography (IP) use. First studies suggest that a hyperactivity of the impulsive system is one reason for impulsive behaviors in the context of problematic IP use. The tripartite-process theory of addiction explains neurocognitive mechanisms beyond common dual-process theories in addictive behaviors. However, the role of the reflective and interoceptive system is still unresolved.
The study comprised a stop-signal task (SST) including neutral and pornographic images during fMRI and questionnaires to investigate associations between symptoms of problematic IP use, craving, and neural activity of the impulsive, reflective, and interoceptive system. We examined 28 heterosexual males with varying symptom severity of problematic IP use.
Data indicates that individuals with more symptoms of problematic IP use showed better performance in the SST which was linked to decreased insula and inferior frontal gyrus activity during pornographic image processing. An increase in craving was associated with lower activity of the ventral striatum during pornographic image processing. The interoceptive system showed varying effects. Increased insula activity during inhibitory control and decreased activity during pornographic image processing were associated with higher inhibitory control performance.
Discussion and Conclusion
Effects of tolerance and motivational aspects may explain the better inhibitory control performance in individuals with higher symptom severity which was associated with differential activity of the interoceptive and reflective system. Diminished control over IP use presumably results from the interaction between the impulsive, reflective, and interoceptive systems.
Authors:Elisa Wegmann, Benjamin Stodt and Matthias Brand
Background and Aims
Most people use the Internet in a functional way to achieve certain goals and needs. However, there is an increasing number of people who experience negative consequences like loss of control and distress based on an excessive use of the Internet and its specific online applications. Some approaches postulate similarities with behavioral addictions as well as substance dependencies. They differentiate between a generalized and a specific Internet addiction, such as the pathological use of social networking sites (SIA–SNS). Prior studies particularly identified the use of applications, personal characteristics, and psychopathological symptoms as significant predictors for the development and maintenance of this phenomenon. So far, it remains unclear how psychopathological symptoms like depression and social anxiety interact with individual expectancies of Internet use and capabilities of handling the Internet, summarized as Internet literacy.
The current study (N = 334) investigated the interaction of these components in a structural equation model.
The results indicate that the effects of depression and social anxiety on SIA–SNS were mediated by Internet use expectancies and self-regulation.
Thus, Internet use expectancies seem to be crucial for SIA–SNS, which is in line with prior models.
SNS use may be reinforced by experienced gratification and relief from negative feelings. Individual competences in handling the Internet may be preventive for the development of SIA–SNS.
Authors:Katrin Starcke, Stephanie Antons, Patrick Trotzke and Matthias Brand
Background and aims
Recent research has applied cue-reactivity paradigms to behavioral addictions. The aim of the current meta-analysis is to systematically analyze the effects of learning-based cue-reactivity in behavioral addictions.
The current meta-analysis includes 18 studies (29 data sets, 510 participants) that have used a cue-reactivity paradigm in persons with gambling (eight studies), gaming (nine studies), or buying (one study) disorders. We compared subjective, peripheral physiological, electroencephal, and neural responses toward addiction-relevant cues in patients versus control participants and toward addiction-relevant cues versus control cues in patients.
Persons with behavioral addictions showed higher cue-reactivity toward addiction-relevant cues compared with control participants: subjective cue-reactivity (d = 0.84, p = .01) and peripheral physiological and electroencephal measures of cue-reactivity (d = 0.61, p < .01). Increased neural activation was found in the caudate nucleus, inferior frontal gyrus, median cingulate cortex, subgenual cingulate, and precentral gyrus. Persons with gambling, gaming, or buying disorders also showed higher cue-reactivity toward addiction-relevant cues compared with control cues: subjective cue-reactivity (d = 0.39, p = .11) and peripheral physiological and electroencephal measures of cue-reactivity (d = 0.47, p = .05). Increased neural activation was found in the caudate nucleus, inferior frontal gyrus, angular gyrus, inferior network, and precuneus.
Discussion and conclusions
Cue-reactivity not only exists in substance-use disorders but also in gambling, gaming, and buying disorders. Future research should differentiate between cue-reactivity in addictive behaviors and cue-reactivity in functional excessive behaviors such as passions, hobbies, or professions.
It is currently under debate whether pathological buying can be considered as a behavioural addiction. Addictions have often been investigated with cue-reactivity paradigms to assess subjective, physiological and neural craving reactions. The current study aims at testing whether cue reactivity towards shopping cues is related to pathological buying tendencies.
A sample of 66 non-clinical female participants rated shopping related pictures concerning valence, arousal, and subjective craving. In a subgroup of 26 participants, electrodermal reactions towards those pictures were additionally assessed. Furthermore, all participants were screened concerning pathological buying tendencies and baseline craving for shopping.
Results indicate a relationship between the subjective ratings of the shopping cues and pathological buying tendencies, even if baseline craving for shopping was controlled for. Electrodermal reactions were partly related to the subjective ratings of the cues.
Cue reactivity may be a potential correlate of pathological buying tendencies. Thus, pathological buying may be accompanied by craving reactions towards shopping cues. Results support the assumption that pathological buying can be considered as a behavioural addiction. From a methodological point of view, results support the view that the cue-reactivity paradigm is suited for the investigation of craving reactions in pathological buying and future studies should implement this paradigm in clinical samples.
Authors:Jaro Pekal, Christian Laier, Jan Snagowski, Rudolf Stark and Matthias Brand
Background and aims
Several authors consider Internet-pornography-use disorder (IPD) as addictive disorder. One of the mechanisms that has been intensively studied in substance- and non-substance-use disorders is an enhanced attentional bias toward addiction-related cues. Attentional biases are described as cognitive processes of individual’s perception affected by the addiction-related cues caused by the conditioned incentive salience of the cue itself. It is assumed in the I-PACE model that in individuals prone to develop IPD symptoms implicit cognitions as well as cue-reactivity and craving arise and increase within the addiction process.
To investigate the role of attentional biases in the development of IPD, we investigated a sample of 174 male and female participants. Attentional bias was measured with the Visual Probe Task, in which participants had to react on arrows appearing after pornographic or neutral pictures. In addition, participants had to indicate their sexual arousal induced by pornographic pictures. Furthermore, tendencies toward IPD were measured using the short-Internetsex Addiction Test.
The results of this study showed a relationship between attentional bias and symptom severity of IPD partially mediated by indicators for cue-reactivity and craving. While men and women generally differ in reaction times due to pornographic pictures, a moderated regression analysis revealed that attentional biases occur independently of sex in the context of IPD symptoms.
The results support theoretical assumptions of the I-PACE model regarding the incentive salience of addiction-related cues and are consistent with studies addressing cue-reactivity and craving in substance-use disorders.
Authors:Cornelia Sindermann, Rayna Sariyska, Bernd Lachmann, Matthias Brand and Christian Montag
Background and aims
Despite indications that the dark triad of personality might be associated with Internet-use disorder (IUD), research about these associations is lacking.
Two studies were performed to grasp the links between these variables. In the first study, a sample consisting of N = 468 participants (n = 130 males) filled in the Short Dark Triad Questionnaire to assess scores in the dark triad of personality and the short Internet Addiction Test to assess tendencies toward unspecified IUD. In the second study, another independent sample of N = 472 participants (n = 143 males) filled in the same questionnaires plus items about specific forms of IUD.
Traits Machiavellianism and psychopathy were positively linked to tendencies toward unspecified IUD in both samples and males and females. Regarding the associations between tendencies toward specific IUDs and the dark triad of personality, no significant associations were found in males (at least not passing correction procedures for multiple testing). In females, trait Machiavellianism/psychopathy and tendencies toward Internet-shopping disorder, trait psychopathy, and tendencies toward Internet-pornography-use disorder as well as trait Machiavellianism and tendencies toward Internet-communication disorder were significantly positively correlated [at least one of the (sub)scales assessing the respective specific IUD was significantly associated with the respective dark triad trait even after correction procedures for multiple testing]. No robust pattern of associations between trait narcissism and unspecified/specific forms of IUD could be observed across (sub)samples.
Discussion and conclusions
These results indicate positive associations of the traits Machiavellianism and psychopathy (on a subclinical level) with tendencies toward IUD, especially unspecified IUD. The associations with tendencies toward specific forms of IUD seem more complex with differential personality correlates for each specific IUD. These associations need to be replicated.
The present theoretical paper introduces the smartphone technology as a challenge for diagnostics in the study of Internet use disorders and reflects on the term “smartphone addiction.”
Such a reflection is carried out against the background of a literature review and the inclusion of Gaming Disorder in ICD-11.
We believe that it is necessary to divide research on Internet use disorder (IUD) into a mobile and non-mobile IUD branch. This is important because certain applications such as the messenger application WhatsApp have originally been developed for smartphones and enfold their power and attractiveness mainly on mobile devices.
Discussion and conclusions
Going beyond the argumentation for distinguishing between mobile and non-mobile IUD, it is of high relevance for scientists to better describe and understand what persons are actually (over-)using. This is stressed by a number of examples, explicitly targeting not only the diverse contents used in the online world, but also the exact behavior on each platform. Among others, it matters if a person is more of an active producer of content or passive consumer of social media.