Unveiling peripheral neuropathy and cognitive dysfunction in diabetes: an observational and proof-of-concept study with video games and sensor-equipped insoles

Background

Proactive screening for cognitive dysfunction (CD) and peripheral neuropathy (PNP) in elderly patients with diabetes mellitus is essential for early intervention, yet clinical examination is time-consuming and prone to bias.

Objective

We aimed to investigate PNP and CD in a diabetes cohort and explore the possibility of identifying key features linked with the respective conditions by machine learning algorithms applied to data sets obtained in playful games controlled by sensor-equipped insoles.

Methods

In a cohort of patients diagnosed with diabetes (n=261) aged over 50 years PNP and CD were diagnosed based on complete physical examination (neuropathy symptom and disability scores, and Montreal Cognitive Assessment). In an observational and proof-of-concept study patients performed a 15 min lasting gaming session encompassing tutorials and four video games with 5,244 predefined features. The steering of video games was solely achieved by modulating plantar pressure values, which were measured by sensor-equipped insoles in real-time. Data sets were used to identify key features indicating game performance with correlation regarding CD and PNP findings. Thereby, machine learning models (e.g. gradient boosting and lasso and elastic-net regularized generalized linear models) were set up to distinguish patients in the different groups.

Results

PNP was diagnosed in 59% (n=153), CD in 34% (n=89) of participants, and 23% (n=61) suffered from both conditions. Multivariable regression analyses suggested that PNP was positively associated with CD in patients with diabetes (adjusted odds ratio = 1.95; 95% confidence interval: 1.03-3.76; P=0.04). Predictive game features were identified that significantly correlated with CD (n=59), PNP (n=40), or both (n=59). These features allowed to set up classification models that were enriched by individual risk profiles (i.e. gender, age, weight, BMI, diabetes type, and diabetes duration). The obtained models yielded good predictive performance with the area under the receiver-operating-characteristic curves reaching 0.95 for CD without PNP, 0.83 for PNP without CD, and 0.84 for CD and PNP combined.

Conclusions

The video game-based assessment was able to categorize patients with CD and/or PNP with high accuracy. Future studies with larger cohorts are needed to validate these results and potentially enhance the discriminative power of video games.

Impulsivity and aggression as risk factors for internet gaming disorder among university students

Internet gaming addiction is a global problem, especially among young individuals. Exhibiting characteristics similar to other addictions, Internet Gaming Disorder (IGD) is linked to adverse mental health outcomes. Identified as risk factors for dependence behaviors, the association of impulsivity and aggression with IGD is relatively under-researched in the student population. The present sample of 350 university students (Mage = 21.30 years, SDage = 4.96 years) from Najran university in Saudi Arabia completed an online questionnaire that included the Internet Gaming Disorder Scale-Short-Form (IGDS9-SF), the Buss-Perry Aggression Questionnaire-Short Form, and the Barratt Impulsiveness Scale (BIS-15). Results indicated that impulsivity and aggression were positively associated with IGD severity and both personality traits explained 34.6% of the variance in IGD scores. Further bivariate analyses suggested that individuals spending 7 or more hours on internet gaming were more likely to exhibit high impulsivity and aggression, and had a relatively higher severity of IGD. These results suggest that individuals with these personality traits may be more vulnerable to developing an addiction to internet gaming. These findings need to be confirmed in future more robust studies; however, this exploratory study provides insights for potential programs to prevent IGD among young individuals.

Games, hormones, and "dark" personalities: Dark tetrad and the effects of violent gaming on aggression, cortisol, and testosterone

We investigated how playing a violent versus non-violent video game affects cortisol and testosterone levels, whether these hormonal changes increase implicit aggressive cognition, and whether so-called Dark Tetrad personality traits (i.e., Machiavellianism, psychopathy, narcissism, everyday sadism) moderate these effects. Fifty-four men played either a violent or a non-violent video game for 25 min. Participants provided salivary samples at the beginning of the experiment (T1), after 25 min of gameplay (T2), and 20 min after gameplay ended (T3). In the violent condition, participants showed a significant decrease in cortisol levels (T1 to T2) and a significant negative trend in cortisol levels from T1 to T3. Moreover, higher Machiavellianism scores were related to a significantly stronger decrease in cortisol (T1 to T2) in this condition. In the non-violent condition, however, participants with higher scores in Machiavellianism had a higher increase in cortisol (T1 to T2). In contrast to changes in hormonal levels, there were no significant effects on implicit aggressive cognition. The present findings illustrate the complex interplay between personality, hormones, and game content, thus further specifying current notions on the effects of violent video games. Playing a violent video game can have a stress-reducing calming effect depending on personality traits such as Machiavellianism and the psychological need satisfaction associated with it. Also, the fact that VVG exposure was not automatically accompanied by an aggression-increasing effect proves that simple cause-effect models are not sufficiently specified without taking the underlying mechanisms into account.

Emotional dysregulation predicts problematic gaming in children and youths: a cross-sectional and longitudinal approach

Adolescents show a high vulnerability for addictive gaming patterns on the one hand and immature emotion regulation (ER) abilities as a risk factor for mental disorders on the other hand. We investigated the predictive value of ER difficulties on problematic gaming (PG) considering age groups (children vs. youths) and gender cross-sectionally and prospectively in a representative sample of German adolescents via online survey with two measurement points 14 months apart. General Poisson, logistic, and multinomial regression models were estimated to predict gaming patterns by ER difficulties controlling for age group and gender. Results revealed ER difficulties to be significantly associated with PG. Moreover, subgroup analyses indicated differing ER patterns for children vs. youths and boys vs. girls: for children, higher PG values were associated with emotional awareness and emotional clarity whereas for youths it was the acceptance of emotional responses. Moreover, gender differences implicated that boys with PG had more deficits in goal-oriented behavior as well as emotional awareness while affected girls were lacking emotional clarity and had problems with the acceptance of their emotional responses. Interestingly, procrastination was a significant predictor for PG irrespective of subgroups. Furthermore, longitudinal analyses indicated that difficulties in ER promoted PG while stronger procrastination tendencies maintained it. With the inclusion of procrastination, which can be understood as a maladaptive ER strategy, a broader picture of ER difficulties as a risk factor for PG could be drawn. The findings support a better understanding of PG etiology and the development of targeted prevention and intervention measures.

Acceptability Assessment of an Executive Function Training Game FISHERMAN for Older Adults

Objective: In recent years, an increasing number of gamification tools have been developed for older adults; however, few studies have explored the acceptability of these tools after initial use and sustained use in older adults. In the current study, we focus on "FISHERMAN," an executive function training game containing a cognitive game and an exergame, with the aim of investigating and comparing the acceptability of both versions of "FISHERMAN" after initial use and 3 months of sustained use in older adults. Materials and Methods: Seventy-six older adults were randomly assigned to the cognitive game training group or the exergame training group. Participants completed two 1-hour sessions per week for 12 weeks. Acceptability was evaluated through a validated, 7-point, self-rating, Interactive Technology Art Installation Technology Acceptance Model Questionnaire after the first and last training sessions, with higher ratings representing higher acceptability. The questionnaire included 22 items and 9 acceptability dimensions: usage behavior, intention to use, perceived usefulness, perceived ease of use, perceived playfulness, subjective norm, image, output quality, and result demonstrability. Descriptive statistics were conducted to evaluate acceptability after initial and sustained use. Two-way (time: initial use and sustained use; group: cognitive game group and exergame group) repeated ANOVAs were conducted to investigate the differences in acceptability. Post hoc, within-group, paired-sample t test analyses were performed to evaluate changes in game acceptability for each group over time. Results: After initial use and 3 months of sustained use, the average scores for overall acceptability and individual dimensions exceeded 5.5 of 7 points in both groups. The two groups presented different changes from initial use to sustained use. The overall acceptability, usage behavior, perceived usefulness, and perceived ease of use were significantly improved after training within the cognitive game group, while perceived playfulness was significantly reduced within the exergame group. Conclusions: The current study provided preliminary evidence that older adults had high acceptability for both the cognitive game and exergame versions of "FISHERMAN." After sustained use, acceptability of the cognitive game increased and acceptability of the exergame decreased, highlighting the importance of assessing game acceptability after initial and sustained use.

Developmental trajectories and predictors of Internet gaming disorder across the university years: A person-centered five-wave cohort study

With a rapid rise in internet gaming, internet gaming disorder (IGD) has become a contemporary concern. However, little is known about the long-term dynamic changes in IGD over time. Using a person-centered five-wave longitudinal design, the current study explored the heterogeneous trajectories of IGD among 5787 students during their university years, and examined the role of protective and risk factors in differentiating distinct patterns of IGD. The growth mixture modeling revealed three distinct trajectories of IGD: stable-low pattern (n = 4575, 87.42 %), increasing pattern (n = 357, 6.80 %), and decreasing pattern (n = 302, 5.78 %). Additionally, the students with high self-control and self-compassion were more likely to be in the stable-low group instead of the other risk groups. Depressive symptoms and peer conflicts, as two time-varying variables, were significant risk predictors for IGD. These findings highlight the importance of identifying high-risk groups for IGD and providing them with personalized and effective mental health services to reduce their risk of developing IGD in the future.

Evaluating the effect of action-like video game play and of casual video game play on anxiety in adolescents with elevated anxiety: protocol for a multi-center, parallel group, assessor-blind, randomized controlled trial

BACKGROUND

Adolescence is a critical period for the onset and maintenance of anxiety disorders, which raises the importance of intervening early; one possibility of doing so is via digital interventions. Within that research field, at least two important research paths have been explored in the past years. On the one hand, the anxiolytic effect of casual video games has been tested as such gaming activity may distract away from anxious thoughts through the induction of flow and redirection of attention toward the game and thus away of anxious thoughts. On the other hand, the bidirectional link between weak attentional control and higher anxiety has led to the design of interventions aiming at improving attentional control such as working memory training studies. Taking stock that another genre of gaming, action video games, improves attentional control, game-based interventions that combines cognitive training and action-like game features would seem relevant. This three-arm randomized controlled trial aims to evaluate the feasibility and the efficacy of two video game interventions to document how each may potentially alleviate adolescent anxiety-related symptoms when deployed fully on-line.

METHODS

The study aims to recruit 150 individuals, 12 to 14 years of age, with high levels of anxiety as reported by the parents' online form of the Screen for Child Anxiety Related Disorders questionnaire. This trial contrasts a child-friendly, "action-like" video game designed to improve attentional control abilities in a progressive and stepwise manner (Eco-Rescue), a casual puzzle video game selected to act as a positive distraction tool (Bejeweled) and finally a control group with no assigned training intervention to control for possible test-retest effects (No-training). Participants will be assigned randomly to one of the three study arms. They will be assessed for main (anxiety) and secondary outcomes (attentional control, affective working memory) at three time points, before training (T1), one week after the 6-week training (T2) and four months after completing the training (T3).

DISCUSSION

The results will provide evidence for the feasibility and the efficacy of two online video game interventions at improving mental health and emotional well-being in adolescents with high levels of anxiety. This project will contribute unique knowledge to the field, as few studies have examined the effects of video game play in the context of digital mental health interventions for adolescents.

TRIAL REGISTRATION

The trial is registered on ClinicalTrials.gov (NCT05923944, June 20, 2023).

The interplay between mental health and dosage for gaming disorder risk: a brief report

The relationship between gaming time and gaming disorder can be moderated by other variables. This study aimed to test the moderating role of mental health. Participants (N = 461) were recruited online. Gaming time was a statistically significant predictor of gaming disorder risk, with an explained variance of 3.3%. The goodness of fit of the model that took into account both moderators (anxiety and depression) improved to 13.9%. The interaction between gaming time and both moderators was significant. The results showed that depression and anxiety acted as moderators of the dosage effect, possibly by amplifying the gratification of playing games and thus contributing to the development of gaming disorder. It may be important in practise, as it seems to place the mental health at the right place, namely among risk factors that can contribute to gaming disorder in combination with a key trigger, which is gaming.

Psychological distress and aggression among adolescents with internet gaming disorder symptoms

The present study aimed to investigate the current situation of internet gaming disorder (IGD) in Chinese adolescents and explore the impact of IGD-related factors on adolescent aggression. We hypothesized that IGD symptoms in adolescents would be associated with aggressive behavior and that risk factors for IGD symptoms could increase the aggressive tendencies of adolescents. To verify the above hypothesis, a cross-sectional survey of junior and senior high school students from southern, southwestern, central, and eastern China was conducted. A total of 9306 valid questionnaires were collected. The results showed that the prevalence of IGD symptoms was 1.78 % among Chinese adolescents. The adolescents in the disordered gamer group had the most severe IGD symptoms, with the highest levels of psychological distress and aggression. Interestingly, adolescents in the casual gamer group had the lowest psychological distress and aggression scores. Linear regression analysis further showed that higher levels of aggression were significantly associated with male sex, younger age, more severe psychological distress and IGD symptoms, and more violent game exposure. Our results suggested that excessive online gaming not only contributes to psychological distress in adolescents but also increases their levels of aggressive behavior. Apart from male sex and younger age, severe IGD symptoms and psychological distress are the most important predictors of the development of aggressive behavior.

EEG components of inhibitory control ability in internet gaming disorder: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Inhibitory control ability is a crucial cognitive function that enables individuals to regulate their impulses and behaviors in a goal-directed manner. However, with the increasing prevalence of internet gaming disorder (IGD), there has been growing concern about the impact of excessive gaming on inhibitory control ability. Despite the accumulating evidence on this topic, the research conclusion on whether people with IGD have worse inhibition control ability than healthy controls remains inconsistent, and the lack of effective electroencephalography prediction indicators further complicates this issue. To address this research gap, the present study aimed to investigate whether N2 event-related potential (ERP) and P3 ERP components could serve as reliable indicators of inhibitory control ability in individuals with IGD.

METHODS

To achieve this goal, a systematic literature search was conducted in several databases, including Web of Science, ScienceDirect (EBSCO), SpringerLink, PubMed, and Wiley Online Library. The inclusion criteria were strictly implemented to ensure the quality of the studies included in the meta-analysis. In the end, a total of 5 studies, with 139 participants diagnosed with IGD and 139 healthy controls, were included in the analysis.

RESULTS

Meta-analysis revealed large effect sizes of N2 and P3 amplitudes in individuals with IGD, indicating that these two ERP components could be potential indicators of inhibitory control ability. Specifically, the N2 and P3 amplitude was significantly larger in individuals with IGD than in the healthy control group, suggesting deficits in inhibitory control function and increased impulsivity in the IGD group. In the inhibition control task, the IGD group required more cognitive resources to suppress impulsive responses.

CONCLUSION

Overall, the findings of this meta-analysis shed light on the potential use of N2 and P3 amplitudes as reliable indicators of inhibitory control ability in individuals with IGD. The results provide crucial insights into the neural mechanisms underlying inhibitory control impairment in IGD, which could inform the development of effective interventions for this condition. Further research is needed to explore the functional significance of these ERP components and their potential clinical applications in the diagnosis and treatment of IGD.

[Primary prevention of computer game addiction in students of educational institutions]

OBJECTIVE

To conduct the primary prevention of computer game addiction (PPCGA) in students of General education institutions (GEI), aimed at preventing the formation of CGA.

MATERIAL AND METHODS

The study included 488 students in grades 7-10 of GEI aged 12-17 years (14.6±2.4 years), of which 393 adolescents, who made up the main group, received PPCGA and 95 - control, without PPCGA.

RESULTS

Preventive measures were carried out without interrupting the educational process; they were carried out by addiction psychiatrists and medical psychologists. PPCGA was aimed at teaching students a healthy lifestyle, the development of their personal resources, the formation of skills to overcome problem situations, a change in the value attitude to computer games and the formation of alternative interests. In the main group, a decrease in the time interval spent by students at the computer was found (p<0.05). There was a decrease in the number of students (p<0.05), experiencing affective disorders when abstaining from the computer, including mild depression and subclinically expressed anxiety/depression, for whom computer games could lead to problems and negative consequences. An increase in the interval of time spent by students at the computer (p<0.05); an increase in the number of students experiencing affective disorders when abstaining from the computer (p<0.05); a trend towards the increase in the frequency of problems and delayed meetings and personal matters related to spending time at the computer; an increase in clearly uncommunicative (p<0.05) were found in the control group.

CONCLUSIONS

Primary prevention of computer gaming increase the number of students who prefer a healthy lifestyle (physical education and sports, rational nutrition, sex education, family relationships) and reduce the number of people who prefer computer games as a form of leisure.

Deep learning(s) in gaming disorder through the user-avatar bond: A longitudinal study using machine learning

Background and aims

Gaming disorder [GD] risk has been associated with the way gamers bond with their visual representation (i.e., avatar) in the game-world. More specifically, a gamer's relationship with their avatar has been shown to provide reliable mental health information about the user in their offline life, such as their current and prospective GD risk, if appropriately decoded.

Methods

To contribute to the paucity of knowledge in this area, 565 gamers (Mage = 29.3 years; SD =10.6) were assessed twice, six months apart, using the User-Avatar-Bond Scale (UABS) and the Gaming Disorder Test. A series of tuned and untuned artificial intelligence [AI] classifiers analysed concurrently and prospectively their responses.

Results

Findings showed that AI models learned to accurately and automatically identify GD risk cases, based on gamers' reported UABS score, age, and length of gaming involvement, both concurrently and longitudinally (i.e., six months later). Random forests outperformed all other AIs, while avatar immersion was shown to be the strongest training predictor.

Conclusion

Study outcomes demonstrated that the user-avatar bond can be translated into accurate, concurrent and future GD risk predictions using trained AI classifiers. Assessment, prevention, and practice implications are discussed in the light of these findings.

Order of first-play in simulated versus monetary gambling

Background and aims

Simulated gambling products, like loot boxes and social casino games, contain gambling elements, but are not classified as gambling. They are available to minors, raising concerns about a "gateway effect" into gambling. This study examined the time course of young people's engagement in simulated and monetary gambling, and associations between simulated gambling and gambling problems and harm. A necessary, although not sufficient, condition for simulated games leading to real money gambling is that simulated play must come first.

Method

Participants were 1,026 young adults (aged 18-25 years) who played video games in the last year. They reported the age at which they first took part in seven simulated and twelve monetary gambling products, and current gambling problems and harm.

Results

First use of loot boxes and video games with gambling content tended to precede monetary gambling. Forms where gambling is a core gameplay element, such as social casino and demonstration games, tended to follow some monetary gambling forms. Engagement in most simulated gambling products was associated with greater harm from monetary gambling.

Discussion

The findings leave open the possibility of a catalyst pathway from youth engagement in loot boxes and games with gambling content to later monetary gambling, but causal psychosocial mechanisms remain unclear. However, a pathway from social casino and demonstration games to monetary gambling appears less likely, which may instead reflect containment or substitution effects. Simulated gambling disproportionately attracts youth who are vulnerable to gambling problems and harm, indicating the need for consumer protection measures.

Heterogeneity of gaming disorder: A clinically-based typology for developing personalized interventions

Background

The eleventh revision of the International Classification of Diseases (ICD-11) defines the three key diagnostic criteria for gaming disorder (GD). These are loss of control over gaming, gaming as a priority over daily activities, and impaired functioning due to gaming. While this definition has implications for the prevention and treatment of GD, there is significant heterogeneity in the symptoms and etiology of GD among individuals, which results in different treatment needs. Cognitive control, emotional regulation, and reward sensitivity are three critical dimensions in the etiology model for GD. Aspects such as gender, comorbidity, motivation for gaming, stage or severity of GD, and risk factors all contribute to the heterogeneity of etiology among individuals with the disorder.

Method

On the basis of clinical symptoms and comorbidity characteristics among approximately 400 patients with gaming disorder, the present paper proposes a clinical typology of patients with GD based on the authors' clinical experience in treating individuals with GD.

Results

The findings indicated three common types of patients with GD: (i) impulsive male patients with attention deficit hyperactivity disorder (ADHD), (ii) dysphoria patients with dysfunctional coping skills, and (iii) isolated patients with social anxiety. The paper also discusses the presentation and treatment priority for these patients.

Conclusion

Personalized treatments for patients with GD should be developed to fit their individual needs. Future studies should examine the heterogeneity of GD and confirm these types, as well as obtain evidence-based information that can help in the development of personalized treatment. Treatment resources should be developed, and professionals should be trained to provide integrated individualized treatment.

Cognitive Patterns and Problematic Use of Video Games in Adolescents: A Cluster Analysis

BACKGROUND

Video game playing (VGP) is an increasingly common leisure activity among children and adolescents, although in some cases, it is accompanied by problems due to misuse.

METHOD

A sample of 2884 children and adolescents aged between 12 and 20, representative of the Community of Madrid (Spain), were studied using a cluster analysis to explore the existence of cognitive patterns associated with engagement, attitudes, and concurrent cognitions. We also explored the relationship between these patterns and problematic VGP, using the 2173 gamers as a reference.

RESULTS

The concurrent cognitions were not qualitatively different between the problematic users and the others. High engagement and high activation of concurrent cognitions (intensity and frequency) showed the greatest relationship with problematic VGP.

CONCLUSIONS

The results suggest the existence of different groups of gamers and the relevance to include psycho-educational aspects in intervention programs, as well as the training of specific skills, especially those related with the control of activation. Limitations related to the sample size and potential supplementary analyses are acknowledged.

Visual Attention and Emotion Analysis Based on Qualitative Assessment and Eyetracking Metrics-The Perception of a Video Game Trailer

Video game trailers are very useful tools for attracting potential players. This research focuses on analyzing the emotions that arise while viewing video game trailers and the link between these emotions and storytelling and visual attention. The methodology consisted of a three-step task test with potential users: the first step was to identify the perception of indie games; the second step was to use the eyetracking device (gaze plot, heat map, and fixation points) and link them to fixation points (attention), viewing patterns, and non-visible areas; the third step was to interview users to understand impressions and questionnaires of emotions related to the trailer's storytelling and expectations. The results show an effective assessment of visual attention together with visualization patterns, non-visible areas that may affect game expectations, fixation points linked to very specific emotions, and perceived narratives based on the gaze plot. The innovation in the mixed methodological approach has made it possible to obtain relevant data regarding the link between the emotions perceived by the user and the areas of attention collected with the device. The proposed methodology enables developers to understand the strengths and weaknesses of the information being conveyed so that they can tailor the trailer to the expectations of potential players.

Desensitized gamers? Violent video game exposure and empathy for pain in adolescents - an ERP study

This Event-Related Potential (ERP) study aimed to test how habitual and short-term violent video game exposure (VVGE) may affect empathy for pain responses in adolescents. In a within-subjects design, boys (N = 56; aged 12-16 years) performed a pain judgment task before and immediately after playing a violent video game. In this task, participants judged whether photos of hands depicted on their screen were in a painful situation or not. While both the P3 and the LPP components were not related to habitual violent video game exposure, general exposure to antisocial media content predicted lower P3 amplitudes to painful pictures. Further, 40 min of violent gameplay did not affect the P3 responses; however, it temporarily decreased LPP responses to painful pictures, suggesting a modest short-term desensitization effect. However, this latter interpretation is limited by a strong LPP pain effect - a significant amplitude difference between painful and non-painful pictures - that remained present in the post-game condition. Such persistent LPP effect may relate to the notion that adolescents are still learning how to properly regulate their emotional reactions. This study contributes to the limited literature on violent video games' desensitization in adolescents' brains, opening new avenues for media violence research.

Gaming passion contributes to the definition and identification of problematic gaming

Even if for most people playing video games is a healthy leisure activity, a minority of vulnerable users present an excessive use associated to negative consequences (e.g., psychosocial maladjustment, sleep interference) and functional impairment. The current study first aims to identify psychological factors that contribute to discriminate highly involved (but healthy) gamers from problematic gamers. For that purpose, we used a cluster analysis approach to identify different groups of gamers based on their profiles of passion towards gaming (using the Dualistic Model of Passion). Another objective of the present study is to explore, using supervised machine-learning, how gaming disorder symptoms, assessed within the substance use disorder framework (e.g., tolerance, withdrawal), might be linked to harmonious and/or an obsessive passion for gaming. Three distinct clusters of gamers were identified based on their passion profiles, including risky gamers, engaged gamers, and casual gamers. Supervised machine-learning algorithms identified that specific gaming disorder symptoms (salience, mood modification, tolerance, low level of conflict) were predominantly related to harmonious passion, whereas others (withdrawal, high level of conflict, relapse) were more directly related to obsessive passion. Our results support the relevance of person-centered approaches to the treatment of problematic gaming.

University Students' Gaming and Gambling Behaviors, Related Factors, and the Relationship Between Gaming and Gambling

The purpose of this study was to investigate university students' gaming and gambling behaviors, the factors that relate to these behaviors, and the connection between gaming and gambling behaviors. The study was designed as survey research, which is one of the quantitative research methods. The sample for the study consists of 232 students who are continuing their education at a state university in Turkey. The data of the research were collected through the Student Information Form, the Game Addiction Scale, and the South Oaks Gambling Screen. While the rate of students with problematic gambling behavior was 9.1% (n = 21), the rate of students with problematic gambling behavior was 14.2% (n = 33). Gaming behavior showed significant differences according to gender, age, the feeling of success, leisure time sufficiency, sleep proficiency, smoking, and alcohol use. Gambling behavior showed significant differences according to gender, family type, family income, the feeling of success, level of happiness, the experience of psychological distress, social relationship satisfaction, smoking, and alcohol use, and the presence of an addicted person in the social environment. Gender, perception of success, leisure proficiency, and alcohol use were variables associated with both gambling and gaming. There was a positive and significant relationship between gaming and gambling behavior (r = .264, p < .001). As a result, it is seen that the variables related to gaming and gambling behavior differ rather than partnership. Considering the weak relationship between gaming and gambling behavior, it is difficult to put forward sharp views on the relationship between gaming and gambling.

Loot boxes use as a new form of gambling within video games

Loot boxes are items within video games which players pay to open and, ultimately, to randomly obtain an object whose value is initially unknown. Being easily accessible for both teenagers and adults, loot boxes have been associated with gambling. The purpose of this study was to explore the use of loot boxes and to analyze whether it is associated with guilt, loss of control, and emotional distress. To this end, 475 participants (266 adolescents and 209 adults) were surveyed on their habits regarding loot boxes and gaming. The results showed that teenagers invest more money in loot boxes than adults. This expenditure increases when a new item is announced on online platforms (Twitch, YouTube). Additionally, not obtaining the coveted items, which is common due to loot box randomness, predicts greater levels of guilt and emotional distress, while obtaining them predicts subsequent loss of control. Thus, 45.5% reported guilt over purchasing, 50% distress and 17% loss of control. Summarizing, loot boxes are increasingly present in video games, and owing to their psycho-emotional outcomes, it is necessary for future research to address this matter in order to develop prevention strategies and to provide support to vulnerable populations.

Development of a serious game-based cognitive rehabilitation system for patients with brain injury

BACKGROUND

Traumatic brain injury (TBI) resulting from a forceful impact to the head can cause severe functional disabilities, with cognitive impairment being a major hindrance to patients' return to daily life. Encouraging patients to engage in rehabilitation programs consistently poses a significant challenge for therapists. To address this issue, gamification has gained momentum as an effective approach. This study aims to develop a serious game-based cognitive rehabilitation system tailored for patients with brain injury.

METHODS

The study included four stages. Initially, the requirements were analyzed through focus groups. Then the system structure and game content were discussed and was agreed as a conceptual model. In second stage, the system design was drawn using various modeling diagrams. In third stage, a system prototype was developed using the Unity game engine and C# programming. Finally, a heuristic evaluation method was employed to assess usability.

RESULTS

Based on the focus group meetings with seven participants, a conceptual model of the system structure and game content was designed. Game's interface was developed for both the therapist and patient versions. The focus groups determined a 2D casual gaming genre with a postman character and 10 missions on the smartphone platform. For example, in the first mission, the postman must move from mailboxes 1 to 10 and pick up the letters. This is according to Trail Making Test task. The 16 tasks in different subcategories of attention were selected to make these missions. The usability evaluation highlighted privacy, help and documentation, and aesthetic and minimalist design as the areas with the highest percentage of problems.

CONCLUSIONS

Cognitive rehabilitation is vital in facilitating patients' faster return to daily routines and enhancing their quality-of-life following brain injury. Incorporating a game-based system provides patients with increased motivation to engage in various cognitive exercises. Additionally, continuous monitoring by specialists ensures effective patient management. The game-based system offers different game stages to strengthen and rehabilitate attention in patients with brain injury. In the next step, the clinical effects of this system will be evaluated.

The relationship between internet gaming disorder and psychotic experiences: cyberbullying and insomnia severity as mediators

BACKGROUND

The nature of the relationship between Internet Gaming Disorder (IGD) and psychosis is unclear so far. There is evidence that greater time spent in playing video games may expose players to both insomnia and a toxic online environment with widespread cyberbullying. These two possible consequences of IGD may, in turn, be associated with greater psychotic experiences (PE). Based on this theoretical framework, the present study proposed to contribute the body of the knowledge in this area, by testing the possible indirect effects of insomnia severity, cyber-victimization and cyberbullying in the cross-sectional association between IGD and PE in a sample of Tunisian university students.

METHOD

We conducted a cross-sectional study over 4 months (February-May 2022). The Arabic versions of the Brief Symptom Inventory, the Internet Gaming disorder-20 Test, the Insomnia Severity Index, and the Revised Cyber Bullying Inventory-II were administered to a total of 851 students (mean age = 21.26 ± 1.68 years, 53.7% females).

RESULTS

We found that 25% of students were at risk of IGD, and 1.8% had an IGD. The results of the mediation analysis showed that insomnia severity fully mediated the association between IGD and paranoid ideation. Higher IGD was significantly associated with more insomnia severity, which was, in turn, significantly associated with more paranoid ideation. Cyberbullying partly mediated the association between IGD and psychoticism. Higher IGD scores were significantly associated with more cyberbullying, which was, in turn, significantly associated with more psychoticism. Finally, greater IGD was significantly and directly associated with higher psychoticism.

CONCLUSION

Our findings suggest that insomnia and cyberbullying may be regarded as potential targets for youth mental health promotion, as well as community-focused prevention and early intervention in psychosis. More particular attention should be devoted to the huge potential for engaging in cyberbullying among online gamers. Sleep deprivation should be prevented, assessed and treated in heavy gamers.

Neuroimaging and behavioral evidence that violent video games exert no negative effect on human empathy for pain and emotional reactivity to violence

Influential accounts claim that violent video games (VVGs) decrease players' emotional empathy by desensitizing them to both virtual and real-life violence. However, scientific evidence for this claim is inconclusive and controversially debated. To assess the causal effect of VVGs on the behavioral and neural correlates of empathy and emotional reactivity to violence, we conducted a prospective experimental study using functional magnetic resonance imaging (fMRI). We recruited 89 male participants without prior VVG experience. Over the course of two weeks, participants played either a highly violent video game or a non-violent version of the same game. Before and after this period, participants completed an fMRI experiment with paradigms measuring their empathy for pain and emotional reactivity to violent images. Applying a Bayesian analysis approach throughout enabled us to find substantial evidence for the absence of an effect of VVGs on the behavioral and neural correlates of empathy. Moreover, participants in the VVG group were not desensitized to images of real-world violence. These results imply that short and controlled exposure to VVGs does not numb empathy nor the responses to real-world violence. We discuss the implications of our findings regarding the potential and limitations of experimental research on the causal effects of VVGs. While VVGs might not have a discernible effect on the investigated subpopulation within our carefully controlled experimental setting, our results cannot preclude that effects could be found in settings with higher ecological validity, in vulnerable subpopulations, or after more extensive VVG play.

Effects of a single bout of mobile action video game play on attentional networks

Background

Video game play has been linked to a range of cognitive advantages, and investigations in this domain have predominantly utilized cross-sectional designs or long-term training paradigms. Nevertheless, the specific effects of engaging in a single bout of video game play remain poorly understood. Consequently, the objective of this study is to examine the influence of a single session of mobile action video game (MAVG) play on attentional networks among college students.

Methods

Seventy-two nonvideo game players were assigned randomly into an MAVG and a control game group. Participants in the MAVG group engaged in a 60-minute session of an action video game played on mobile phones, while the control group played a mobile card game for the same duration. All participants completed the attentional network test (ANT), which assesses alerting, orienting, and executive control network efficiencies, before and after the intervention.

Results

The MAVG group had significantly improved alerting network efficiency following the intervention, compared to before (p < 0.05); the control game group did not. Neither executive control network efficiency nor orienting network efficiency were found to be improved by the intervention.

Conclusion

The present data demonstrated that a single bout of MAVG play can improve alerting network efficiency selectively in young-adult college students. MAVGs may be useful for promoting attentional function with the advantages of being accessible virtually any time and anywhere.

Factor structure and psychometric properties of an Arabic version of the Internet Gaming Disorder Scale, short form (IGDS-SF9)

Background

In its most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the American Psychological Association recognized that internet gaming disorder is a psychological condition and provides nine criteria for its diagnosis, and the Internet Gaming Disorder Scale, short form (IGDS-SF9) was developed to assess individuals.

Aim

To develop and investigate the psychometric properties of an Arabic version of IGDS-SF9.

Method

A five-stage translation and verification process produced an Arabic version of IGDS-SF9, and a study was conducted using a sample of 410 respondents (45.6% females, mean age = 17.6, SD = 1.56) to assess its psychometric properties. Respondents completed the Arabic version, the Smartphone Addiction Scale, the Smartphone Application-Based Addiction Scale, the Hospital Anxiety and Depression Scale, as well as a demographic survey. Exploratory and confirmatory factor analyses, measurement invariance, item response theory, convergent, concurrent, criterion validity, and internal consistency reliability and test-retest reliability were employed to validate the scale.

Results

The exploratory factor analysis suggested the scale's unidimensional structure; the confirmatory factor analysis exhibited good model fit and factor loadings. Measurement invariance, and concurrent, convergent, and criterion validity were established, resulting in good internal consistency and test-retest reliability for the scale.

Conclusion

The Arabic version of IGDS-SF9 is a valid and reliable measure for research and diagnosis in Arabic-speaking countries.