The cognitive psychology of Internet gaming disorder

Need fulfilment and internet gaming disorder: A preliminary integrative model

BACKGROUND

The need for a better understanding of the risk factors underpinning disordered gaming has been consistently emphasized. Although, gaming may offer a simple and straightforward means of alleviating distress, relying on gaming to address one's unmet psychological needs could invite problematic usage. Self-determination theory highlights the significance of three universally inherent psychological needs for relatedness, competency, and autonomy. A motivation to engage in gaming may be to address unmet needs and may become problematic.

OBJECTIVE

This study aimed to assess whether experienced levels of loneliness, depression and self-esteem mediate the association between Internet Gaming Disorder (IGD) behaviours and Need-Fulfilment deficits.

METHOD

The participants comprised of 149 adults (83 males, 66 females), aged between 18 and 62 years. A series of self-reported questionaries assessing their levels of IGD behaviours, depression, loneliness, self-esteem and need-fulfilment were completed.

RESULTS

Need-fulfilment deficits were linked to higher IGD behaviours. Interestingly, this association was mediated by the reported levels of self-esteem and depression and not loneliness.

CONCLUSIONS

The findings lend further empirical support for the mediating role of psychological distress between need fulfilment deficits and IGD behaviours.

The role of family and personality traits in Internet gaming disorder: A mediation model combining cognitive and attachment perspectives

BACKGROUND AND AIMS

Gaming disorder was recently recognized as a mental health disorder by the World Health Organization and included in the International Classification of Diseases. Extensive research has been conducted with regard to psychosocial correlates and comorbidity, less so for the developmental mechanisms and the processes leading to the disorder. The association between family factors, personality traits, and gaming has been studied independently but not in combination. To fill this gap in knowledge, this study examined (a) the association between parental acceptance-rejection theory and Internet gaming disorder (IGD) and (b) the mediating and moderating effect of core self-evaluations (CSE), a personality construct, on the aforementioned variables.

METHODS

The study was quantitative and involved young adults members of online gaming communities (N = 225).

RESULTS

The results showed that parental rejection is associated with the occurrence of IGD, only through the mediating effect of CSE. The moderation model was not confirmed.

DISCUSSION

Findings bridge early emotional deficits with CSE personality traits and IGD, based on two widely acknowledged theoretical frameworks. In addition, they highlight the importance of the father's role in upbringing.

CONCLUSIONS

These frameworks combine cognitive and attachment perspectives and a process-oriented approach to the development and maintenance of IGD. The implications of these findings are discussed in relation to (a) the mechanisms leading to the disorder and (b) providing an evidence base for therapeutic interventions for IGD to go beyond abstinence and include self-esteem enhancement and efficacy contingencies. Directions for future research are also provided in this study.

The relative contribution of motives and maladaptive cognitions to levels of Internet Gaming Disorder

This study aimed at determining whether motives and/or maladaptive cognitions would predict levels of Internet Gaming Disorder independently of negative affect and problematic Internet use. Seventy-nine Internet gamers completed the following questionnaires: Ten-Item Internet Gaming Disorder Test, Problematic Internet Use Questionnaire Short Form, Depression Anxiety and Stress Scale 21, Motives for Online Gaming Questionnaire, and Maladaptive Gaming-Related Cognitions Scale. Results showed that all variables were positively and significantly correlated with levels of Internet Gaming Disorder with the exception of motives relating to recreation. Furthermore, a hierarchical linear regression analysis showed that motives relating to coping and skills development and maladaptive cognitions relating to overvaluing of game rewards were the only significant predictors of levels of Internet Gaming Disorder when controlling for negative affect and problematic Internet use. The implications of these findings are discussed.

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Motives and maladaptive cognitions predict levels of IGD.

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Motives relating to coping skills development and maladaptive cognitions relating to overvaluing game rewards were the strongest predictors of IGD.

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Findings were independent of negative affect and problematic Internet use.

Relationships between Internet addiction and clinicodemographic and behavioral factors

BACKGROUNDS AND AIMS

While the Internet became an indispensable component of our contemporary life, public and academic attention is also gathered to its negative impact, namely Internet addiction (IA). Although clinicodemographic and behavioral factors are hypothetically implicated in the mechanism of IA, it still remains largely unknown how such factors are linked to IA severity. Thus, this study sought to examine relationships among IA severity and factors potentially associated with IA in Japanese students in different educational stages.

METHODS

We conducted a questionnaire-based survey, which included questions about types of online activities and clinicodemographic information, the IA test for IA severity, and the K6 scale for psychological distress in 3,224 students at elementary, junior, and senior high schools, and universities. A multiple regression analysis was performed to predict IA severity with clinicodemographic and behavioral factors.

RESULTS

IA severity was significantly positively related to the following factors: e-messaging, social networking services (SNS), games, holiday Internet usage, and K6 scores, while IA severity had negative correlation with using Internet for educational purposes, age of first exposure to the Internet, and sleep duration. Age was not related to IA severity among participants using both SNS and e-messaging.

CONCLUSIONS

IA was linked to various online activities and the degree of psychological distress. This indicates the importance of comprehensive assessment of online behavior and psychological factors for further understanding of IA.

Cognitive-behavioral therapy for Internet gaming disorder: A systematic review and meta-analysis

OBJECTIVE

Although there is sufficient research and clinical evidence to support the inclusion of gaming disorder in the latest revision of the International Classification of Diseases, relatively little is known about the effectiveness of first-line psychological treatment for gaming disorder or internet gaming disorder (IGD) as it is listed in the Diagnostic and Statistical Manual. This systematic review employed meta-analytic techniques to determine the effectiveness of cognitive-behavioural therapy (CBT) for IGD on four key outcomes: IGD symptoms, anxiety, depression, and time spent gaming.

METHOD

A database search identified 12 independent CBT studies. Effect size estimates (Hedges' g) with associated confidence intervals, prediction intervals, and p values for each pre-post treatment outcome, were calculated. Study reporting quality was evaluated in accordance with the Consolidated Standards of Reporting Trials guidelines. Subgroup and moderator analyses were undertaken to investigate potential sources of heterogeneity.

RESULTS

CBT demonstrated high efficacy in reducing IGD symptoms (g = 0.92; [0.50, 1.34]) and depression (g = 0.80, [0.21, 1.38]), and showed moderate efficacy in reducing anxiety (g = 0.55, [0.17, 0.93]) at post-test. There was insufficient power to determine whether CBT was capable of reducing time spent gaming. Treatment gains at follow-up were nonsignificant across the four treatment outcomes.

CONCLUSIONS

The pooled findings suggest that CBT for IGD is an effective short-term intervention for reducing IGD and depressive symptoms. However, the effectiveness of CBT for reducing actual time spent gaming was unclear. Given the limitations of this evidence base, there is a need for more rigorous studies to determine the potential long-term benefits of CBT for IGD.

PUBLIC HEALTH SIGNIFICANCE STATEMENT

Given the rise in treatment demand for internet gaming disorder (IGD) and problematic gaming, it is necessary to determine which treatments are most effective for whom and under which conditions. This review shows that cognitive-behavioural therapy for IGD, which is often considered the first-line therapy, can improve IGD symptoms and comorbid depression. However, treatment gains tend to be short-term and their effect in reducing time spent gaming is unclear. Programs that target problematic gaming may be improved by additional support beyond the standard program of therapy sessions. More funding and resources are needed to support the development of a more rigorous evidence base on IGD and its treatment.

Altered Eye-Movement Patterns During Text Reading in Obsessive-Compulsive Disorder and Internet Gaming Disorder

Obsessive-compulsive disorder (OCD) and internet gaming disorder (IGD), which are similar in that both involve repetitive behaviors and related with cognitive dysfunctions, frequently begin in early adolescence, which is a critical period for learning. Although the deterioration in cognitive functioning caused by these conditions may have adverse effects on information processing, such as text reading, there has been no comprehensive research on the objective indicators of altered reading patterns in these patients. Therefore, we evaluated eye-movement patterns during text reading in patients with OCD or IGD. In total, 20 patients with OCD, 28 patients with IGD and 24 healthy controls (HCs) participated in the reading task using an eye tracker. We compared the fixation durations (FDs), saccade amplitudes and eye-movement regressions of the three groups during reading. We explored relationships between the parameters reflecting altered reading patterns and those reflecting the severity of clinical symptoms. The average FDs and forward saccade amplitudes did not differ significantly among the groups. There were more eye-movement regressions in patients with OCD than in patients with IGD and HCs. No correlation was found between altered eye-movement patterns during reading and the severity of clinical symptoms in any of the patient groups. The significantly increased number of regressions (NRs) in the OCD group during reading may reflect these patients’ difficulties with inferential information processing, whereas the reading pattern in the IGD group is relatively intact. These findings suggest that patients with OCD and patients with IGD have different eye-movement patterns during reading reflecting distinct cognitive impairments in the two patient groups.

A preliminary cross-cultural study of Hikikomori and Internet Gaming Disorder: The moderating effects of game-playing time and living with parents

Background

Internet Gaming Disorder (IGD) and Hikikomori (an extreme form of social real-life withdrawal, where individuals isolate themselves from society) have both been suggested as mental disorders that require further clinical research, particularly among young adult populations.

Objective

To add to the extant literature, the present study used a cross-cultural, cross-sectional design to investigate the association between Hikikomori and IGD, and the potential moderating effects of reported game-playing time and living with parents.

Method

Two online samples of 153 Australian and 457 U.S.-North American young adult players of Massively Multiplayer Online (MMO) games were collected. The nine-item Internet Gaming Disorder Scale-Short Form (IGDS-SF9), and the Hikikomori Social Withdrawal Scale were administered to dimensionally assess IGD and Hikikomori, respectively.

Results

Linear regression analyses confirmed that Hikikomori symptoms are associated with IGD. Additionally, moderation analyses indicated that the association was exacerbated by longer game playing time across both populations. Gamers living with their parents was a significant moderator of the relationship for the Australian sample.

Conclusions

Extreme real-life social withdrawal and IGD are related, and this association is exacerbated for those who spend more time playing MMOs per day, and, for Australian participants, living with their parents.

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Internet Gaming Disorder (IGD) and Hikikomori are two relatively new disorders.

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Hikikomori symptoms are associated with higher IGD scores.

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Longer periods of gaming exacerbated the Hikikomori-IGD association.

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Living with parents exacerbated IGD among Australian gamers.

The imperative of integrating empirical and theoretical considerations when developing policy responses to Internet-gaming disorder

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.

May the passion be with you: The addictive potential of collectible card games, miniatures, and dice of the Star Wars universe

BACKGROUND AND AIMS

In recent years, we have witnessed a growing research interest in behavioral addictions and in pleasurable behaviors that generate a certain discomfort in the people who engage in them. The objective of this study was to assess if users of collectible card games, miniatures, and dice from the Star Wars Universe Games (SWUG) may also present criteria of addiction and if the presence of these criteria is related to demographic variables, game-playing habits, and other variables.

METHODS

SWUG players were contacted through specialized gaming chats, and 218 of them completed the Internet Gaming Disorder Scale - Short Form (IGDS-SF9), a scale that assesses motivation to engage in the game (Massively Multiplayer Online Motivations Scale), the Rosenberg Self-Esteem Questionnaire, the Diener Satisfaction with Life Scale, and a question for the self-assessment of addiction.

RESULTS

Significant predictors of addictive symptoms were the motivation to seek dissociation and (negatively) self-esteem. Users more significantly dedicate indirect hours to the game (thinking about the game, preparing material, etc.) than to actually playing. No participant could be considered pathologically addicted, as no one scored above the tentative cut-off point of the IGDS-SF9.

DISCUSSION AND CONCLUSIONS

Despite the fact that many players considered themselves "addicted" and some presented various economic and family problems related to their activity, it was found that playing these games could not be equated to true addictive behavior, since no player had scores above the cut-off point. This finding contributes to current discussions about the tendency to overestimate excessive pleasurable behaviors.

Time to call for a global public health approach in prevention of the onset and progression of problematic gaming

Problematic video gaming is a global problem. Policy and programs responses to the problem vary among countries, partly due to cultural differences in the east and the west, meaning that caution is needed in drawing comparisons. Promoting parental education and positive youth development would be a useful approach to curb problematic behavior among children and adolescents. We suggest using a public health approach, based on our experience in dealing with commodities, which are harmful to health.

Personality and Cognition in Gamers: Avoidance Expectancies Mediate the Relationship Between Maladaptive Personality Traits and Symptoms of Internet-Gaming Disorder

Internet-gaming disorder (IGD) has become a clinically relevant phenomenon worth investigating with respect to its mechanisms of development and maintenance. Considering theoretical models of specific Internet-use disorders, we assumed an interaction of maladaptive personality traits as unspecific predisposing factors and experience-based, gaming-related Internet-use expectancies in predicting symptoms of IGD. Therefore, 103 male and female regular Internet gamers were investigated with questionnaires assessing maladaptive personality traits in accordance to DSM-5, gaming-related positive and avoidance Internet-use expectancies, and symptoms of IGD. The results demonstrated that negative affectivity, detachment, antagonism, disinhibition, psychoticism as well as gaming-related positive and avoidance expectancies were related to symptoms of IGD. Moreover, the relationship between maladaptive personality traits as represented by negative affectivity, detachment, and psychoticism with symptoms of IGD was mediated by avoidance expectancies. Positive gaming-related use expectancies were related to detachment, and were not a significant mediator in the hypothesized model. The findings give reason to assume that maladaptive personality traits in combination with gaming-related positive expectancies and avoidance expectancies are important factors for the development of IGD, but that positive expectancies and avoidance expectancies play a differential role regarding there mediating role between personality characteristics and symptoms of IGD.

Discordance between self-report and clinical diagnosis of Internet gaming disorder in adolescents

This study aimed to estimate overreporting (the false positive) and underreporting (false negative) rates in self-reported IGD assessment compared with clinical diagnosed IGD. The study population consisted of 45 with IGD and 228 without IGD based on clinical diagnosis from the Internet User Cohort for Unbiased Recognition of Gaming Disorder in Early Adolescence (iCURE) study. All participants completed self-reported IGD assessments. Clinical interviews were conducted blindly by trained mental health professionals based on DSM-5 IGD criteria. Self-assessed average daily amount of gaming time and game genre were measured. Psychological characteristics, including anxiety, suicidality, aggression, self-control, self-esteem, and family support, were obtained from the baseline survey. The false-negative rate for self-reported IGD assessment was 44%. The false-negative group reported less time playing online games than the IGD group, though their psychological characteristics were similar to those of the IGD group. The false-positive rate was 9.6%. They reported more time playing online games than non-IGD group, though their psychological characteristics were similar to those of non-IGD group except self-control. The discrepancy of IGD diagnoses between self-reports and clinical diagnosis revealed limitations of self-measurements. Various strategies are required to overcome the methodological shortfalls of self-reports for the assessment of IGD.

Diffusion-weighted MRI measures suggest increased white-matter integrity in Internet gaming disorder: Evidence from the comparison with recreational Internet game users

Several studies have suggested that Internet gaming disorder (IGD) is related to altered brain white matter integrity. However, seeming inconsistencies exist and may reflect comparison groups not matched well for certain gaming characteristics. In order to address this possible concern, we recruited in the present study individuals with recreational Internet game use (RGU) comprised of individuals who spend similar amounts of time as IGD subjects playing online games without developing IGD. Diffusion tensor imaging data were collected from 42 IGD and 44 RGU subjects. Whole-brain comparisons showed that IGD subjects demonstrated increased fractional anisotropy (FA) in the bilateral anterior thalamic radiation, anterior limb of the internal capsule, bilateral corticospinal tract, bilateral inferior fronto-occipital fasciculus, corpus callosum, and bilateral inferior longitudinal fasciculus. In addition, Internet-addiction severity was positively correlated with FA values. Taken together, we conclude that IGD is associated with measures of increased white-matter integrity in tracts linking reward circuitry and sensory and motor control systems.

Internet Gaming Disorder: An Emergent Health Issue for Men

Internet gaming is a legitimate leisure activity worldwide; however, there are emerging concerns that vast numbers of gamers are becoming addicted. In 2013, the American Psychiatric Association (APA) classified Internet Gaming Disorder (IGD) as a condition warranting more clinical research ahead of formalizing it as a mental disorder. Proposed as a behavioral addiction, IGD shares many similarities in both physical and psychosocial manifestations with substance use disorder, including cerebral changes on functional magnetic resonance imaging (fMRI). Among the gaming population, compared to females, adolescent and adult males demonstrate far more addictive internet gaming use in terms of screen hours, craving, and negative impacts on health, which have, in isolated incidents, also caused death. The current article draws findings from a scoping review of literature related to IGD as a means to raising awareness about an emergent men's health issue. Included are three themes: (a) unveiling the nature, impacts and symptoms of IGD; (b) conceptualizing IGD through neuroscience; and (c) treatment approaches to IGD. Afforded by these themes is an overview and synthesis of the existing literature regarding IGD as a means of providing direction for much needed research on gaming addiction and orientating primary care providers (PCPs) to the specificities of IGD in men's health. The findings are applied to a discussion of the connections between IGD and masculinity and the importance of recognizing how behaviors such as social isolation and game immersion can be maladaptive coping strategies for males.

Treatment Considerations in Internet and Video Game Addiction: A Qualitative Discussion

Internet and video game addiction has been a steadily developing consequence of modern living. Behavioral and process addictions and particularly Internet and video game addiction require specialized treatment protocols and techniques. Recent advances in addiction medicine have improved our understanding of the neurobiology of substance and behavioral addictions. Novel research has expanded the ways we understand and apply well-established addiction treatments as well as newer therapies specific to Internet and video game addiction. This article reviews the etiology, psychology, and neurobiology of Internet and video game addiction and presents treatment strategies and protocols for addressing this growing problem.

Clinical predictors of gaming abstinence in help-seeking adult problematic gamers

Research into the effectiveness of interventions for problematic gaming has been limited by a lack of data concerning the clinical characteristics of voluntary treatment-seekers; the nature and history of their gaming problems; and, their reasons for seeking help. The study aimed to identify variables predictive of short-term commitment to gaming abstinence following initial voluntary contact with an online help service. A total of 186 adult gamers with gaming-related problems were recruited online. Participants completed the DSM-5 Internet gaming disorder (IGD) checklist, Depression Anxiety Stress Scales-21, Internet Gaming Cognition Scale, Gaming Craving Scale, and Gaming Quality of Life Scale. A one-week follow up survey assessed adherence with intended gaming abstinence. Abstainers were less likely to have withdrawal symptoms and less likely to play action shooting games. Participants with mood symptoms (40% of the total) reported significantly more IGD symptoms, stronger maladaptive gaming cognitions (e.g., overvaluing game rewards), more previous occurrences of gaming problems, and poorer quality of life. However, mood symptoms did not predict abstinence from or continuation of gaming. Adults with gaming disorder seeking help to reduce their gaming may benefit initially from strategies that manage withdrawal and psychoeducation about riskier gaming activities.

Gamers' insights into the phenomenology of normal gaming and game "addiction": A mixed methods study

In response to calls for further research into the phenomenology of Internet gaming disorder (IGD), we used a community-engaged consensus development approach to evaluate how members of the "gamer culture" describe problematic gaming and the relationship of these descriptions to the proposed IGD criteria. Two focus groups of gamers were recruited at a video game convention. Participants were asked to submit suggestions for signs of game "addiction". Participants discussed and ranked the criteria in order of conceptual importance. The rankings were analyzed quantitatively, and then a multidisciplinary team compared the ranked criteria to the DSM-5 IGD proposed criteria. The strongest agreement between participants' rankings and IGD symptomatology was found for harms/functional impairment due to gaming, continued use despite problems, unsuccessful attempts to control gaming, and loss of interest in previous hobbies and entertainment. There was less support for other IGD criteria. Participants also offered new content domains. These findings suggest that collaborative knowledge-building approaches may help researchers and policymakers understand the characteristics and processes specific to problematic video game play and improve content validity of IGD criteria. Future efforts may benefit from multi-stakeholder approaches to refine IGD criteria and inform theory, measurement and intervention.

Cognitive distortions and gambling near-misses in Internet Gaming Disorder: A preliminary study

Increased cognitive distortions (i.e. biased processing of chance, probability and skill) are a key psychopathological process in disordered gambling. The present study investigated state and trait aspects of cognitive distortions in 22 individuals with Internet Gaming Disorder (IGD) and 22 healthy controls. Participants completed the Gambling Related Cognitions Scale as a trait measure of cognitive distortions, and played a slot machine task delivering wins, near-misses and full-misses. Ratings of pleasure (“liking”) and motivation to play (“wanting”) were taken following the different outcomes, and gambling persistence was measured after a mandatory phase. IGD was associated with elevated trait cognitive distortions, in particular skill-oriented cognitions. On the slot machine task, the IGD group showed increased “wanting” ratings compared with control participants, while the two groups did not differ regarding their “liking” of the game. The IGD group displayed increased persistence on the slot machine task. Near-miss outcomes did not elicit stronger motivation to play compared to full-miss outcomes overall, and there was no group difference on this measure. However, a near-miss position effect was observed, such that near-misses stopping before the payline were rated as more motivating than near-misses that stopped after the payline, and this differentiation was attenuated in the IGD group, suggesting possible counterfactual thinking deficits in this group. These data provide preliminary evidence for increased incentive motivation and cognitive distortions in IGD, at least in the context of a chance-based gambling environment.

Tolerance in Internet gaming disorder: A need for increasing gaming time or something else?

Background and aims The criterion of tolerance in DSM-5 Internet gaming disorder (IGD) refers to a need for increasing time spent gaming. However, this focus on "need for gaming time" may overlook some of the broader motivations, outcomes, or effects of gaming that underlie excessive play. This study aimed to explore regular and problematic gamers' experiences and perceptions of tolerance in IGD. Methods An online survey of 630 adult gamers yielded 1,417 text responses to open-ended questions. A thematic analysis of 23,373 words was conducted to extract dominant themes. Results Participants reported that they increasingly desired game items, status, or story progress as they became more involved or invested in games. As players develop higher standards of play in games, an increasing number of potential reward outcomes may have diminishing mood-modifying effects. None of the participants, including those with self-reported IGD, explicitly referred to a need for increasing time spent gaming. Discussion and conclusions These results suggest that players may be motivated by preferences for specific goals or reinforcers in games rather than wanting an amount of time spent gaming. Thus, problematic gaming may involve a need for completion of increasingly intricate, time-consuming, or difficult goals to achieve satisfaction and/or reduce fears of missing out. Further research is needed to determine whether these cognitive and motivational factors related to gaming stimuli should extend or replace the concept of tolerance in IGD or be considered as separate but related processes in disordered gaming.

Merging Theoretical Models and Therapy Approaches in the Context of Internet Gaming Disorder: A Personal Perspective

Although, it is not yet officially recognized as a clinical entity which is diagnosable, Internet Gaming Disorder (IGD) has been included in section III for further study in the DSM-5 by the American Psychiatric Association (APA, 2013). This is important because there is increasing evidence that people of all ages, in particular teens and young adults, are facing very real and sometimes very severe consequences in daily life resulting from an addictive use of online games. This article summarizes general aspects of IGD including diagnostic criteria and arguments for the classification as an addictive disorder including evidence from neurobiological studies. Based on previous theoretical considerations and empirical findings, this paper examines the use of one recently proposed model, the Interaction of Person-Affect-Cognition-Execution (I-PACE) model, for inspiring future research and for developing new treatment protocols for IGD. The I-PACE model is a theoretical framework that explains symptoms of Internet addiction by looking at interactions between predisposing factors, moderators, and mediators in combination with reduced executive functioning and diminished decision making. Finally, the paper discusses how current treatment protocols focusing on Cognitive-Behavioral Therapy for Internet addiction (CBT-IA) fit with the processes hypothesized in the I-PACE model.

Video game addiction and psychological distress among expatriate adolescents in Saudi Arabia

Introduction

Few studies have estimated screen time among Arab adolescents, and no studies, to date, have published data on addiction to video games or Internet games among Arab adolescents. This study aimed to assess the prevalence of addiction to video games and its correlation with mental health in a sample of expatriate high school students from the Al-Qassim region of Saudi Arabia.

Methods

The survey was conducted in 2016 among 276 students enrolled in ninth through twelfth grades in the International Schools in Buraidah, Al-Qassim. Students who returned signed consent forms from their parents filled out a self-administered questionnaire that included validated scales on addiction to video games, general health, and lifestyle.

Results

The proportion between the sexes and the schools were roughly equal. Around 32% were overweight or obese, 75% had screen time ≥ 2 h/day, and 20% slept < 5 h/night. Sixteen per cent (16%) were addicted to video games and 54% had psychological distress. Addiction to video games was strongly associated with psychological distress (OR = 4.1, 95% CI = 1.80, 9.47). Other significant correlates were female gender, higher screen time, and shorter sleep hours.

Conclusions

The proportion of students with psychological distress was high. Future studies should investigate other potential correlates of distress such personal traits, family relations, and academic performance.

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Proportion of adolescents addicted to video games was 16%.

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Relationship between video game addiction and psychological distress was significant.

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Risk factors for distress included being female, fewer hours of sleep, and higher screen time.

"Internet Addiction": a Conceptual Minefield

With Internet connectivity and technological advancement increasing dramatically in recent years, “Internet addiction” (IA) is emerging as a global concern. However, the use of the term ‘addiction’ has been considered controversial, with debate surfacing as to whether IA merits classification as a psychiatric disorder as its own entity, or whether IA occurs in relation to specific online activities through manifestation of other underlying disorders. Additionally, the changing landscape of Internet mobility and the contextual variations Internet access can hold has further implications towards its conceptualisation and measurement. Without official recognition and agreement on the concept of IA, this can lead to difficulties in efficacy of diagnosis and treatment. This paper therefore provides a critical commentary on the numerous issues of the concept of “Internet addiction”, with implications for the efficacy of its measurement and diagnosticity.

Unconscious Processing of Facial Expressions in Individuals with Internet Gaming Disorder

Internet Gaming Disorder (IGD) is characterized by impairments in social communication and the avoidance of social contact. Facial expression processing is the basis of social communication. However, few studies have investigated how individuals with IGD process facial expressions, and whether they have deficits in emotional facial processing remains unclear. The aim of the present study was to explore these two issues by investigating the time course of emotional facial processing in individuals with IGD. A backward masking task was used to investigate the differences between individuals with IGD and normal controls (NC) in the processing of subliminally presented facial expressions (sad, happy, and neutral) with event-related potentials (ERPs). The behavioral results showed that individuals with IGD are slower than NC in response to both sad and neutral expressions in the sad–neutral context. The ERP results showed that individuals with IGD exhibit decreased amplitudes in ERP component N170 (an index of early face processing) in response to neutral expressions compared to happy expressions in the happy–neutral expressions context, which might be due to their expectancies for positive emotional content. The NC, on the other hand, exhibited comparable N170 amplitudes in response to both happy and neutral expressions in the happy–neutral expressions context, as well as sad and neutral expressions in the sad–neutral expressions context. Both individuals with IGD and NC showed comparable ERP amplitudes during the processing of sad expressions and neutral expressions. The present study revealed that individuals with IGD have different unconscious neutral facial processing patterns compared with normal individuals and suggested that individuals with IGD may expect more positive emotion in the happy–neutral expressions context.

Reciprocal Relationship between Internet Addiction and Network-Related Maladaptive Cognition among Chinese College Freshmen: A Longitudinal Cross-Lagged Analysis

This study explored the reciprocal relationship between Internet addiction (IA) and network-related maladaptive cognition (NMC) in Chinese college freshmen. A short-term longitudinal survey with a sample of 213 college freshmen was conducted in Shandong province, China. The results revealed that IA can significantly predict the generation and development of NMCs, and that when such maladaptive cognitions have been established, they can further adversely affect the extent of the students' IA. A vicious cycle was observed between these two variables, with IA having predictive priority in its relationship with NMC. This study also determined that the relationship between these two variables was the same for both males and females; therefore, the final model we established can be extensively applied to Chinese college freshmen, regardless of gender. Understanding the reciprocal relationship between these two variables can assist in interventions in IA at the outset of students' college life.

Not good enough? Further comments to the wording, meaning, and the conceptualization of Internet Gaming Disorder

In their commentary, Kuss, Griffiths, and Pontes (2016) criticize the use of the term "Internet" in the recently proposed diagnosis for Internet Gaming Disorder (IGD) and its use as one of the included diagnostic criteria. We agree with the exclusion of the term "Internet" in the diagnosis, but have some considerations to the comments regarding the nine criteria for IGD. Specifically, we discuss the meaning, the wording, and the importance of the criteria, as well as the importance of distress or functional impairment in the proposed diagnosis. We also address the possibility of categorizing IGD as a subtype of a general behavioral addiction diagnosis.

Chaos and confusion in DSM-5 diagnosis of Internet Gaming Disorder: Issues, concerns, and recommendations for clarity in the field

Background The umbrella term "Internet addiction" has been criticized for its lack of specificity given the heterogeneity of potentially problematic behaviors that can be engaged in online as well as different underlying etiological mechanisms. This has led to the naming of specific online addictions, the most notable being Internet Gaming Disorder (IGD). Methods Using the contemporary literature concerning IGD and cognate topics, issues and concerns relating to the concept of IGD are examined. Results Internet addiction and IGD are not the same, and distinguishing between the two is conceptually meaningful. Similarly, the diagnosis of IGD as proposed in the appendix of the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) remains vague regarding whether or not games need to be engaged in online, stating that IGD typically involves specific Internet games, but can also include offline games, adding to the lack of clarity. A number of authors have voiced concerns regarding the viability of including the word "Internet" in IGD, and instead proposed to use the term "video gaming disorder" or simply "gaming disorder," suggesting addiction to video gaming can also occur offline. Conclusion The DSM-5 has caused more confusion than clarity regarding the disorder, reflected by researchers in the field contesting a supposedly reached consensus for IGD diagnosis.

Internet gaming disorder: Inadequate diagnostic criteria wrapped in a constraining conceptual model

Background and aims The paper "Chaos and confusion in DSM-5 diagnosis of Internet Gaming Disorder: Issues, concerns, and recommendations for clarity in the field" by Kuss, Griffiths, and Pontes (in press) critically examines the DSM-5 diagnostic criteria for Internet gaming disorder (IGD) and addresses the issue of whether IGD should be reconceptualized as gaming disorder, regardless of whether video games are played online or offline. This commentary provides additional critical perspectives on the concept of IGD. Methods The focus of this commentary is on the addiction model on which the concept of IGD is based, the nature of the DSM-5 criteria for IGD, and the inclusion of withdrawal symptoms and tolerance as the diagnostic criteria for IGD. Results The addiction framework on which the DSM-5 concept of IGD is based is not without problems and represents only one of multiple theoretical approaches to problematic gaming. The polythetic, non-hierarchical DSM-5 diagnostic criteria for IGD make the concept of IGD unacceptably heterogeneous. There is no support for maintaining withdrawal symptoms and tolerance as the diagnostic criteria for IGD without their substantial revision. Conclusions The addiction model of IGD is constraining and does not contribute to a better understanding of the various patterns of problematic gaming. The corresponding diagnostic criteria need a thorough overhaul, which should be based on a model of problematic gaming that can accommodate its disparate aspects.

Attachment Style and Internet Addiction: An Online Survey

BACKGROUND

One of the clinically relevant problems of Internet use is the phenomenon of Internet addiction. Considering the fact that there is ample evidence for the relationship between attachment style and substance abuse, it stands to reason that attachment theory can also make an important contribution to the understanding of the pathogenesis of Internet addiction.

OBJECTIVE

The aim of this study was to examine people's tendency toward pathological Internet usage in relation to their attachment style.

METHODS

An online survey was conducted. Sociodemographic data, attachment style (Bielefeld questionnaire partnership expectations), symptoms of Internet addiction (scale for online addiction for adults), used Web-based services, and online relationship motives (Cyber Relationship Motive Scale, CRMS-D) were assessed. In order to confirm the findings, a study using the Rorschach test was also conducted.

RESULTS

In total, 245 subjects were recruited. Participants with insecure attachment style showed a higher tendency to pathological Internet usage compared with securely attached participants. An ambivalent attachment style was particularly associated with pathological Internet usage. Escapist and social-compensatory motives played an important role for insecurely attached subjects. However, there were no significant effects with respect to Web-based services and apps used. Results of the analysis of the Rorschach protocol with 16 subjects corroborated these results. Users with pathological Internet use frequently showed signs of infantile relationship structures in the context of social groups. This refers to the results of the Web-based survey, in which interpersonal relationships were the result of an insecure attachment style.

CONCLUSIONS

Pathological Internet use was a function of insecure attachment and limited interpersonal relationships.

Dissociable neural processes during risky decision-making in individuals with Internet-gaming disorder

Risk-taking is purported to be central to addictive behaviors. However, for Internet gaming disorder (IGD), a condition conceptualized as a behavioral addiction, the neural processes underlying impaired decision-making (risk evaluation and outcome processing) related to gains and losses have not been systematically investigated. Forty-one males with IGD and 27 healthy comparison (HC) male participants were recruited, and the cups task was used to identify neural processes associated with gain- and loss-related risk- and outcome-processing in IGD. During risk evaluation, the IGD group, compared to the HC participants, showed weaker modulation for experienced risk within the bilateral dorsolateral prefrontal cortex (DLPFC) (t = - 4.07; t = - 3.94; PFWE  < 0.05) and inferior parietal lobule (IPL) (t = - 4.08; t = - 4.08; PFWE  < 0.05) for potential losses. The modulation of the left DLPFC and bilateral IPL activation were negatively related to addiction severity within the IGD group (r = - 0.55; r = - 0.61; r = - 0.51; PFWE  < 0.05). During outcome processing, the IGD group presented greater responses for the experienced reward within the ventral striatum, ventromedial prefrontal cortex, and orbitofrontal cortex (OFC) (t = 5.04, PFWE  < 0.05) for potential gains, as compared to HC participants. Within the IGD group, the increased reward-related activity in the right OFC was positively associated with severity of IGD (r = 0.51, PFWE  < 0.05). These results provide a neurobiological foundation for decision-making deficits in individuals with IGD and suggest an imbalance between hypersensitivity for reward and weaker risk experience and self-control for loss. The findings suggest a biological mechanism for why individuals with IGD may persist in game-seeking behavior despite negative consequences, and treatment development strategies may focus on targeting these neural pathways in this population.

The Cognitive Psychopathology of Internet Gaming Disorder in Adolescence

Adolescents are known to be an at-risk population for developing Internet gaming disorder (IGD). A recent clinical model has proposed that adolescents with IGD may endorse a unique set of maladaptive beliefs that underlie persistent and excessive involvement in Internet gaming activities. These include (a) beliefs about game reward value and tangibility, (b) maladaptive and inflexible rules about gaming behaviour, (c) over-reliance on gaming to meet self-esteem needs, and (d) gaming as a method of gaining social acceptance. A sample of 824 adolescents (402 male and 422 female) were recruited from multiple secondary schools and administered a survey that included measures of IGD symptomatology, problematic Internet gaming cognition, and psychological distress. The results showed that adolescents with IGD report significantly more maladaptive gaming beliefs than adolescents without IGD, including those who play Internet games for more than 30 h per week. The size of observed effects were large. The strong association between gaming cognitions and IGD symptoms still held after controlling for measures of gaming activity and psychological distress. These findings indicate that adolescents with IGD have distinct problematic thoughts about gaming, and highlight the importance of addressing these cognitions in therapeutic interventions for the disorder.

Maladaptive cognitions predict changes in problematic gaming in highly-engaged adults: A 12-month longitudinal study

Understanding the role of maladaptive gaming-related cognitions may assist in screening and interventions for problematic gaming, including Internet gaming disorder (IGD). Cognitive-behavioural interventions that target specific cognitions related to gaming may be more effective than more general approaches that focus only on preoccupation with games. Although past research has identified cross-sectional associations between maladaptive cognitions and problematic gaming, it is less clear whether these cognitions can predict future changes in problematic gaming behaviour. The present study employed an 18-item measure of gaming cognition, assessing perfectionism, cognitive salience, regret, and behavioural salience, to investigate potential changes in problematic gaming over a 12-month period. The sample included 465 Australian adults (84% male, M_age=26.2years). It was found that individuals who became problematic gamers over 12months had higher baseline scores on perfectionism (d=1.20), cognitive salience (d=0.74) and regret (d=0.69) than those who remained non-problematic gamers. Problematic gamers who became non-problematic gamers had lower baseline perfectionism scores (d=0.62) than those who remained problematic gamers. Cognitive change accounted for an additional 28% of variance in problematic gaming scores beyond gender, age, and frequency of gaming. These findings suggest that maladaptive gaming-related cognitions could be screened in clinical trials to aid in case formulation and inform decisions on needed interventions to deliver optimal client outcomes.

Virtual addictions: An examination of problematic social casino game use among at-risk gamblers

The overlap of gaming and gambling activities within online digital technologies is of growing relevance to the study of technological addictions. Social casino games are immensely popular 'free to play' games that offer realistic emulation of financial gambling activities. Their structural similarities might suggest that engagement in social casino games may be particularly risky for people with existing gambling problems. Currently it is not known whether social casino games are used problematically by individuals who also experience problematic gambling, the extent of this overlap, the characteristics of those who experience problems with both activities, and the symptoms of problematic social casino game use they experience. An online survey was administered to Internet users (N=1554) to assess social casino game use and associated problems. This study examined a subsample of 176 adults who played social casino games and reported self-identified gambling problems. The results indicated that a greater frequency and diversity of social casino game playing and more frequent and larger expenditure on social casino games was significantly positively associated with symptom severity of problematic social casino game use. Gamblers who were younger, less educated, spoke a non-English language, and with higher psychological distress, were more likely to report greater problems. Playing social casino games to escape or relieve a negative mood was the most commonly reported symptom. These findings suggest that some problem gamblers may also be at risk of problematic engagement in online gambling activities that lack financial incentives. Gamblers' concurrent engagement in social casino games therefore warrants further consideration in gambling research studies and clinical practice settings.

Impaired Feedback Processing for Symbolic Reward in Individuals with Internet Game Overuse

Reward processing, which plays a critical role in adaptive behavior, is impaired in addiction disorders, which are accompanied by functional abnormalities in brain reward circuits. Internet gaming disorder, like substance addiction, is thought to be associated with impaired reward processing, but little is known about how it affects learning, especially when feedback is conveyed by less-salient motivational events. Here, using both monetary (±500 KRW) and symbolic (Chinese characters "right" or "wrong") rewards and penalties, we investigated whether behavioral performance and feedback-related neural responses are altered in Internet game overuse (IGO) group. Using functional MRI, brain responses for these two types of reward/penalty feedback were compared between young males with problems of IGO (IGOs, n = 18, mean age = 22.2 ± 2.0 years) and age-matched control subjects (Controls, n = 20, mean age = 21.2 ± 2.1) during a visuomotor association task where associations were learned between English letters and one of four responses. No group difference was found in adjustment of error responses following the penalty or in brain responses to penalty, for either monetary or symbolic penalties. The IGO individuals, however, were more likely to fail to choose the response previously reinforced by symbolic (but not monetary) reward. A whole brain two-way ANOVA analysis for reward revealed reduced activations in the IGO group in the rostral anterior cingulate cortex/ventromedial prefrontal cortex (vmPFC) in response to both reward types, suggesting impaired reward processing. However, the responses to reward in the inferior parietal region and medial orbitofrontal cortex/vmPFC were affected by the types of reward in the IGO group. Unlike the control group, in the IGO group the reward response was reduced only for symbolic reward, suggesting lower attentional and value processing specific to symbolic reward. Furthermore, the more severe the Internet gaming overuse symptoms in the IGO group, the greater the activations of the ventral striatum for monetary relative to symbolic reward. These findings suggest that IGO is associated with bias toward motivationally salient reward, which would lead to poor goal-directed behavior in everyday life.

Integrating psychological and neurobiological considerations regarding the development and maintenance of specific Internet-use disorders: An Interaction of Person-Affect-Cognition-Execution (I-PACE) model

Within the last two decades, many studies have addressed the clinical phenomenon of Internet-use disorders, with a particular focus on Internet-gaming disorder. Based on previous theoretical considerations and empirical findings, we suggest an Interaction of Person-Affect-Cognition-Execution (I-PACE) model of specific Internet-use disorders. The I-PACE model is a theoretical framework for the processes underlying the development and maintenance of an addictive use of certain Internet applications or sites promoting gaming, gambling, pornography viewing, shopping, or communication. The model is composed as a process model. Specific Internet-use disorders are considered to be the consequence of interactions between predisposing factors, such as neurobiological and psychological constitutions, moderators, such as coping styles and Internet-related cognitive biases, and mediators, such as affective and cognitive responses to situational triggers in combination with reduced executive functioning. Conditioning processes may strengthen these associations within an addiction process. Although the hypotheses regarding the mechanisms underlying the development and maintenance of specific Internet-use disorders, summarized in the I-PACE model, must be further tested empirically, implications for treatment interventions are suggested.

Gaming behavior and addiction among Hong Kong adolescents

Objectives

Game playing is very popular among Hong Kong teenagers. This study aimed to investigate adolescent gaming behavior and addiction at the Internet cafe, and to explore perceived benefits and harms associated with the activity.

Methods

A convenient sample of 13 male high school students aged 12–15 years (mean age = 13.6 years) were interviewed at two Internet cafes. Young’s (Caught in the net, Wiley, New York, 1998) criteria of Internet addiction were modified to assess gaming addiction.

Results

Internet cafes were described as a safe and ideal rendezvous for gamers. The benefits of gaming included fun and satisfaction, fostering social support and teamwork, meeting new friends and becoming sociable, boosting cognitive techniques and intellectual agility, improved responsiveness and quick thinking. Perceived harms of gaming addiction were reduced time and interest in other important activities, poor academic performance, physical harms and emotional distress, disrupted friendship with non-gaming peers, risked family relationship and financial problems. Five interviewees (38.5 %) could be categorized as pathological gamers and two were problem gamers (15.4 %). The psychological factors associated with gaming addiction include low self-esteem, a strong desire for aggressive and exciting experiences, reliance on gaming to kill time and to obtain satisfaction, coping with problems and negative emotions, and obsession with achieving higher rankings in games. The social and environmental risk factors are accessibility to the Internet cafés, aggressive promotional activities at the Internet cafes, peer pressure, family influence and early gaming experiences, perceived parental approval, lack of parental supervision, and poor family relationship.

Conclusions

The study results throw light on prevention programs.