Neurobiological correlates of internet gaming disorder: Similarities to pathological gambling

A meta-review of screening and treatment of electronic "addictions"

Concerns surrounding electronic addictions, an umbrella term including any clinically significant technology-based addictive problem, have increased as technology has advanced. Although researchers and clinicians have observed detrimental effects associated with excessive technology use, there is no agreed-on definition or set of criteria for these problems. The lack of a consistent understanding of electronic addictions has led to a lack of consistency in both assessment and treatment studies, precluding strong recommendations for effective screening and clinical intervention. This meta-review integrates findings from 22 systematic reviews and meta-analyses of electronic addictions to determine which measures and interventions may effectively measure and treat electronic addictions. We conducted a meta-review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Findings suggest that although some measures may have good internal consistency and reliability among college students, there was a general lack of consistency in how measures were used across studies, making comparison difficult. Psychological and exercise-based interventions were shown to reduce symptoms of electronic addictions short-term, but no treatment was superior to others in overall symptom reduction. Most included reviews raise serious concerns about the lack of consensus on what constitutes an electronic addiction. Consequently, it was not possible to draw conclusions about the overall efficacy of any measurement tools or interventions. We provide suggestions for next steps to establish the phenomenology of electronic addictions before additional research on assessment and intervention is conducted.

Outcome assessment of different reward stimuli in Internet gaming disorder by event-related potentials

An imbalance in sensitivity to different types of reward stimuli may be an important cause of addiction that is mainly manifested in high sensitivity to addictive substance rewards and blunting of natural rewards. However, contradictions remain in the research results on the sensitivity of individuals with Internet gaming disorder (IGD) to different reward stimuli. Based on participants' neural responses to win and loss feedback (in door task), the event-related potential (ERP) technique was used to investigate the effects of different types of reward stimuli on the assessment of reward-processing outcomes in individuals with IGD. The results showed that in the gain condition, the FB-P3 amplitude induced by game stimuli in the IGD group was significantly higher than that in the control group, and the FN amplitude induced by money stimuli was significantly lower than that in the control group. However, the FB-P3 and FN amplitudes induced by food were not significantly different from those in the control group. In the loss condition, there were no between-group differences in the FB-P3 and FN amplitudes evoked by the three reward stimuli. This indicates that the IGD group showed increased hedonic responses to game stimuli and decreased hedonic responses to money but no differences in hedonic responses to food during the reward assessment phase. Therefore, heightened sensitivity to game rewards and diminished sensitivity to monetary rewards during outcome assessment may play a crucial role in the development of IGD.

Problematic Gaming and Gambling: A Systematic Review of Task-Specific EEG Protocols

Even though gaming and gambling bear similar problematic behavioral aspects, there are no recognizable neurophysiological biomarkers or features characterizing and/or distinguishing these conditions. A systematic review of the literature with a focus on methods was performed in PubMed, Scopus, Web of Science (Web of Science Core Collection), EBSCOhost Research Databases (APA PsycINFO; APA PsycArticles; OpenDissertations; ERIC) databases. Following search terms were used to search the databases: ERP, "event related potential*", EP, "evoked potential*", SS, "steady state", EEG, electroencephal*; gam*. Data about the participants (total number, gender, age), main aim of the study and information about the experimental setup (experimental task description, stimuli used, ERPs measured (latency windows and placement of the electrodes), process evaluated) was extracted. A total of 24 studies were revised (problematic gaming - 16, pathological gambling - 8). The experimental protocols could be grouped into 3 main target domains (Cue-reactivity, General Information processing and Reward Processes & Risk Assessment). Sample-related limitations (small sample sizes, gender differences, differences between the groups regarding potential confounding variables) and heterogeneity regarding the experimental tasks, implementation and interpretation reviewed. Gambling-related research is highly focused on the investigation of the reward-related processes, whereas gaming-related research is mostly focused on the altered aspects of more general information processing. A vast heterogeneity regarding the ERP experimental paradigms being used and lack of clear guidelines and standardized procedures prevents identification of measures capable to reliably discriminate or characterize the population susceptible to addictive behavior or being able to diagnose and monitor these disorders.

The functional connectivity between right parahippocampal gyrus and precuneus underlying the association between reward sensitivity and procrastination

Procrastination has adverse effects on personal growth and social development. Behavior research has found reward sensitivity is positively correlated with procrastination. However, it remains unclear that the neural substrates underlie the relationship between reward sensitivity and procrastination. To address this issue, the present study used voxel-based morphometry (VBM) and resting-state functional connectivity (RSFC) analyses to investigate the neural substrates underlying the association with reward sensitivity and procrastination in two independent samples (N1 = 388, N2 = 330). In Sample 1, the behavioral result indicated reward sensitivity was positively correlated with procrastination. Moreover, the VBM analysis showed that reward sensitivity was positively associated with the gray matter volume (GMV) of the right parahippocampal gyrus. Furthermore, the RSFC result found reward sensitivity was negatively associated with the functional connectivity of the right parahippocampal gyrus-precuneus. Crucially, the mediation analysis revealed that functional connectivity of the right parahippocampal gyrus-precuneus mediated the relationship between reward sensitivity and procrastination. To verify the robustness of the results, confirmatory analysis was carried out in Sample 2. The results of Sample 1 (i.e., the behavioral, VBM, RSFC, and mediation results) can be verified in Sample 2. In brief, these findings suggested that the functional connectivity of the right parahippocampal gyrus-precuneus involved in reward impulsive control could modulate the relationship between reward sensitivity and procrastination, which is the first to reveal the neural underpinning of the association between reward sensitivity and procrastination.

The epidemiology and effects of video game addiction: A systematic review and meta-analysis

With the increasing popularity and accessibility of video games, the public concern about their effects - positive and negative - has also increased. In this regard, this systematic review sought to identify and thematically analyze recent studies (in the last five years) and report on video games' epidemiological characteristics and outcomes. A systematic database search was done on ScienceDirect, APA PsycINFO, Emerald, and Scopus databases for articles published from January 1, 2017, to April 1, 2022. The Meta XL software - an add-in for Microsoft Excel - was used to calculate the pooled prevalence level of video game addiction. The database search yielded a total of 693 non-duplicate articles. After applying the inclusion and exclusion criteria, 27 articles were selected to be included in the systematic review. Along with this, 12 articles were considered for the final meta-analysis. The pooled prevalence level of gaming addiction was 5.0 % (95 % CI, 2.1-8.8 %). The I2 value was 99.297 with a p-value of 0.000. The factors that accompanied addictive video gaming were psychological, social, and personal. An addictive gaming behavior was characterized by spending an above-average time on gaming, doing most of the gaming online, and gaming activities interfering with sleep patterns. Some predictors of addictive gaming were emotional dependence, social detachment, increased gaming time, preference for playing online than offline, and increased emotional and psychological stress. Engaging in addictive gaming led to adverse outcomes such as lower academic scores, depression, and anxiety, as well as decreased self-esteem, life satisfaction, and social support. From the collected findings it could be concluded that extreme playing of video games can be classified as addictive. Following the identification of risk factors, appropriate corrective or interventional measures should be developed and applied coherently to newer statistical data.

Effects of internet addiction and academic satisfaction on mental health among college students after the lifting of COVID-19 restrictions in China

Background

Internet addiction (IA) among students, worsened by Coronavirus disease 2019 (COVID-19) pandemic, has become a social problem with the digitalization of school learning and many aspects of daily life. However, few studies on IA have been conducted among students after the lifting of COVID-19 restrictions in China.

Method

This large-sample, cross-sectional, online survey was conducted to explore the characteristics of IA and the association among IA, academic satisfaction, and mental health problems from December 14, 2022 to February 28, 2023 in Sichuan, China. All participants (N = 22,605) were students in colleges and universities, recruited via their teachers and professors.

Results

Of all the participants, 14,921 (66.0%) participants had IA. Participants with IA were more likely to have depression symptom, anxiety symptom, insomnia, and lifetime suicidal ideation. In addition, participants with severe IA had significantly higher rates of mental health problems (e.g., depression, anxiety, insomnia, and suicidal ideation) than those with mild IA. A significant IA-by-academic satisfactory-interaction on mental health was identified: participants with higher level of IA showed particularly severe symptom of depression, anxiety and insomnia when affected by low satisfactory of academy (p < 0.001).

Conclusion

This study reveals that IA has a significantly negative impact on mental health among college students after the lifting of COVID-19 restrictions in China. IA and academic satisfaction have interactive impacts on mental health problems among students. Further educational and health policies and psychosocial interventions should be developed to reduce IA and enhance academic satisfaction for improving students' mental health.

Neuroimaging correlates of internet gaming disorder: Can we achieve the promise of translating understandings of brain functioning into clinical advances?

Objectives

Here we aimed to consider the neural factors associated with internet gaming disorder (IGD), as well as the associations between these factors and existing treatments for the disorder.

Methods

A narrative review was conducted.

Results

Pharmacological as well as psychological treatments for IGD may be associated with specific changes in multiple brain areas and circuits. In particular, fronto-striatal and subcortical regions and pathways appear relevant to IGD and its treatment.

Conclusions

Neuroimaging holds promise for identifying specific mechanisms underlying IGD interventions. However, to date, firm conclusions are difficult to draw and more research examining neural mechanisms of empirically supported treatments for IGD is needed.

Biopsychosocial factors of gaming disorder: a systematic review employing screening tools with well-defined psychometric properties

Background and aims

Considering the growing number of gamers worldwide and increasing public concerns regarding the negative consequences of problematic gaming, the aim of the present systematic review was to provide a comprehensive overview of gaming disorder (GD) by identifying empirical studies that investigate biological, psychological, and social factors of GD using screening tools with well-defined psychometric properties.

Materials and methods

A systematic literature search was conducted through PsycINFO, PubMed, RISS, and KISS, and papers published up to January 2022 were included. Studies were screened based on the GD diagnostic tool usage, and only five scales with well-established psychometric properties were included. A total of 93 studies were included in the synthesis, and the results were classified into three groups based on biological, psychological, and social factors.

Results

Biological factors (n = 8) included reward, self-concept, brain structure, and functional connectivity. Psychological factors (n = 67) included psychiatric symptoms, psychological health, emotion regulation, personality traits, and other dimensions. Social factors (n = 29) included family, social interaction, culture, school, and social support.

Discussion

When the excess amount of assessment tools with varying psychometric properties were controlled for, mixed results were observed with regards to impulsivity, social relations, and family-related factors, and some domains suffered from a lack of study results to confirm any relevant patterns.

Conclusion

More longitudinal and neurobiological studies, consensus on a diagnostic tool with well-defined psychometric properties, and an in-depth understanding of gaming-related factors should be established to settle the debate regarding psychometric weaknesses of the current diagnostic system and for GD to gain greater legitimacy in the field of behavioral addiction.

Stigmatizing attitudes toward Internet gaming disorder, Problematic smartphone use and Problematic social networking site use: An experimental vignette study

Public stigma on substance and gambling disorders have been well documented. Negative effects of stigma include shame, embarrassment, fear being judged and the determent of help-seeking behaviors among stigmatized individuals. Less is known about the public perception toward Internet gaming disorder (IGD) and other widespread problematic behaviors that share some characteristics with established behavioral addictions, such as Problematic smartphone use (PSU) and Problematic social networking sites use (PSNSU). The purpose of this study is to compare the public perception of problematic Internet gamers, problematic smartphone users and problematic social networking sites users using an experimental within-group vignette study design. A sample of 280 adults (F = 72.1%; M_age = 32.84, SD = 13.85) was recruited and completed the study online. Participants were presented with male OR female vignettes (i.e. the gender of the target in the vignette was randomized) describing an individual with IGD, PSU, and PSNSU. A repeated-measures ANOVA followed by post hoc tests using Bonferroni's correction was used. IGD was seen as more serious, more noticeable, and less understandable than both PSU and PSNU. Moreover, participants' emotional reaction (e.g., anger and sadness) and desired social distance were significantly stronger toward IGD. However, vanity attributions were higher for individuals with PSNSU, which were also more blamed compared to both IGD and PSU. PSU was seen as more controllable than both IGD and PSNSU. The results, taken together, suggest that IGD is perceived as more inherently problematic, but PSNSU also seem to deserve scientific attention as individuals showing symptoms of PSNSU are blamed more than problematic Internet gamers. Our findings provide initial information that can be used when developing interventions to impact stigma toward technological addictions.

Personality traits and their role as risk modifiers in gaming disorder and internet use disorders

PURPOSE OF REVIEW

After its initial recognition in the DSM-5, Gaming Disorder has now officially been included as a mental disorder in the ICD-11 as a behavioral addiction. In the past decades, research on this phenomenon has increased and in particular theories on its etiopathology have been suggested. In that respect, underlying factors, including neurobiological, social, and psychological factors, have been described. One commonly discussed etiological factor is supposed in specific personality traits. Knowing more about underlying personality factors of Gaming Disorder and other subtypes of internet use disorders would allow for a construction of more sophisticated etiological models, tailored prevention approaches, and would affect the specificity of treatment strategies. This overview provides information on current research on the role of the Big Five personality traits in Gaming Disorder as potential risk modifiers and maintaining factors.

RECENT FINDINGS

Research has especially identified high neuroticism and low conscientiousness as correlates of Gaming Disorder. Yet, results based on prospective studies are lacking largely, although there is the first evidence that personality traits might not only act as risk modifying factors but could also be influenced by Gaming Disorder.

SUMMARY

Suggestions for future research and the need for a more pronounced perspective taking into account the changing dynamics of personality are presented in this contribution. Addressing personality traits in treatment programs could be a promising approach in preventing patients from premature treatment termination and later relapse.

Attentional biases and daily game craving dynamics: An ecological momentary assessment study

BACKGROUND AND AIMS

Theories posit that the combination of external (e.g. cue exposure) and internal (e.g. attention biases) factors contributes to the development of game craving. Nevertheless, whether different components of attentional biases (namely, engagement bias and disengagement bias) play separate roles on game craving has not been fully elucidated. We aimed to examine the associations between two facets of attentional biases and game craving dynamics under a daily life setting.

METHODS

Participants (110 regular internet game players) accomplished the modified attentional assessment task in the laboratory, after which they entered a 10-day ecological momentary assessment (EMA) to collect data on their momentary game craving and occurrence of game-related events at five different time points per day.

RESULTS

We found that occurrence of game-related events was significantly associated with increased game craving. Moreover, attentional disengagement bias, instead of engagement bias, bore on the occasional level variations of game craving as moderating variables. Specifically, attentional disengagement bias, not engagement bias, was associated with a greater increase in game craving immediately after encountering a game-related event; however, neither attentional engagement bias nor disengagement bias was associated with the craving maintenance after a relatively long period.

DISCUSSION AND CONCLUSIONS

The present study highlights the specific attentional processes involved in game craving dynamics, which could be crucial for designing interventions for attentional bias modification (ABM) in Internet Gaming Disorder (IGD) populations.

Escapism and Excessive Online Behaviors: A Three-Wave Longitudinal Study in Finland during the COVID-19 Pandemic

Excessive online behaviors refer to harmful or disproportionate use of digital network applications. Such behaviors are likely to be associated with escapist motives. Our aim was to analyze whether escapism predicts excessive gambling, excessive gaming, and excessive internet use over time. A longitudinal sample of Finnish residents aged 18-75 years (n = 1022, 51.27% male) was surveyed at three time points during the COVID-19 pandemic in 6-month intervals: April 2021 (Time 1), October-November 2021 (Time 2), and April-May 2022 (Time 3). Of the original Time 1 respondents, 66.80% took part in the surveys at both Time 2 and Time 3. All surveys included measures for excessive gambling (Problem Gambling Severity Index), excessive gaming (Internet Gaming Disorder Test), and excessive internet use (Compulsive Internet Use Scale). Three escapism-specific questions were used to construct a dedicated escapism variable. Socio-demographic variables, alcohol consumption, and psychological distress were used as controls. The study was conducted with multilevel regression analyses using hybrid models. Our research showed that escapism had strong within-person effects on excessive gambling, B = 0.18, p = 0.003; excessive gaming, B = 0.50, p < 0.001; and excessive internet use, B = 0.77, p < 0.001 over time. The between-person effect of escapism was demonstrated on excessive gaming B = 0.91, p < 0.001, and excessive internet use B = 0.61, p = 0.036. Adverse societal events and uncertain times can manifest in excessive online behaviors motivated by escapism, highlighting a need to focus prevention efforts on healthy coping methods.

Sex differences in neural substrates of risk taking: Implications for sex-specific vulnerabilities to internet gaming disorder

BACKGROUND AND AIMS

Sex differences in internet gaming disorder (IGD) remain unknown. Investigating sex-specific neural features that underlie the core risk factor (i.e., risk-taking) of IGD would help in understanding sex-specific vulnerabilities to IGD and advance sex-specific treatments and prevention for IGD.

METHODS

111 participants (28 IGD males, 27 IGD females, 26 recreational game user (RGU) males, 30 RGU females) completed a probability discounting task during fMRI scanning.

RESULTS

First, among RGUs, males showed a higher risk-taking tendency and greater neural activation associated with risk/value evaluation for reward (the ventromedial prefrontal cortex (vmPFC), anterior cingulate cortex (ACC), left putamen) and smaller activation associated with cognitive control (the inferior frontal gyrus) than females during the contrast of risky-safe choices. Moreover, males showed a greater modulatory effect of risky choices on the connection from the vmPFC/ACC to the left putamen than females. Second, IGD males showed decreased activation in the vmPFC/ACC and left putamen compared to RGU males, whereas this decrease did not exist in IGD females.

DISCUSSION

Males show a higher risk-taking tendency than females. Altered neural substrates associated with risky decision-making exist in IGD males but not in IGD females.

CONCLUSIONS

The present findings fill the gap in information on the behavioral and neural substrates underlying IGD among females and demonstrate that a high risk-taking tendency is a risk factor and core symptom only in IGD males but not in IGD females. It is necessary to design and adopt distinct treatments and prevention strategies for IGD in males and females.

Do Individuals with Internet Gaming Disorder Share Personality Traits with Substance-Dependent Individuals?

(1) Background: Internet gaming disorder (IGD) shares many similarities with substance use disorder (SUD), contributing to its recognition as an addictive disorder. Nevertheless, no study has compared IGD to other addictive disorders in terms of personality traits established as highly co-occurring with SUDs. (2) Methods: We recruited a sample of gamers (massively multiplayer online role-playing games) (MMORPGs) via online in-game forums. We compared 83 individuals with IGD (MMORPG-IGD group) to 47 former heroin addicts under methadone maintenance treatment (MMT; MMT group) with regard to alexithymia, impulsivity, sensation seeking and aggressiveness assessed through self-administered scales, being TAS-20, BIS-10, Z-SSS and BDHI, respectively. (3) Results: Our results draw a relatively similar personality profile between groups but indicate that the subject traits are generally more pronounced in the MMT cohort. The overall lesser intensity of these traits in the MMORPG-IGD group might reflect the greater variability in the severity of the IGD. (4) Conclusions: IGD shares personality traits with MMT, and intensity may be influenced by the severity of the addiction or by certain direct environmental factors, and might also influence the propensity towards one behavior rather than another.

Predictors of Gaming Disorder or Protective from It, in a French Sample: A Symptomatic Approach to Self-Regulation and Pursued Rewards, Providing Insights for Clinical Practice

Gaming disorder (GD) is a new health condition still requiring a lot of evidence established around its underlying and related psychological mechanisms. In our study we focused on Massively Multiplayer Online Role Playing Games (MMORPGs), a specific very popular and engaging game genre, to determine that benefit, motivation and control aspects could be predictive of a dysfunctional engagement in gaming. In total, 313 participants were recruited from private forums of gamers between May 2009 and March 2010. They filled out a questionnaire on their socio-demographic data and their weekly gaming time. They also completed different psychometric assessments such as the DSM IV-TR criteria for substance dependence adapted to gaming such as the Dependence Adapted Scale (DAS), the external rewards they expected from gaming (External Motives), the expected internal reward they expected from gaming (Internal Motives), the Zuckerman Sensation Seeking Scale (ZSSS), and the Barratt impulsiveness Scale (BIS-10). Results showed that some psychological factors related to online gaming represented risk factors for GD in participants (i.e., competition and advancement motives, reduced anxiety, solace, greater personal satisfaction, and sense of power), whereas some others were found to be protective factors from GD (i.e., recreation, enjoyment and experience seeking) in participants. Additionally, the study found that disinhibition, boredom susceptibility, thrill and adventure seeking, and high impulsivity were correlated to GD in participants. In conclusion, not only motives for gaming and impulsivity could be predictors for GD, but maladaptive coping strategies based on experienced relief in-game from negative feelings (anxiety and boredom) or experienced improvement in-game of self-perception (personal satisfaction, sense of power) could play as well a role of negative reinforcers for GD. Some benefits from gaming, typically entertainment and enjoyment, are shown to be protective factors from GD, playing the role of positive reinforcing factors. They are worthy of being identified and promoted as functional gaming habits. These findings can feed the clinical and health promotion fields, with a more in-depth understanding of diverse psychological factors in gamers, identifying those at risk for GD and those protective from it. The current work can foster a more balanced approach towards gaming activities, taking their opportunities for mankind and controlling for their adverse effects in some individuals.

Novel approaches for treating Internet Gaming Disorder: A review of technology-based interventions

Internet Gaming Disorder (IGD) has become a significant issue in mental healthcare over the past decades as the number of people engaging in excessive and unhealthy gaming increases with each year. Despite its inclusion in the 5th Edition of Diagnostic Statistical Manual and the development of a number of treatment methods that have been designed and tested for IGD, treatment remains a challenge. This review attempts to give an overview of the current state of IGD and its treatment with a specific focus on the potential of technology-based solutions, such as web-based programs, mobile applications, and virtual reality. The review also highlights the need for additional work in the area of treatment development for IGD and the preliminary evidence for the usefulness and importance of technology-based treatment methods which offer unique advantages, such as accessibility, scalability, and cost-effectiveness, over other existing treatment options.

Prefrontal cortical activation in Internet Gaming Disorder Scale high scorers during actual real-time internet gaming: A preliminary study using fNIRS

Background

Observation of real-time neural characteristics during gameplay would provide distinct evidence for discriminating the currently controversial diagnosis of internet gaming disorder (IGD), and elucidate neural mechanisms that may be involved in addiction. We aimed to provide preliminary findings on possible neural features of IGD during real-time internet gaming using functional near-infrared spectroscopy (fNIRS).

Methods

Prefrontal cortical activations accompanying positive and negative in-game events were investigated. Positive events: (1) participant's champion slays or assists in slaying an opponent without being slain. (2) the opposing team's nexus is destroyed. Negative events: (1) participant's champion is slain without slaying or assisting in slaying any opponent. (2) the team's nexus is destroyed. Collected data were compared between the IGD group and control group, each with 15 participants.

Results

The IGD group scored significantly higher than the CTRL group on the craving scale. Following positive events, the IGD group displayed significantly stronger activation in the DLPFC. Following negative events, the IGD group displayed significantly weaker activation in the lateral OFC.

Discussion and Conclusions

Individuals scoring high on the IGD scale may crave for more internet gaming after encountering desired events during the game. Such observations are supported by the correlation between the craving scale and DLPFC activation. The IGD group may also show diminished punishment sensitivity to negative in-game experiences rendering them to continue playing the game. The present study provides preliminary evidence that IGD may demonstrate neural characteristics observed in other addictive disorders and suggests the use of fNIRS in behavioral addiction studies.

Moderating Effects of Depressive Symptoms and Self-Control Trait on the Association Between Problematic Internet Gaming and Time Spent

This study was performed to examine whether depressive symptoms (DPs) and low self-control (LSC) traits has modifying effects on the association of time spent on Internet gaming and problematic Internet game use (PIGU). Among 1,535 middle school students, 42.1 percent reported playing ≥1.5 hours of Internet games/day on average, and 10.0 percent were classified as PIGU. Stratified multiple logistic regression analysis showed gameplay of ≥1.5 hours/day led to more PIGU in the non-LSC traits group (higher DP group, p < 0.001; lower group, p = 0.019). In LSC trait group, in contrast, time spent on Internet gamine was not associated with PIGU regardless of the level of DP. Adolescents without LSC traits, to which most youths belong, might have higher possibility of PIGU if they do not limit their time spent on Internet gaming, regardless of whether they are depressed or not. In case of LSC trait, additional strategies would be needed. ClinicalTrials.gov identifier: NCT02415322.

Factors related to the dual condition of gambling and gaming disorders: A path analysis model

BACKGROUND AND AIMS

Gaming disorder has experienced rapid growth in the last decade among youth and adult populations, in parallel to the expansion of the videogame industry. The objective of this study was to explore the underlying process to explain the dual diagnosis of gaming with gambling disorder.

METHODS

The sample included n = 117 patients who met clinical criteria for gaming disorder, recruited from a tertiary care unit specialized in the treatment of behavioral addictions. Path analysis (implemented through structural equation modeling) assessed the direct and mediational mechanisms between the dual condition of gaming + gambling disorder and sociodemographic variables and personality traits.

RESULTS

The comorbid gaming + gambling disorder was met for 14.5% of the participants (additionally, 6.0% of the sample also met criteria for problematic gambling). The dual diagnosis was directly related to an older age at onset of the addiction problems, a higher level of the novelty seeking trait and being in active work. Employment status also mediated the relationship between persistence levels and chronological age. Greater psychopathological distress was related to females, higher levels of harm avoidance and persistence and lower levels of self-directedness.

CONCLUSIONS

The results of this study provide empirical evidence for the specific factors that increase the likelihood of the dual gaming + gambling disorder. Clinical settings should consider these features to improve gaming diagnosis and treatment. Preventive programs should also be focused on the most vulnerable groups to prevent onset and progression of this comorbid condition.

Reliability, and Convergent and Discriminant Validity of Gaming Disorder Scales: A Meta-Analysis

Background: An association between gaming disorder (GD) and the symptoms of common mental disorders is unraveled yet. In this preregistered study, we quantitatively synthesized reliability, convergent and discriminant validity of GD scales to examine association between GD and other constructs. Methods: Five representative GD instruments (GAS-7, AICA, IGDT-10, Lemmens IGD-9, and IGDS9-SF) were chosen based on recommendations by the previous systematic review study to conduct correlation meta-analyses and reliability generalization. A systematic literature search was conducted through Pubmed, Proquest, Embase, and Google Scholar to identify studies that reported information on either reliability or correlation with related variables. 2,124 studies were full-text assessed as of October 2020, and 184 were quantitatively synthesized. Conventional Hedges two-level meta-analytic method was utilized. Results: The result of reliability generalization reported a mean coefficient alpha of 0.86 (95% CI = 0.85-0.87) and a mean test-retest estimate of 0.86 (95% CI = 0.81-0.89). Estimated effect sizes of correlation between GD and the variables were as follows: 0.33 with depression (k = 45; number of effect sizes), 0.29 with anxiety (k = 37), 0.30 with aggression (k = 19), -0.22 with quality of life (k = 18), 0.29 with loneliness (k = 18), 0.56 with internet addiction (k = 20), and 0.40 with game playtime (k = 53), respectively. The result of moderator analyses, funnel and forest plots, and publication bias analyses were also presented. Discussion and Conclusion: All five GD instruments have good internal consistency and test-retest reliability. Relatively few studies reported the test-retest reliability. The result of correlation meta-analysis revealed that GD scores were only moderately associated with game playtime. Common psychological problems such as depression and anxiety were found to have a slightly smaller association with GD than the gaming behavior. GD scores were strongly correlated with internet addiction. Further studies should adopt a rigorous methodological procedure to unravel the bidirectional relationship between GD and other psychopathologies. Limitations: The current study did not include gray literature. The representativeness of the five tools included in the current study could be questioned. High heterogeneity is another limitation of the study. Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42020219781].

Impact of the COVID-19 lockdown on screen media use in patients referred for ADHD to child and adolescent psychiatry: an introduction to problematic use of the internet in ADHD and results of a survey

The COVID-19 outbreak and lockdown have been associated with multiple consequences for mental health, including an excessive and potentially harmful increase in screen media use. The specific consequences for children, adolescents and young adults with ADHD are still unknown. In the first part of this study, a short review of problematic use of the internet (PUI) in ADHD is presented, showing that patients with ADHD are at risk for different aspects of PUI, such as excessive gaming or problematic social media use. In the second part, we report original data of an online survey on screen media use before, during and after the lockdown completed by parents of children and adolescents clinically referred for ADHD. Parents rated children's/adolescents' media-related behavior and media time on a new screening questionnaire for PUI. Each item was rated three times, referring to the observed behavior before, during and 1-2 months after the lockdown. N = 126 parents of patients referred for ADHD aged 10-18 years participated in the study. Total media time increased by 46% during the lockdown and did not completely return to pre-Corona levels afterwards. Patients with difficulties concentrating, high irritability or deterioration of ADHD problems under lockdown spent more time with screen media than those with milder or no such problems. While the effects of the lockdown on screen media use and its negative impact on everyday life appear to be largely reversible, a small proportion of patients with ADHD apparently continue to show increased media use.

Gaming among Children and Adolescents during the COVID-19 Lockdown: The Role of Parents in Time Spent on Video Games and Gaming Disorder Symptoms

It is mainly children and adolescents who are involved in video gaming. The lockdown caused by the COVID-19 pandemic may have further increased their use of video games and, consequently, the risk of gaming disorder (GD) symptoms. However, currently, we do not have exhaustive knowledge of this issue. To fill this gap, the current study aims to analyze video gaming habits in children and adolescents during the lockdown, starting in March 2020 in Italy, the first European country affected by the pandemic. Specifically, we aim to understand how variables related to parents—for instance, knowledge of their offspring’s life, the monitoring of their video gaming habits, and parental use of video games—are related to their offspring’s time spent on video games and GD symptoms. A web-based survey involving parents (n = 554, 79% mothers, mean age = 45.39) of 554 children and adolescents (73% males, mean age = 11.11) was utilized. The results showed that they were involved in video games, particularly boys and adolescents, with high rates of GD symptoms. The parents also spent a considerable amount of time playing video games. A path model that explained the mechanisms through which parental variables were related to their offspring’s time spent on video games and GD symptoms, controlling for gender and age, was verified. Overall, the findings indicate the importance of educating parents to behave effectively with respect to video games and monitor their offspring’s video gaming habits.

Suchtartiges Arbeiten: Persönlichkeitsfaktoren und berufliche Rahmenbedingungen

Zusammenfassung. Fragestellung: Suchtartiges Arbeiten stellt ein ernst zu nehmendes Problem in unserer Gesellschaft dar. In dieser Studie wird der Frage nachgegangen, welche Rolle berufliche Rahmenbedingungen (Entgrenzung der Arbeit) und Persönlichkeitsfaktoren (Big Five) bei suchtartigem Arbeiten spielen. Methode: 111 Erwerbstätige im Alter von 19 bis 66 Jahren beantworteten online den Persönlichkeitstest Big Five Inventory-SOEP, den Fragebogen zur Erfassung zentraler Merkmale der Arbeit 4.0 und die Skala zur Erfassung von Arbeitssucht. Die statistischen Auswertungen (Korrelationsanalysen, moderierte Regressionsanalyse) erfolgten mittels „R“ und „PSPP“. Ergebnisse: Suchtartiges Arbeiten korreliert signifikant mit Entgrenzung (r = .208), Neurotizismus (r = .356) und dem Alter der Probanden (r = -.321). Alle drei Prädiktoren zusammen erklären insgesamt 29 Prozent der Varianz von suchtartigem Arbeiten. Es konnte kein moderierender Effekt der Variablen Entgrenzung der Arbeit auf den Zusammenhang zwischen Neurotizismus und suchtartigem Arbeiten gefunden werden. Schlussfolgerungen: Neben dem Persönlichkeitsfaktor Neurotizismus und dem Alter spielen bei der Vorhersage suchtartigen Arbeitens auch das Ausmaß der Entgrenzung der Arbeit eine relevante Rolle. Die Ergebnisse sind vor dem Hintergrund der Covid-19-Pandemie relevant, da bei Mitarbeitern im Homeoffice die Grenzen von Arbeit und Privatleben besonders stark verwischen.

A neural mechanism of the relationship between impulsivity and emotion dysregulation in patients with Internet gaming disorder

Impulsivity and emotion dysregulation have been known to be risk factors for Internet gaming disorder (IGD), but their underlying neural mechanisms are not yet fully understood. Given that the prefrontal cortex has a key role in higher order cognition and addiction, the present study aimed to investigate emotional influences on response inhibition in situations with different cognitive demands. A total of 41 young male adults (20 with and 21 without IGD) were scanned while performing two versions of an emotional go/no-go task with demands on low and high working memory load. Patients with IGD showed a failure in response inhibition and increased activation of widespread brain regions, including prefrontal, motor-sensory, parietal, occipital, insula, and striatal regions across tasks. Among these regions, involvement of the dorsolateral prefrontal cortex and ventral striatum was observed only during the task with high demands on working memory. Moreover, it was also only during the high-load task that interaction between response inhibition and emotional states was observed in the dorsomedial prefrontal cortex, with observations revealing that its alteration in patients with IGD was associated with number of hours spent on Internet gaming. Our findings highlight a failure of response inhibition and dysfunction within the inhibitory control network. The special significance of our study is that dysfunctional dorsomedial prefrontal cortex may mediate abnormal emotional influences on response inhibition in patients with IGD.

Maladaptive Personality Traits and Their Interaction with Outcome Expectancies in Gaming Disorder and Internet-Related Disorders

Gambling disorder and gaming disorder have recently been recognized as behavioral addictions in the ICD-11 (International Classification of Diseases, 11th edition). The association between behavioral addictions and personality has been examined before, yet there is a lack of studies on maladaptive traits and their relationship to specific outcome expectancies. In study 1, we recruited a community sample (n = 365); in study 2 a sample of treatment-seekers was enrolled (n = 208). Maladaptive personality traits were assessed by the brief form of the Personality Inventory for DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition). Internet-related outcome expectancies were measured by the Virtual Expectancy Questionnaire. In the clinical sample, the Global Assessment of Functioning was additionally administered. Behavioral Addictions were closely associated with maladaptive traits that in turn were related to a poorer level of psychosocial functioning. There is evidence for an exacerbated risk of internet-related disorders when specific outcome expectancies and maladaptive traits interact. Implications for phenomenology and treatment are discussed.

A systematic review of metacognitions in Internet Gaming Disorder and problematic Internet, smartphone and social networking sites use

Background

The use of new technologies is growing, and some authors have suggested that frequent use might hide a non‐chemical addiction (i.e., technological addiction). Over the last 5 years, several studies investigating the role of metacognitions in technological addictions have been published. We aim to provide the first systematic review focused on this topic, by updating the initial evidence highlighted by a previous systematic review on metacognitions across addictive behaviours (Hamonniere & Varescon, 2018).

Methods

Electronic literature databases (Pubmed, PsychINFO, SCOPUS and Web of Science) were searched to identify studies that examined the relationship between metacognitions and four different technological addictions (Internet Gaming Disorder, IGD; problematic Internet use, PIU; problematic smartphone use, PSU; and problematic social networking sites use, PSNSU).

Results

We found 13 empirical studies published between 2018 and 2021. Positive low to moderate cross‐sectional associations between the four technological addictions and both generic and specific metacognitions were found, in accordance with the metacognitive model of addictive behaviours. Positive beliefs about worry, negative beliefs about thoughts concerning uncontrollability and danger, beliefs about the need to control thoughts and a lack of cognitive confidence were associated with IGD, PIU, PSU and PSNSU.

Conclusions

The absence of longitudinal studies prevents us from providing definitive answers about the role of metacognitions in technological addictions. Despite this limitation, interventions that target metacognitions could be beneficial for people presenting with technological addictions.

Monetary Reward Discounting, Inhibitory Control, and Trait Impulsivity in Young Adults With Internet Gaming Disorder and Nicotine Dependence

Internet Gaming Disorder (IGD) has been considered a potential behavioral or non-substance addiction that requires further investigation. Recognition of the commonalities between IGD and Substance Use disorders (SUD) would be of great help to better understand the basic mechanisms of addictive behaviors and excessive Internet gaming. However, little research has targeted a straightforward contrast between IGD and SUD on neuropsychological aspects. The present study thus aimed to explore the associations of reward processing and inhibitory control with IGD and nicotine dependence (ND) in young adults. Fifty-eight IGD and 53 ND individuals, as well as 57 age- and gender-matched healthy controls, were assessed with a series of measurements including the Delay-discounting Test (DDT), Probability Discounting Test (PDT), the Stroop Color-Word Task, a revised Go/No Go Task, and the Barratt Impulsiveness Scale (BIS-11). Multivariate analysis of variance (mANOVA) models revealed that both IGD and ND groups scored higher than healthy controls on the BIS-11 attentional, motor, and non-planning impulsiveness (Cohen's d = 0.41-1.75). Higher degrees of delay discounting on the DDT were also found in IGD and ND groups compared to healthy controls (Cohen's d = 0.53-0.69). Although IGD group did not differ from healthy controls on the PDT, ND group had a lower degree of probability discounting than healthy controls (Cohen's d = 0.55), suggesting a reduction in risk aversion. Furthermore, ND subjects showed a lower correct accuracy in the incongruent trials of the Stroop task than healthy controls (Cohen's d = 0.61). On the Go/No Go task, both IGD and ND groups had a lower correct accuracy in the No-Go trials than healthy controls (Cohen's d = 1.35-1.50), indicating compromised response inhibition. These findings suggested that IGD was linked to both anomalous reward discounting and dysfunctional inhibitory control, which was comparable with one typical SUD category (i.e., ND). This study might promote a better understanding of the pathogenesis of IGD as a potential addictive disorder similar to SUD.

Application of the eleventh revision of the International Classification of Diseases gaming disorder criteria to treatment-seeking patients: Comparison with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders Internet gaming disorder criteria

The World Health Organization included gaming disorder (GD) in the eleventh revision of International Classification of Diseases in 2019. Due to the lack of diagnostic tools for GD, a definition has not been adequately applied. Therefore, this study aimed to apply an operationalized definition of GD to treatment-seekers. The relationship between the diagnoses of GD and Internet gaming disorder (IGD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders was also examined. Methods: Study participants comprised 241 treatment-seekers who had engaged in excessive gaming and experienced related problems. Psychiatrists applied the GD diagnostic criteria to the participants using a diagnostic form developed for this study. Information on gaming behavior and functional impairment was obtained through face-to-face interviews conducted by clinical psychologists. Results: In total, 78.4 and 83.0% of the participants fulfilled the GD and IGD diagnostic criteria, respectively. The sensitivity and specificity of GD diagnosis were both high when the IGD diagnosis was used as the gold standard. Participants with GD preferred online PC and console games, spent significantly more time gaming, and showed a higher level of functional impairment compared to those who did not fulfill the GD diagnostic criteria. Discussion and Conclusion: The definition of GD can be successfully applied to treatment-seekers with excessive gaming and related problems. A high concordance of GD and IGD diagnoses was found in those participants with relatively severe symptoms. The development and validation of a diagnostic tool for GD should be explored in future studies.

Current Research and Viewpoints on Internet Addiction in Adolescents

PURPOSE OF REVIEW

This review describes recent research findings and contemporary viewpoints regarding internet addiction in adolescents including its nomenclature, prevalence, potential determinants, comorbid disorders, and treatment.

RECENT FINDINGS

Prevalence studies show findings that are disparate by location and vary widely by definitions being used. Impulsivity, aggression, and neuroticism potentially predispose youth to internet addiction. Cognitive behavioral therapy and medications that treat commonly co-occurring mental health problems including depression and ADHD hold considerable clinical promise for internet addiction.

SUMMARY

The inclusion of internet gaming disorder in the DSM-5 and the ICD-11 has prompted considerable work demonstrating the validity of these diagnostic approaches. However, there is also a movement for a conceptualization of the disorder that captures a broader range of media-use behaviors beyond only gaming. Efforts to resolve these approaches are necessary in order to standardize definitions and clinical approaches. Future work should focus on clinical investigations of treatments, especially in the USA, and longitudinal studies of the disorder's etiology.

Gaming Disorder and Well-Being Among Emirati College Women

Background: The present study examined Internet Gaming Disorder (IGD) and depressive symptom levels among a predominantly female sample of college students from the United Arab Emirates (UAE). Methods: IGD was assessed among two successive cohorts of students at the beginning of the academic year in 2016 and 2019, respectively. All participants (n = 412) completed the Internet Gaming Disorder Scale - Short-Form (IGDS9-SF) and the WHO-5 Well-being Index (WHO-5), a tool widely used for the screening and assessment of depressive symptomatology. Results: Mean IGDS9-SF scores (15.85, SD = 6.40) were fairly similar to those observed in other nations. The prevalence of IGD was 1.45%, based on the stringent cut-off score (> = 40). Prevalence of IGD rose to 18.20% when using the less stringent cut-off (> = 21). There was an increase in the rate of IGD between 2016 and 2019, although not statistically significant. Higher IGDS9-SF scores were associated with greater depressive symptomatology; those scoring above the less stringent IGD cut-off had a greater likelihood of screening positive for depression OR = 2.28, 95% CI (1.176-4.428). Conclusions: This study provides insights about IGD among a predominantly female Arab population, finding a correlation with mood disorder symptomatology and suggesting an increase in problematic gaming over time. The results are discussed with reference to the mood repair hypothesis and the possibility of IGD being a dual disorder. The association with depressive symptoms is also discussed in light of the neurobiology of addictive behaviors and sexual dimorphism.

Preschool Exposure to Online Games and Internet Gaming Disorder in Adolescents: A Cohort Study

Objectives: Although considerable evidence has already been collected on the effects of early initiation of drug/alcohol consumption on addictive behaviors in adolescents, little is known about the impact of early exposure to online games during preschool ages on the risk of internet gaming disorder (IGD). We evaluated the effects of exposure to online games before entering elementary school on IGD occurrence during the secondary school years using a community-based longitudinal study. Methods: Data from 1,760 adolescents (seventh grade), who were recruited from the iCURE study and followed for 2 years, were analyzed. A high risk of IGD (HRIGD) was assessed by the Internet Game Use Elicited Symptom Screen, a self-reported questionnaire based on the fifth version of DSM-5 IGD criteria. Early exposure to online gaming was defined as when adolescents played online games during their preschool years. A multivariate generalized-estimating-equation model was applied to examine the independent risk factor of the occurrence of HRIGD during the 2-year follow-up period. Results: As compared with the later-exposure group, those with early exposure to online games showed an ~1.7-fold greater incidence of HRIGD over the 2-year follow-ups after adjusting for potential confounders including baseline IGD scores (adjusted relative risk:1.69; 95%confidence interval:1.08-2.66). Pre-specified sensitivity analyses showed that the results were robust. Conclusion: Exposure to online gaming during the preschool years increases the likelihood of occurrence of HRIGD in adolescence. Restricting exposure to online games during the preschool years should be examined as a way to reduce the risk of IGD in adolescents. Clinical Trial Registration: www.clinicaltrials.gov, identifier: NCT02415322.

Risk Factors of Problem Gaming and Gambling in US Emerging Adult Non-Students: The Role of Loot Boxes, Microtransactions, and Risk-Taking

Video gaming and gambling have increasingly converged with one another (e.g., social casino games). For emerging adults (18-25 years old), who are already at an elevated risk for addictive disorders, this overlap in these activities may increase the likelihood of problematic involvement. At the moment, Internet gaming disorder (IGD) is being considered as a future medical diagnosis by the American Psychiatric Association. Therefore, the purpose of this study was to examine the potential comorbidity between IGD and gambling disorder (GD) in emerging adults, as well as explore if problematic engagement in gaming and gambling may be explained by recent trends in video game microtransactions (e.g., loot boxes) and risk-taking behaviors. An online survey was completed by 300 emerging adult non-students (M_age = 22.79, 49% male) from across the United States. The results revealed that compared to non-gamers, problematic gamers were 6.45 times more likely to problem gamble and compared to non-gamblers, problem gamblers were 5.62 times more likely to problem game. Microtransactions were the major mechanism for the relationship between IGD and GD. Participants with higher severity levels of either disorder demonstrated a greater likelihood of purchasing microtransactions, in addition to displaying significantly less aversion towards several domains of risk-taking. These findings suggest that emerging adults with probable IGD or GD may share common risk factors and patterns of behavior that transdiagnostic treatment approaches may better serve than syndrome-specific models.

The role of inhibitory control and decision-making in the course of Internet gaming disorder

BACKGROUND AND AIMS

Internet gaming disorder (IGD) is associated with impaired inhibitory control and more impulsive decision-making. However, it remains unclear whether these associations are cross-sectional or predictive. We aimed to test the hypotheses that lower inhibitory control and more impulsive decision-making correlate with, are predicted by and predict more time spent on gaming and higher IGD severity.

METHODS

A stratified convenience sample of 70 male participants (18-21 years) was recruited to achieve broad data variability for hours spent on gaming and IGD severity. In three annual assessments (T1, T2, T3), we measured gaming behaviour and IGD severity using the Video Game Dependency Scale (CSAS-II). Both gaming-related measures were correlates (T1), predictors (T2), or outcomes (T3) of inhibitory control and decision making, which were assessed at T2 using a go/no-go task and an intertemporal-choice task, respectively.

RESULTS

Higher IGD severity at T1 predicted more impulsive decision-making at T2 (β = 0.45, 95% CI = 0.14-0.76). Lower inhibitory control at T2 predicted more hours spent on gaming at T3 (β = -0.13, 95% CI = -0.25 to -0.02). We found weak or no evidence for the other associations.

DISCUSSION AND CONCLUSIONS

Lower inhibitory control predicts more time spent gaming, possibly due to insufficient top-down regulation of the behaviour. Impulsive decision-making is rather a consequence of IGD than a predictor, which may be due to altered reward learning. One-dimensional etiological assumptions about the relationship between neurocognitive impairments and IGD seem not to be appropriate for the complexity of the disorder.

Neglecting Long-Term Risks: Self-Disclosure on Social Media and Its Relation to Individual Decision-Making Tendencies and Problematic Social-Networks-Use

Social media including social-networking sites (SNS) encourage people to disclose personal information via profiles and posts. It is assumed that positive short-term effects and immediate feedback (e.g., getting Likes) have a rewarding nature and may complicate the rational weighing of possible negative long-term consequences related to self-disclosure. Dual-process theories assume risky behaviors to result from more impulsive/short-term oriented compared to reflective/long-term oriented decision making. The current laboratory study investigates whether the extent of online self-disclosure is explained by the general tendency to choose short-term rewards by neglecting long-term risks as well as by tendencies toward a problematic social-networks-use. Participants (N = 88) were asked to log into their Facebook account to answer questions about their actual self-disclosing behavior. Furthermore, they performed an experimental decision-making task and answered a questionnaire assessing problematic social-networks-use. The quantity of self-disclosure via posts was negatively associated with advantageous decision making and positively with tendencies toward a problematic social-networks-use. The findings indicate that high self-disclosure via posts is associated with a general tendency to neglect long-term risks. Moreover, a problematic social-networks-use can additionally increase individual's self-disclosure via posts.

Effect of the mobile phone-related background on inhibitory control of problematic mobile phone use: An event-related potentials study

The present study aims to provide electrophysiological evidence for deficient inhibitory control in problematic mobile phone use and to investigate whether reduced inhibition is more pronounced during exposure to a mobile phone related background cue. A screen scale of smartphone addiction was completed by 227 college students, and finally an experimental group and a control group consisting of 20 problematic mobile phone users and 19 controls were included in the study. Event-related potentials were recorded during a backgrounded Go/NoGo task performed by those two groups, in which either a frequent Go signal (letter "M") or a rare NoGo signal (letter "W") was superimposed on three different background cues: neutral, mobile phone application-related and mobile phone using-related pictures. Results showed that problematic mobile phone users performed more commission errors than controls following mobile phone application background. Furthermore, problematic mobile phone users displayed a weaker NoGo P3 amplitude than controls on the mobile phone application background. The result might suggest that there is no general impairment of inhibitory control in problematic mobile phone use. The deficient inhibitory control on behavioral and psychophysiological level appeared merely in the mobile phone-related background. Such deficient stimuli-specific inhibitory control appears at the late stage of inhibitory control. Prevention programs should be designed to curtail exposure to the mobile phone-related stimulus and enhance cognitive control of potential problematic mobile phone users.

A Multimodal Analysis Combining Behavioral Experiments and Survey-Based Methods to Assess the Cognitive Effect of Video Game Playing: Good or Evil?

This study aims to bridge the gap between the discrepant views of existing studies in different modalities on the cognitive effect of video game play. To this end, we conducted a set of tests with different modalities within each participant: (1) Self-Reports Analyses (SRA) consisting of five popular self-report surveys, and (2) a standard Behavioral Experiment (BE) using pro- and antisaccade paradigms, and analyzed how their results vary between Video Game Player (VGP) and Non-Video Game Player (NVGP) participant groups. Our result showed that (1) VGP scored significantly lower in Behavioral Inhibition System (BIS) than NVGP (p = 0.023), and (2) VGP showed significantly higher antisaccade error rate than NVGP (p = 0.005), suggesting that results of both SRA and BE support the existing view that video game play has a maleficent impact on the cognition by increasing impulsivity. However, the following correlation analysis on the results across individual participants found no significant correlation between SRA and BE, indicating a complex nature of the cognitive effect of video game play.

Early-Life Interpersonal and Affective Risk Factors for Pathological Gaming

Internet gaming is among the most popular entertainment options, worldwide; however, a considerable proportion of gamers show symptoms of pathological gaming. Internet gaming disorder (IGD) has been proposed to describe a behavioral addiction, which shares many similarities, both physical and psychological, with substance use disorder. Environmental factors, such as interpersonal and relationship dynamics during childhood and adolescence, have been suggested to modulate the onset and trajectories of IGD. However, studies exploring the contributions of dysfunctional family environments to the development of IGD remain limited. This minireview aims to offer an overview of the current knowledge regarding the impacts of early-life interpersonal and relationship dynamics on the development of IGD and to provide a snapshot of the current state of the literature in this field. Specifically, it underlines the modulatory role of early-life relational factors such as a) family function, b) parent-child relationships, c) childhood maltreatment, and d) bullying and cyberbullying on the development of IGD. Consistent with this evidence, therapeutic interventions that aim to "restructure" the emotional ties and familiar dynamics that are known to be associated with dysfunctional behaviors and feelings, and likely promote pathological gaming, are recognized as the most successful clinical therapeutic approaches for IGD.

Treatments for internet addiction, sex addiction and compulsive buying: A meta-analysis

BACKGROUND AND AIMS

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

METHODS

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

RESULTS

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

DISCUSSION AND CONCLUSIONS

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

Spanish Validation of the Internet Gaming Disorder Scale-Short Form (IGDS9-SF): Prevalence and Relationship with Online Gambling and Quality of Life

Online gaming is a very common form of leisure among adolescents and young people, although its excessive and/or compulsive use is associated with psychological impairments in a minority of gamers. The latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, Section III) tentatively introduced Internet Gaming Disorder (IGD). Since then, a number of evaluation tools using the DSM-5 criteria have been developed, including the Internet Gaming Disorder Scale-Short Form (IGDS9-SF). The main objective of this study was to translate and adapt the IGDS9-SF into Spanish, as well as to obtain indicators relating to its validity and reliability. The Spanish version of four scales were administered: IGDS9-SF, Mobile Phone-Related Experiences Questionnaire (CERM), Online Gambling Disorder Questionnaire (OGD-Q), and KIDSCREEN-27. The sample comprised 535 Vocational Training students (mean age 18.35 years; SD±2.13; 78.5% males) who reported playing video games in the past 12 months. Confirmatory factor analysis yielded a one-dimensional model with a good fit while the reliability indicators were satisfactory. Findings indicated that 1.9% of gamers were classified with IGD (meeting five or more criteria for more than 12 months). Additionally, another 1.9% were considered gamers 'at-risk' because they endorsed four criteria. Positive and significant relationships were found between the IGDS9-SF, the CERM, and the OGD-Q. Participants classified with IGD had poorer health-related quality of life. In conclusion, the Spanish IGDS9-SF is a valid and reliable instrument to assess IGD according to the DSM-5.

Internet Gaming Disorder Clustering Based on Personality Traits in Adolescents, and Its Relation with Comorbid Psychological Symptoms

In recent years, the evidence regarding Internet Gaming Disorder (IGD) suggests that some personality traits are important risk factors for developing this problem. The heterogeneity involved in problematic online gaming and differences found in the literature regarding the comorbid psychopathology associated with the problem could be explained through different types of gamers. Clustering analysis can allow organization of a collection of personality traits into clusters based on similarity. The objectives of this study were: (1) to obtain an empirical classification of IGD patients according to personality variables and (2) to describe the resultant groups in terms of clinical and sociodemographic variables. The sample included 66 IGD adolescent patients who were consecutive referrals at a mental health center in Barcelona, Spain. A Gaussian mixture model cluster analysis was used in order to classify the subjects based on their personality. Two clusters based on personality traits were detected: type I "higher comorbid symptoms" (n = 24), and type II "lower comorbid symptoms" (n = 42). The type I included higher scores in introversive, inhibited, doleful, unruly, forceful, oppositional, self-demeaning and borderline tendency traits, and lower scores in histrionic, egotistic and conforming traits. The type I obtained higher scores on all the Symptom Check List-90 items-Revised, all the State-Trait Anxiety Index scales, and on the DSM-5 IGD criteria. Differences in personality can be useful in determining clusters with different types of dysfunctionality.

Is monetary reward processing altered in drug-naïve youth with a behavioral addiction? Findings from internet gaming disorder

Current models of addiction biology highlight altered neural responses to non-drug rewards as a central feature of addiction. However, given that drugs of abuse can directly impact reward-related dopamine circuitry, it is difficult to determine the extent to which reward processing alterations are a trait feature of individuals with addictions, or primarily a consequence of exogenous drug exposure. Examining individuals with behavioral addictions is one promising approach for disentangling neural features of addiction from the direct effects of substance exposure. The current fMRI study compared neural responses during monetary reward processing between drug naïve young adults with a behavioral addiction, internet gaming disorder (IGD; n = 22), and healthy controls (n = 27) using a monetary incentive delay task. Relative to controls, individuals with IGD exhibited blunted caudate activity associated with loss magnitude at the outcome stage, but did not differ from controls in neural activity at other stages. These findings suggest that decreased loss sensitivity might be a critical feature of IGD, whereas alterations in gain processing may be less characteristic of individuals with IGD, relative to those with substance use disorders. Therefore, classic theories of altered reward processing in substance use disorders should be translated to behavioral addictions with caution.

Pathways of migration from gaming to gambling

Gaming and gambling have been studied in terms of similarity of its manifestations. There is a dearth of empirical-based evidence for the exploration of pathways to understand the shift from gaming to gambling. A 23-year-old male from a nuclear family was assessed using clinical interview for the pathways for shifting from gaming to gambling. The pathways were personality predispositions, maladaptive coping, interpersonal distress, peer pressure, variable reward anticipation, addiction characteristics in the form of craving, loss of control and use despite having consequences. These findings suggest that there is a need to create awareness among young adults about these potential causes related to transition from gaming to gambling.

Measuring addiction to internet gaming among Indian medical students: Development and preliminary psychometric properties of a new scale

BACKGROUND

Internet gaming disorder (IGD) is emerging as an important source of behavioral addiction in young people globally.

OBJECTIVE

The aim of this study was to assess addiction to internet gaming in medical students using a self designed research instrument.

MATERIALS AND METHODS

We conducted a cross-sectional study and enrolled 264 male and 160 female MBBS students (n = 424) in Delhi, India. The study instruments included: a 2-item Internet gaming screening questionnaire (IGSQ), a 14-item self-designed Internet gaming addiction scale (IGAS) to measure addiction-like behavior associated with multiplayer Internet gaming, and the Pittsburgh Sleep Quality Index to measure sleep quality.

RESULTS

After preliminary screening, 91 male and 6 female participants were found to be multiplayer Internet gamers, and were further assessed using the 14-item IGAS. The Cronbach's alpha of the IGAS was 0.879. Principal component analysis revealed a three-component IGAS structure based on eigenvalue cutoff (>1), loading score >0.4, and inspection of the scree-plot that explained 66.71% of the total variance. The IGAS score and the average weekly gaming time of the participants showed a moderate positive correlation (r = 0.45, P < 0.001). Only 17 (4.0%) participants reported agreement/strong agreement across ≥5 domains of addiction. The mean (standard deviation) IGAS score was significantly higher in the participants reporting poor sleep quality (PQSI > 6) (P = 0.047).

CONCLUSION

IGD has low prevalence among medical students, and the problem is negligible among female students. The 14-item IGAS, in conjunction with the 2-item IGSQ, are reliable and valid tools for the assessment of IGD.

Efficacy of Short-term Treatment of Internet and Computer Game Addiction: A Randomized Clinical Trial

IMPORTANCE

Internet and computer game addiction represent a growing mental health concern, acknowledged by the World Health Organization.

OBJECTIVE

To determine whether manualized cognitive behavioral therapy (CBT), using short-term treatment for internet and computer game addiction (STICA), is efficient in individuals experiencing internet and computer game addiction.

DESIGN, SETTING, AND PARTICIPANTS

A multicenter randomized clinical trial was conducted in 4 outpatient clinics in Germany and Austria from January 24, 2012, to June 14, 2017, including follow-ups. Blinded measurements were conducted. A consecutive sample of 143 men was randomized to the treatment group (STICA; n = 72) or wait-list control (WLC) group (n = 71). Main inclusion criteria were male sex and internet addiction as the primary diagnosis. The STICA group had an additional 6-month follow-up (n = 36). Data were analyzed from November 2018 to March 2019.

INTERVENTIONS

The manualized CBT program aimed to recover functional internet use. The program consisted of 15 weekly group and up to 8 two-week individual sessions.

MAIN OUTCOMES AND MEASURES

The predefined primary outcome was the Assessment of Internet and Computer Game Addiction Self-report (AICA-S). Secondary outcomes were self-reported internet addiction symptoms, time spent online on weekdays, psychosocial functioning, and depression.

RESULTS

A total of 143 men (mean [SD] age, 26.2 [7.8] years) were analyzed based on intent-to-treat analyses. Of these participants, 50 of 72 men (69.4%) in the STICA group showed remission vs 17 of 71 men (23.9%) in the WLC group. In logistic regression analysis, remission in the STICA vs WLC group was higher (odds ratio, 10.10; 95% CI, 3.69-27.65), taking into account internet addiction baseline severity, comorbidity, treatment center, and age. Compared with the WLC groups, effect sizes at treatment termination of STICA were d = 1.19 for AICA-S, d = 0.88 for time spent online on weekdays, d = 0.64 for psychosocial functioning, and d = 0.67 for depression. Fourteen adverse events and 8 serious adverse events occurred. A causal relationship with treatment was considered likely in 2 AEs, one in each group.

CONCLUSIONS AND RELEVANCE

Short-term treatment for internet and computer game addiction is a promising, manualized, short-term CBT for a broad range of internet addictions in multiple treatment centers. Further trials investigating the long-term efficacy of STICA and addressing specific groups and subgroups compared with active control conditions are required.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01434589.