Dysfunctional attentional bias and inhibitory control during anti-saccade task in patients with internet gaming disorder: An eye tracking study

Digital Phenotypes for Early Detection of Internet Gaming Disorder in Adolescent Students: Explorative Data-Driven Study

BACKGROUND

Limited awareness, social stigma, and access to mental health professionals hinder early detection and intervention of internet gaming disorder (IGD), which has emerged as a significant concern among young individuals. Prevalence estimates vary between 0.7% and 15.6%, and its recognition in the International Classification of Diseases, 11th Revision and Diagnostic and Statistical Manual of Mental Disorders, 5th Edition underscores its impact on academic functioning, social isolation, and mental health challenges.

OBJECTIVE

This study aimed to uncover digital phenotypes for the early detection of IGD among adolescents in learning settings. By leveraging sensor data collected from student tablets, the overarching objective is to incorporate these digital indicators into daily school activities to establish these markers as a mental health screening tool, facilitating the early identification and intervention for IGD cases.

METHODS

A total of 168 voluntary participants were engaged, consisting of 85 students with IGD and 83 students without IGD. There were 53% (89/168) female and 47% (79/168) male individuals, all within the age range of 13-14 years. The individual students learned their Korean literature and mathematics lessons on their personal tablets, with sensor data being automatically collected. Multiple regression with bootstrapping and multivariate ANOVA were used, prioritizing interpretability over predictability, for cross-validation purposes.

RESULTS

A negative correlation between IGD Scale (IGDS) scores and learning outcomes emerged (r166=-0.15; P=.047), suggesting that higher IGDS scores were associated with lower learning outcomes. Multiple regression identified 5 key indicators linked to IGD, explaining 23% of the IGDS score variance: stroke acceleration (β=.33; P<.001), time interval between keys (β=-0.26; P=.01), word spacing (β=-0.25; P<.001), deletion (β=-0.24; P<.001), and horizontal length of strokes (β=-0.21; P=.02). Multivariate ANOVA cross-validated these findings, revealing significant differences in digital phenotypes between potential IGD and non-IGD groups. The average effect size, measured by Cohen d, across the indicators was 0.40, indicating a moderate effect. Notable distinctions included faster stroke acceleration (Cohen d=0.68; P=<.001), reduced word spacing (Cohen d=.57; P=<.001), decreased deletion behavior (Cohen d=0.33; P=.04), and longer horizontal strokes (Cohen d=0.34; P=.03) in students with potential IGD compared to their counterparts without IGD.

CONCLUSIONS

The aggregated findings show a negative correlation between IGD and learning performance, highlighting the effectiveness of digital markers in detecting IGD. This underscores the importance of digital phenotyping in advancing mental health care within educational settings. As schools adopt a 1-device-per-student framework, digital phenotyping emerges as a promising early detection method for IGD. This shift could transform clinical approaches from reactive to proactive measures.

Functional MRI of inhibitory control processing in problematic mobile video gamers

With the development of mobile technology, mobile video games provide people with a more convenient way of entertainment, but problematic playing could also bring some negative consequences. Prior studies have indicated that Internet gaming addicts were accompanied by impaired inhibitory control. However, as a relatively new form of problematic game usage based on mobile devices, little is known about the neurobiological underpinnings of inhibitory control in problematic mobile video game (PMVG) users. Adopting an event-related fMRI Stroop task, the present study aimed to examine the different neural correlates of inhibitory control between PMVG and healthy control (HC) subjects. Compared with HC group, PMVG group showed greater brain activities in the right dorsolateral prefrontal cortex (DLPFC) during the Stroop process. Moreover, correlation analysis showed that brain activities extracted from the voxel in the DLPFC cluster had a significantly negative correlation with reward sensitivity. Our current findings may suggest the compensating effect in key brain regions of inhibitory control in problematic mobile video gamers relative to healthy controls.

Measuring attentional bias in smokers during and after psychosocial stress induction with a Trier Social Stress Test in virtual reality via eye tracking

Introduction

Attentional bias (AB) is considered an important factor not only in the etiology of addiction, but also with respect to relapse. However, evidence for the predictive ability of AB for relapse is not robust. One reason for this might be fluctuations of AB due to stress. Therefore, the current study investigated whether AB was present during and after stress induction and whether AB was enhanced by stress induction.

Methods

A Virtual Reality (VR) adaptation of the Trier Social Stress Test (VR-TSST) was used to induce psychosocial stress in smokers (n = 34) and non-smokers (n = 37) followed by a novel free-viewing task in VR. Eye tracking data was recorded to examine gaze behavior to smoking-related and neutral stimuli presented in the VR-TSST and the free-viewing task.

Results

Stress ratings increased significantly from baseline to post VR-TSST in smokers and non-smokers. During the VR-TSST we observed, more frequent, longer, and earlier fixations on smoke-related compared with neutral stimuli without significant group differences. However, in the free-viewing task following the stress induction, a specific AB of smokers in terms of earlier and longer fixations on smoke stimuli was found.

Conclusion

Results indicate that AB is not a persistent trait in smokers, but is context dependent. It is suggested that emotional learning processes such as smoking in the context of relief after stress may contribute to changes of AB both in terms of increased initial attention and deeper stimulus processing. Additionally, the potential of the VR-TSST to induce psychosocial stress could be replicated.

Attentional Bias Is Associated with Negative Emotions in Problematic Users of Social Media as Measured by a Dot-Probe Task

OBJECTIVE

Social media (SM) have flourished and are affecting human lives on an unprecedented scale. Problematic social media use (PSMU) is a recently emerging problematic behavior that affects both physical and mental health. The purpose of this study was to investigate whether problematic users of SM display attentional bias (AB) toward SM-related cues, as well as the relationships between AB, the severity of PSMU, and negative emotions.

METHOD

1000 college students were recruited through classes and online forums and then tested using the Bergen Social Media Addiction Scale (BSMAS). Eventually, 60 participants, identified by the cut-off point for BSMAS, consented to participate in the study and were divided into two groups (i.e., a problematic use group and a typical use group). The severity of PSMU and negative emotions (i.e., anxiety, depression, social fear, and loneliness) were evaluated by self-report questionnaires. AB was assessed by an addiction Stroop task and a dot-probe task (DPT).

RESULTS

PSMU was found to be positively associated with anxiety (r = 0.28, p < 0.05), depression (r = 0.35, p < 0.01), and social fear (r = 0.38, p < 0.01), but not with loneliness (r = 0.19, p = 0.15). Participants with a tendency toward PSMU displayed AB toward SM-related cues in the DPT [F (1, 58) = 26.77, p < 0.001, ηp2 = 0.32], but not in the Stroop task [F (1, 58) = 0.61, p = 0.44, ηp2 = 0.01]. Moreover, AB toward SM-related stimuli was found to be positively correlated with the severity of PSMU (r = -0.51, p < 0.001), anxiety (r = -0.37, p < 0.01), depression (r = -0.51, p < 0.001), and social fear (r = -0.30, p < 0.05) in the DPT.

CONCLUSIONS

Problematic users of SM show AB towards SM-related cues in the DPT, which is more reliable for assessing AB than the Stroop task. Moreover, it is suggested that in clinical interventions we should work to change the AB towards SM-related stimuli and improve negative emotions to decrease risks of PSMU.

Abnormal psychological performance as potential marker for high risk of internet gaming disorder: An eye-tracking study and support vector machine analysis

Individuals with high risk of internet gaming disorder (HIGD) showed abnormal psychological performances in response inhibition, impulse control, and emotion regulation, and are considered the high-risk stage of internet gaming disorder (IGD). The identification of this population mainly relies on clinical scales, which are less accurate. This study aimed to explore whether these performances have highly accurate for discriminating HIGD from low-risk ones. Eye tracking based anti-saccade task, Barratt impulsiveness scale (BIS), and Wong and Law emotional intelligence scale (WLEIS) were used to evaluate psychological performances in 57 individuals with HIGD and 52 matched low risk of internet gaming disorder (LIGD). HIGD group showed significantly increased BIS total (t = −2.875, p = 0.005), attention (t = −2.139, p = 0.035), motor (t = −2.017, p = 0.046), and non-planning (t = −2.171, p = 0.032) scores, but significantly decreased WLEIS emotion regulation score (t = 2.636, p = 0.010) and correct rate of eye tracking anti-saccade task (t = 2.294, p = 0.024) compared with LIGD group. BIS total score was negatively correlated with the WLEIS total (r = −0.473, p &lt; 0.001) and WLEIS emotion regulation (r = −0.366, p &lt; 0.001) scores. A combination of the WLEIS emotion regulation score and the correct rate of anti-saccade task could discriminate HIGD from LIGD with 91.23% sensitivity, 82.69% specificity, and 87.16% accuracy. Participants with higher gaming hours daily were 40 times more likely to be high risk than their counterparts (p &lt; 0.001). Hence, psychological performances were worse in HIGD. A combination of abnormal emotion regulation and response inhibition might be a potential marker to identify HIGD individuals.

Assessing the attentional bias of smokers in a virtual reality anti-saccade task using eye tracking

INTRODUCTION

Cognitive biases (among them attentional bias, AB) are considered an important factor in the development, maintenance, and recurrence of addiction. However, traditional paradigms to measure AB have been criticized regarding external validity and methodical issues. Therefore, and because the neurophysiological correlates of anti-saccade tasks are known, we implemented a novel smoking anti-saccade task in virtual reality (VR) to measure AB and inhibitory control in different contexts and with higher ecological validity.

METHODS

Smokers (n = 20) and non-smokers (n = 20) were tested on a classic pro- and anti-saccade task, a VR anti-saccade task and a VR attention fixation task (all containing smoking-related and neutral stimuli) while eye-tracking data was collected. Two VR contexts (park and office room) were applied.

RESULTS

Saccade latencies were significantly higher for the smoking group in the VR anti-saccade task. However, this effect did not differ between smoking-related and neutral stimuli, thus overall no AB was observed. Instead, AB was only present in the park context. Additionally, saccade latencies and error rates were significantly higher in the park context.

CONCLUSIONS

Results indicate impaired inhibitory control in smokers relative to non-smokers. The lack of evidence for a general AB might be due to the lower severity of smoking dependence in the smoking sample. Instead, results suggest context specificity of AB. Implications for smoking cessation interventions in the field of inhibitory control training and attention bias modification are discussed.

Escapism-Based Motivation Affected the Psychological Performances of High-Risk Internet Gaming Disorder Individuals

Background

Escapism-based motivation (EBM) is considered as one of the diagnostic criteria for internet gaming disorder (IGD). However, how EBM affects the high risk of IGD (HIGD) population remains unclear.

Methods

An initial number of 789 college students participated in the general, internet gaming behavior, and motivation surveys. After multiple evaluations, 57 individuals were identified as HIGD (25 with EBM, H-EBM; 32 with non-EBM, H-nEBM). In addition, 51 no-gaming individuals were included as the control group (CONTR). The cohorts completed the psychological assessments and eye-tracking tests, and analyses of group differences, correlations, and influencing factors of the indicators were performed.

Results

The Barratt impulsiveness score of H-nEBM and H-EBM was significantly higher than that of CONTR (MD = 3.605, P = 0.017; MD = 3.744, P = 0.022). In addition, emotional intelligence self-emotion management ability was significantly lower in the H-EBM than in CONTR (MD = -2.038, P = 0.004). Correct rates and reaction times in the anti-saccade task differed significantly between the three groups (F = 3.525, P = 0.033; F = 4.459, P = 0.014). However, no differences were found in the comparison of the digital span test (DST), trail making test (TMT), animal verbal fluency test, Stroop test, and mental rotation test results. The anti-saccade test indicators were positively correlated with the DST results but negatively correlated with the Stroop test results (P < 0.05). Correct rates in the mental rotation test were negatively correlated with the TMT results but positively correlated with the DST results (P < 0.05). The participants with high Stroop test scores and no lover experience and who were raised by their grandparents were likely to develop EBM to engage in high risk of internet gaming disorder (P < 0.05).

Conclusion

EBM has a significantly negative effect on impulsivity, self-emotion management ability, and response inhibition in the HIGD participants.

Anti-saccade as a Tool to Evaluate Neurocognitive Impairment in Alcohol Use Disorder

It has been widely shown that chronic alcohol use leads to cognitive dysfunctions, especially inhibitory control. In an extension of the traditional approach, this research field has benefited from the emergence of innovative measures, among which is an anti-saccade, allowing direct and sensitive measure of the eye movements indexing attention bias to alcohol-related cues and the capability of inhibiting the reflexive saccades to the cues. During the past decade, there are numerous reports showing that drinkers make more unwanted reflexive saccades and longer latency in the anti-saccade task. These increased errors are usually explained by the deficits in inhibitory control. It has been demonstrated that inhibitory control on eye movement may be one of the earliest biomarkers of the onset of alcohol-related cognitive impairments. This review summarizes how an anti-saccade task can be used as a tool to investigate and assess the cognitive dysfunctions and the early detection of relapsing risk of alcohol dependence.

Eye Tracking Studies Exploring Cognitive and Affective Processes among Alcohol Drinkers: a Systematic Review and Perspectives

Acute alcohol intoxication and alcohol use disorders are characterized by a wide range of psychological and cerebral impairments, which have been widely explored using neuropsychological and neuroscientific techniques. Eye tracking has recently emerged as an innovative tool to renew this exploration, as eye movements offer complementary information on the processes underlying perceptive, attentional, memory or executive abilities. Building on this, the present systematic and critical literature review provides a comprehensive overview of eye tracking studies exploring cognitive and affective processes among alcohol drinkers. Using PRISMA guidelines, 36 papers that measured eye movements among alcohol drinkers were extracted from three databases (PsycINFO, PubMed, Scopus). They were assessed for methodological quality using a standardized procedure, and categorized based on the main cognitive function measured, namely perceptive abilities, attentional bias, executive function, emotion and prevention/intervention. Eye tracking indexes showed that alcohol-related disorders are related to: (1) a stable pattern of basic eye movement impairments, particularly during alcohol intoxication; (2) a robust attentional bias, indexed by increased dwell times for alcohol-related stimuli; (3) a reduced inhibitory control on saccadic movements; (4) an increased pupillary reactivity to visual stimuli, regardless of their emotional content; (5) a limited visual attention to prevention messages. Perspectives for future research are proposed, notably encouraging the exploration of eye movements in severe alcohol use disorders and the establishment of methodological gold standards for eye tracking measures in this field.

Attentional control moderates the relationship between pain catastrophizing and selective attention to pain faces on the antisaccade task

Cognitive models of chronic pain emphasize the critical role of pain catastrophizing in attentional bias to pain-related stimuli. The aim of this study was (a) to investigate the relationship between pain catastrophizing and the ability to inhibit selective attention to pain-related faces (attentional bias); and (b) to determine whether attentional control moderated this relationship. One hundred and ten pain-free participants completed the anti-saccade task with dynamic facial expressions, specifically painful, angry, happy, and neutral facial expressions and questionnaires including a measure of pain catastrophizing. As predicted, participants with high pain catastrophizing had significantly higher error rates for antisaccade trials with pain faces relative to other facial expressions, indicating a difficulty disinhibiting attention towards painful faces. In moderation analyses, data showed that attentional control moderated the relationship between attentional bias to pain faces and pain catastrophizing. Post-hoc analyses demonstrated that it was shifting attention (not focusing) that accounted for this effect. Only for those with high self-reported ability to shift attention was there a significant relationship between catastrophizing and attentional bias to pain. These findings confirm that attentional control is necessary for an association between attentional bias and catastrophizing to be observed, which may explain the lack of relationships between attentional bias and individual characteristics, such as catastrophizing, in prior research.

Clarifying terminologies in research on gaming disorder and other addictive behaviors: distinctions between core symptoms and underlying psychological processes

There exists ongoing debate regarding the clinical validity of single symptoms of and diagnostic criteria for gaming disorder. In particular, the potential symptom of gaming disorder that addresses coping with and escaping from negative feelings has received much attention and remains a focus of intensive discussion. We argue that it is important to consider differences or distinguish between, on the one hand, symptoms of and criteria for a disorder due to addictive behaviors, such as gaming disorder, versus, on the other hand, motivations, mechanisms, and psychological processes that may be involved in promoting addictive behaviors and that may explain symptom severity and course of the addictive disorder including potential treatment responses.