Excessive Internet gaming and decision making: do excessive World of Warcraft players have problems in decision making under risky conditions?

Effect of excessive internet gaming on inhibitory control based on resting EEG and ERP

Previous research indicates that individuals with Internet gaming disorder (IGD) show impaired inhibitory control and abnormal EEG/ERP patterns. However, it is unclear how those individuals with excessive Internet game use (EUG) but without addiction differ. This study examined inhibitory control, resting EEG, and ERP in EUG gamers compared to non-gamers. Fifteen participants in each group underwent 4-min eyes-closed EEG recordings and a color-word Stroop task. Results showed no significant differences in reaction time, accuracy, or P3 amplitude between EUG gamers and non-gamers. However, EUG gamers exhibited shortened P3 latency, which may suggest enhanced inhibitory control. Additionally, EUG gamers showed reduced theta and alpha band power during the resting state compared to non-gamers. These findings suggest that excessive gaming without addiction may enhance inhibitory control and influence brain activity differently from IGD.

Social Information Processing and Executive Functions in Male Children and Adolescents with Internet Gaming Disorder

In recent years, in addition to its clinical importance, interest in the social-cognitive aspect of internet gaming disorder (IGD) has increased. This study aimed to investigate autistic traits, executive functions, and self-regulation abilities of patients with IGD. Eighty-seven male patients with IGD and eighty-three male healthy controls (HC) were included in the study. All patients were diagnosed with IGD as per the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders-5. Healthy controls without any comorbid psychiatric diagnosis were recruited from the community. The Brief Rating Inventory of Executive Function (BRIEF) and the Social Responsiveness Scale (SRS) were implemented to evaluate autistic traits, executive functions, and self-regulation skills. The Beck Depression Inventory (BDI), Screen for Child Anxiety and Related Disorders and Internet Gaming Disorder Scale-Short-Form were used to evaluate psychopathology. The effect size of the impairments in executive functions and self-regulation skills was large (Cohen's d = 1.0-2.0). IGD groups had higher levels of autistic traits compared to healthy controls (d = 1.0-1.4). The differences in BDI and BRIEF scores remained significant in logistic regression analysis. Age at illness-onset, total severity of anxiety, and autistic traits were found as significant correlates of deficits in executive functions among patients with IGD. The results of this study supported the higher autistic traits and poorer executive function skills of patients with IGD. Deficits in executive functions were associated with autistic traits and younger age-onset of the illness.

Neuropsychological Deficits in Disordered Screen Use Behaviours: A Systematic Review and Meta-analysis

Over the last few decades, excessive and disordered screen use has become more prevalent, prompting investigations into its associated consequences. The extent to which disordered screen use behaviours impact neuropsychological functioning has been reportedly mixed and at times inconsistent. This review sought to synthesise the literature and estimate the magnitude of overall cognitive impairment across a wide range of disordered screen use behaviours. We also sought to determine the cognitive domains most impacted, and whether the observed impairments were moderated by the classification of screen-related behaviours (i.e., Internet or gaming) or the format of cognitive test administration (i.e., paper-and-pencil or computerised). A systematic search of databases (Embase, PsycINFO, MEDLINE) identified 43 cross-sectional articles that assessed neuropsychological performance in disordered screen use populations, 34 of which were included in the meta-analysis. A random-effects meta-analysis revealed significant small/medium (g = .38) cognitive deficits for individuals with disordered screen use behaviours relative to controls. The most affected cognitive domain with a significant medium effect size (g = .50) was attention and focus followed by a significant reduction in executive functioning (g = .31). The classification of disordered screen use behaviours into Internet or gaming categories or the format of cognitive testing did not moderate these deficits. Additionally, excluding disordered social media use in an exploratory analysis had little effect on the observed outcomes. This study highlights a number of methodological considerations that may have contributed to disparate findings and shows that disordered screen use can significantly impact cognitive performance. Recommendations for future research are also discussed. Data for this study can be found at https://osf.io/upeha/ .

Brain responses to decision-making in easy and hard choices in internet gaming disorder: Implications for irrepressible gaming behaviours

BACKGROUND

Impaired decision-making was observed in internet gaming disorder (IGD), however, these studies did not differentiate 'hard' to 'easy' decisions, and only the 'hard' decision-making could reveal the mechanism underlying this issue.

METHODS

We recruited forty-eight individuals with IGD and forty-six recreational internet game users (RGUs) as a control group in this study. fMRI data were collected when they were finishing a value-matching delayed discount task (DDT), which included easy and hard decisions judging based on the indifference points of every participant. The correlations between brain responses during DDT and IGD severity and the effective connectivity between brain regions were calculated.

RESULTS

Compared to RGUs, IGD subjects showed enhanced activation in the orbitofrontal cortex (OFC) when facing hard choices, and this feature was associated with IGD severity. In addition, individuals with IGD showed increased effective connectivity from the OFC to the dorsolateral prefrontal cortex and the OFC to the occipital lobe and decreased effective connectivity from the occipital lobe to the OFC.

CONCLUSION

The current study showed that the abnormal activation in the OFC was associated with IGD severity and higher OFC-DLPFC/OFC-occipital lobe effective connectivity and lower occipital lobe-OFC effective connectivity when individuals with IGD faced different choices in the DDT. These findings suggest the neural mechanisms of impulsive decision-making in individuals with IGD due to dysfunction with subjective evaluation and dysfunction of the connection with the executive control system.

A systematic review and meta-analysis of risky decision-making in specific domains of problematic use of the internet: Evidence across different decision-making tasks

This systematic review summarizes empirical evidence on risky decision-making (objective risk and ambiguity) in specific domains of problematic use of the internet (PUI) focusing on online addictive behaviors. We conducted a pre-registered (PROSPERO: CRD42020188452) PubMed search for PUI domains: gaming, social-network use, online buying-shopping, online pornography use, and unspecified PUI. We used the Newcastle-Ottawa Scale for quality assessment. Relevant studies were identified only for gaming (n = 19), social-network use (n = 8), unspecified PUI (n = 7), and online gambling (n = 1). The meta-analyses included 25 studies (2498 participants) comparing PUI and control groups regarding decision-making performance under objective risk and ambiguity. Across PUI domains, individuals with PUI compared to control participants showed more disadvantageous decision-making in measures of objective risk (g = -0.42 [-0.69, -0.16], p = .002) but not ambiguity (g = -0.22 [-0.47, -0.04], p = .096). PUI domain and gender were significant moderators. In the risk domain, effects were particularly present in gaming disorder, especially in exclusively male samples. Overall, the paucity of empirical studies in the considered area necessitates further research to identify probable gender- and disorder-specific cognitive relationships.

Priming effects of a slot machine game and amphetamine on probabilistic risk-taking in people with gambling disorder and healthy controls

INTRODUCTION

The Game of Dice Task (GDT) captures probabilistic risk-taking, which is an important feature of addictions and integral to gambling disorder (GD). No research appears to have assessed effects of gambling-specific priming manipulations or the pharmacological basis of such effects on the GDT.

AIMS

To investigate effects of slot machine gambling (Slots) and d-amphetamine (AMPH; 20 mg) on risk-taking in people with GD and healthy controls (HCs) (n = 30/group). The role of dopamine (DA) was assessed by pre-treating participants with the D2 receptor (D2R)-preferring antagonist, haloperidol (HAL; 3-mg) or mixed D1R-D2R antagonist, fluphenazine (FLU; 3-mg).

HYPOTHESES

Slots and AMPH will each increase risk-taking based on fewer (less probable) possible outcomes selected (POS) and poorer net monetary outcomes (NMO; gains minus losses) on the GDT, with stronger effects in Group GD. If DA mediates these effects, outcomes will vary with pre-treatment.

METHOD

Participants attended a pre-experimental baseline session and 4 test sessions. Antagonist Group (HAL, FLU) was manipulated between-participants. Pre-treatment (antagonist, placebo) was manipulated within-participants and counterbalanced over sessions for Slots and AMPH test phases. Moderator/mediator effects of trait and neuropsychological factors and GD severity (South Oaks Gambling Screen; SOGS) were explored via covariance.

RESULTS

AMPH led to an escalation in risky POS over trial blocks in both groups, regardless of pre-treatment. Cognitive inflexibility (high perseveration-proneness) moderated this effect in Group HC. In Group GD, SOGS selectively predicted riskier POS on AMPH sessions. Group GD achieved poorer NMO vs. Group HC on the pre-experimental baseline and Placebo-Slots sessions. Group HC selectively displayed poorer NMO on the Antagonist-Slots session.

CONCLUSIONS

The GDT can detect behavioral and pharmacological priming effects. Cognitive inflexibility and symptom severity moderate AMPH-induced risk-taking in HC and GD participants, respectively. Sensitization-related "wanting" of risk may contribute to the latter effect in people with GD.

The association of problematic gaming characteristics with dietary habits among Finnish vocational school students

Digital gaming is a popular pastime among young people, but its links to dietary habits have been little studied. The purpose of the study was to describe dietary habits and to examine their associations to problematic gaming behavior with regard to the degree of daily digital gaming time and the overall levels of disordered-like gaming behavior among students in vocational education in the Oulu region of Finland. This cross-sectional study consisted of a total of 773 first-year vocational school students who had played digital games regularly. Data was collected by using an online survey measuring sociodemographic information, dietary habits, amount of digital gaming time, and symptoms of problematic gaming behavior. Most prevalent weekly consumed food types were chicken (90.1%), chips (87.7%), and sausages/cold cuts (85.4%). Around one-fourth of students skipped breakfast on weekdays and at weekends. A higher amount of digital gaming time was associated with skipping breakfast on weekdays. More elevated levels of disordered gaming behavior were particularly associated with the use of a group of food types encompassing carbohydrate-dense and fast food. Current research provides indications that digital gaming may have an impact on youths' dietary habits, while at the same time, however, emphasizing that the issue can be affected by several interrelated and complex factors.

Decision Making and Risk Propensity in Individuals with Tendencies towards Specific Internet-Use Disorders

The uncontrolled use of specific Internet applications is increasingly recognized as a mental health issue. Gaming disorder, which is one subtype of specific Internet-use disorders (sIUDs), has been included in the ICD-11 as disorder due to addictive behaviors. Addictive disorders are assumed to be accompanied by cognitive deficits as indicated by weaker performance in executive function and risky decision-making tasks. This study investigates risky decision-making in individuals with tendencies towards sIUDs including gaming, online buying-shopping, and social-networks-use disorders. A total of 293 individuals participated in the study. Based on specific screening instruments, the participants were assigned to a group with tendencies towards sIUD or a control group. Participants completed a risky decision-making task and questionnaires assessing risk-taking propensity, impulsivity, psychopathology, and perceived stress. The group with sIUD tendencies showed higher attentional impulsivity and higher levels of depression and anxiety compared to the control group. The groups did not differ in decision making and risk propensity. Decision making did not have significant effects on sIUD symptoms. Risk for developing sIUDs does not appear to be accompanied by altered general decision-making tendencies. Rather, psychological (pre-)load and attentional deficits appear to be relevant features in uncontrolled use of the Internet.

Reward-related decision-making deficits in internet gaming disorder: a systematic review and meta-analysis

AIMS

To estimate the aggregated effect sizes of reward-related decision-making deficits in internet gaming disorder (IGD) and to explore potential moderators on the variability of effect sizes across studies.

DESIGN

Review of peer-reviewed studies comparing reward-related decision-making performance between IGD and control participants identified via PubMed, Web of Science and ProQuest databases. Random-effects modeling was conducted using Hedge's g as the effect size (ES). The effects of decision-making situation, valence, sample type, testing environment, IGD severity and self-reported impulsivity on decision-making differences were examined by moderator analyses.

SETTING

No restrictions on location.

PARTICIPANTS

Twenty-four studies (20 independent samples) were included in the meta-analysis, resulting in 604 IGD and 641 control participants and 35 ESs.

MEASURES

Reward-related decision-making differences between IGD and control groups.

FINDINGS

The overall ES for decision-making deficits in IGD was small (g = -0.45, P < 0.01). The effects were comparable across risky, ambiguous and inter-temporal decision-making. Larger aggregate ESs were identified for pure-gain and mixed compared with pure-loss decision-making. Studies based on clinical and community samples showed similar effects. No significant difference between behavioral studies and those with extra measurements was observed. Decision-making alterations were not closely associated with IGD severity or self-reported impulsivity differences at the study level.

CONCLUSIONS

Internet gaming disorder appears to be consistently associated with reward-related decision-making deficits.

Meta-analysis of structural and functional brain alterations in internet gaming disorder

Background

Many neuroimaging studies have reported abnormalities in brain structure and function in internet gaming disorder (IGD). However, the findings were divergent. We aimed to provide evidence-based evidence of structural and functional changes in IGD by conducting a meta-analysis integrating these studies quantitatively.

Method

A systematic search was conducted in PubMed, ScienceDirect, Web of Science, and Scopus from January 1, 2010 to October 31, 2021, to identify eligible voxel-based morphometry (VBM) and functional magnetic resonance imaging (fMRI) studies. Brain alternations between IGD subjects and healthy controls (HCs) were compared using the anisotropic seed-based d mapping (AES-SDM) meta-analytic method. Meta-regression analysis was used to investigate the relationship between gray matter volume (GMV) alterations and addiction-related clinical features.

Results

The meta-analysis contained 15 VBM studies (422 IGD patients and 354 HCs) and 30 task-state fMRI studies (617 IGD patients and 550 HCs). Compared with HCs, IGD subjects showed: (1) reduced GMV in the bilateral anterior/median cingulate cortex, superior/inferior frontal gyrus and supplementary motor area; (2) hyperactivation in the bilateral inferior frontal gyrus, precentral gyrus, left precuneus, right inferior temporal gyrus and right fusiform; (3) hypoactivation in the bilateral lingual and the left middle frontal gyrus; and (4) both decreased GMV and increased activation in the left anterior cingulate. Furthermore, Meta-regression revealed that GMV reduction in left anterior cingulate were positively correlated with BIS-11 score [r = 0.725, p = 0.012(uncorrected)] and IAT score [r = 0.761, p = 0.017(uncorrected)].

Conclusion

This meta-analysis showed structural and functional impairments in brain regions related to executive control, cognitive function and reward-based decision making in IGD. Furthermore, multi-domain assessments captured different aspects of neuronal changes in IGD, which may help develop effective interventions as potential therapeutic targets.

Resting-state functional connectivity within orbitofrontal cortex and inferior frontal gyrus modulates the relationship between reflection level and risk-taking behavior in internet gaming disorder

Internet gaming disorder (IGD) has become an increasing mental health issue worldwide. Previous studies indicated that IGD was related to maladaptive risk-taking behavior. However, the relationship among risk-taking behavior, reflection level, and resting-state functional connectivity (rsFC) between brain regions in IGD individuals remains unclear. The current study combined resting-state fMRI and the Devil task to investigate this issue. The behavioral results suggested that IGD participants exhibited increased risk-taking behavior in the Devil task than healthy controls. Moreover, IGD participants' risk-taking behavior was positively correlated with their reflection level. As for fMRI results, IGD participants showed stronger rsFC between orbitofrontal cortex (OFC) and inferior frontal gyrus (IFG) than healthy controls. Additionally, the mediation analyses revealed that, among IGD participants, the rsFC between OFC and IFG fully mediated the relationship between reflection level and risk-taking behavior. Together, the current study highlighted that the altered rsFC between OFC and IFG in IGD individuals modified the relationship between their reflection level and risk-taking behavior, which might contribute to the understanding of neural mechanisms underlying risk-taking behavior in IGD individuals.

A Latent Profile Analysis of Problematic Media Device Use and Its Association With Executive Function and Behavioral Problem Among Children: A Population-Based Study

OBJECTIVE

Despite the rapid increase in problematic media device use, relatively little is known about specific characteristics and extent of problematic media device and how they relate to different psychological features.

METHODS

Data extracted from the Panel Korea Study for the Child Cohort Study were used. At the age of 9 years, media device addiction severity was assessed using the K-scale, and children's behavioral outcomes were assessed using the Child Behavior Checklist. Among children with problematic media device use (n=339), we performed latent profile analysis using the K-scale to identify subtypes of problematic media device use, and then compared the child behavioral problems and executive function according to the different subtypes of problematic media device use.

RESULTS

Children with problematic media device use were divided into class 1 (n=51), class 2 (n=138), and class 3 (n=150). Compared with classes 2 and 3, class 1 had more severe problematic media device use, including daily activity disturbance, withdrawal, and tolerance. Class 1 had the most serious behavioral problems and executive function difficulties among classes. Class 2 had greater daily activity disturbance and tolerance than those of class 3, but executive function showed no significant difference between the two classes. In logistic regression analysis, behavioral problems except for somatization were more common in class 1 than in the control group.

CONCLUSION

Results suggest that problematic media device use is associated with significant behavioral problem and executive function difficulties and underscore the need for further clinical and research attention for these specific subgroup members.

Digital resilience mediates healthy use of technology

Excessive use of online technology brings with it the risk of problematic digital behaviour like over-use of social media, online gambling, webinar fatigue, digital burnout, and in extreme cases doom surfing, and doom scrolling. In addition, digital failures can cause significant mental health distress to people, and unhealthy interactions on social media can also lead to deviant behaviour such as cyber bullying and cybercrime. This paper discusses the various vulnerabilities an individual is predisposed to on the internet, and highlights the importance of "Digital Resilience". Digital resilience is a new concept which refers to the learning, recovery, and bouncing back process after having negative or adverse experiences online. A comprehensive and holistic model to introduce Digital Resilience to everyone through a multitier approach that includes Individual, Societal, and Community intervention is formulated and elaborated. The importance of addressing these concerns from both a psychological and legal perspective is also discussed.

The role of repetitive transcranial magnetic stimulation (rTMS) in the treatment of behavioral addictions: Two case reports and review of the literature

BACKGROUND

Several behaviors, besides consumption of psychoactive substances, produce short-term reward that may lead to persistent aberrant behavior despite adverse consequences. Growing evidence suggests that these behaviors warrant consideration as nonsubstance or "behavioral" addictions, such as pathological gambling, internet gaming disorder and internet addiction.

CASE PRESENTATION

Here, we report two cases of behavioral addictions (BA), compulsive sexual behavior disorder for online porn use and internet gaming disorder. A 57-years-old male referred a loss of control over his online pornography use, started 15 years before, while a 21-years-old male university student reported an excessive online gaming activity undermining his academic productivity and social life. Both patients underwent a high-frequency repetitive transcranial magnetic stimulation (rTMS) protocol over the left dorsolateral prefrontal cortex (l-DLPFC) in a multidisciplinary therapeutic setting. A decrease of addictive symptoms and an improvement of executive control were observed in both cases.

DISCUSSION

Starting from these clinical observations, we provide a systematic review of the literature suggesting that BAs share similar neurobiological mechanisms to those underlying substance use disorders (SUD). Moreover, we discuss whether neurocircuit-based interventions, such as rTMS, might represent a potential effective treatment for BAs.

Decision-making, cognitive functions, impulsivity, and media multitasking expectancies in high versus low media multitaskers

In several studies, individuals who reported to frequently multitask with different media displayed reduced cognitive performance, for example in fluid intelligence and executive functioning. These cognitive functions are relevant for making advantageous decisions under both objective risk (requiring reflection and strategical planning) and ambiguous risk (requiring learning from feedback). Thus, compared to low media multitaskers (LMMs), high media multitaskers (HMMs) may perform worse in both types of decision situations. The current study investigated HMMs and LMMs in a laboratory setting with the Game of Dice Task (GDT; objective risk), the Iowa Gambling Task (IGT; ambiguous risk), various tests quantifying cognitive functions (logical reasoning, working memory, information processing, general executive functions), and self-report measures of impulsivity, media multitasking expectancies, and problematic Internet use. From 182 participants, 25 HMMs and 19 LMMs were identified using the Media Multitasking Index. Results show that HMMs compared to LMMs performed weaker on the IGT but not on the GDT. Furthermore, HMMs had slightly decreased performance in tests of logical reasoning and working memory capacity. HMMs tended to increased information processing speed but this difference was not significant. Furthermore, HMMs have more positive expectancies regarding media multitasking and reported higher tendencies toward problematic Internet use. HMMs and LMMs did not differ significantly with respect to impulsivity and executive functions. The results give a first hint that HMMs may have difficulties in decision-making under ambiguous but not under objective risk. HMMs may be more prone to errors in tasks that require feedback processing. However, HMMs appear not to be impaired in aspects of long-term strategic decision-making.

Event-related brain response to visual cues in individuals with Internet gaming disorder: relevance to attentional bias and decision-making

This study investigated attentional bias toward game-related cues in Internet gaming disorder (IGD) using electrophysiological markers of late positive potential (LPP) and identifying the sources of LPP. In addition, the association between LPP and decision-making ability was investigated. The IGD (n = 40) and healthy control (HC; n = 39) participants viewed a series of game-related and neutral pictures, while their event-related potentials (ERPs) were recorded. LPPs were calculated as the mean amplitudes between 400 and 700 ms at the centro-parietal (CP3, CP1, Cpz, CP2, and CP4) and parietal (P3, P1, Pz, P2, and P4) electrode sites. The source activations of LPP were estimated using standardized low-resolution brain electromagnetic tomography (sLORETA). In addition, decision-making ability was evaluated by the Cambridge Gambling Task. Higher LPP amplitudes were found for game-related cues in the IGD group than in the HC group. sLORETA showed that the IGD group was more active in the superior and middle temporal gyri, which are involved in social perception, than in the HC group, whereas it was less active in the frontal area. Individuals with IGD have deficits in decision-making ability. In addition, in the HC group, the lower the LPP when looking at the game-related stimuli, the better the quality of decision-making, but not in the IGD group. Enhanced LPP amplitudes are associated with emotional arousal to gaming cues and decision-making deficits in IGD. In addition, source activities suggest that patients with IGD perceive game-related cues as social stimuli. LPP can be used as a neurophysiological marker of IGD.

Social-Emotional Learning Competencies and Problematic Internet Use among Chinese Adolescents: A Structural Equation Modeling Analysis

To advance the understanding about social-cognitive factors related to Chinese adolescents’ experience with problematic Internet use (PIU), we examined the associations between social-emotional learning (SEL) competencies (i.e., responsible decision-making, social awareness, self-management, self-awareness, and social relationship) and problematic Internet use (PIU) among 1141 11th grade high school students from Southwest China. Through comparing the latent means of PIU across students with different demographic background (i.e., gender, social-economic status, left-behind status), the study found that male students endorsed higher levels of overall PIU and more problematic time management with Internet use than female students. No latent PIU mean differences were observed across family income and students’ left-behind status. Using structural equation modeling (SEM) while controlling for demographic factors, overall SEL competencies were found to have a significantly negative association with PIU. Meanwhile, all five SEL domains were also negatively associated with students’ PIU. The findings imply the importance of fostering SEL competencies in preventing PIU among Chinese adolescents. The study provides important practical implications for informing school-based SEL competencies programs for PIU prevention among Chinese youths.

Differences in resting-state functional connectivity according to the level of impulsiveness in patients with internet gaming disorder

BACKGROUND AND AIMS

Impulsiveness is an important factor in the pathophysiology of Internet gaming disorder (IGD), and regional brain functions can be different depending on the level of impulsiveness. This study aimed to demonstrate that different brain mechanisms are involved depending on the level of impulsiveness among patients with IGD.

METHODS

Resting-state functional MRI data were obtained from 23 IGD patients with high impulsivity, 27 IGD patients with low impulsivity, and 22 healthy controls, and seed-based functional connectivity was compared among the three groups. The seed regions were the ventromedial prefrontal cortex (vmPFC), dorsolateral prefrontal cortex, nucleus accumbens (NAcc), and amygdala.

RESULTS

Connectivity of the vmPFC with the left temporo-parietal junction (TPJ) and NAcc-left insula connectivity were significantly decreased in the patients with high impulsivity, compared with the patients with low impulsivity and healthy controls. On the other hand, amygdala-based connectivity with the left inferior frontal gyrus showed decreases in both patient groups, compared with the healthy controls.

CONCLUSION

These findings may suggest a potential relationship between impulsivity and deficits in reward-related social cognition processes in patients with IGD. In particular, certain interventions targeted at vmPFC-TPJ connectivity, found to be impulsivity-specific brain connectivity, are likely to help with addiction recovery among impulsive patients with IGD.

Mediating effects of rumination and bedtime procrastination on the relationship between Internet addiction and poor sleep quality

BACKGROUND AND AIMS

Numerous studies have shown that people who have Internet addiction (IA) are more likely to experience poor sleep quality than people who do not. However, few studies have explored mechanisms underlying the relation between IA and poor sleep quality. As a first attempt to address this knowledge gap, a cross-sectional design was applied, and structural equation modeling was used to explore the direct relationship between IA and poor sleep quality, as well as the potential mediating roles of rumination and bedtime procrastination.

METHODS

A convenience sample, consisting of 1,104 Chinese University students (696 females or 63%), completed an online survey that included the following measures: Young's 8-item Internet Addiction Diagnosis Questionnaire, the Pittsburgh Sleep Quality Index, the Ruminative Responses Scale, and the Bedtime Procrastination Scale.

RESULTS

While the direct path between IA and poor sleep quality was not found to be significant, rumination and bedtime procrastination were each shown to separately mediate the predictive effect of IA on poor sleep quality. However, the greatest level of support was found for the sequential mediating effects of rumination and bedtime procrastination between IA and poor sleep quality.

CONCLUSION

While rumination and bedtime procrastination were both shown to be important independent mediators for the relation between IA and poor sleep quality, their combined effect was as great as either alone.

Effects of transcranial direct current stimulation on addictive behavior and brain glucose metabolism in problematic online gamers

BACKGROUND AND AIMS

Some online gamers may encounter difficulties in controlling their gaming behavior. Previous studies have demonstrated beneficial effects of transcranial direct current stimulation (tDCS) on various kinds of addiction. This study investigated the effects of tDCS on addictive behavior and regional cerebral metabolic rate of glucose (rCMRglu) in problematic online gamers.

METHODS

Problematic online gamers were randomized and received 12 sessions of either active (n = 13) or sham tDCS (n = 13) to the dorsolateral prefrontal cortex over 4 weeks (anode F3/cathode F4, 2 mA for 30 min, 3 sessions per week). Participants underwent brain 18F-fluoro-2-deoxyglucose positron emission tomography scans and completed questionnaires including the Internet Addiction Test (IAT), Brief Self-Control Scale (BSCS), and Behavioral Inhibition System/Behavioral Activation System scales (BIS/BAS) at the baseline and 4-week follow-up.

RESULTS

Significant decreases in time spent on gaming (P = 0.005), BIS (P = 0.03), BAS-fun seeking (P = 0.04), and BAS-reward responsiveness (P = 0.01), and increases in BSCS (P = 0.03) were found in the active tDCS group, while decreases in IAT were shown in both groups (P < 0.001). Group-by-time interaction effects were not significant for these measures. Increases in BSCS scores were correlated with decreases in IAT scores in the active group (β = -0.85, P < 0.001). rCMRglu in the left putamen, pallidum, and insula was increased in the active group compared to the sham group (P for interaction < 0.001).

DISCUSSION AND CONCLUSIONS

tDCS may be beneficial for problematic online gaming potentially through changes in self-control, motivation, and striatal/insular metabolism. Further larger studies with longer follow-up period are warranted to confirm our findings.

Choice of Leisure Activities by Adolescents and Adults With Internet Gaming Disorder: Development and Feasibility Study of a Virtual Reality Program

Background

Excessive internet game use frequently leads to various physical, psychological, and social problems, and internet gaming disorder (IGD) has become a serious public health issue worldwide. Recently, virtual reality (VR) therapy has emerged as a promising method to increase psychological treatment motivation and accessibility. However, few studies have examined the potential of VR technology for the management of IGD, and VR content tailored to IGD characteristics remains scarce.

Objective

This preliminary study aimed to examine the potential of a VR-based program that was designed to help users identify their leisure time use patterns, especially those related to gaming, and to modify their gaming overuse by alternative activities provided in the VR content. Moreover, to investigate whether users’ VR activities reflect various clinical variables of IGD in youth, we examined the relationships among the leisure time activity selection pattern, built-in response, and speech data obtained from the VR program, as well as symptom severity of internet gaming, psychiatric comorbidities, and motivation of participants reported through relevant questionnaire data.

Methods

Three types of VR content (understanding my daily activities at home, finding an alternative activity to internet gaming at home, expressing contradictory opinions toward a friend’s gaming beliefs) were developed by simulating the daily situations in which patients with IGD can select alternative free-time leisure activities. We examined internet addiction, mental health problems, and motivation for 23 IGD and 29 control participants. Behavioral and self-rated responses from VR, such as alternative activity selection data and speech patterns (speech time, speech satisfaction, and speech accordance), and results from various questionnaires were compared between groups. The correlations between IGD behaviors in VR and real-life behaviors assessed by questionnaire measures were analyzed.

Results

Significant correlations were found between internet gaming behavior and user activity data, such as speech and activity selection pattern, in our VR program. Our results showed that the IGD group had fewer leisure activities and preferred game or digital activities to other types of activities compared to controls, even in VR. There was a positive relationship between the viability of alternative leisure activities the participants selected in VR and the amount of perceived satisfaction from that activity (r=.748, P<.001). Speech accordance in the IGD group was lower than in the control group and was correlated negatively with Internet Addiction Test and Internet Addiction Test–gaming scores (r=.300, P=.03) but positively with users’ motivation (r=.312, P=.02).

Conclusions

The results from our VR program can provide information about daily activity patterns of youths with IGD and the relationship between user VR activities and IGD symptoms, which can be useful in applying VR technology to IGD management.

Fear of Missing Out (FoMO) and Gaming Disorder among Chinese University Students: Impulsivity and Game Time as Mediators

BACKGROUND AND AIMS

Research into the fear of missing out (FoMO) has greatly increased in recent years. Given the negative consequences of gaming disorder (GD) among a small minority of individuals, there is an increasing need for research examining the impact of FoMO on GD. However, little is known about the roles of impulsivity and gaming time as mediators in the relationship between FoMO and GD. The present study examined whether impulsivity and gaming time mediated the relationship between FoMO (trait-FoMO and state-FoMO) and GD among Chinese university students, as well as the prevalence of GD.

METHODS

A total of 1127 university students completed an online survey including the Chinese Trait-State Fear of Missing Out Scale (T-SFoMOS-C), the Barratt Impulsiveness Scale-Brief (BIS-Brief), gaming time survey, and the Chinese Gaming Disorder Scale (CGDS).

RESULTS

The prevalence of GD was 6.4% among Chinese university students. Trait-FoMO was found to indirectly impact GD via impulsivity and gamine time, whereas the direct effect of trait-FoMO on GD and the mediation effects of gaming time were not confirmed. State-FoMO impacted on GD both directly, and indirectly via the mediation effects of impulsivity as well as impulsivity and gaming time.

CONCLUSION

Trait-FoMO on GD was fully mediated via impulsivity and gaming time, whereas state-FoMO on GD was partly mediated via impulsivity and gaming time. Individuals with high levels of FoMO were more likely to show impulsivity and spend a longer time gaming, and these factors were associated with GD. These findings provide insights to incorporate into health prevention programs to help regulate emotion, control impulsivity, and decrease GD.

Gaming Disorder: How to Translate Behavioral Neuroscience Into Public Health Advances

Purpose of Review

Gaming disorder (GD), meanwhile classified as a mental disorder in both DSM-5 and ICD-11, is a current public health issue. Theoretical models assume core psychological processes, such as cue reactivity, craving, reward processing, decision-making, cognitive biases, inhibitory control, and stress relief, to be crucially involved in the development and maintenance of GD. This review summarizes neuroscientific findings on these processes in the context of GD as well as treatments and intervention programs addressing these processes.

Recent Findings

We identified overlaps regarding the involvement of neural structures and networks related to psychological processes which may be targeted by public health programs. Complex interactions between executive control, salience, reward, and habit networks are crucially linked to processes involved in GD and public health programs respectively.

Summary

We point at the difficulties of making one to one assignments of neural networks to psychological processes or interventions. Furthermore, new treatment and prevention programs of GD are discussed pointing at possible future directions for neuroscientific research and treatment programs for GD.

Cognitive Correlates in Gaming Disorder and Social Networks Use Disorder: a Comparison

Purpose of Review

This overview aims at summarizing studies, which investigated cognitive correlates of gaming disorder and of a problematic use of social networks by using behavioral experimental paradigms and brain imaging techniques.

Recent Findings

Based on theoretical models, inhibition/inhibitory control, attentional bias, executive functions, decision-making, and working memory capabilities have been identified as cognitive components, which are assumed to play a crucial role in the development and maintenance of an addictive behavior. A systematic search shows that various studies have already examined the involvement of different cognitive components in both types of potential addictive behaviors. However, the number of studies addressing cognitive correlates of social networks use disorder is very much lower compared with gaming disorder, even if there is a positive trend in terms of new publications in recent years.

Summary

Cognitive correlates have been frequently investigated in gaming disorder, as in many other disorders due to substance use or addictive behaviors. Studies on cognitive aspects involved in a problematic social networks use are still rare, but they are needed in order to further show if this phenomenon may also deserve a classification as addictive disorder. Interactions between different cognitive and affective processes are still understudied in both gaming disorder and problematic social networks use.

Self-Efficacy and Clinical Characteristics in Casual Gamers Compared to Excessive Gaming Users and Non-Gamers in Young Adults

This study investigated differences in the self-efficacy and clinical characteristics which were found relevant to addictive behaviors in young adults according to time spent gaming. To our knowledge, this is the first study to explore self-efficacy in casual gamers relative to patients with internet gaming disorder (IGD) and non-gamers. In total, 158 young adults participated in this study and were divided into three groups: excessive gamers, who were diagnosed with IGD based on the Diagnostic and Statistical Manual of Mental Disorder-fifth edition (DSM-5, n = 71); casual gamers, who played games regularly but did not meet the criteria for IGD (n = 37); and non-gamers/controls, who did not engage in gaming (n = 50). All participants completed self-administered questionnaires, including measures of self-efficacy and clinical features such as the Barratt Impulsiveness Scale, Beck Depression Inventory, Beck Anxiety Inventory, Behavioral Activation/Inhibition Systems, aggression, and psychosocial well-being. There were significant differences in the self-efficacy according to the extent of gaming (excessive gamers < casual gamers < non-gamers). In addition, aggression, impulsivity, depression, anxiety, level of stress, and behavioral inhibition system scores were significantly higher in excessive gamers than in casual gamers and non-gamers. These findings showed that individuals who spend more time playing games tend to have lower self-efficacy. Our study suggests that self-efficacy may protect against or constitute a risk of excessive gaming, particularly among casual gamers. It is necessary to pay attention to enhancing psychological well-being through self-efficacy to prevent addiction in young adult gamers.

Problematic internet use: an exploration of associations between cognition and COMT rs4818, rs4680 haplotypes

OBJECTIVE

Problematic internet users suffer from impairment in a variety of cognitive domains. Research suggests that COMT haplotypes exert differential effects on cognition. We sought to investigate differences in the genetic profiles of problematic internet users and whether those could shed light on potential cognitive differences.

METHODS

We recruited 206 non-treatment seeking participants with heightened impulsive traits and obtained cross-sectional demographic, clinical, and cognitive data as well as the genetic haplotypes of COMT rs4680 and rs4818. We identified 24 participants who presented with problematic internet use (PIU) and compared PIU and non-PIU participants using one-way analysis of variance (ANOVA) and chi square as appropriate.

RESULTS

PIU was associated with worse performance on decision making, rapid visual processing, and spatial working memory tasks. Genetic variants were associated with altered cognitive performance, but rates of PIU did not statistically differ for particular haplotypes of COMT.

CONCLUSION

This study indicates that PIU is characterized by deficits in decision making and working memory domains; it also provides evidence for elevated impulsive responses and impaired target detection on a sustained attention task, which is a novel area worth exploring further in future work. The effects observed in the genetic influences on cognition of PIU subjects imply that the genetic heritable components of PIU may not lie within the genetic loci influencing COMT function and cognitive performance; or that the genetic component in PIU involves many genetic polymorphisms each conferring only a small effect.

Altered core networks of brain connectivity and personality traits in internet gaming disorder

BACKGROUND AND AIMS

Although the Internet has provided convenience and efficiency in many areas of everyday life, problems stemming from Internet use have also been identified, such as Internet gaming disorder (IGD). Internet addiction, which includes IGD, can be viewed as a behavioral addiction or impulse control disorder. This study investigated the altered functional and effective connectivity of the core brain networks in individuals with IGD compared to healthy controls (HCs).

METHODS

Forty-five adults with IGD and 45 HCs were included in this study. To examine the brain networks related to personality traits that influence problematic online gaming, the left and right central executive network (CEN) and the salience network (SN) were included in the analysis. Also, to examine changes in major brain network topographies, we analyzed the default mode network (DMN).

RESULTS

IGD participants showed lower functional connectivity between the dorsal lateral prefrontal cortex (DLPFC) and other regions in the CEN than HC participants during resting state. Also, IGD participants revealed reduced functional connectivity between the dorsal anterior cingulate cortex and other regions in the SN and lower functional connectivity in the medial prefrontal cortex of the anterior DMN. Notably, in IGD individuals but not HC individuals, there was a positive correlation between IGD severity and effective connectivity and a positive correlation between reward sensitivity and effective connectivity within the ventral striatum of the SN.

CONCLUSIONS

Problematic online gaming was associated with neurofunctional alterations, impairing the capacity of core brain networks.

Altered brain activities associated with cue reactivity during forced break in subjects with Internet gaming disorder

BACKGROUND

Studies have proven that forced break can elicit strong psychological cravings for addictive behaviors. This phenomenon could create an excellent situation to study the neural underpinnings of addiction. The current study explores brain features during a cue-reactivity task in Internet gaming disorder (IGD) when participants were forced to stop their gaming behaviors.

METHODS

Forty-nine IGD subjects and forty-nine matched recreational Internet game users (RGU) were asked to complete a cue-reactivity task when their ongoing gaming behaviors were forced to break. We compared their brain responses to gaming cues and tried to find specific features associated with IGD.

RESULTS

Compared with RGU, the IGD subjects showed decreased activation in the anterior cingulate cortex (ACC), parahippocampal gyrus, and dorsolateral prefrontal cortex (DLPFC). Significant negative correlations were observed between self-reported gaming cravings and the baseline activation level (bate value) of the ACC, DLPFC, and parahippocampal gyrus.

CONCLUSIONS

IGD subjects were unable to suppress their gaming cravings after unexpectedly forced break. This result could also explain why RGU subjects are able to play online games without developing dependence.

Differences in associations between problematic video-gaming, video-gaming duration, and weapon-related and physically violent behaviors in adolescents

Seemingly mixed findings have been reported on possible relationships between video-gaming and violent or aggressive behaviors. Given the prevalence of gaming in adolescents and potential harms associated with violent behaviors, relationships between problematic gaming, gaming engagement, and risk behaviors involving weapons and physical violence require further research. This study examined in a large sample of high-school students the relationships between problem-gaming severity, gaming duration, and violence-related measures including weapon-carrying, having been threatened by someone with a weapon, perceived insecurity, physical fights and serious fights leading to injuries. Potential moderation by sensation-seeking and impulsivity was also tested. Participants were 3,896 Connecticut high-school adolescents. Chi-square, logistic regression, and moderation models were conducted. Adolescents with at-risk/problem gaming, compared to low-risk and non-gaming adolescents, reported more weapon-carrying, having been threatened with weapons, feeling unsafe at school, and serious fighting leading to injury. Among those reporting gaming, weekly time spent gaming was associated with problem-gaming severity. Those with longer (versus shorter) gaming durations were more likely to report weapon-carrying and feeling unsafe at school. Sensation-seeking moderated associations between at-risk/problem gaming and weapon-carrying frequency. Associations between gaming quantity and problem-gaming severity and measures of weapon-carrying and physical violence in adolescents suggest that understanding further their mechanistic relationships may be important in promoting safer developmental trajectories for youth. Future longitudinal studies may provide important insight into the etiologies underlying these relationships and such information may help develop more effective prevention and intervention strategies.

Functional neural changes and altered cortical-subcortical connectivity associated with recovery from Internet gaming disorder

BACKGROUND AND AIMS

Although studies have suggested that individuals with Internet gaming disorder (IGD) may have impairments in cognitive functioning, the nature of the relationship is unclear given that the information is typically derived from cross-sectional studies.

METHODS

Individuals with active IGD (n = 154) and those individuals no longer meeting criteria (n = 29) after 1 year were examined longitudinally using functional magnetic resonance imaging during performance of cue-craving tasks. Subjective responses and neural correlates were contrasted at study onset and at 1 year.

RESULTS

Subjects' craving responses to gaming cues decreased significantly at 1 year relative to study onset. Decreased brain responses in the anterior cingulate cortex (ACC) and lentiform nucleus were observed at 1 year relative to onset. Significant positive correlations were observed between changes in brain activities in the lentiform nucleus and changes in self-reported cravings. Dynamic causal modeling analysis showed increased ACC-lentiform connectivity at 1 year relative to study onset.

CONCLUSIONS

After recovery from IGD, individuals appear less sensitive to gaming cues. This recovery may involve increased ACC-related control over lentiform-related motivations in the control over cravings. The extent to which cortical control over subcortical motivations may be targeted in treatments for IGD should be examined further.

Behaviors Associated with Internet Use in Military Medical Students and Residents

INTRODUCTION

Problematic use of video games, social media, and Internet-related activities may be associated with sleep deprivation and poor work performance. The Internet Addiction Test was given to military medical and nursing students and housestaff to assess problematic Internet use.

METHODS

Medical and nursing students at the Uniformed Services University of the Health Sciences and residents from Naval Medical Center San Diego were contacted via email (n = 1,000) and given a survey that included the Internet Addiction Test (IAT) and questions asking about other specific lifestyle variables. Individuals who received an Internet Addiction Score (IAS) ≥50 were identified as likely experiencing harmful effects of Internet addiction (IA).

RESULTS

Of 399 surveys submitted, 68 were omitted due to gross incompletion or failing to finish the entirety of the IAT. Of the participants included, 205 (61.1%) were male and 125 (37.9%) were female. The mean age was 28.6 years old (S.D. = 5.1 years). In regards to training status, completed surveys were assessed for 94 medical residents, 221 School of Medicine students, and 16 Graduate School of Nursing students. Our survey showed 5.5% of the participants (n = 18) indicated problems with Internet use that are concerning for IA.

CONCLUSIONS

The study results indicated that our population showed problematic Internet use in the lower range of global estimates of IA. Rates of IA further decreased between medical students and residents. Multiple lifestyle variables were significantly associated with IA score and may serve as indicators of a higher score. Interestingly, the use of social media during sleeping hours was most significantly associated with increased IAS. This paper discusses IA among military medical and nursing trainees and how problematic Internet use may affect work performance and force readiness.

Cognitive deficits in problematic internet use: meta-analysis of 40 studies

BACKGROUND

Excessive use of the internet is increasingly recognised as a global public health concern. Individual studies have reported cognitive impairment in problematic internet use (PIU), but have suffered from various methodological limitations. Confirmation of cognitive deficits in PIU would support the neurobiological plausibility of this disorder.

AIMS

To conduct a rigorous meta-analysis of cognitive performance in PIU from case-control studies; and to assess the impact of study quality, the main type of online behaviour (for example gaming) and other parameters on the findings.

METHOD

A systematic literature review was conducted of peer-reviewed case-controlled studies comparing cognition in people with PIU (broadly defined) with that of healthy controls. Findings were extracted and subjected to a meta-analysis where at least four publications existed for a given cognitive domain of interest.

RESULTS

The meta-analysis comprised 2922 participants across 40 studies. Compared with controls, PIU was associated with significant impairment in inhibitory control (Stroop task Hedge's g = 0.53 (s.e. = 0.19-0.87), stop-signal task g = 0.42 (s.e. = 0.17-0.66), go/no-go task g = 0.51 (s.e. = 0.26-0.75)), decision-making (g = 0.49 (s.e. = 0.28-0.70)) and working memory (g = 0.40 (s.e. = 0.20-0.82)). Whether or not gaming was the predominant type of online behaviour did not significantly moderate the observed cognitive effects; nor did age, gender, geographical area of reporting or the presence of comorbidities.

CONCLUSIONS

PIU is associated with decrements across a range of neuropsychological domains, irrespective of geographical location, supporting its cross-cultural and biological validity. These findings also suggest a common neurobiological vulnerability across PIU behaviours, including gaming, rather than a dissimilar neurocognitive profile for internet gaming disorder.

DECLARATION OF INTEREST

S.R.C. consults for Cambridge Cognition and Shire. K.I.'s research activities were supported by Health Education East of England Higher Training Special interest sessions. A.E.G.'s research has been funded by Innovational grant (VIDI-scheme) from ZonMW: (91713354). N.A.F. has received research support from Lundbeck, Glaxo-SmithKline, European College of Neuropsychopharmacology (ECNP), Servier, Cephalon, Astra Zeneca, Medical Research Council (UK), National Institute for Health Research, Wellcome Foundation, University of Hertfordshire, EU (FP7) and Shire. N.A.F. has received honoraria for lectures at scientific meetings from Abbott, Otsuka, Lundbeck, Servier, Astra Zeneca, Jazz pharmaceuticals, Bristol Myers Squibb, UK College of Mental Health Pharmacists and British Association for Psychopharmacology (BAP). N.A.F. has received financial support to attend scientific meetings from RANZCP, Shire, Janssen, Lundbeck, Servier, Novartis, Bristol Myers Squibb, Cephalon, International College of Obsessive-Compulsive Spectrum Disorders, International Society for Behavioral Addiction, CINP, IFMAD, ECNP, BAP, the World Health Organization and the Royal College of Psychiatrists. N.A.F. has received financial royalties for publications from Oxford University Press and payment for editorial duties from Taylor and Francis. J.E.G. reports grants from the National Center for Responsible Gaming, Forest Pharmaceuticals, Takeda, Brainsway, and Roche and others from Oxford Press, Norton, McGraw-Hill and American Psychiatric Publishing outside of the submitted work.

Maladaptive player-game relationships in problematic gaming and gaming disorder: A systematic review

While certain player vulnerabilities are known to increase risk of gaming disorder (GD), the topic of maladaptive player × game relationships in GD has received limited attention. This review aimed to: (1) identify game types associated with GD symptomatology; and (2) evaluate individual differences (e.g., age, personality, depression) in the relationship between gaming and GD symptomatology. A systematic review of six databases identified 23 studies of the relations between game types and GD, including 13 studies employing multivariate analyses. Player vulnerabilities implicated in GD included impulsivity, risk-taking, psychopathological symptoms (e.g., depression, anxiety), and stronger gaming motivations (e.g., escapism, achievement). MMORPG involvement had the strongest positive association with GD. Problematic MMORPG players tend to have a socially anxious profile and may be attracted to the work-like roles and conventions of this genre. Problematic players of shooters tend to score higher on measures of sensation-seeking and impulsivity than other players. These findings suggest that GD may develop more readily and at more severe levels in complex, endless, socially driven games, irrespective of person-level characteristics. Some player vulnerabilities may selectively increase risk of GD for certain game types. Further research should investigate different player-game interactions to refine current models and interventions for GD.

Meta-analyses of the functional neural alterations in subjects with Internet gaming disorder: Similarities and differences across different paradigms

Internet gaming disorder (IGD) has become a global public health concern due to its increasing prevalence and potential negative consequences. Researchers have sought to identify which brain regions are associated with this disorder. However, inconsistent results have been reported among studies due to the heterogeneity of paradigms and subjects. The present research aimed to combine the results of individual studies to provide a more coherent and powerful explanation. By selecting 40 studies utilizing a qualified whole-brain analysis, we performed a comprehensive series of meta-analyses that employed seed-based d mapping. We divided the existing experimental paradigms into 3 categories: game-related cue-reactivity, executive control, and risk-reward-related decision-making tasks. We divided all studies into three subgroups according to their paradigms. In cue-reactivity tasks, patients with IGD exhibited significant hyperactivation in the bilateral precuneus and bilateral cingulate and significant hypoactivation in the insula, but there were no differences in the striatum. In executive control tasks, patients with IGD displayed significant hyperactivation in the right superior temporal gyrus, bilateral precuneus, bilateral cingulate, and insula and hypoactivation in the left inferior frontal gyrus. In risky decision-making paradigms, IGD patients exhibited significant hyperactivation in the left striatum, right inferior frontal gyrus, and insula and hypoactivation in the left superior frontal gyrus, left inferior frontal gyrus, and right precentral gyrus. Our study aimed to discover the similarities among all studies and to explore the uniqueness of the different paradigms. This study further confirmed the critical role of reward circuitry and executive control circuitry in IGD but not under all conditions.

The effects of video gaming on visual selective attention

A growing body of research shows that video games may be used to enhance cognitive skills, with particular reference to attentional abilities. This research study explored the effects of video game playing on visual selective attention in a young adult sample. A secondary research objective explored the possibility that gender acted as a moderating variable with regard to their visual selective attention. This was achieved by means of a quantitative research design, which consisted of a survey research and a quasi-experimental research design. Participants were sampled using purposive sampling ( n = 80), and to test the effects of video game playing and gender on visual selective attention, participants were exposed to a computerised version of the Stroop task. Data were analysed using a two-way between-group analysis of variance (ANOVA) and results indicated a statistically significant difference in visual selective attention abilities between video game players and the non-players. Video gamers thus exhibited more advanced attentional skills than non-players. There were no interaction effects between video game playing and gender, and gender did not have a statistically significant main effect on participants’ visual selective attention.

The Effectiveness of the Game of Dice Task in Predicting At-Risk and Problem Gambling Among Adolescents: The Contribution of the Neural Networks

The Game of Dice Task (GDT; Brand et al. in Neuropsychology 19:267-277, 2005a; Psychiatry Res 133:91-99, 2005b) measures decision-making under objective risk conditions. Although disadvantageous decision-making has been shown in individuals with substance dependency, such as pathological dependency, any studies have been conducted with adolescents by using the GDT to investigate the relationship between the performance on the task and gambling behavior. Moreover, all the previous studies have considered only the GDT net score and not the single choices. In the current study, focusing on adolescents, we wanted to investigate the relationship between the sequence of the choices at the GDT and gambling behavior, measured with the SOGS-RA. To analyze the predictive power of the sequence of choices made in the GDT and problem gambling and gambling frequency, we used the Neural Networks (NNs), which are often used to find relationships between a series of input actions and the correspondent empirical outputs in order to discover behavioral patterns that may be predictive of at-risk behaviors. Results showed that neither a linear or a non-linear relationship could be detected between the GDT performance and the SOGS-RA classification both in terms of gambling problem severity and gambling frequency. Indeed, different training algorithms produced different performances of the NN on the training sets, but all of them showed a very low prediction capability on new samples. Thus, the performance at the GDT did not discriminate between adolescent gamblers with different and progressive levels of problematic gambling behavior and gambling frequency. Limitations and future studies are discussed.

The Correlation between the Frontostriatal Network and Impulsivity in Internet Gaming Disorder

As excessive use of internet gaming has become a serious public health concern, increasing studies have revealed that impulsivity is one of the important risk factors of internet gaming disorder (IGD). This study was designed to investigate the altered resting-state functional connectivity (FC) of the bilateral orbitofrontal cortex (OFC) in IGD participants and to examine its relationship with impulsivity compared with the normal controls (NC). Seed-based analyses verified that participants with IGD displayed decreased FC between the OFC and frontal, striatal, temporal and occipital regions different from NC. Moreover, IGD participants showed weankened FC from the OFC with dorsal anterior cingulate cortex as well as with dorsolateral prefrontal cortex and dorsal striatum as the results of group difference. These results could suggest that the decreased frontostriatal connectivity was associated with excessive internet gaming. Also, the increased FC in frontostriatal regions was correlated with impulse control in the NC but not the IGD participants. Further insight into the brain circuitry on frontostriatal could provide the target for developing treatment approaches of impulse control in IGD.

Stress System Response and Decision Making in Heavy Episodic Users of Alcohol and Online Video Games

Objective: Few empirical studies have addressed stress system response and subsequent decision making in problematic online video game players who also consume alcohol. Method: Participants were randomly assigned to either receive a psychosocial stressor, including evaluated public speaking and mental arithmetic, or control condition. Salivary cortisol, cardiovascular and subjective responses were collected. Following, decision making was assessed using the Iowa Gambling Task. Results: In this sample of moderate internet gamers (N = 71; 45 male, 16.9% meeting suggested DSM-5 criteria for internet gaming disorder), 53.52% met gender-specific cut-points for heavy episodic drinking. Overall, participants in the TSST condition demonstrated elevated systolic and diastolic blood pressure, self-reported anxiety, and negative affect (ps < .05). However, response to the TSST was varied, particularly in individuals reporting binge internet gaming (6 h or more consecutive use in the last 30 d) who did not display the expected decline in positive affect in response to the TSST (p = .02). Differences in greater advantageous decision making between heavy episodic internet gaming participants in the stress condition, versus those reading a travel magazine, were also noted. These differences were not significant in participants reporting an absence of heavy episodic gaming behavior. Conclusions: These findings support the continued study of individuals who engage in problematic internet gaming behavior, particularly those who engage in heavy episodic use of alcohol.

Bad Choices Make Good Stories: The Impaired Decision-Making Process and Skin Conductance Response in Subjects With Smartphone Addiction

Introduction: Smartphone Addiction (SA) has caused negative consequences and functional impairments in college students, such as reduction of academic performance and impairment in sleep quality. Studies have shown that individuals with chemical and behavioral dependencies have a bias in decision-making process, which leads to short-term advantageous choices even if they cause long-term harm. This bias in decision-making process is accompanied by a change in somatic markers and is associated with the development and maintenance of addictive behavior. The decision-making process and the measurement of physiological parameters have not yet been analyzed in SA. The neuropsychological and physiological characterization of the SA can contribute to its approach with the other dependency syndromes and to its recognition as a disease. Objective: we aimed to evaluate the decision-making process under risk and under ambiguity in individuals with SA and to measure the physiological parameters that accompany this process. Method: We compared the performance in the Iowa Gambling Task (IGT), Game of Dice Task (GDT) and skin conductance response (SCR) between 50 individuals with SA and 50 controls. Results: Smartphone dependents presented a profile of impairment in decision-making under ambiguity, without impairment in decision-making under risk. They demonstrated lower SCR before disadvantageous choices, higher SCR after rewards and lower SCR after punishments during decision-making, which suggests difficulty in recognizing disadvantageous alternatives, high sensitivity to rewards, and low sensitivity to punishments. Conclusion: The impairment in the decision-making process in smartphone dependents is similar to that found in other chemical and behavioral addictions, such as alcohol addiction, gambling disorders and pathological buy. The impairment in decision under ambiguity with preservation of decision under risk may reflect dysfunction of implicit emotional processes without dysfunction of explicit cognitive process. This profile can contribute to the recognition of SA as a behavioral dependence and to guide specific preventive and therapeutic strategies.

Internet Use Influences Self-Related Process: Evidence From Behavior and ERPs

The present study aimed to examine whether a self-related stimulus produces a self-related process bias between pathological-tendency Internet users and ordinary Internet users. Participants were asked to judge the color of the target stimulus' frame (Internet pictures) in an implicit priming task, which enclosed the prime of self/other related words and the target of the online image in sequence. Results from Experiment 1 showed that response time (RT) in the self-related condition was significantly longer than that of the other related condition. Further analysis showed that RT in the self-related condition was significantly longer than that under the other related conditions for pathological-tendency Internet users but not for ordinary Internet users. In Experiment 2, behavior results demonstrated that RT under the self-related condition was significantly longer than that in the other-related condition for both groups, and the RT was shorter for pathological-tendency Internet users than that of the ordinary Internet users. Moreover, ERP data showed that the N2 amplitude was larger in the self-related condition than that of other related conditions for pathological-tendency Internet users but not for ordinary Internet users. The amplitudes of late positive component (LPC) was smaller in the self-related condition than those of the other related conditions. Hence, the Internet use influenced the inhibition control in self-unrelated stimuli and automatically retrieved the self-related stimuli.

Transcranial direct current stimulation for online gamers: A prospective single-arm feasibility study

AIM

Excessive use of online games can have negative influences on mental health and daily functioning. Although the effects of transcranial direct current stimulation (tDCS) have been investigated for the treatment of addiction, it has not been evaluated for excessive online game use. This study aimed to investigate the feasibility and tolerability of tDCS over the dorsolateral prefrontal cortex (DLPFC) in online gamers.

METHODS

A total of 15 online gamers received 12 active tDCS sessions over the DLPFC (anodal left/cathodal right, 2 mA for 30 min, 3 times per week for 4 weeks). Before and after tDCS sessions, all participants underwent ¹⁸F-fluoro-2-deoxyglucose positron emission tomography scans and completed the Internet Addiction Test (IAT), Brief Self Control Scale (BSCS), and Beck Depression Inventory-II (BDI-II).

RESULTS

After tDCS sessions, weekly hours spent on games (p = .02) and scores of IAT (p < .001) and BDI-II (p = .01) were decreased, whereas BSCS score was increased (p = .01). Increases in self-control were associated with decreases in both addiction severity (p = .002) and time spent on games (p = .02). Moreover, abnormal right-greater-than-left asymmetry of regional cerebral glucose metabolism in the DLPFC was partially alleviated (p = .04).

CONCLUSIONS

Our preliminary results suggest that tDCS may be useful for reducing online game use by improving interhemispheric balance of glucose metabolism in the DLPFC and enhancing self-control. Larger sham-controlled studies with longer follow-up period are warranted to validate the efficacy of tDCS in gamers.

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

This commentary proposes an integrative approach of theoretical and empirical considerations when developing policy responses to Internet-gaming disorder and when evaluating their efficacy. It complements the overview by Király et al. (2018) about preventive and treatment programs by referring to a lack of inclusion of internal factors, such as individual aspects and cognitions, and missing empirical evidence. This commentary claims the integration of current research addressing individual predisposing and maintaining factors in order to evaluate existing programs and to enhance the exchange between actors including policy. This integrative approach has the potential to develop successful preventive strategies, which could be implemented realistically and socially responsible.

Internet Game Overuse Is Associated With an Alteration of Fronto-Striatal Functional Connectivity During Reward Feedback Processing

Internet gaming disorder is associated with abnormal reward processing in the reward circuit, which is known to interact with other brain regions during feedback learning. Kim et al. (1) observed that individuals with internet game overuse (IGO) exhibit altered behavior and neural activity for non-monetary reward, but not for monetary reward. Here, we extend our analysis of IGO to the functional connectivity of the reward network. Functional MRI data were obtained during a stimulus-response association learning task from 18 young males with IGO and 20 age-matched controls, where either monetary or non-monetary rewards were given as positive feedback for a correct response. Group differences in task-dependent functional connectivity were examined for the ventromedial prefrontal cortex (vmPFC) and ventral striatum (VS), which are known for reward evaluation and hedonic response processing, respectively, using a generalized form of the psychophysiological interaction approach. For non-monetary reward processing, no differences in functional connectivity were found. In contrast, for monetary reward, connectivity of the vmPFC with the left caudate nucleus was weaker for the IGO group relative to controls, while vmPFC connectivity with the right nucleus accumbens (NAcc) was elevated. The strength of vmPFC-NAcc functional connectivity appeared to be behaviorally relevant, because individuals with stronger vmPFC-NAcc connectivity showed lower learning rates for monetary reward. In addition, the IGO group showed weaker ventral striatum functional connectivity with various brain regions, including the right ventrolateral prefrontal cortex, dorsal anterior cingulate regions, and left pallidum. Thus, for monetary reward, the IGO group exhibited stronger functional connectivity within the brain regions involved in motivational salience, whereas they showed reduced functional connectivity the widely distributed brain areas involved in learning or attention. These differences in functional connectivity of reward networks, along with related behavioral impairments of reward learning, suggest that internet gaming disorder is associated with the increased incentive salience or "wanting" of addiction disorders, and may serve as the neurobiological mechanisms underlying the impaired goal-directed behavior.

Internet gaming disorder in children and adolescents: a systematic review

AIM

Internet gaming disorder (IGD) is a serious disorder leading to and maintaining pertinent personal and social impairment. IGD has to be considered in view of heterogeneous and incomplete concepts. We therefore reviewed the scientific literature on IGD to provide an overview focusing on definitions, symptoms, prevalence, and aetiology.

METHOD

We systematically reviewed the databases ERIC, PsyARTICLES, PsycINFO, PSYNDEX, and PubMed for the period January 1991 to August 2016, and additionally identified secondary references.

RESULTS

The proposed definition in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition provides a good starting point for diagnosing IGD but entails some disadvantages. Developing IGD requires several interacting internal factors such as deficient self, mood and reward regulation, problems of decision-making, and external factors such as deficient family background and social skills. In addition, specific game-related factors may promote IGD. Summarizing aetiological knowledge, we suggest an integrated model of IGD elucidating the interplay of internal and external factors.

INTERPRETATION

So far, the concept of IGD and the pathways leading to it are not entirely clear. In particular, long-term follow-up studies are missing. IGD should be understood as an endangering disorder with a complex psychosocial background.

WHAT THIS PAPER ADDS

In representative samples of children and adolescents, on average, 2% are affected by Internet gaming disorder (IGD). The mean prevalences (overall, clinical samples included) reach 5.5%. Definitions are heterogeneous and the relationship with substance-related addictions is inconsistent. Many aetiological factors are related to the development and maintenance of IGD. This review presents an integrated model of IGD, delineating the interplay of these factors.