"Computer addiction": a critical consideration

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

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

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/ .

Surfing Alone: From Internet Addiction to the Era of Smartphone Dependence

Technological addiction refers to behavior characterized by excessive and prolonged use of technological devices; reactions of anger, frustration, or panic when unable to use them; and unsuccessful attempts to reduce the time spent on them [...].

Problematic video gaming is negatively associated with bone mineral density in adolescents

Adolescent bone health may be negatively impacted by problematic video gaming (PVG) due to factors such as prolonged screen time, poor sleep quality, and increased depression. Although sedentary behaviors have been linked to decreased bone mass, there is limited research on how PVG impacts bone health. We aimed to evaluate the association between PVG and bone mineral density (BMD) in adolescents by comparing the BMD z-scores of adolescents with and without PVG and by identifying PVG-related risk factors that may affect low BMD scores. This cross-sectional study took place between May 2019 and August 2021 with 110 adolescents who played video games for at least two hours per day. Data on screen time, game genre, tobacco, alcohol, caffeine consumption, and vigorous physical activity status were recorded. PVG was assessed using the Internet Gaming Disorder-Short Form (IGDS9-SF), with scores ≤ 16 comprising the control group and > 16 the PVG group. Sleep quality was assessed by Pittsburgh Sleep Quality Index, and depression was evaluated by Children's Depression Inventory. Dual-energy X-ray absorptiometry measurements of femoral neck and lumbar spine BMD were compared between the two groups. The mean age of the participants was 14.2 ± 1.8 years, and 86.4% were males. The PVG group exhibited lower femoral neck z-scores (p = 0.013) and a higher proportion of adolescents with low femoral neck BMD risk (27.8% vs 9.7%, p = 0.041). Lumber spine z-scores did not differ (p = 0.271). Despite poorer depressive symptoms and sleep quality in the PVG group, they were not associated with low BMD risk (OR 1.02, 95% CI 0.97-1.08, p = 0.398 and OR 1.00, 95% CI 0.87-1.18, p = 0.972, respectively). Among all PVG-related risk factors, video game time (aOR = 1.22, 95% CI = 1.06-1.41, p = 0.006) and vigorous physical activity amount (aOR = 2.86, 95% CI = 0.93-8.76, p = 0.080) showed the strongest associations with femoral neck z-scores.  Conclusion: The results of this study, showing a negative association between PVG and femoral neck BMD in adolescents, underscore the importance evaluating, monitoring, and supporting lower extremity bone health in adolescents with PVG. What is Known: • Adolescents with problematic video gaming are at risk for depression, impaired sleep; sedentary lifestyle; consumption of tobacco, alcohol, and drugs; and high caffeine intake. • These risk factors might lead to compromised bone health. What is New: • Problematic video gaming is associated with the low femoral neck bone mineral density risk in adolescents. • Extended video game time and reduced physical activity are found to be the primary risk factors.

Using Theoretical Models of Problematic Internet Use to Inform Psychological Formulation: A Systematic Scoping Review

BACKGROUND

Empirical research has been produced on the topic of 'Internet Addiction' or 'Problematic Internet Use' (PIU) for more than 20 years, with a variety of theoretical approaches suggested by scholars to account for the behaviour. However, the discourse has been fraught with debate around construct definition, measurement, and validity.

AIMS

This review aimed to systematically review the extant literature on the topic of PIU, to identify the published psychological theories in the area, and to synthesise the findings to produce actionable information for practicing psychologists as well as academics.

METHOD

Given the breadth of the aims, a scoping review methodology was utilised. Four major reference libraries (Scopus, Proquest, Pubmed, Technology Research Database) were searched using a string of relevant terms.

RESULTS

Of 1412 initial search results, eighteen theories were included in the study. Nine theories related to generalised PIU, seven related to specific Internet use issues, such as online gaming or social media, while two theories took account of both a generalised and specific view. Data were analysed using Formulation-Based Thematic Analysis (FBTA) to synthesise theory elements under the deductive headings of Predisposing, Precipitating, Maintaining, and Protective factors.

DISCUSSION

The lack of protective factors against PIU was a prominent finding. The utility of the psychological formulation approach, particularly in an area fraught with conceptual debate and frustration with traditional medical classification systems, is emphasised.

Is Problematic Internet and Smartphone Use Related to Poorer Quality of Life? A Systematic Review of Available Evidence and Assessment Strategies

Purpose of Review

Previous studies have explored the links between problematic Internet use (PIU) or problematic smartphone use (PSU) and quality of life (QOL). In this systematic review, we (i) describe the instruments used to assess QOL or health-related quality of life (HRQOL) in these studies, (ii) critically examine the content validity of the instruments used, and (iii) examine the relationships between PIU, PSU, QOL, and HRQOL.

Recent Findings

We identified 17 PIU and 11 PSU studies in a systematic search. Evidence suggests that PIU and PSU negatively correlate with either QOL or HQOL and most of their domains (especially mental and physical health). Multiple instruments were used to assess QOL or HRQOL in these studies. Our analysis showed an important heterogeneity in the domains covered by these instruments.

Summary

Because of the widespread prevalence of PIU and PSU, which tend to be linked with lower QOL or HRQOL, in particular poor mental and physical health, a more systematic public health campaign is required to target the healthy use of these communication devices. Prevention programs should also target vulnerable individuals, focusing on the most affected domains of QOL and HRQOL (i.e., physical and psychological health). Among the existing instruments, the World Health Organization Quality of Life for adults and the Pediatric Quality of Life Inventory for adolescents (aged 13-18 years) proved to be the most relevant, although new measurement instruments are needed to target domains that are specifically relevant in the context of PIU and PSU (e.g., physical and psychological health domains such as sleep, loneliness, and quality of familial relations).

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

Background

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

Methods

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

Results

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

Discussion and Conclusions

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

Tracing 20 years of research on problematic use of the internet and social media: Theoretical models, assessment tools, and an agenda for future work

Over the past two decades, there has been increasing interest in the impact of internet use and growing concern about whether problematic use of the internet (PUI) constitutes an addiction. Despite the growing number of studies investigating PUI and PUI subtypes, its conceptualization and inclusion in a classification system have not been possible yet. Several models aimed at inspiring clinical research and practice have proposed possible mechanisms involved in PUI and problematic use of social media, and multiple self-report instruments have been consequentially developed. The diversity of theoretical models and instruments currently hinders standardized assessment procedures across studies and, in turn, their comparability. The purpose of the present overview is to highlight the current conceptualization and assessment of both PUI and problematic use of social media, in order to critically discuss the existing fragmentation in the field and the need to achieve conceptual convergence. Two suggestions for future directions are also provided, i.e., define diagnostic criteria by bottom-up and top-down processes and develop a psychobiological hypothesis including the description of higher-order mechanisms involved in PUI and not other psychopathological conditions (e.g., the multiple available internet-related cues and outcomes that may lead to parallel forms of associative learning; probabilities of obtaining internet-related reinforcements; and intrinsic motivation processes).

Identifying the central symptoms of problematic social networking sites use through network analysis

BACKGROUND

Problematic social media use (PSMU) has received growing attention in the last fifteen years. Even though PSMU has been extensively studied, its internal structure is not fully understood. We used network analysis to evaluate which symptoms and associations between symptoms are most central to PSMU - as assessed by the Generalized Problematic Internet Use Scale-2 adapted for PSMU - among undergraduates.

METHOD

Network analysis was applied to a large gender-balanced sample of undergraduates (n = 1344 participants; M = 51.9%; mean age = 22.50 ± 2.20 years).

RESULTS

The most central nodes in the network were the difficulty of controlling one's own use of social media, the tendency to think obsessively about going online, the difficulties in resisting the urge to use social media and the preference for communicating with people online rather than face-to-face. This last element was strongly associated with a general preference for online social interactions and the feeling of being more comfortable online. The network was robust to stability and accuracy tests. The mean levels of symptoms and symptom centrality were not associated.

CONCLUSIONS

Deficient self-regulation and preference for online communication were the most central symptoms of PSMU, suggesting that these symptoms should be prioritized in theoretical models of PSMU and could also serve as important treatment targets for PSMU interventions.

The relationship of smartphone addiction with psychological distress and neuroticism among university medical students

Background

Smartphone plays a vital role in higher education as it serves as a device with multiple functions. Smartphone addiction was reported on the rise among college and university students. The addiction may result in unwanted consequences on their academic performance and psychological health. One factor that consistently relates to psychological distress and smartphone addiction is the neurotic personality trait. This study explored the relationship of smartphone addiction with psychological health and neuroticism among USM medical students.

Methods

A cross-sectional study was carried out on medical students in a public medical school. DASS-21, the neuroticism-subscale of USMaP-i and SAS-SV were administered to measure psychological distress, neuroticism, and smartphone addiction of the medical students. Spearman correlation was performed to examine the correlation between smartphone addiction with psychological distress and neuroticism. Simple linear regression was performed to investigate relationship factors of smartphone addiction.

Results

A total of 574 medical students participated in this study. The prevalence of smartphone addiction was 40.6%. It was higher among male (49.2%) compared to female (36.6%) medical students. The result showed a fair positive correlation between smartphone addiction and psychological health (rdepression = 0.277, p-value < 0.001; ranxiety = 0.312, p-value < 0.001; rstress = 0.329, p-value < 0.001). However, there was a poor positive correlation between smartphone addiction and neuroticism (r = 0.173, p-value < 0.001). The simple linear regression showed a significant increase in the levels of depression, anxiety, stress and neuroticism upon one unit increase in smartphone addiction (bdepression = 0.101, p-value < 0.001; banxiety = 0.120, p-value < 0.001; bstress = 0.132, p-value < 0.001; bneuroticism = 0.404, p-value < 0.05). These results indicated significant relationships between smartphone addiction, psychological health and neuroticism.

Conclusion

This study suggested a high prevalence of smartphone addiction among medical students, particularly in male medical students. The smartphone addiction might lead to psychological problems and the most vulnerable group is the medical student with the neurotic personality trait.

Risky cyber behaviors in adolescents with depression: A case control study

OBJECTIVE

This study aimed to compare adolescents diagnosed with major depressive disorder (MDD) and healthy adolescents with regard to cyberbullying, cyber victimization, internet addiction, and digital game addiction.

MATERIALS AND METHODS

This cross-sectional study was performed in Selçuk University Hospital. The study sample consisted of 34 adolescents with MDD and 39 controls without any psychopathology. A socio-demographic data form, the Cyber bullying Scale (CBS), Cyber Victimization Scale (CVS), Cyber bullying Sensibility Scale (CBSS), Internet Addiction Scale (IAS), Digital Game Dependence Scale (DGA-7), and Children's Anxiety and Depression Scale-Refurbished (RCADS) were administered to all participants.

RESULTS

CBS, CVS, IAS and DGAS-7 scores of the MDD group were significantly higher than those of the control group. The significant differences persisted even after controlling for confounding factors such as age, gender, socio-economic level, and parental educational levels with MANCOVA. A strong positive correlation existed between CBS and CVS scores, and higher IAS scores were associated with higher CBS scores in the MDD group. CBSS scores negatively correlated with DGAS-7 scores in the MDD group.

LIMITATIONS

Due to the cross-sectional design of this study, conclusions about causality remain speculative.

CONCLUSION

This study demonstrated the importance of assessing problems related to the online environment in the presence of depression in adolescents. Our results suggested that evaluating the use of technology with a view to the potential for cyber bullying and cyber victimization as well as internet addiction and addiction to digital games may be necessary as a holistic approach in the follow-up of adolescent depression.

Problematic internet use in children and adolescents: associations with psychiatric disorders and impairment

BACKGROUND

Problematic internet use (PIU) is an increasingly worrisome issue, as youth population studies are establishing links with internalizing and externalizing problems. There is a need for a better understanding of psychiatric diagnostic profiles associated with this issue, as well as its unique contributions to impairment. Here, we leveraged the ongoing, large-scale Child Mind Institute Healthy Brain Network, a transdiagnostic self-referred, community sample of children and adolescents (ages 5-21), to examine the associations between PIU and psychopathology, general impairment, physical health and sleep disturbances.

METHODS

A total sample of 564 (190 female) participants between the ages of 7-15 (mean = 10.80, SD = 2.16), along with their parents/guardians, completed diagnostic interviews with clinicians, answered a wide range of self-report (SR) and parent-report (PR) questionnaires, including the Internet Addiction Test (IAT) and underwent physical testing as part of the Healthy Brain Network protocol.

RESULTS

PIU was positively associated with depressive disorders (SR: aOR = 2.43, CI: 1.22-4.74, p = .01; PR: aOR = 2.56, CI: 1.31-5.05, p = .01), the combined presentation of ADHD (SR: aOR = 1.91, CI: 1.14-3.22, p = .01; PR: n.s.), Autism Spectrum Disorder (SR: n.s.; PR: aOR = 2.24, CI: 1.34-3.73, p < .001), greater levels of impairment (SR: Standardized Beta = 4.63, CI: 3.06-6.20, p < .001; PR: Standardized Beta = 5.05, CI: 3.67-6.42, p < .001) and increased sleep disturbances (SR: Standardized Beta = 3.15, CI: 0.71-5.59, p = .01; PR: Standardized Beta = 3.55, CI: 1.34-5.75, p < .001), even when accounting for demographic covariates and psychiatric comorbidity.

CONCLUSIONS

The association between PIU and psychopathology, as well as its impact on impairment and sleep disturbances, highlight the urgent need to gain an understanding of mechanisms in order to inform public health recommendations on internet use in U.S. youth.

Attentional bias in Internet users with problematic use of social networking sites

BACKGROUND AND AIMS

Evidence from the field of addictive disorders suggests that attentional bias for stimuli related to a substance or activity of abuse (e.g., gambling) exacerbates the addictive behavior. However, evidence regarding attentional bias in PIU is sparse. This study aims to investigate whether individuals who express problematic tendencies toward social networking sites (SNS), a subtype of PIU, show attentional bias for stimuli associated with social media.

METHODS

Sixty-five participants performed Visual Dot-Probe and Pleasantness Rating Tasks containing SNS-related and matched control images during eye movements were recorded, providing a direct measure of attention. Participants were assessed on their levels of SNS Internet use (ranging from problematic to non-problematic) and their levels of urges to be online (high vs. low).

RESULTS

Problematic SNS users and, in particular, a subgroup expressing higher levels of urges to be online showed an attentional bias for SNS-related images compared to control images.

CONCLUSION

These results suggest that attentional bias is a common mechanism associated with problematic Internet use as well as other addictive disorders.

Internet addiction: a new addiction?

The internet today has become an integral part of daily life that facilitates communication, education, and entertainment. The behavioral pattern of excessive internet usage has similarities to substance addiction, such as tolerance, withdrawal, repeated failure to reduce or quit, and impairment in daily life. Yet, there is no consistent physiological change that accompanies excessive use of the internet, as there is in excessive substance use. Neurological and neuroimaging studies of excessive internet users show biological changes in the prefrontal cortex that are similar to those found in other addictive syndromes. Brain structure changes also occur in the temporal cortex and ventral striatum, compromising executive function in planning and reasoning and increasing impulsive risk, resulting in loss of control over internet use. Of all the potential online applications known to cause addiction, only internet gaming disorder has been selected in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a condition for further study.

Adição à internet ou uso problemático da internet? Qual dos termos usar?

Resumo O uso da internet tem aumentado exponencialmente a nível mundial. Ainda que ele não seja por si só negativo, já que integra benefícios vários, alguns indivíduos parecem exibir problemas relacionados com o seu uso excessivo, descontrolado e disfuncional. Consequentemente, tem sido crescente, particularmente nas últimas duas décadas, o interesse dos investigadores em explorar este uso, quando excessivo e pouco saudável. Porém, e sendo um tema/constructo tratado por diferentes autores com quadros teóricos também diferentes, são vários os termos usados na literatura para descrever este fenómeno. Neste sentido, este artigo propõe-se a apresentar o trabalho uma revisão de literatura de dois dos conceitos mais usados e espartilhados na literatura científica, ou seja, adição à internet e uso problemático da internet.

Internet addiction and attention-deficit-hyperactivity disorder: Effects of anxiety, depression and self-esteem

BACKGROUND

Attention-deficit-hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood. Behavioral disinhibition, poor neurocognitive skills and immediate reward preference in children with ADHD have been suggested as risk factors for Internet addiction (IA). The aim of the present study was therefore to investigate the relationship between IA and depression, anxiety, and self-esteem in adolescents with ADHD, and to identify the features of Internet use that predict IA.

METHODS

We studied 111 patients with ADHD aged 12-18 years, and 108 healthy controls. The ADHD patients and controls were asked to complete a sociodemographic data form, the Internet Addiction Scale (IAS), Children's Depression Inventory, Childhood Screening Scale for Anxiety in Children, and the Rosenberg Self-Esteem Scale.

RESULTS

IAS total score in the adolescents with ADHD was significantly higher than in the control group. Compared with the control group, the ADHD group depression scale score was significantly higher, and self-esteem score significantly lower (P < 0.05 for both). There was no difference between the groups in anxiety score. IAS score had a positive correlation with depression and anxiety scores, and a negative correlation with self-esteem score.

CONCLUSION

The relationship between IA scale score and depression, anxiety and self-esteem scale scores were similar in the ADHD and the control group. In addition, IAS subscale and total scores were significantly higher in the ADHD group than the control group, even after controlling for the effects of self-esteem, depression and anxiety scores. Thus, ADHD is thought to be an independent risk factor for depression, anxiety and self-esteem, and, hence, for IA.

Problematic internet use and psychiatric co-morbidity in a population of Japanese adult psychiatric patients

BACKGROUND

Many studies reported the high prevalence of problematic internet use (PIU) among adolescents (13-50%), and PIU was associated with various psychiatric symptoms. In contrast, only a few studies investigated the prevalence among the adult population (6%). This study aimed to investigate the prevalence of PIU and psychiatric co-morbidity among adult psychiatric patients.

METHODS

Three hundred thirty-three adult psychiatric patients were recruited over a 3-month period. Two hundred thirty-one of them completed the survey (response rate: 69.4%, 231/333; Male/Female/Transgender: 90/139/2; mean age = 42.2). We divided participants into "normal internet users" and "problematic internet users" using a combination of Young's Internet Addiction Test (IAT) and the Compulsive Internet Use Scale (CIUS). Demographic data and comorbid psychiatric symptoms were compared between the two groups using self-rating scales measuring insomnia (Athens Insomnia Scale, AIS), depression (Beck Depression Inventory, BDI), anxiety (State-trait Anxiety Inventory, STAI), attention deficit hyperactivity disorder (ADHD) (Adult ADHD Self-report Scale, ASRS), autism (Autism Spectrum Quotient, AQ), obsessive-compulsive disorder (OCD) (Obsessive-Compulsive Inventory, OCI), social anxiety disorder (SAD) (Liebowitz Social Anxiety Scale, LSAS), alcohol abuse, and impulsivity (Barratt Impulsive Scale, BIS).

RESULTS

Among 231 respondents, 58 (25.1%) were defined as problematic internet users, as they scored high on the IAT (40 or more) or CIUS (21 or more). The age of problematic internet users was significantly lower than that of normal internet users (p < 0.001, Mann-Whitney U test). The problematic internet users scored significantly higher on scales measuring sleep problems (AIS, 8.8 for problematic internet users vs 6.3 for normal internet users, p < 0.001), depression (BDI, 27.4 vs 18.3, p < 0.001), trait anxiety (STAI, 61.8 vs 53.9, p < 0.001), ADHD (ASRS, part A 3.1 vs 1.8 and part B 3.5 vs 1.8, p < 0.001), autism (AQ, 25.9 vs 21.6, p < 0.001), OCD (OCI, 63.2 vs 36.3, p < 0.001), SAD (LSAS, 71.4 vs 54.0, p < 0.001), and impulsivity (BIS, 67.4 vs 63.5, p = 0.004).

CONCLUSIONS

The prevalence of PIU among adult psychiatric patients is relatively high. As previous studies reported in the general population, lower age and psychiatric comorbidity were associated with PIU among adult psychiatric patients. More research is needed to determine any causal relations between PIU and psychopathological illnesses.

Neuroticism and quality of life: Multiple mediating effects of smartphone addiction and depression

The purposes of this study were to investigate the mediating effect of smartphone addiction and depression on neuroticism and quality of life. Self-reported measures of neuroticism, smart-phone addiction, depression, and quality of life were administered to 722 Chinese university students. Results showed smartphone addiction and depression were both significantly affected neuroticism and quality of life. The direct effect of neuroticism on quality of life was significant, and the chain-mediating effect of smartphone addiction and depression was also significant. In conclusion, neuroticism, smartphone addiction, and depression are important variables that worsen quality of life.

How can we conceptualize behavioural addiction without pathologizing common behaviours?

Following the recent changes to the diagnostic category for addictive disorders in DSM-5, it is urgent to clarify what constitutes behavioural addiction to have a clear direction for future research and classification. However, in the years following the release of DSM-5, an expanding body of research has increasingly classified engagement in a wide range of common behaviours and leisure activities as possible behavioural addiction. If this expansion does not end, both the relevance and the credibility of the field of addictive disorders might be questioned, which may prompt a dismissive appraisal of the new DSM-5 subcategory for behavioural addiction. We propose an operational definition of behavioural addiction together with a number of exclusion criteria, to avoid pathologizing common behaviours and provide a common ground for further research. The definition and its exclusion criteria are clarified and justified by illustrating how these address a number of theoretical and methodological shortcomings that result from existing conceptualizations. We invite other researchers to extend our definition under an Open Science Foundation framework.

Conceptualizing Internet use disorders: Addiction or coping process?

This paper problematizes the tendency to study Internet use disorders from a perspective of addiction. It is argued that an addiction perspective, grounded in our understanding of substance use disorders, has not contributed much to an improved understanding of the antecedents and etiology of Internet use disorders. Despite this, researchers continue to frame Internet use disorders as an addiction, recently exemplified by the inclusion of Internet gaming disorder in the DSM-5 research appendix as a behavioral addiction. This paper claims that the decision to use an addiction framework to study Internet use disorders has consequences for the way in which results are interpreted, which impacts the potential for theoretical and etiological contributions negatively. The paper argues that a perspective of addiction may not be the most useful approach because it causes a mismatch between theory and findings in empirical work: it is not uncommon to find that a study is positioned as a study of addiction, but presents findings more illustrative of coping behaviors. The paper draws on two examples from the literature to illustrate this mismatch and discusses how this hinders theoretical and etiological development. The question that is asked going forward is what alternative explanations we might identify by not exclusively adhering to an addiction framework for purposes of research. Recommendations are given for how to usefully approach the study of Internet use disorders outside a framework of addiction. It also discusses how scholars who still prefer a framework of addiction might strengthen their conceptual position to ensure improved contributions to etiology and theoretical development.

Neural correlate of Internet use in patients undergoing psychological treatment for Internet addiction

BACKGROUND

The new version of Diagnostic and Statistical Manual of Mental Disorders (DSM-5th) proposed the Internet Gaming Disorder for the diagnosis of Internet addiction (IA) considering the neurobiological evidence of the craving.

AIMS

The aim was to test the neural correlate in response to the Internet cue in patients with IA.

METHODS

Sixteen males with IA diagnosis (clinical group) and 14 healthy male (control group) were recruited for an experimental visual task composed of Internet images and emotional images. During the visual presentation of Internet cue, electroencefalographic data were recorded using Net Station 4.5.1 with a 256-channels HydroCel Geodesic Sensor Net. Event-related potential (ERP) components and low-resolution electromagnetic tomography (sLoreta) were analysed.

RESULTS

sLoreta analyses showed that patients from the clinical group presented a higher primary somatosensorial cortex and lower paralimbic, temporal and orbito-frontal activation in response to both Internet and emotional images compared to those of the control group.

CONCLUSIONS

These results suggest that clinically recognized pathological use of Internet could be linked to dissociative symptoms.

Treatment with the Self-Discovery Camp (SDiC) improves Internet gaming disorder

INTRODUCTION

Internet gaming disorder (IGD) is a novel behavioral addiction that influences the physical, mental, and social aspects of health due to excessive Internet gaming. One type of intensive treatment for IGD is the therapeutic residential camp (TRC), which comprises many types of therapies, including psychotherapy, psychoeducational therapy, and cognitive behavioral therapy. The TRC was developed in South Korea and has been administered to many patients with IGD; however, its efficacy in other countries remains unknown. We investigated the efficacy of the Self-Discovery Camp (SDiC), a Japanese version of a TRC, and the correlations between individual characteristics and outcome measures.

METHODS

We recruited 10 patients with IGD (all male, mean age=16.2years, diagnosed using the DSM-5) to spend 8 nights and 9days at the SDiC. We measured gaming time as well as self-efficacy (using the Stages of Change Readiness and Treatment Eagerness Scale, a measure of therapeutic motivation and problem recognition).

RESULTS

Total gaming time was significantly lower 3months after the SDiC. Problem recognition and self-efficacy towards positive change also improved. Furthermore, there was a correlation between age of onset and problem recognition score.

CONCLUSIONS

Our results demonstrate the effectiveness of the SDiC for IGD, especially regarding gaming time and self-efficacy. Additionally, age of onset may be a useful predictor of IGD prognosis. Further studies with larger sample sizes and control groups, and that target long-term outcomes, are needed to extend our understanding of SDiC efficacy.

Are Mental Health Effects of Internet Use Attributable to the Web-Based Content or Perceived Consequences of Usage? A Longitudinal Study of European Adolescents

BACKGROUND

Adolescents and young adults are among the most frequent Internet users, and accumulating evidence suggests that their Internet behaviors might affect their mental health. Internet use may impact mental health because certain Web-based content could be distressing. It is also possible that excessive use, regardless of content, produces negative consequences, such as neglect of protective offline activities.

OBJECTIVE

The objective of this study was to assess how mental health is associated with (1) the time spent on the Internet, (2) the time spent on different Web-based activities (social media use, gaming, gambling, pornography use, school work, newsreading, and targeted information searches), and (3) the perceived consequences of engaging in those activities.

METHODS

A random sample of 2286 adolescents was recruited from state schools in Estonia, Hungary, Italy, Lithuania, Spain, Sweden, and the United Kingdom. Questionnaire data comprising Internet behaviors and mental health variables were collected and analyzed cross-sectionally and were followed up after 4 months.

RESULTS

Cross-sectionally, both the time spent on the Internet and the relative time spent on various activities predicted mental health (P<.001), explaining 1.4% and 2.8% variance, respectively. However, the consequences of engaging in those activities were more important predictors, explaining 11.1% variance. Only Web-based gaming, gambling, and targeted searches had mental health effects that were not fully accounted for by perceived consequences. The longitudinal analyses showed that sleep loss due to Internet use (ß=.12, 95% CI=0.05-0.19, P=.001) and withdrawal (negative mood) when Internet could not be accessed (ß=.09, 95% CI=0.03-0.16, P<.01) were the only consequences that had a direct effect on mental health in the long term. Perceived positive consequences of Internet use did not seem to be associated with mental health at all.

CONCLUSIONS

The magnitude of Internet use is negatively associated with mental health in general, but specific Web-based activities differ in how consistently, how much, and in what direction they affect mental health. Consequences of Internet use (especially sleep loss and withdrawal when Internet cannot be accessed) seem to predict mental health outcomes to a greater extent than the specific activities themselves. Interventions aimed at reducing the negative mental health effects of Internet use could target its negative consequences instead of the Internet use itself.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number (ISRCTN): 65120704; http://www.isrctn.com/ISRCTN65120704?q=&filters=recruitmentCountry:Lithuania&sort=&offset= 5&totalResults=32&page=1&pageSize=10&searchType=basic-search (Archived by WebCite at http://www.webcitation/abcdefg).

Testing the Predictive Validity and Construct of Pathological Video Game Use

Three studies assessed the construct of pathological video game use and tested its predictive validity. Replicating previous research, Study 1 produced evidence of convergent validity in 8th and 9th graders (N = 607) classified as pathological gamers. Study 2 replicated and extended the findings of Study 1 with college undergraduates (N = 504). Predictive validity was established in Study 3 by measuring cue reactivity to video games in college undergraduates (N = 254), such that pathological gamers were more emotionally reactive to and provided higher subjective appraisals of video games than non-pathological gamers and non-gamers. The three studies converged to show that pathological video game use seems similar to other addictions in its patterns of correlations with other constructs. Conceptual and definitional aspects of Internet Gaming Disorder are discussed.

Psychometrische Eigenschaften und Normierung der deutschen Version der Compulsive Internet Use Scale (CIUS)

Zusammenfassung. Die epidemiologische Beschreibung von Internetabhängigkeit und die Entwicklung von Interventionen erfordern eine reliable und ökonomische Erfassungsmethode von Internetabhängigkeit. Die Compulsive Internet Use Scale (CIUS) erfasst die Kernelemente von Internetabhängigkeit mit 14 Items, allerdings fehlten bisher bevölkerungsrepräsentative Normwerte für die deutsche Version der CIUS. In der vorliegenden Studie werden nun teststatistische Kennwerte und Normwerte für die deutsche Version der CIUS vorgelegt. 8 132 Personen aus der Allgemeinbevölkerung (14 – 64 Jahren) mit einer durchschnittlichen privaten Internetnutzung von einer Stunde oder länger, an mindestens einem Tag in der Woche oder am Wochenende beantworteten die CIUS. Insgesamt weist die CIUS gute psychometrische Eigenschaften auf und die vorgelegten Normwerte bieten die Möglichkeit für Vergleiche von individuellen Werten mit denen der internetnutzenden Bevölkerung.

The mediating role of Internet addiction in depression, social anxiety, and psychosocial well-being among adolescents in six Asian countries: a structural equation modelling approach

OBJECTIVES

This study examines the associations of Internet addiction with social anxiety, depression, and psychosocial well-being among Asian adolescents. A self-medication model conceptualizing Internet addiction as a mediating role in relating depression and social anxiety to negative psychosocial well-being was tested.

STUDY DESIGN

A cross-sectional survey.

METHODS

In the Asian Adolescent Risk Behavior Survey (AARBS), 5366 adolescents aged 12-18 years from six Asian countries (China, Hong Kong, Japan, South Korea, Malaysia, and Philippines) completed a questionnaire with items of the Internet Addiction Test (IAT), Social Anxiety Scale for Adolescents (SAS-A), Center for Epidemiological Studies Depression Scale (CESD), Self-Rated Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA-SR) in the 2012-2013 school year. Structural equation modelling was used to examine the mediating role of Internet addiction in depression, social anxiety, and subjective psychosocial well-being.

RESULTS

Significant differences on the scores of IAT, SAS-A, CESD, and HoNOSCA-SR across the six countries were found. The proposed self-medication model of Internet addiction received satisfactory goodness-of-fit with data of all countries. After the path from social anxiety to Internet addiction had been discarded in the revised model, there was a significant improvement of the goodness-of-fit in the models for Japan, South Korea, and the Philippines.

CONCLUSIONS

Depression and social anxiety reciprocally influenced, whereas depression associated with poorer psychosocial well-being directly and indirectly through Internet addiction in all six countries. Internet addiction mediated the association between social anxiety and poor psychosocial well-being in China, Hong Kong, and Malaysia.

Evaluation of the psychometric properties of the Italian Internet Addiction Test

Since the diffusion of Internet addiction has emerged in several cultural contexts, it seems relevant to study the properties of the Internet Addiction Test (IAT)-the most widely used screening instrument-across various cultures. In Italy, only one study has examined the IAT factor validity, and a comprehensive investigation of its psychometric characteristics is so far lacking. The purpose of this study was to perform a psychometric analysis of the Italian IAT. A total of 840 students (Mage=18.65 years, SD=3.85 years; 59% female) were recruited. Pertaining to scale dimensionality, the best-fit measurement model includes two factors: "Emotional and cognitive preoccupations with the Internet and social consequences" and "Loss of control and interference with daily duties" (χ(2)/df=3.38; comparative fit index=0.88; Tucker-Lewis Index=0.87; root mean square error of approximation=0.07), which together explained 45.59% of the variance. Internal consistency Cronbach's alpha values ranged from 0.83 to 0.86. Convergent validity was demonstrated, with significant correlations between IAT and Generalized Problematic Internet Use Scale 2 scores. The Italian version of the IAT was found to have good psychometric properties and a two-factorial structure. Identification of the IAT dimensions may help to define the construct better and develop intervention strategies.

The Internet Process Addiction Test: Screening for Addictions to Processes Facilitated by the Internet

The Internet Process Addiction Test (IPAT) was created to screen for potential addictive behaviors that could be facilitated by the internet. The IPAT was created with the mindset that the term “Internet addiction” is structurally problematic, as the Internet is simply the medium that one uses to access various addictive processes. The role of the internet in facilitating addictions, however, cannot be minimized. A new screening tool that effectively directed researchers and clinicians to the specific processes facilitated by the internet would therefore be useful. This study shows that the Internet Process Addiction Test (IPAT) demonstrates good validity and reliability. Four addictive processes were effectively screened for with the IPAT: Online video game playing, online social networking, online sexual activity, and web surfing. Implications for further research and limitations of the study are discussed.

The impact of Internet-based specific activities on the perceptions of Internet addiction, quality of life, and excessive usage: A cross-sectional study

Introduction

Recent research has examined the context in which preference for specific online activities arises, leading researchers to suggest that excessive Internet users are engaged in specific activities rather than ‘generalized’ Internet use. The present study aimed to partially replicate and expand these findings by addressing four research questions regarding (i) participants' preferred online activities, (i) possible expected changes in online behavior in light of hypothetical scenarios, (iii) perceived quality of life when access to Internet was not possible, and (iv) how participants with self-diagnosed Internet addiction relate to intensity and frequency of Internet use.

Methods

A cross-sectional design was adopted using convenience and snowball sampling to recruit participants. A total of 1057 Internet users with ages ranging from 16 to 70 years (M_age = 30 years, SD = 10.84) were recruited online via several English-speaking online forums.

Results

Most participants indicated that their preferred activities were (i) accessing general information and news, (ii) social networking, and (iii) using e-mail and/or online chatting. Participants also reported that there would be a significant decrease of their Internet use if access to their preferred activities was restricted. The study also found that 51% of the total sample perceived themselves as being addicted to the Internet, while 14.1% reported that without the Internet their life would be improved.

Conclusions

The context in which the Internet is used appears to determine the intensity and the lengths that individuals will go to use this tool. The implications of these findings are further discussed.

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Preferred non-work online activities were of informational and social nature.

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Online behaviors may change by manipulating the availability of online activities.

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Perceived quality of life can be affected in the absence of Internet access.

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Perception of Internet addiction may be a useful indicator of possible addiction.

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Specific online activities are associated with perceived Internet addiction.

Problematic Online Pornography Use: A Media Attendance Perspective

Since the rise of the popularity of the Internet, the accessibility of pornography has been a growing concern. One particular concern is the potential risk for addictive behaviors to occur as a result of the ease of viewing online pornographic material. The research presented herein explored online pornography addiction using a media attendance perspective, which allows media critics to examine the needs that people seek to fulfill from engaging with various media. Past studies that have used a media attendance perspective to explore media addiction, rephrased here as problematic media use, have done so using social cognitive theory and the concept of deficient self-regulation. Deficient self-regulation may be experienced by all media consumers and can range from normally impulsive media choices to pathological media choices which may result in detrimental life consequences. Borrowing from this, the current study reevaluated online pornography addiction using deficient self-regulation within a sociocognitive framework of media attendance. Results of our model show deficient self-regulation influences habitual online pornography consumption. Moreover, online pornography use motivated by social needs is perpetuated by deficient self-regulation and may lead to negative life consequences in some individuals. These findings contribute a new perspective and framework for understanding problematic online pornography use.

A critical review of "Internet addiction" criteria with suggestions for the future

AIMS

In the last 5 years a deluge of articles on the topic of Internet addiction (IA) has proposed many candidate symptoms as evidence of this proposed disease. We critically reviewed the current approach to the measurement and identification of this new excessive behavior syndrome.

METHODS

Three popular models of IA were discussed: Griffith’s components model; Young’s Internet Addiction Test (IAT); and the criteria by Tao et al. (2010). We selected these models because they are widely cited and propose specific criteria for IA disorder. Our approach is not meant to provide an exhaustive review, but to discuss and critique the most salient trends in the field.

RESULTS

The models of Internet addiction share some criteria, including feeling a loss of control over Internet use; ensuing psychological, social, or professional conflict or problems; and preoccupation when not using the Internet. Other criteria inconsistently mentioned include: mood management, tolerance, withdrawal, and craving/anticipation. The models studied here share the assumption that the Internet can produce a qualitative shift to a diseased state in humans.

CONCLUSIONS

We critically discussed the above criteria and concluded that the evidence base is currently not strong enough to provide support for an Internet addiction disorder. Future research areas are suggested: (1) Focusing on common impaired dimensions, (2) exploring neuroimaging as a model building tool, and (3) identifying shifts in the rewarding aspects of Internet use. Given the lack of consensus on the subject of Internet addiction, a focus on problem behaviors appears warranted.