Addiction Research Unit: Affective and cognitive mechanisms of specific Internet-use disorders

Transfer from goal-directed behavior to stimulus-response habits and its modulation by acute stress in individuals with risky gaming behavior

Habitual responses towards addiction-related cues play a relevant role in the development and maintenance of addictions. Such automatic responses may be more likely under stress, as stress has been shown to induce a shift from goal-directed to habitual behavior. The current study investigated these mechanisms in risky gaming behavior. Individuals with risky gaming behavior (n = 68), as established by a structured clinical interview, and a matched control group (n = 67) completed a Pavlovian-to-Instrumental Transfer (PIT) paradigm with gaming-related cues and rewards. After the Pavlovian training, participants underwent a stress (Trier Social Stress Test) or control condition before performing the instrumental training and the transfer phase of the PIT paradigm. To assess habitual behavior, the gaming-related rewards were devalued after half of the transfer phase. In both groups, gaming-related cues enhanced the choice of the gaming-related reward and this gaming PIT effect was reduced, however, not eliminated by the devaluation. Unexpectedly, stress did not significantly increase responding for the gaming-related reward in participants aware of the stimulus-outcome associations, however seemed to enhance habitual responding in unaware participants. Our findings underline the relevance of gaming-related cues in triggering habitual responses, which may undermine attempts to change a problematic gaming behavior.

Social Media Use and Well-Being: A Systematic Review and Meta-Analysis

Prior research has investigated the link between social media use (SMU) and negative well-being. However, the connection with positive well-being has not been extensively studied, leading to a situation where there are inconsistent and inconclusive findings. This study fills this gap by examining the correlation between excessive and problematic SMU and subjective as well as psychological well-being (PWB). We conducted a systematic search across databases such as PubMed, Scopus, and Web of Science, and gray literature sources such as Research Gate and ProQuest, yielding 51 relevant studies for meta-analysis, encompassing a sample size of 680,506 individuals. Employing the Newcastle-Ottawa Scale, we assessed study quality, whereas statistical analysis was executed using R Studio. Excessive SMU showed no significant association with subjective (ES = 0.003, 95% confidence interval [95% CI]: -0.08, 0.09; p = 0.94, I2 = 95.8%, k =16) and PWB (ES = 0.16, 95% CI: -0.15, 0.45; p = 0.26, I2 = 98%, k = 7). Conversely, problematic SMU showed a negative correlation with subjective (ES = -0.14, 95% CI: -0.20, -0.09; p = 0.00, I2 = 93.3%, k = 25) and PWB (ES = -0.19, 95% CI: -0.31, -0.06; p = 0.01, I2 = 95%, k = 5), with two outliers removed. No publication bias was detected. Subgroup analysis highlighted effects of "sampling method" (p < 0.05), "study quality" (p < 0.05), "developmental status" (p < 0.05), "forms of social media" (p < 0.05), and "type of population" (p < 0.01) on the estimated pooled effect sizes. Although univariate meta-regression showed the effects of "% of Internet users" (p < 0.05) and "male%" (p < 0.05), and multivariate meta-regression showed the combined effect of moderators only on the relationship between problematic SMU and subjective well-being.

Problematic pornography use and novel patterns of escalating use: A cross-sectional network analysis with two independent samples

Modern internet pornography allows users to harness sexual novelty in numerous ways, which can be used to overcome desensitisation through increasing volume of use (quantitative tolerance), progressing to more stimulating genres (qualitative escalation), skipping between stimuli (tab-jumping), delaying orgasm ('edging'), and engaging in pornographic binges. However, existing research has not yet evaluated how these potentially reciprocal consumption patterns relate to problematic pornography use (PPU). To this end, we recruited two independent samples of male pornography users (N1 = 1,356, Mage = 36.86, SD = 11.26; N2 = 944, Mage = 38.69, SD = 12.26) and examined the relationships between these behavioural dimensions and self-reported difficulties in controlling one's pornography use. Data were analysed through the network analysis approach (using Gaussian graphical models). As hypothesised, i) quantitative tolerance was centrally placed within the overall network, and ii) acted as a statistical bridge node between other patterns of pornography use (e.g., pornographic binges), and all measured facets of PPU. Our results are consistent with other emerging literature suggesting that tolerance, pornographic binges, tab-jumping, and edging behaviours as relevant features ofPPU, and that upscaling overall usage may connect broader patterns of use with problematic engagement. Clinical and theoretical implications, as well as future research directions, are discussed.

Promoting Adolescent Safer Gambling Through Self-Referent Counterfactual Thinking and Knowledge of Probabilistic Outcome

Research have continued to advocate for various safer gambling strategies (SGs) to curb initiation and sustenance of problem gambling through the conceptualization and development of SG tools. The present study aims to extend this advocacy by examining cognitive processes that promote adolescent responsible gambling (RG) in Nigeria. Young adolescents (N = 962, Mage =16.06, SD = 4.12) recruited from a high school population responded to measures of self-referent counterfactual thinking (S-RCFT), knowledge of probabilistic outcomes (KPO), and RG. Hayes PROCESS macro analysis result showed that S-RCFTs and KPO were positively associated with RG. More importantly, it was revealed that KPO amplified the S-RCFT-RG link and provided a plausible pathway to understanding the effect of S-RCFT on RG. This calls for SG advocacies to encourage adolescent gamblers to hold themselves responsible for responsible gambling, and to understand that gambling wins randomly occur. The limitations of the study and recommendations are highlighted.

Insights on associations between the frequency of use of diverse social media products and social networks use disorder tendencies from a German speaking sample

OBJECTIVE

In the present work we investigate how individual differences in at least occasionally using distinct social media platforms is linked to social networks use disorder (SNUD) tendencies. A final sample of n = 2200 participants filled in the AICA-C-9 measure to get insights into individual differences in overuse of social media and participants also indicated which platforms they used at least once a month.

RESULTS

The analysis revealed a robust positive association between number of at least occasionally used social media apps and SNUD tendencies (r = .44, p < .001). Further, platforms differed in terms of their "addictive potential", if one takes associations between frequency of distinct platforms use and SNUD tendencies as a proxy for this (and of course the actual descriptive statistics of the SNUD scale for the (non-)frequent user groups of the different platforms). In this regard, at least occasionally using some platforms (here Tumblr, Twitter and TikTok) was associated with highest SNUD tendencies. Moreover, largest differences in terms of effect sizes between the occasional and non-occasional user groups regarding SNUD scores could be observed for Instagram, WhatsApp, and TikTok. The present work bases on data from a larger project investigating associations between SNUD and tobacco use disorder.

Stress and compulsive buying-shopping disorder: A scoping review

INTRODUCTION

Theoretical frameworks of behavioral addictions mostly acknowledge the role of stress in the development and maintenance of these disorders, models of compulsive buying-shopping disorder (CBSD) however rarely incorporated stress. The association between stress and CBSD has not been reviewed yet.

METHODS

A scoping review was conducted to evaluate empirical results on the association between stress and CBSD. A comprehensive search string was employed in three databases.

RESULTS

16 studies were included. Correlative studies suggested significant correlations between general perceived stress and CBSD symptom severity. Studies involving mean comparisons found higher general perceived stress levels in persons with problematic buying-shopping behavior/CBSD compared to control participants (large effects). Mixed results were found in studies involving regression/structural equation models and ecological momentary assessments. One study with a stress/negative mood induction observed more CBSD symptoms in a high stress group compared to a low stress group.

DISCUSSION

The studies are heterogeneous concerning design, samples and measures. Only very few studies surpass the level of cross-sectional correlative data which limits the ability to draw clear conclusions. Future research should study the impact of experimentally induced stress on CBSD symptoms, examine the relationship between stress and CBSD longitudinally and assess objective stress markers.

Appetitive conditioning with pornographic stimuli elicits stronger activation in reward regions than monetary and gaming-related stimuli

Appetitive conditioning plays an important role in the development and maintenance of pornography-use and gaming disorders. It is assumed that primary and secondary reinforcers are involved in these processes. Despite the common use of pornography and gaming in the general population appetitive conditioning processes in this context are still not well studied. This study aims to compare appetitive conditioning processes using primary (pornographic) and secondary (monetary and gaming-related) rewards as unconditioned stimuli (UCS) in the general population. Additionally, it investigates the conditioning processes with gaming-related stimuli as this type of UCS was not used in previous studies. Thirty-one subjects participated in a differential conditioning procedure in which four geometric symbols were paired with either pornographic, monetary, or gaming-related rewards or with nothing to become conditioned stimuli (CS + porn, CS + game, CS + money, and CS-) in an functional magnetic resonance imaging study. We observed elevated arousal and valence ratings as well as skin conductance responses for each CS+ condition compared to the CS-. On the neural level, we found activations during the presentation of the CS + porn in the bilateral nucleus accumbens, right medial orbitofrontal cortex, and the right ventral anterior cingulate cortex compared to the CS-, but no significant activations during CS + money and CS + game compared to the CS-. These results indicate that different processes emerge depending on whether primary and secondary rewards are presented separately or together in the same experimental paradigm. Additionally, monetary and gaming-related stimuli seem to have a lower appetitive value than pornographic rewards.

Alexithymia in gaming addiction and engagement

BACKGROUND

It has been suggested that alexithymia plays a significant role in substance and behavioral addictions. However, only a handful of studies investigated this construct in relation to gaming addiction, and no study analyzed its differential effect on gaming engagement and addiction.

METHODS

A total of u adult gamers (Mage = 26.04, SD = 5.78, 94 % male) completed a questionnaire that included the Toronto Alexithymia Scale (and its subscales of difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking), the Addiction-Engagement Questionnaire, and additional questions about gender, age, and time spent gaming. Structural equation modeling was used as the main analytical strategy.

RESULTS

Difficulty identifying feelings (β = 0.28) and externally oriented thinking (β = 0.19) showed a significant positive effect on gaming addiction. Contrary to addiction, externally oriented thinking showed a significant negative effect (β = -0.21) on gaming engagement. No other alexithymia subscales were significant. The model with alexithymia explained 32.7 % of the variance in gaming addiction while only 10.4 % of gaming engagement.

CONCLUSIONS

Alexithymia is a strong predictor of gaming addiction. Gaming engagement seems to be a qualitatively different phenomenon that shows an opposite association with alexithymia than gaming addiction. However, both are related to increased time spent gaming. This suggests a need to distinguish between problematic vs. non-problematic excessive gaming as they have different associations with affect dysregulation.

Neurocognitive predictors of addiction-related outcomes: A systematic review of longitudinal studies

It is well-established that addiction is typically associated with a distinct pattern of neurocognitive functioning with a consensus that it is typified by impaired top-down executive control and aberrant risk-reward processing. Despite a consensus that neurocognition plays an important role in characterizing and maintaining addictive disorders, there is a lack of systematic, bottom-up synthesis of quantitative evidence showing that neurocognition predicts addictive behaviors, and which neurocognitive constructs have the best predictive validity. This systematic review aimed to assess whether cognitive control and risk-reward processes as defined by the Research Domain Criteria (RDoC) predict the development and maintenance of addictive behaviors specifically, consumption, severity, and relapse. The findings from this review expose the substantial lack of evidence for neurocognition predicting addiction outcomes. However, there is evidence that suggests reward-related neurocognitive processes may be important for the detection of early risk for addiction, as well as a potentially viable target for designing novel, more effective interventions.

Cue-reactivity to distal cues in individuals at risk for gaming disorder

BACKGROUND

Gaming disorder (GD) is a disorder due to addictive behaviors (ICD-11). Cue-reactivity and craving are relevant mechanisms in the development and maintenance of addictive behaviors. When confronted with cues showing in-game content (proximal cues) individuals with higher symptom severity show increased cue-reactivity. Based on conditioning and addiction theories on incentive sensitization, cue-reactivity responses may generalize to more distal cues, e.g. when individuals at risk of developing a GD are confronted with a starting page of an online game. In cue-reactivity paradigms so far, only proximal gaming cues have been used.

METHODS

We investigated the effect of distal gaming cues compared to gaming-unrelated control cues on cue-reactivity and craving in 88 individuals with non-problematic use of online games (nPGU) and 69 individuals at risk for GD (rGD). The distal cues showed the use of an electronic device (e.g., desktop PC or smartphone) whose screen showed starting pages of either games (target cues), shopping- or pornography sites (control cues) from a first-person perspective.

FINDINGS

We found significantly higher urge and arousal ratings as well as longer viewing times for gaming-related compared to gaming-unrelated control cues in rGD compared to nPGU. Valence ratings did not differ between groups.

INTERPRETATION

The results demonstrate that already distal gaming-specific cues lead to cue-reactivity and craving in rGD. This finding indicates that based on conditioning processes, cue-reactivity and craving develop during the course of GD and generalize to cues that are only moderately related to the specific gaming activity.

Social-networks use as adaptive or maladaptive strategy for coping with stress

Social networks are frequently used to distract, procrastinate, or cope with stress. We aimed to investigate how (problematic) social-networks use affect stress perception in interaction with different stress recovery conditions. A total of 104 participants were randomly assigned to one of four groups. Three groups underwent a stress induction with subsequent stress recovery via (1) using Facebook, (2) reading magazines, or (3) waiting. Another group (4) waited without stress induction. Stress perception was repeatedly assessed with the State-Trait-Anxiety-Inventory. Facebook use and reading magazines decreased acute stress indicating adaptive coping strategies. Stress-recovery conditions and symptom severity showed significant interactions. Facebook use was not effective for individuals with high symptom severity in contrast to non-digital strategies or for individuals with low symptom severity. The usage of social networks may be an adaptive strategy for coping with stress for some people, it is maladaptive for individuals having a problematic usage.

Online compulsive buying-shopping disorder and social networks-use disorder: More similarities than differences?

BACKGROUND

Studies in convenience, non-clinical samples of young adults suggest overlap between online compulsive buying-shopping disorder (OCBSD) and social-networks-use disorder (SNUD). Considering the dearth of research, this study investigated OCBSD and SNUD in clinical samples.

METHODS

Women with either OCBSD (n = 37) or SNUD (n = 41) were compared regarding sociodemographic variables, use time of the first-choice application, OCBSD/SNUD severity, general internet use, impulsivity, materialism, perceived chronic stress and the frequency of viewing posts of influencers and the urge to visit shopping websites or social networks after viewing influencer posts.

RESULTS

Women in the OCBSD group were older, more often employed, had less often a qualification for university entrance, indicated a lower daily use time of the first-choice application and higher materialistic values as compared to those in the SNUD group. No group differences emerged regarding general internet use, impulsivity and chronic stress. Regression models indicate that chronic stress predicted the symptom severity in the SNUD but not in the OCBSD group. The SNUD group reported a higher frequency of viewing influencer posts as compared to the OCBSD group. The urge for online shopping or using social networks after viewing influencer posts did not significantly differ between both groups.

CONCLUSION

The findings suggest commonalities and distinct features of OCBSD and SNUD which require further investigation.

The relationship between executive functioning and addictive behavior: new insights from a longitudinal community study

RATIONALE

Although there is evidence that impaired executive functioning plays a role in addictive behavior, the longitudinal relationship between the two remains relatively unknown.

OBJECTIVES

In a prospective-longitudinal community study, we tested the hypothesis that lower executive functioning is associated with more addictive behavior at one point in time and over time.

METHODS

Three hundred and thirty-eight individuals (19-27 years, 59% female) from a random community sample were recruited into three groups: addictive disorders related to substances (n = 100) or to behaviors (n = 118), or healthy controls (n = 120). At baseline, participants completed nine executive function tasks from which a latent variable of general executive functioning (GEF) was derived. Addictive behavior (i.e., quantity and frequency of use, and number of DSM-5 criteria met) were assessed using standardized clinical interviews at baseline and three annual follow-ups. The trajectories of addictive behaviors were examined using latent growth curve modeling.

RESULTS

At baseline, we found weak to no evidence of an associations between GEF and addictive behavior. We found evidence for an association between a lower GEF at baseline and a higher increase in the quantity of use and a smaller decrease in frequency of use over time, but no evidence for an association with an increase in the number of DSM-5 criteria met.

CONCLUSIONS

Lower EFs appear to lead to a continuing loss of control over use, whereas addictive disorders may develop secondarily after a long period of risky use. Previous etiological models assuming lower EF as a direct vulnerability factor for addictive disorders need to be refined.

Implicit Cognitions, Use Expectancies and Gratification in Social-Networks-Use Disorder and Tobacco Use Disorder

Abstract: Aims: The problematic use of social networks is discussed as a further specific type of Internet-use disorders. Our project aims to clarify whether social-networks-use disorder (SNUD) is marked by characteristics of addictive behaviors by tracking behavior and investigating the relevance of 1) implicit cognitions, 2) the experiences of gratification and compensation and 3) use expectancies in SNUD compared to tobacco-use disorder. Methodology: Four groups will be examined: individuals with 1) SNUD without tobacco use, 2) risky use patterns with regard to social networks without tobacco use, 3) tobacco use disorder and 4) healthy controls. All participants first complete a laboratory examination including the Implicit Association Test (IAT) and the Approach-Avoidance task (AAT). We will use smartphone-based data tracking for 14 days following laboratory testing to record smoking and social-networks-use patterns. During this period, we further measure use expectancies and the experience of gratification and compensation by means of a smartphone-based experience sampling method (ESM). Conclusions: This is the first study to examine relevant characteristics of addictive behaviors in individuals with SNUD compared to individuals with tobacco use, using a combination of experimental psychological methods and smartphone-based measurements. We expect that this investigative approach will contribute to a deeper understanding of the processes involved in SNUD.

The experience of gratification and compensation in addictive behaviors: How can these experiences be measured systematically within and across disorders due to addictive behaviors?

BACKGROUND

Beyond gaming disorder and gambling disorder, pornography-use disorder, buying-shopping disorder, and social-networksuse disorders are discussed as further disorders due to addictive behaviors. For addictive behaviors, it is assumed that the experience of gratification and the experience of compensation due to the specific behavior represent reinforcing processes involved in the development and maintenance of the problematic behaviors. We aimed to develop two questionnaires that capture the experienced gratification and experienced compensation while using online activities. We additionally assume significant relationships with further addiction-related constructs such as symptom severity, use expectancies, and craving experiences.

METHODS

We conducted three studies for the development of the "Experience of Gratification Scale" (EGS) and the "Experience of Compensation Scale" (ECS). In each study, participants answered the questionnaires modified for their preferred online activity (gaming, gambling, buying-shopping, social-networks use, pornography use). Additional questionnaires were used, assessing further addiction-related constructs.

RESULTS

The results of the gradual approach by using exploratory and confirmatory factor analyses indicated for both scales a two-factor solution resulting in "gratification of needs" and "experience of pleasure" for the EGS, and "compensation of needs" and "experience of relief from negative feelings" for the ECS. The factors were significantly correlated with each other as well as with craving experiences, use expectancies, and symptom severity. Moreover, we found significant differences in the experienced gratification and experienced compensation for specific online behaviors.

CONCLUSION

The theoretically plausible specific factors for experienced gratification and experienced compensation could be identified and were related to constructs considered important in addictive online behaviors. Further studies should investigate the relevance of these constructs for different types of addictive behaviors, but also within the addiction process addressing specific needs and motives as well as further positive and negative reinforcement mechanisms.

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.

Problematic Online Buying-Shopping: Is it Time to Considering the Concept of an Online Subtype of Compulsive Buying-Shopping Disorder or a Specific Internet-Use Disorder?

Purpose of Review

Problematic online buying-shopping became a recent research topic, and the question arises as to whether it would be useful to differentiate between a “predominantly online” and a “predominantly offline” compulsive buying-shopping disorder (CBSD) subtype by analogy with gaming disorder and gambling disorder in the ICD-11. This narrative review aims at reflecting the discussions on overlaps of problematic online buying-shopping with both offline CBSD and specific internet-use disorders.

Recent Findings

Preliminary data suggest that problematic online buying-shopping shares many commonalities with both offline CBSD and potential specific internet-use disorders (e.g., gaming disorder, pornography-use disorder, or social-network–use disorder). However, there is a lack of research addressing the etiology, underlying affective and cognitive mechanisms, psychosocial correlates, comorbidity profiles, and treatment of problematic online buying-shopping.

Summary

The question of whether online CBSD can develop independently from offline CBSD or only as medial transformation of offline CBSD still remains unanswered due to limited research on problematic online buying-shopping. Both perspectives are conceivable: that online CBSD represents a standalone specific internet-use disorder or the online subtype of CBSD. Future studies should examine which approach has clinical utility and indicates specific treatment options and better outcomes.