Inhibitory control and problematic Internet-pornography use - The important balancing role of the insula

How much online pornography is too much? A comparison of two theoretically distinct assessment scales

BACKGROUND

Online pornography use, an ever more common activity, has raised myriad psychosocial and clinical concerns. While there is a need to screen for and measure its problematic dimension, there is a debate about the adequacy of existing assessment tools.

OBJECTIVE

The study compares two instruments for measuring pathological online pornography use (POPU) that are based on different theoretical frameworks-one in line with DSM-5 criteria and the six-component addiction model and one in line with ICD-11 criteria.

METHODS

An international sample of 1,823 adults (Mean age = 31.66, SD = 6.74) answered an online questionnaire that included the Short Version of the Problematic Pornography Consumption Scale (PPCS-6) and the Assessment of Criteria for Specific Internet-Use Disorders (ACSID-11). Factorial, correlational, and network analyses were conducted on the data.

RESULTS

Both tools adequately screened for online "addictive" behavior, but the ACSID-11 was superior in assessing the degree of clinical risk.

CONCLUSION

Depending on the specific aim of the assessment (screening vs. clinical diagnostics), both online pornography measurement tools may be useful.

The neurocognitive correlates of non-substance addictive behaviors

Neurocognitive deficits have been implicated as transdiagnostic risk markers of substance use disorders. However, these have yet to be comprehensively evaluated in other, non-substance addictions. In a large, general community sample (N = 475) the present study evaluated the neurocognitive correlates of problem alcohol use and three non-substance-related addictive behaviors: addictive eating (AE), problematic pornography use (PPU), and problematic use of the internet (PUI), to identify potential shared and distinct neurocognitive correlates. A sample of Australian residents (54.4 % female M[SD] age = 32.4[11.9] years) completed a comprehensive online assessment of neurocognitive tasks tapping into eight distinct expert-endorsed domains purportedly associated with addiction. Multiple linear regressions with bootstrapping were used to examine associations among each addictive behavior of interest and neurocognition, trait impulsivity, and compulsivity, as well as key covariates. Neurocognition was differentially associated with each addictive behavior. None of the neurocognitive domains were significantly associated with problematic alcohol use or AE (p >.05), poorer performance monitoring was significantly associated with higher levels of PPU and PUI (β = -0.10, p =.049; β = -0.09, p =.028), and a preference for delayed gratification was associated with more severe PUI (β = -0.10, p =.025). Our findings have theoretical implications for how we understand non-substance addiction and suggest the need for a more nuanced approach to studying addictive behaviors that take into account the underlying neurocognitive mechanisms associated with each type of addiction.

Decision making and executive functions in problematic pornography use

Introduction

Previous research on cognitive functions in Compulsive Sexual Behavior Disorder (CSBD) and problematic pornography use (PPU) reported inconsistent findings and mostly included sexual pictures in the used tasks. The role of general executive functions and cognitive competences (without the presence of appetitive stimuli) in the context of PPU is largely unexplored.

Methods

This study investigated differences between individuals with high versus low problem severity of PPU regarding decision making and executive functions. The sample of the laboratory study consisted of N = 102 male adults. Besides measures of trait impulsivity, we used standard neuropsychological tests (Trail Making Test and three-back working memory task) and an intertemporal risky choice paradigm, the Cards & Lottery Task (CLT).

Results

The results show heightened impulsivity (urgency and deficits in perseverance) in individuals with high PPU, but no differences regarding performance in the CLT and executive function tasks.

Discussion

The findings indicate that PPU might be associated with impulsive behavior when experiencing strong emotions (urgency) and deficient cognitive performance especially in the presence of sexual stimuli but not in general.

Biopsychosocial Determinants of Problematic Pornography Use: A Systematic Review

Background

Although some studies have examined the determinants of problematic pornography use (PPU), few systematic comparisons of risk profiles have been conducted so far. Research on risk profiles can shed a bright light on our knowledge of both the early diagnosis and etiology of such highly prevalent disorders. Accordingly, the present study aimed to provide a comprehensive overview of the determinants of PPU.

Methods

Scopus, Web of Science, PubMed, and PsycINFO databases were systematically searched, and relevant English articles, including longitudinal and cross-sectional studies on risk factors published from January 2000 to February 2022 were reviewed.

Findings

The determinants of PPU extracted from the investigated studies (n=66) were summarized and clustered into biological, psychological, and social categories. The findings indicated that ventral striatum activity is a consistent biological factor which plays a key role in the development of PPU, while there were other psychological factors influencing PPU as mentioned in several studies, including craving, low self-esteem, sexual arousal, coping styles, stress, frequent pornography watching, avoidance, negative beliefs, and emotional deficiency. In addition, the social factors affecting PPU have been reported to be male gender, age, religion, moral incompatibility, and loneliness. According to these results, the identified factors could be considered in preventive treatment.

Conclusion

This systematic review provided a comprehensive overview of the biopsychosocial determinants of PPU by analyzing 66 articles mostly from Europe and North America. Most studies showed that ventral striatum activity, craving, self-esteem, stress, frequent pornography watching, gender, age, and religion are related to PPU.

Profiles of Pornography Use Based on Addictive Mechanisms and Psychopathological Features

Studies using person-centered approaches to further explore the profiles of pornography users throw their psychiatric features are lacking. This study was designed to examine the different profiles of pornography users based on the addictive dimensions of Problematic Pornography Use (PPU) and to characterize these profiles according to psychopathological variables such as depression, anxiety, attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). A sample of 1001 French adults participated to a survey containing scales related to psychopathological variables, cybersexual addiction and PPU. PPU was assessed with the French Version of Problematic Pornography Consumption Scale (Fr-PPCS-18). An Agglomerative Hierarchical Classification was performed on the basis of FR-PPCS-18. A student's t-test was used to observe PPU and psychopathological differences between profiles. Findings revealed three profiles of users: non-problematic users (66.5%), at-risk users (29.9%), and problematic users (3.6%). There were significant differences between the three profiles concerning levels of global PPU, PPU mechanisms, cybersexual addiction symptoms, ADHD symptomatology and depressive symptomatology. Results confirmed the existence of different levels of severity of pornography use corresponding to three different profiles. Also, findings revealed the influence of ADHD symptoms, obsessive-compulsive symptoms and depressive symptoms on PPU.

Gender differences in symptom structure of adolescent problematic internet use: A network analysis

BACKGROUND

Gender differences in problematic Internet use (PIU) have long been discussed. However, whether and how female and male adolescents differ in central symptoms and symptom associations are not fully understood.

METHODS

As a national survey in the Chinese mainland, 4884 adolescents (51.6% females; M_age = 13.83 ± 2.41) participated in the present study. This study applies network analysis to identify central symptoms of PIU networks in female and male adolescents and compares whether and how global and local connectivity of PIU networks differ by gender.

RESULTS

Female and male network structures of PIU were different and global strength was stronger in males than females, indicating a higher risk of chronicity of PIU among male adolescents. Specifically, "Reluctant to turn off Internet" exerted the largest effect on both genders. "Increase time online to achieve satisfaction" and "Feel depressed once not online for a while" were particularly critical to female and male adolescents, respectively. Moreover, females scored higher centralities in social withdrawal symptoms and males did so in interpersonal conflicts owing to PIU.

CONCLUSIONS

These findings provide novel insights into gender differential risks and features of adolescent PIU. Differences in the core symptoms of PIU suggest that gender-specific interventions focusing on core symptoms might effectively relieve PIU and maximize treatment effects.

Self-regulatory Processes in Problematic Pornography Use

Purpose of Review

A core symptom of problematic pornography use (PPU) is the repeated failure to control sexual impulses resulting in pornography use; however, the field of self-regulation research has rarely been applied to PPU.

Recent Findings

Various goals can underly the use of online pornography. These goals can conflict with other self-regulatory goals a person holds, which leads to moments of self-control. The outcome of such self-control moments depends on multiple internal factors, including the strength of the desire to use pornography, whether a person perceives a conflict with their behaviour, and the motivation to resist their desire, as well as external, situational factors. Findings on the contribution of volition towards self-regulation in PPU are inconclusive.

Summary

More research is needed to further explore what influences moments of self-control, specifically in PPU. The proposed model of self-control moments can be used to derive research questions for further studies as well as to develop prevention and intervention approaches.

Slow-Wave EEG Activity Correlates with Impaired Inhibitory Control in Internet Addiction Disorder

Impaired inhibitory control is a core feature of internet addiction disorder (IAD). It is therefore of interest to determine the neurophysiological markers associated with it. The present study aimed to find such biomarkers with a resting-state electroencephalogram (EEG). We specifically used scores on the Chinese Internet Addiction Scale revised edition (CIAS-R) to divide 46 participants into two groups: the IAD group (>53, n = 23) and control group (<46, n = 23). Both behavioral aspects (Go/NoGo responses and impulsivity) and EEG were measured in the lab. The results suggest that the IAD group presented a decreased slow-wave (1−8 Hz) absolute power across the whole brain. The slow-wave activities in the frontal areas were also correlated with the commission error rate in the Go/NoGo task in the IAD group. These results imply that the frontal slow-wave EEG activity may serve as a neurophysiological marker of IAD, helping to understand the underlying neural mechanisms of inhibitory control deficits in IAD and point to possible interventions.

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.

Electrophysiological evidence of enhanced early attentional bias toward sexual images in individuals with tendencies toward cybersex addiction

BACKGROUND AND AIMS

Attentional bias is a key factor in addictive behavior maintenance. However, whether attentional bias has a similar effect on cybersex addiction is unclear. We investigated differences in the attentional processing of sexually explicit images between individuals with high tendencies toward cybersex addiction (TCA) versus low tendencies using behavioral and electrophysiological indices.

METHODS

Twenty-eight individuals with high TCA and 29 with low TCA performed an addiction Stroop task comprising sexual and neutral images in colored frames. Participants were asked to respond to the frame color and not the image contents, and behavioral and event-related potentials were recorded.

RESULTS

Behaviorally, an addiction Stroop interference effect was found in the high TCA group, as shown by the longer reaction times to judge the frame colors of sexual images. Electrophysiologically, a P200 (150-220 ms) enhancement was present in response to sexual images compared with neutral ones, which was absent in the low TCA group. The event-related potential correlates with the addiction Stroop interference effect, indicating that the attentional bias underlying the addiction Stroop interference operates at an automatic level. A general, sexually related bias was found in the late positive potential (300-700 ms) amplitude, although between-group differences were insignificant.

DISCUSSION AND CONCLUSIONS

These findings indicate that sexual stimuli grab the attentional resources of individuals with high TCA at early automatic stages of attentional processing. Increased cue reactivity to sexual stimuli may contribute to pornographic consumption and play a crucial role in sustaining problematic excessive use of online pornography.

Problematic Pornography Use: Legal and Health Policy Considerations

Purpose of Review

Reports of sexual violence, especially towards women and children, are rapidly increasing. At the same time, rates of problematic pornography use (PPU) are accelerating across the world too. The purpose of this review is to consider the recent research on PPU and its contribution to sexual violence. The article offers guidance to governments on possible health policy interventions and legal actions to prevent the development of PPU and to reduce the incidence of sexual violence in society.

Recent Findings

Working from the consumer’s point of view, we identify PPU and ask how much pornography is needed to cause PPU. We examine how PPU drives sexual offending in children, adolescents and adults. The impact of PPU on some consumers’ behaviour suggests significant links to domestic violence. Sexual strangulation is highlighted as an example. Artificial intelligence algorithms play a key role in the pornography industry and appear to be driving escalation to more violent material, inducing high levels of sexual dysfunction in consumers and creating appetites for viewing child sexual abuse material (CSAM).

Summary

Easy access to internet pornography has led to an increase in PPU and sexual violence. Diagnoses and treatments for PPU are examined, as are legal transgressions of a civil and criminal nature arising from PPU. Legal remedies and government policy implications are discussed from the point of view of the precautionary principle. Strategies covered include age verification for pornography, public health campaigns and embedded health and legal warnings for users at the start of pornography sessions along with lessons for pupils about pornography’s impact on the brain.

Aberrant orbitofrontal cortex reactivity to erotic cues in Compulsive Sexual Behavior Disorder

BACKGROUND AND AIMS

Compulsive Sexual Behavior Disorder (CSBD) is characterized by increased reactivity to erotic reward cues. Cue-encoded reward parameters, such as type (e.g. erotic or monetary) or probability of anticipated reward, shape reward-related motivational processes, increase the attractiveness of cues and therefore might enhance maladaptive behavioral patterns in CSBD. Studies on the neural patterns of cue processing in individuals with CSBD have been limited mainly to ventral striatal responses. Therefore, here we aimed to examine the cue reactivity of multiple key structures in the brain's reward system, taking into account not only the type of predicted reward but also its probability.

METHODS

Twenty Nine men seeking professional help due to CSBD and 24 healthy volunteers took part in an fMRI study with a modified Incentive Delay Task with erotic and monetary rewards preceded by cues indicating a 25%, 50%, or 75% chance of reward. Analyses of functional patterns of activity related to cue type and probability were conducted on the whole-brain and ROI levels.

RESULTS

Increased anticipatory response to cues predictive of erotic rewards was observed among CSBD participants when compared to controls, in the ventral striatum and anterior orbitofrontal cortex (aOFC). The activity in aOFC was modulated by reward probability.

DISCUSSION AND CONCLUSIONS

Type of anticipated reward (erotic vs monetary) affects reward-related behavioral motivation in CSBD more strongly than reward probability. We present evidence of abnormal aOFC function in CSBD by demonstrating the recruitment of additional subsections of this region by erotic reward cues.

Identifying Internet Addiction and Evaluating the Efficacy of Treatment Based on Functional Connectivity Density: A Machine Learning Study

Although mounting neuroimaging studies have greatly improved our understanding of the neurobiological mechanism underlying internet addiction (IA), the results based on traditional group-level comparisons are insufficient in guiding individual clinical practice directly. Specific neuroimaging biomarkers are urgently needed for IA diagnosis and the evaluation of therapy efficacy. Therefore, this study aimed to develop support vector machine (SVM) models to identify IA and assess the efficacy of cognitive behavior therapy (CBT) based on unbiased functional connectivity density (FCD). Resting-state fMRI data were acquired from 27 individuals with IA before and after 8-week CBT sessions and 30 demographically matched healthy controls (HCs). The discriminative FCDs were computed as the features of the support vector classification (SVC) model to identify individuals with IA from HCs, and the changes in these discriminative FCDs after treatment were further used as features of the support vector regression (SVR) model to evaluate the efficacy of CBT. Based on the informative FCDs, our SVC model successfully differentiated individuals with IA from HCs with an accuracy of 82.5% and an area under the curve (AUC) of 0.91. Our SVR model successfully evaluated the efficacy of CBT using the FCD change ratio with a correlation efficient of 0.59. The brain regions contributing to IA classification and CBT efficacy assessment were the left inferior frontal cortex (IFC), middle frontal cortex (MFC) and angular gyrus (AG), the right premotor cortex (PMC) and middle cingulate cortex (MCC), and the bilateral cerebellum, orbitofrontal cortex (OFC) and superior frontal cortex (SFC). These findings confirmed the FCDs of hyperactive impulsive habit system, hypoactive reflecting system and sensitive interoceptive reward awareness system as potential neuroimaging biomarkers for IA, which might provide objective indexes for the diagnosis and efficacy evaluation of IA.

Cognitive processes related to problematic pornography use (PPU): A systematic review of experimental studies

INTRODUCTION

Some people experience symptoms and negative outcomes derived from their persistent, excessive, and problematic engagement in pornography viewing (i.e., Problematic Pornography Use, PPU). Recent theoretical models have turned to different cognitive processes (e.g., inhibitory control, decision making, attentional bias, etc.) to explain the development and maintenance of PPU, but empirical evidence derived from experimental studies is still limited. In this context, the present systematic review aimed to review and compile the evidence around cognitive processes related to PPU.

METHODS

A systematic review was performed in accordance with PRISMA guidelines to compile evidence regarding cognitive processes related to PPU. We retained and analyzed 21 experimental studies addressing this topic.

RESULTS

Studies were focused on four cognitive processes: attentional bias, inhibitory control, working memory, and decision making. In brief, PPU is related to (a) attentional biases toward sexual stimuli, (b) deficient inhibitory control (in particular, to problems with motor response inhibition and to shift attention away from irrelevant stimuli), (c) worse performance in tasks assessing working memory, and (d) decision making impairments (in particular, to preferences for short-term small gains rather than long-term large gains, more impulsive choice patterns than non-erotica users, approach tendencies toward sexual stimuli, and inaccuracies when judging the probability and magnitude of potential outcomes under ambiguity).

CONCLUSION

This systematic review offers a comprehensive overview of the current state of knowledge regarding the cognitive features related to PPU, and points out new areas that warrants further research.

Event-related potentials in a two-choice oddball task of impaired behavioral inhibitory control among males with tendencies towards cybersex addiction

BACKGROUND AND AIMS

Impaired behavioral inhibitory control (BIC) is known to play a crucial role in addictive behavior. However, research has been inconclusive as to whether this is also the case for cybersex addiction. This study aimed to investigate the time course of BIC in male individuals with tendencies towards cybersex addiction (TCA) using event-related potentials (ERPs) and to provide neurophysiological evidence of their deficient BIC.

METHODS

Thirty-six individuals with TCA and 36 healthy controls (HCs) were given a Two-Choice Oddball task that required them to respond differently to frequent standard stimuli (images of people) and infrequent deviant stimuli (pornographic images) within 1,000 ms. Electroencephalography (EEG) was recorded as the participants performed the task.

RESULTS

Despite the similarity of standard stimuli between the groups in terms of reaction times (RTs), the RTs of the TCA group to deviant stimuli were much slower than those of the HC group. The behavioral difference was accompanied by group differences in the averaged amplitudes of N2 (200-300 ms) and P3 (300-500 ms) components in the deviant-standard difference wave. More specifically, compared to the HC group, the TCA group demonstrated smaller N2 and P3 amplitude differences for deviant than standard stimuli.

DISCUSSION AND CONCLUSIONS

Individuals with TCA were more impulsive than HC participants and shared neuropsychological and ERP characteristics of substance use disorder or behavioral addictions, which supports the view that cybersex addiction can be conceptualized as a behavioral addiction.

Event-related potentials in a two-choice oddball task of impaired behavioral inhibitory control among males with tendencies towards cybersex addiction

BACKGROUND AND AIMS

Impaired behavioral inhibitory control (BIC) is known to play a crucial role in addictive behavior. However, research has been inconclusive as to whether this is also the case for cybersex addiction. This study aimed to investigate the time course of BIC in male individuals with tendencies towards cybersex addiction (TCA) using event-related potentials (ERPs) and to provide neurophysiological evidence of their deficient BIC.

METHODS

Thirty-six individuals with TCA and 36 healthy controls (HCs) were given a Two-Choice Oddball task that required them to respond differently to frequent standard stimuli (images of people) and infrequent deviant stimuli (pornographic images) within 1,000 ms. Electroencephalography (EEG) was recorded as the participants performed the task.

RESULTS

Despite the similarity of standard stimuli between the groups in terms of reaction times (RTs), the RTs of the TCA group to deviant stimuli were much slower than those of the HC group. The behavioral difference was accompanied by group differences in the averaged amplitudes of N2 (200-300 ms) and P3 (300-500 ms) components in the deviant-standard difference wave. More specifically, compared to the HC group, the TCA group demonstrated smaller N2 and P3 amplitude differences for deviant than standard stimuli.

DISCUSSION AND CONCLUSIONS

Individuals with TCA were more impulsive than HC participants and shared neuropsychological and ERP characteristics of substance use disorder or behavioral addictions, which supports the view that cybersex addiction can be conceptualized as a behavioral addiction.