Approach bias for erotic stimuli in heterosexual male college students who use pornography

Reducing problematic pornography use with imaginal retraining-A randomized controlled trial

Background and aim

Problematic pornography use (PPU) can be a manifestation of compulsive sexual behavior disorder (CSBD). Studies investigating PPU confirm approach-avoidance tendencies in response to pornographic stimuli in this population. This study show indications of the significance of the efficacy of imaginal retraining, a variant of approach bias modification, as an intervention for PPU.

Methods

A total of 274 participants (86.5% male; mean age = 30.65, SD = 10.13) with self-reported PPU were randomized to imaginal retraining (instruction video) or a waitlist control group. Assessments were conducted online at baseline and after the six-week intervention period. The primary outcome was a reduction in problematic pornography use. Compulsive sexual behavior, sexual desire, depressiveness, and satisfaction with the intervention served as secondary outcomes.

Results

Retention was low (51.7%), but comparable between groups. The retraining was performed at least once a week (the per-protocol [PP] criterion) by 51.4% of participants. The PP analyses of 111 participants showed a significant reduction in problematic pornography use (primary outcome) in the intervention compared to the control group. The intention-to-treat analyses (ITT), however, did not corroborate this result. Despite low adherence, participants rated their satisfaction with the intervention positively.

Discussion and Conclusion

Imaginal retraining can function as a low-threshold self-help intervention for PPU to overcome help-seeking barriers and may reduce PPU in a subgroup of users. Low adherence limits the results of this trial. Given the need for low-threshold interventions for PPU and/or CSBD, further research should focus on increasing adherence and should evaluate retraining for clinical groups. Modifications to augment efficacy are suggested.

Two subtypes of compulsive sexual behavior disorder

Models explaining addictive behaviors such as the Interaction of Person-Affect-Cognition-Execution (I-PACE) model emphasize the importance of reinforcement mechanisms for developing and maintaining these behaviors, including compulsive sexual behavior disorder (CSBD) as well as personal characteristics as vulnerability factors. This study aimed to determine whether there are CSBD subtypes distinguished by reinforcement sensitivity. We hypothesize that one subtype is sensitive to positive reinforcement (C+subtype) and one is sensitive to negative reinforcement (Ȼ-subtype). We calculated a cluster analysis with data from 62 patients with CSBD and tested differences between the identified clusters by t-test. The sample consisted only of men. Cluster variables were: the sensitivity to the Behavioral Inhibition and Approach System (BIS/BAS), the severity of depressive symptoms (BDI-II), the severity of Trait Anxiety (STAI-T), Sexual Sensation Seeking (SSSS), Thrill- and Adventure-Seeking (SSS-V subscale), Disinhibition (SSS-V subscale), Experience Seeking (SSS-V subscale), and Boredom Susceptibility (SSS-V subscale). Between-cluster differences were analyzed for Trait Sexual Motivation (TSMQ) and Sexual Compulsivity (SCS). The results showed a two-cluster solution with cluster 1 representing patients sensitive to negative reinforcement (Ȼ-subtype) and cluster 2 representing patients sensitive to positive reinforcement (C+subtype). No significant difference in symptom severity of Sexual Compulsivity between clusters was found. Cluster 2 showed higher Importance of Sex and a higher motivation to seek sexual encounters than cluster 2. We found a two-cluster solution regarding reinforcement sensitivity in patients with CSBD. This may have clinical implications regarding individual therapy by focusing on the underlying maintenance mechanisms.

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.

The Development and Validation of the Pornography Use in Romantic Relationships Scale

Recent reviews of the pornography literature have called for the development of valid and reliable measures that assess multiple facets of pornography use. Moreover, despite pornography use having important implications for romantic relationships, there are currently no self-report assessments of pornography use specifically within the context of romantic relationships. To address these limitations, the current paper reports on two studies regarding the development and psychometric evaluation of a 38-item multidimensional measure of pornography use within the context of romantic relationships: the Pornography Use in Romantic Relationships Scale (PURRS). Study 1 (n = 739) reports on an Exploratory and Confirmatory Factor Analytic approach to determine the factor structure of the PURRS. Study 2 (n = 765) reports on the cross-validation of the factor structure of the PURRS, before assessing the criterion validity of the measure. The PURRS exhibited good internal consistency, construct validity, and criterion validity. The findings suggest that the PURRS is best modeled by 13 first-order factors, though a higher-order factor structure comprising four broad factors may also be used. The PURRS significantly extends on past assessments of pornography use, and in particular, advances the assessment and study of pornography use within the context of romantic relationships.

Use of experimental medicine approaches for the development of novel psychiatric treatments based on orexin receptor modulation

Despite progress in understanding the pathological mechanisms underlying psychiatric disorders, translation from animal models into clinical use remains a significant bottleneck. Preclinical studies have implicated the orexin neuropeptide system as a potential target for psychiatric disorders through its role in regulating emotional, cognitive, and behavioral processes. Clinical studies are investigating orexin modulation in addiction and mood disorders. Here we review performance-outcome measures (POMs) arising from experimental medicine research methods which may show promise as markers of efficacy of orexin receptor modulators in humans. POMs provide objective measures of brain function, complementing patient-reported or clinician-observed symptom evaluation, and aid the translation from preclinical to clinical research. Significant challenges include the development, validation, and operationalization of these measures. We suggest that collaborative networks comprising clinical practitioners, academics, individuals working in the pharmaceutical industry, drug regulators, patients, patient advocacy groups, and other relevant stakeholders may provide infrastructure to facilitate validation of experimental medicine approaches in translational research and in the implementation of these approaches in real-world clinical practice.

The World Federation of Societies of Biological Psychiatry guidelines on the assessment and pharmacological treatment of compulsive sexual behaviour disorder

OBJECTIVES

The current guidelines aim to evaluate the role of pharmacological agents in the treatment of patients with compulsive sexual behaviour disorder (CSBD). They are intended for use in clinical practice by clinicians who treat patients with CSBD.

METHODS

An extensive literature search was conducted using the English-language-literature indexed on PubMed and Google Scholar without time limit, supplemented by other sources, including published reviews.

RESULTS

Each treatment recommendation was evaluated with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. Psychoeducation and psychotherapy are first-choice treatments and should always be conducted. The type of medication recommended depended mainly on the intensity of CSBD and comorbid sexual and psychiatric disorders. There are few randomised controlled trials. Although no medications carry formal indications for CSBD, selective-serotonin-reuptake-inhibitors and naltrexone currently constitute the most relevant pharmacological treatments for the treatment of CSBD. In cases of CSBD with comorbid paraphilic disorders, hormonal agents may be indicated, and one should refer to previously published guidelines on the treatment of adults with paraphilic disorders. Specific recommendations are also proposed in case of chemsex behaviour associated with CSBD.

CONCLUSIONS

An algorithm is proposed with different levels of treatment for different categories of patients with CSBD.

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.

A motivation model of sex addiction - Relevance to the controversy over the concept

An integrative model of sexual addiction is presented, involving a combination of models based upon (i) incentive motivation theory and (ii) the dual organisation of the control of behavior. The model is related to ongoing arguments about the validity of the notion of addiction when applied to sexual behavior. It is suggested that the evidence strongly favors the viability of an addiction model of sex. Strong similarities to the classical addiction to hard drugs are observed and features can be better understood with the help of the model. These include tolerance, escalation and withdrawal symptoms. It is argued that other candidates for accounting for the phenomena, such as obsessive-compulsive behavior, faulty impulse control, high drive and hypersexuality do not fit the evidence. The role of dopamine is central to the model. The model's relevance to stress, abuse, development, psychopathy, fantasy, sex differences, evolutionary psychology and the interaction with drug-taking is shown.

Reward Responsiveness, Learning, and Valuation Implicated in Problematic Pornography Use — a Research Domain Criteria Perspective

Purpose of Review

Problematic pornography use (PPU) describes a pattern of behavior characterized by excessive time spent using or thinking about pornography and continued use despite negative consequences. To help advance the understanding of transdiagnostic underlying psychological and neurobiological mechanisms in PPU, we aim to review existing evidence on these mechanisms focusing on positive valence systems within the transdiagnostic Research Domain Criteria (RDoC) framework.

Recent Findings

Reward anticipation processes seem to be increased in individuals with PPU symptoms when they anticipate sexual stimuli compared with other rewards. Studies further suggest that the initial neural and attentional responses to sexual rewards compared with different control stimuli are also increased in individuals with PPU symptoms, as are conditioned responses in sexual reward learning paradigms. Sexual reward valuation studies point towards an increased neural value differentiation with increasing PPU symptoms.

Summary

The current state of evidence indicates that positive valence systems are altered in persons with PPU. This framework of organizing evidence may aid in elucidating PPU development and maintenance as well as planning future studies.

Effects of Depression on Processing and Evaluation of Sexual Stimuli in Women

BACKGROUND

Sexual dysfunctions are commonly associated with depression by which women are particularly affected.

AIM

In the following study, we looked at which stage-early attention-related processes or later evaluation-related processes-of the processing of sexual stimuli deviations occur in depressed individuals.

METHODS

We examined 96 women who either suffered from a major depressive disorder, or had recovered from it, and a healthy control group. The early level of attention processes was represented by reaction time tasks (dot probe, line orientation, picture categorization). In addition, implicit approach and avoidance behavior was tested by the Approach-Avoidance Task. Later evaluation of the visual material was determined with the help of a questionnaire for recording automatic negative thoughts regarding sexuality.

OUTCOMES

Reaction times and explicit ratings as well as the Becks Depression Inventory (BDI II), the Trait Sexual Motivation Questionnaire (TSMQ), the Sexual Modes Questionnaire (SMQ) and a screening for sexual dysfunction were used.

RESULTS

Depressed women did not differ significantly from healthy women in their attention processes and approach-avoidance behavior. However, there were clear differences in explicit assessment and automatic thoughts about sexual stimuli. Women who had recovered from depression lay between the 2 groups.

CLINICAL IMPLICATIONS

The results indicated that the therapy of sexual dysfunction in depressed patients should focus more on automatic thoughts than on attention processes.

STRENGTHS & LIMITATIONS

This study is the first to experimentally research the attention processes of depression towards sexual stimuli. However, participants were only tested on one occasion so that change of attention processes and evaluation of sexual stimuli over the course of a depression could not be assessed.

CONCLUSION

Our novel findings demonstrate the role of attention processes in sexual dysfunctions of depressed women and suggest potential mechanisms that may underlie the observed correlation between depression and sexual dysfunction. Baranowski AM, Noll A-K, Golder S, et al. Effects of Depression on Processing and Evaluation of Sexual Stimuli in Women. J Sex Med 2022;19:441-451.

Psychometric Properties of the Problematic Pornography Use Scale in a Japanese Sample

Problematic pornography use (PPU) is the inability to control the use of pornography and is considered a form of compulsive sexual behavior. It can have a negative effect on one's life and is an important clinical and social issue. In Japan, there is no assessment tool to measure PPU and very little research has been done. The Problematic Pornography Use Scale is one of the scales assessing the severity of PPU. This study validated a Japanese version of the Problematic Pornography Use Scale (PPUS-J) and examined its psychometric properties in a sample of 1011 individuals through an online survey (502 men, 509 women; M_age = 35.9 years, SD = 13.75). The results of the confirmatory factor analysis indicated that the four factors in the original scale were consistent with the factors in the PPUS-J, and strict invariance could be assumed for male and female participants. With regard to reliability, internal consistency indices were appropriate both at the overall and subscale levels for male and female participants. The PPUS-J showed good convergent and divergent validity due to the relationship between the subscales and other measures such as the Sexual Compulsivity Scale. These results demonstrate the validity of the PPUS-J for assessing problematic pornography use in a Japanese sample. Given the paucity of studies conducted in non-Western cultures and on women, this study will be useful in advancing research on PPU across different cultures. Future studies should examine test-retest reliability of the PPUS-J and its use with clinical groups.

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.

An empirical study of affective and cognitive functions in Compulsive Sexual Behavior Disorder

BACKGROUND AND AIMS

Despite the inclusion of the Compulsive Sexual Behavior Disorder (CSBD) in the International Classification of Diseases, very little is known about the underlying affective and cognitive processes. To fill this gap, we compared CSBD subjects and Healthy-Controls (HC) across negative/positive valence, cognitive and sensorimotor systems, as proposed by the Research Domain Criteria framework.

METHODS

74 heterosexual CSBD and 66 matched HC males were studied with 10 questionnaires and 8 behavioral tasks. Analyses were conducted with frequent and Bayesian statistics.

RESULTS

CSBD individuals showed significantly higher (than HC) punishment sensitivity, anxiety, depression, compulsivity, and impulsivity symptoms. Frequentist statistical analysis revealed significant interaction between subject group and condition in Incentive Delay Task, concerning the strength of motivation and hedonic value of erotic rewards. Bayesian analysis produced evidence for the absence of group differences in Facial Discrimination Task, Risk-Ambiguity Task, and Learning Task. Also, Bayesian methods provided evidence for group differences in the Emotional Stroop Task and the Incentive Delay Task. Sexual Discounting Task, Attentional Network Task, and Stop Signal Task produced mixed results.

CONCLUSIONS

Higher punishment sensitivity and impulsivity among CSBD subjects, along with significant interaction between these groups and erotic vs. non-erotic reward processing is in line with previous findings on negative/positive valence alterations in CSBD patients. This result shows that there are similarities to substance and behavioral addictions. The absence of group differences and mixed results related to cognitive and sensorimotor systems raise concerns to what extent CSBD resembles a wide spectrum of impairments observed in disorders, and demand further research.

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.

Affective and cognitive processes involved in behavioral addictions

This special issue addresses the affective and cognitive processes and their interactions potentially reflecting mechanisms underlying the development, maintenance of, or recovery from behavioral addictions. Various specific types of behavioral addictions will be considered, including those already in ICD-11 (gambling disorder, gaming disorder), but also new phenomena that are not yet classified (e.g., buying-shopping disorder, social-network-disorder) and phenomena potentially belonging to behavioral addictions although they are currently classified elsewhere (e.g., compulsive sexual behavior disorder). The articles included in this special issue directly investigate affective processes (e.g., cue-reactivity, craving, mood, stress, social interactions) and/or cognitive processes (e.g., executive functions, attention, memory). The studies involve experimental paradigms, neuropsychological tasks, psychophysiological measures, and neuroimaging techniques. Specific articles also deal with the relationship between affective and cognitive processes. The special issue is complemented by articles covering current debates and reviewing current empirical findings in the field.

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.

Problematic consumption of online pornography during the COVID-19 pandemic: clinical recommendations

The coronavirus disease (COVID-19) pandemic is one of the greatest contemporary challenges. Feelings of fear and uncertainty triggered by this pandemic have had noxious effects on people's mental health. This seems to have increased during quarantine and there is evidence of an intensification of rewarddirected behavior. Nevertheless, there are few studies dealing with pornography consumption during this period. The aim of this manuscript is to contextualize this phenomenon during the pandemic and suggest some clinical recommendations on the matter.

Mindfulness and equanimity moderate approach/avoidance motor responses

A person's tendency to approach pleasant stimuli and to avoid unpleasant stimuli reflects a basic psychological phenomenon. The present research aimed to investigate the extent to which mindfulness practices and trait equanimity can attenuate this motivational process. In two studies, participants were asked to perform an Approach/Avoidance Task (AAT). In Study 1 (N = 84), prior to completing the AAT, participants were randomly assigned to one of two guided mindfulness-based meditation conditions (breathing or body-scan) or to an active control condition. In Study 2 (N = 71), which controlled for mindfulness practice, motor responses to the AAT were compared by level of equanimity of the participants (low vs. high). The results revealed that breathing meditation practice and trait equanimity significantly moderated participants' motor responses to the AAT, and that the body-scan meditation did not moderate these responses. Bayesian analyses showed that participants in the breathing meditation group (Study 1) and those with higher equanimity (Study 2) showed a reduction of bias in their motor responses to the AAT. These results suggest that meditation practice and trait equanimity may promote a decrease in automatic motivational approach and avoidance tendencies evoked by positive and negative stimuli.

Decision-Making in Gambling Disorder, Problematic Pornography Use, and Binge-Eating Disorder: Similarities and Differences

Purpose of Review

The present review attempts to provide a comprehensive and critical overview of the neurocognitive mechanisms of gambling disorder (GD), problematic pornography use (PPU) and binge-eating disorder (BED), focusing specifically on decision-making processes.

Recent findings

GD, PPU and BED have been associated with decision-making impairments both under risk and ambiguity. Features such as intelligence, emotions, social variables, cognitive distortions, comorbidities, or arousal may condition decision-making processes in these individuals.

Summary

Impairments in decision-making seem to be a shared transdiagnostic feature of these disorders We also hypothesized the EG relative to the NEG group would demonstrate weaker relationships between problem-gambling severity and health/functioning measures (e.g., substance use) and gambling behaviors (e.g., more time spent gambling) given that EG would account for some of the variance in the relationships between ARPG and these measures. However, there is varying support for the degree to which different features may affect decision-making. Therefore, the study of decision-making processes can provide crucial evidence for understanding addictions and other disorders with addiction-like symptomatology.

Approach bias for erotic stimuli among heterosexual female college students who use pornography

Repeated engagement in addictive behaviors may lead to relatively automatic action tendencies whereby individuals approach rather than avoid addictive stimuli. This study assessed whether an approach bias for erotic stimuli exists among heterosexual college-aged females who report using pornography. We tested 121 female undergraduates using an approach-avoidance task (AAT) employing both erotic and neutral stimuli, during which participants were instructed to push or pull a gaming joystick in response to image orientation. To simulate approach and avoidance movements, pulling the joystick enlarged the image and pushing shrunk the image. Severity of pornography use was assessed using the Brief Pornography Screener (BPS) and the Problematic Pornography Use Scale (PPUS). Participants demonstrated a significant approach bias of 24.81 ms for erotic stimuli as compared to neutral stimuli, and this approach bias significantly positively correlated with PPUS scores. Moreover, approach bias scores were significantly positively correlated with anhedonia (as assessed by the Snaith-Hamilton Pleasure Scale), indicating that the stronger the degree of approach for erotic stimuli, the more anhedonia that was observed. Anhedonia was not significantly associated with pornography use severity, however. Findings implicate both similarities and differences in problematic pornography use among female and male users. A limitation of the current study is that it assessed approach biases among only heterosexual females due to the erotic stimuli employed during the AAT. Future studies should examine approach biases among females of varying sexual orientations.

Sexual cues alter working memory performance and brain processing in men with compulsive sexual behavior

Pornography has been repeatedly at the centre of public attention and has been controversially discussed for a long time. However, little is known about the connection between pornographic stimuli and individual (neuronal) processing of attention and memory. Here, the impact and neural underpinnings of pornographic pictures on working memory processes in a sample of subjects with compulsive sexual behaviour was investigated. Therefore, whilst using functional magnetic resonance imaging (fMRI), a letter n-back task with neutral or pornographic pictures in the background was employed in 38 patients and 31 healthy controls. On the behavioural level, patients were slowed down by pornographic material depending on their pornography consumption in the last week, which was reflected by a higher activation in the lingual gyrus. In addition, the lingual gyrus showed a higher functional connectivity to the insula during processing of pornographic stimuli in the patient group. In contrast, healthy subjects showed faster responses when confronted with pornographic pictures only with high cognitive load. Also, patients showed a better memory for pornographic pictures in a surprise recognition task compared to controls, speaking for a higher relevance of pornographic material in the patient group. These findings are in line with the incentive salience theory of addiction, especially the higher functional connectivity to the salience network with the insula as a key hub and the higher lingual activity during processing of pornographic pictures depending on recent pornography consumption.

From sign-tracking to attentional bias: Implications for gambling and substance use disorders

Sign-tracking behavior in Pavlovian autoshaping is known to be a relevant index of the incentive salience attributed to reward-related cues. Evidence has accumulated to suggest that animals that exhibit a sign-tracker phenotype are especially vulnerable to addiction and relapse due to their proneness to attribute incentive salience to drug cues, and their relatively weak cognitive and attentional control over their behavior. Interestingly, sign-tracking is also influenced by reward uncertainty in a way that may promote gambling disorder. Research indicates that reward uncertainty sensitizes sign-tracking responses and favors the development of a sign-tracker phenotype, compatible with the conditioned attractiveness of lights and sounds in casinos for problem gamblers. The study of attentional biases in humans (an effect akin to sign-tracking in animals) leads to similar observations, notably that the propensity to develop attraction for conditioned stimuli (CSs) is predictive of addictive behavior. Here we review the literature on drug addiction and gambling disorder, highlighting the similarities between studies of sign-tracking and attentional biases.

The Assessment of Problematic Internet Pornography Use: A Comparison of Three Scales with Mixed Methods

The primary aim of this study was to compare different screening tools for problematic internet pornography use (IPU) and identify the most accurate measure. The reliability and validity of three scales, namely, the Problematic Pornography Consumption Scale (PPCS), Problematic Pornography Use Scale (PPUS), and Short Internet Addiction Test Adapted to Online Sexual Activities(s-IAT-sex), were examined using three homogeneous groups, respectively. A total of 972 adults (mean age = 24.8) from 28 provinces/regions in China participated in the quantitative part (QUAN). The Brief Pornography Screener served as the reference standard. The PPCS demonstrated stronger reliability and validity, including criterion validity, as well as greater sensitivity and acceptable specificity; therefore, it was considered to be the more accurate screening instrument. In the qualitative part (QUAL), we interviewed 22 volunteers and 11 therapists (who had worked with individuals with problematic IPU) to examine their perspectives on the core features of problematic IPU and dimensions of the PPCS. Almost all the interviewees endorsed the structure of the PPCS. These findings encourage the use of the PPCS in future research studies and underscore its screening applications because of its ability to classify IPU as problematic or nonproblematic.