Neurobiological Correlates in Internet Gaming Disorder: A Systematic Literature Review

Altered local intrinsic neural activity and molecular architecture in internet use disorders

BACKGROUND

Internet gaming disorder (IGD) is mainly characterized by its core dysfunction in higher-order brain cortices involved in inhibitory control, whose neurobiological basis remains unclear. Then, we will investigate local intrinsic neural activity (INA) alterations in IGD, ascertain whether these potential alterations are related to clinical characteristics, and further explore the underlying molecular architecture.

METHOD

In this study, we performed the fractional amplitude of low-frequency fluctuation (fALFF) and regional homogeneity (ReHo) derived from resting-state functional magnetic resonance imaging (rs-fMRI) to explore the impact of IGD on local INA. Correlation analysis revealed the relationship between ReHo and fALFF in terms of group differences and clinical characteristics. Moreover, correlations between fALFF, ReHo, and PET- and SPECT-driven maps were investigated to elucidate the specific molecular architecture alternations in IGD. Finally, receiver operating characteristic curve (ROC) analysis was used to show the potential abilities of fALFF and ReHo in distinguishing individuals with IGD (IGDs) from healthy controls (HCs).

RESULT

Compared with HCs, IGDs revealed increased ReHo and fALFF in the prefrontal cortex. Significantly decreased ReHo was observed in the temporal lobe, occipital lobe, and cerebellum. In addition, the ReHo values in the cerebellum_7b_R were positively correlated with internet addiction severity. ROC curve analysis showed that ReHo and fALFF-altered brain regions could effectively distinguish IGDs from HCs. More importantly, cross-modal correlations revealed local INA changes in brain regions associated with the monoamine neurotransmitter system and the less studied cholinergic/GABAergic system.

CONCLUSION

These results suggest that local functional impairments are shown in the audiovisual and inhibitory control circuits in IGDs. This may be associated with underlying neurotransmitter system alterations. Therefore, this study provides the possibility of GABAergic receptor agonists and cholinergic receptor inhibitors for the treatment of IGD.

Nature Connectedness Reduces Internet Gaming Disorder: The Chain Mediating Role of Intolerance of Uncertainty and Desire Thinking

While online gaming has become a choice for relaxation and entertainment in today's digital age, Internet Gaming Disorder (IGD) has also become a widely concerning mental disorder. Nature connectedness has been found to effectively reduce addiction-related risks and alleviate symptoms of addictive behaviors. It is a relatively lacking but very important factor influencing psychological recovery and regulation in the digital society. This study aims to explore the relationship between nature connectedness and IGD, and the mediating roles of intolerance of uncertainty and desire thinking. A total of 571 young people voluntarily participated in the questionnaire survey. The results showed that: (1) nature connectedness was negatively correlated with IGD; (2) intolerance of uncertainty plays a mediating role between nature connectedness and IGD; and (3) intolerance of uncertainty and desire thinking plays a chain mediating role between nature connectedness and IGD. Analysis of the research results indicates that nature connectedness can effectively reduce IGD and reveal its mechanism of action. The findings provide new insights for the study and intervention of IGD in the digital age.

Systematic Review of Gaming and Neuropsychological Assessment of Social Cognition

Playing video games is associated with cognitive changes and possibly psychosocial difficulties. Problematic gaming occurs upon the loss of control over videogame playing; gaming disorder is considered a behavioral addiction in the 11th version of the International Classification of Diseases. Models used to understand behavioral addictions include cognition as an essential factor in the development, maintenance, and relapse of addiction. Nevertheless, some aspects of cognition, such as social cognition, remain underexplored, despite evidence of alterations in cognitive and social function among patients with problematic gaming. This review aimed to describe the current understanding of social cognition in individuals exposed to videogames. We included all studies assessing social cognition in participants of any age with a wide range of exposure to video games (from simple use of video games (such as at least two exposures) to problematic gaming, defined according to the included study). This wide range of exposure allowed us to explore the whole process from repeated exposure to addiction. We included only studies that used neuropsychological tasks to assess social cognition. Patient-reported outcomes that could be biased by subjective self-report data were not included. The search was conducted from inception to January 2022 in three databases (PubMed, PsycINFO, and Web of Science). The systematic search identified 39 studies that assessed facial emotion processing, empathy, theory of mind, social decision-making, aggressive behavior, and moral competence. In general, results have been mixed, and a number of questions remain unanswered. Nevertheless, several studies showed cerebral changes when processing facial emotion that were linked with problematic gaming, while no link was obtained between nonproblematic gaming and empathy alterations. The influences of cooperation patterns, theory of mind, moral competence, and gaming frequency were highlighted. Finally, there was substantial heterogeneity in the population assessed and the methods used.

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

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

Problematic Gaming and Gambling: A Systematic Review of Task-Specific EEG Protocols

Even though gaming and gambling bear similar problematic behavioral aspects, there are no recognizable neurophysiological biomarkers or features characterizing and/or distinguishing these conditions. A systematic review of the literature with a focus on methods was performed in PubMed, Scopus, Web of Science (Web of Science Core Collection), EBSCOhost Research Databases (APA PsycINFO; APA PsycArticles; OpenDissertations; ERIC) databases. Following search terms were used to search the databases: ERP, "event related potential*", EP, "evoked potential*", SS, "steady state", EEG, electroencephal*; gam*. Data about the participants (total number, gender, age), main aim of the study and information about the experimental setup (experimental task description, stimuli used, ERPs measured (latency windows and placement of the electrodes), process evaluated) was extracted. A total of 24 studies were revised (problematic gaming - 16, pathological gambling - 8). The experimental protocols could be grouped into 3 main target domains (Cue-reactivity, General Information processing and Reward Processes & Risk Assessment). Sample-related limitations (small sample sizes, gender differences, differences between the groups regarding potential confounding variables) and heterogeneity regarding the experimental tasks, implementation and interpretation reviewed. Gambling-related research is highly focused on the investigation of the reward-related processes, whereas gaming-related research is mostly focused on the altered aspects of more general information processing. A vast heterogeneity regarding the ERP experimental paradigms being used and lack of clear guidelines and standardized procedures prevents identification of measures capable to reliably discriminate or characterize the population susceptible to addictive behavior or being able to diagnose and monitor these disorders.

Mobile phone short video use negatively impacts attention functions: an EEG study

The pervasive nature of short-form video platforms has seamlessly integrated into daily routines, yet it is important to recognize their potential adverse effects on both physical and mental health. Prior research has identified a detrimental impact of excessive short-form video consumption on attentional behavior, but the underlying neural mechanisms remain unexplored. In the current study, we aimed to investigate the effect of short-form video use on attentional functions, measured through the attention network test (ANT). A total of 48 participants, consisting of 35 females and 13 males, with a mean age of 21.8 years, were recruited. The mobile phone short video addiction tendency questionnaire (MPSVATQ) and self-control scale (SCS) were conducted to assess the short video usage behavior and self-control ability. Electroencephalogram (EEG) data were recorded during the completion of the ANT task. The correlation analysis showed a significant negative relationship between MPSVATQ and theta power index reflecting the executive control in the prefrontal region (r = -0.395, p = 0.007), this result was not observed by using theta power index of the resting-state EEG data. Furthermore, a significant negative correlation was identified between MPSVATQ and SCS outcomes (r = -0.320, p = 0.026). These results suggest that an increased tendency toward mobile phone short video addiction could negatively impact self-control and diminish executive control within the realm of attentional functions. This study sheds light on the adverse consequences stemming from short video consumption and underscores the importance of developing interventions to mitigate short video addiction.

Dimensions of family stress and repetitive nonsuicidal self-injury in adolescence: Examining the interactive effects of impulsivity and emotion dysregulation

BACKGROUND

Repetitive non-suicidal self-injury (R-NSSI) in adolescence represents a significant risk factor for suicide. Although exposure to family stress is robustly associated with the risk of non-suicidal self-injury (NSSI), studies have not examined the potential mechanisms linking different forms of family stress and R-NSSI.

OBJECTIVE

This study examined how unique dimensions of family stress (threat and deprivation) relate to R-NSSI via interactions between impulsivity and emotion dysregulation.

PARTICIPANTS AND SETTING

The current sample included 3801 middle-school adolescents (42.2 % girls, Mage = 13.21 years).

METHODS

We conducted a two-wave study with 6-month intervals. Participants completed self-report measures assessing family stress, impulsivity, emotion dysregulation, and NSSI.

RESULTS

Moderate mediation analyses showed that threat was indirectly associated with NSSI frequency through the interaction of impulsivity and emotion dysregulation in the R-NSSI group and indirectly through impulsivity in the occasional NSSI (O-NSSI) group. Deprivation did not predict subsequent NSSI frequency in either group.

CONCLUSIONS

These findings lend empirical support to dimensional models of adversity and suggest that adolescents who experience threat-related family stress may have greater impulsivity and are more likely to report R-NSSI in the context of emotion dysregulation.

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.

Comparative efficacy of different interventions on executive function in adolescents with internet use disorder

BACKGROUND

The formation and relapse of Internet use disorder (IUD) are related to the decline in executive function. Previous studies have indicated that exercise intervention and high-definition transcranial direct current stimulation (HD-tDCS) can improve the cognitive abilities of adolescents with IUD. However, the combined intervention's impact on executive function in these adolescents remains unclear. Therefore, this study aims to explore the effects and differences of multimodal exercise, HD-tDCS intervention, and combined intervention on the executive function of adolescents with IUD.

METHODS

Forty-eight adolescents with IUD were randomly assigned to the multimodal exercise group, HD-tDCS intervention group, combined intervention group, and control group. The intervention groups received 4 weeks of moderate-intensity multimodal exercise, HD-tDCS intervention (2 mA, 20min/session, 3 times/week), or combined multimodal exercise with HD-tDCS intervention. The control group received conventional educational learning. Executive function measurements were taken before intervention, after intervention, and 2 weeks post-intervention.

RESULTS

Compared to pre-intervention, different interventions effectively improved the behavioral performance of adolescents with IUD in executive function tasks. In comparison to single interventions, the combined intervention significantly outperformed multimodal exercise and HD-tDCS intervention in influencing the executive function (especially inhibitory control and working memory) in adolescents with IUD.

CONCLUSION

Combined multimodal exercise with HD-tDCS intervention proves to be an effective means of enhancing executive function in adolescents with IUD, particularly contributing to the improvement of explicit behavioral performance related to executive function.

The prevalence and possible risk factors of gaming disorder among adolescents in China

BACKGROUND

Nowadays, moderate gaming behaviors can be a pleasant and relaxing experiences among adolescents. However, excessive gaming behavior may lead to gaming disorder (GD) that disruption of normal daily life. Understanding the possible risk factors of this emerging problem would help to suggest effective at preventing and intervening. This study aimed to investigate the prevalence of GD and analyze its possible risk factors that adolescents with GD.

METHODS

Data were collected between October 2020 and January 2021. In total, a sample of 7901 students (4080 (52%) boys, 3742 (48%) girls; aged 12-18 years) completed questionnaires regarding the Gaming-Related Behaviors Survey, Gaming Disorder Symptom Questionnaire-21 (GDSQ-21); Behavioral Inhibition System and Behavioral Activation System Scale (BIS/BAS Scale); Emotion Regulation Questionnaire (ERQ); Short-form Egna Minnenav Barndoms Uppfostran for Chinese (s-EMBU-C); and Adolescent Self-Rating Life Events Checklist (ASLEC).

RESULTS

The prevalence of GD was 2.27% in this adolescent sample. The GD gamers were a little bit older (i.e., a higher proportion of senior grades), more boys, with more gaming hours per week in the last 12 months, with more reward responsiveness, maternal rejecting and occurrence of negative life events (e.g., interpersonal relationships, being punished and bereavement factors).

CONCLUSION

These possible risk factors may influence the onset of GD. Future research in clinical, public health, education and other fields should focus on these aspects for provide target prevention and early intervention strategies.

The mediating effect of dispositional mindfulness on the association between UPPS-P impulsivity traits and gaming disorder among Asia-Pacific young adults

BACKGROUND

Little evidence is available to verify the mediating effect of dispositional mindfulness on the association between gaming disorder and various impulsivity traits. The present study aimed to investigate the mediating effect of dispositional mindfulness on the association between the five UPPS-P impulsivity traits and the risk of gaming disorder among young adults.

METHODS

It was an inter-regional cross-sectional study using online survey in Australia, Japan, The Philippines and China. Impulsivity measured by the UPPS-P Impulsive Behavior Scale-Short version; dispositional mindfulness measured by the Mindfulness Attention Awareness Scale; and the risk of gaming disorder measured by the Internet Gaming Disorder Scale were collected in the focal regions. Structural equation modeling was performed by SPSS AMOS version 26 to verify the study hypotheses. Bootstrapped 95% confidence interval was reported. Statistical significance was indicated by the p-value below 0.05.

RESULTS

Among the 1,134 returned questionnaires, about 40% of them aged 18-20 years and 21-23 years, respectively. 53.8% were male. 40.7% had been playing digital and video games for over 10 years. The prevalence of gaming disorder was 4.32%. The model fitness indices reflected that the constructed model had an acceptable model fit (χ2(118) = 558.994, p < 0.001; χ2/df = 4.737; CFI = 0.924; TLI = 0.890; GFI = 0.948; RMSEA = 0.058; SRMR = 0.0487). Dispositional mindfulness fully mediated the effect of positive urgency and negative urgency on the risk of gaming disorder. The effect of lack of premeditation on the risk of gaming disorder was partially mediated by dispositional mindfulness. However, dispositional mindfulness did not mediate the effect of sensation seeking on the risk of gaming disorder.

CONCLUSIONS

The varied associations between dispositional mindfulness and the five impulsivity traits hints that improving some impulsive traits may increase dispositional mindfulness and so lower the risk of gaming disorder. Despite further studies are needed to verify the present findings, it sheds light on the need to apply interventions on gamers based on their impulsivity profile. Interventions targeting at emotion regulation and self-control such as mindfulness-based interventions seem to be effective to help gamers with dominant features of urgency and lack of premeditation only. Other interventions shall be considered for gamers with high sensation seeking tendency to enhance the effectiveness of gaming disorder prevention.

Video game addiction is associated with early stage of inhibitory control problems: An event-related potential study using cued Go/NoGo task

Video game addiction (VGA) is associated with cognitive problems, particularly deficits in inhibitory control. The present study aimed to investigate behavioural responses and event-related potential associated with specific response inhibition using the cued Go/NoGo task to examine the effects of VGA on brain activity related to response inhibition. Twenty-five individuals addicted to video games (action video games) and 25 matched healthy controls participated in the study. The results showed that the VGA group had significantly more commission error in the NoGo trials and faster reaction time in the Go trials compared with the control group. The event-related potential analyses revealed significant reductions in amplitudes of N2 cue and N2 NoGo in the VGA group. While there was no significant difference between the N2 amplitudes of the Go and NoGo trials in the VGA group, the control group had a larger N2 amplitude in the NoGo trials. These results indicate that VGA subjects have difficulties in the early stages of response inhibition, as well as some level of impairment in proactive cognitive control.

Impulsivity and aggression as risk factors for internet gaming disorder among university students

Internet gaming addiction is a global problem, especially among young individuals. Exhibiting characteristics similar to other addictions, Internet Gaming Disorder (IGD) is linked to adverse mental health outcomes. Identified as risk factors for dependence behaviors, the association of impulsivity and aggression with IGD is relatively under-researched in the student population. The present sample of 350 university students (Mage = 21.30 years, SDage = 4.96 years) from Najran university in Saudi Arabia completed an online questionnaire that included the Internet Gaming Disorder Scale-Short-Form (IGDS9-SF), the Buss-Perry Aggression Questionnaire-Short Form, and the Barratt Impulsiveness Scale (BIS-15). Results indicated that impulsivity and aggression were positively associated with IGD severity and both personality traits explained 34.6% of the variance in IGD scores. Further bivariate analyses suggested that individuals spending 7 or more hours on internet gaming were more likely to exhibit high impulsivity and aggression, and had a relatively higher severity of IGD. These results suggest that individuals with these personality traits may be more vulnerable to developing an addiction to internet gaming. These findings need to be confirmed in future more robust studies; however, this exploratory study provides insights for potential programs to prevent IGD among young individuals.

Connected minds in disconnected bodies: Exploring the role of interoceptive sensibility and alexithymia in problematic use of the internet

INTRODUCTION

The ever-increasing prominence of the internet and digital technology in our society requires a deeper examination of how these developments alter perception of our bodies and emotions. One such consequence is the emergence of Problematic Use of the Internet (PUI) - an array of compulsive or addictive behaviors mediated by the web that detrimentally affect an individual's functioning. This suggests that some people may be shifting their consciousness from the physical realm to the digital world. The objective of this study was to investigate how shortcomings in interoception (the sensibility to bodily signals) and alexithymia (an inability to identify and express emotions) might contribute to PUI.

METHODS

The Internet Addiction Test (IAT), the Toronto Alexithymia Scale (TAS-20), and the Multidimensional Assessment of Interoceptive Awareness (MAIA) were used to assess a sample of 1076 adolescents and young adults aged between 16 and 26 years via an online survey. Data analysis was based on t-test, correlations and multivariate regression.

RESULTS

26.8% (n = 288) of participants met the criteria for moderate PUI. Individuals with PUI displayed higher levels of alexithymia (p < 0.001) and diminished abilities in certain aspects of interoceptive sensibility, including placing trust in their own bodily signals (p = 0.006), not responding excessively to uncomfortable sensations with worry (p < 0.001), and not denying them (p = 0.006). Multivariate modelling revealed associations between PUI and the following factors: having a boyfriend/girlfriend (aOR = 5.70), substance use (aOR = 1.78), difficulty in identifying feelings (aOR = 1.09), externally oriented thinking (aOR = 1.05), low disposition in perceiving body sensations (aOR = 0.25), tendency to become distracted (aOR = 0.82) or excessively worried (aOR = 0.11) in the face of pain. Furthermore, the analysis indicated how these aspects of body perception may be interrelated, either enhancing or reducing the risk of PUI when examined individually, collectively, or in combination.

CONCLUSIONS

This study underlines the potential connection between difficulties in the mind-body interaction and the development of PUI. It suggests a bidirectional relationship between excessive digital device use and distorted bodily interoceptive processes in PUI, reinforcing the notion that individuals struggling with emotion identification and expression may be more prone to excessive internet usage. To further comprehend the relevance of these constructs in PUI, it is necessary to conduct more targeted investigations and longitudinal studies.

Heterogeneity of gaming disorder: A clinically-based typology for developing personalized interventions

Background

The eleventh revision of the International Classification of Diseases (ICD-11) defines the three key diagnostic criteria for gaming disorder (GD). These are loss of control over gaming, gaming as a priority over daily activities, and impaired functioning due to gaming. While this definition has implications for the prevention and treatment of GD, there is significant heterogeneity in the symptoms and etiology of GD among individuals, which results in different treatment needs. Cognitive control, emotional regulation, and reward sensitivity are three critical dimensions in the etiology model for GD. Aspects such as gender, comorbidity, motivation for gaming, stage or severity of GD, and risk factors all contribute to the heterogeneity of etiology among individuals with the disorder.

Method

On the basis of clinical symptoms and comorbidity characteristics among approximately 400 patients with gaming disorder, the present paper proposes a clinical typology of patients with GD based on the authors' clinical experience in treating individuals with GD.

Results

The findings indicated three common types of patients with GD: (i) impulsive male patients with attention deficit hyperactivity disorder (ADHD), (ii) dysphoria patients with dysfunctional coping skills, and (iii) isolated patients with social anxiety. The paper also discusses the presentation and treatment priority for these patients.

Conclusion

Personalized treatments for patients with GD should be developed to fit their individual needs. Future studies should examine the heterogeneity of GD and confirm these types, as well as obtain evidence-based information that can help in the development of personalized treatment. Treatment resources should be developed, and professionals should be trained to provide integrated individualized treatment.

Association between gaming disorder and regional homogeneity in highly involved male adult gamers: A pilot resting-state fMRI study

BACKGROUND

Gaming behavior can induce cerebral changes that may be related to the neurobiological features of gaming disorder (GD). Additionally, individuals with higher levels of depression or impulsivity are more likely to experience GD. Therefore, the present pilot study explored potential neurobiological correlates of GD in the context of depression and impulsivity, after accounting for video gaming behavior.

METHODS

Using resting-state functional magnetic resonance imaging (fMRI), a cross-sectional study was conducted with 35 highly involved male adult gamers to examine potential associations between GD severity and regional homogeneity (ReHo) in the entire brain. A mediation model was used to test the role of ReHo in the possible links between depression/impulsivity and GD severity.

RESULTS

Individuals with greater GD severity showed increased ReHo in the right Heschl's gyrus and decreased ReHo in the right hippocampus (rHip). Furthermore, depression and impulsivity were negatively correlated with ReHo in the rHip, respectively. More importantly, ReHo in the rHip was found to mediate the associations between depression/impulsivity and GD.

CONCLUSIONS

These preliminary findings suggest that GD severity is related to ReHo in brain regions associated with learning/memory/mood and auditory function. Higher levels of depression or impulsivity may potentiate GD through the functional activity of the hippocampus. Our findings advance our understanding of the neurobiological differences behind GD symptoms in highly involved gamers.

Internet gaming and related psychotic disorder: An emerging phenomenon

Internet addiction has recently been suggested as a possible diagnostic entity in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and incorporated in the International Classification of Diseases 11th Revision (ICD-11) as a gaming disorder, predominantly, online or offline. Mostly, psychotic phenomena have been described by either alcohol or opioid withdrawal, but there is a paucity of literature on Internet-related psychosis. We report two cases from Northern India of sudden onset of psychosis due to Internet addiction. The contents of hallucinations and delusions reflected themes of Internet gaming. Psychosis as a specifier for Internet gaming disorder (IGD) is not defined in DSM-5, whereas it should be considered as one of the presentations of Internet addiction.

Neuroimaging correlates of internet gaming disorder: Can we achieve the promise of translating understandings of brain functioning into clinical advances?

Objectives

Here we aimed to consider the neural factors associated with internet gaming disorder (IGD), as well as the associations between these factors and existing treatments for the disorder.

Methods

A narrative review was conducted.

Results

Pharmacological as well as psychological treatments for IGD may be associated with specific changes in multiple brain areas and circuits. In particular, fronto-striatal and subcortical regions and pathways appear relevant to IGD and its treatment.

Conclusions

Neuroimaging holds promise for identifying specific mechanisms underlying IGD interventions. However, to date, firm conclusions are difficult to draw and more research examining neural mechanisms of empirically supported treatments for IGD is needed.

A Systematic Review of Pharmacological Treatments for Internet Gaming Disorder

OBJECTIVE

Internet gaming disorder (IGD) is an increasingly common behavioral addiction, with an estimated global prevalence of 3%. A variety of pharmacological treatments have been used to treat IGD, yet no review to date has synthesized clinical trials evaluating their efficacy. This systematic review therefore synthesized the literature reporting on clinical trials of pharmacological treatments for IGD.

METHODS

We reviewed articles from MEDLINE, Embase, PubMed Central, CINAHL, and PsycINFO that were published as of March of 2022. A total of 828 articles were retrieved for review and 12 articles were included, reporting on a total of 724 participants.

RESULTS

Most participants were male (98.6%), and all were currently living in South Korea. The most common drugs used to treat IGD were bupropion, methylphenidate, and a range of selective serotonin reuptake inhibitors. The Young Internet Addiction Scale was the most frequently used to measure gaming-related outcomes. All studies reported reduced symptoms of IGD from pre- to post-treatment. Across all clinical trials, IGD symptom reductions following the administration of pharmacological treatments ranged from 15.4% to 51.4%. A risk of bias assessment indicated that only four studies had a low risk of bias.

CONCLUSION

Preliminary results suggest that a wide array of pharmacological interventions may be efficacious in the treatment of IGD. Future studies using double-blind randomized controlled trial designs, recruiting larger and more representative samples, and controlling for psychiatric comorbidities are needed to better inform understanding of pharmacological treatments for IGD.

Neuroimaging findings in adolescent gaming disorder: a systematic review

OBJECTIVES

Gaming disorder is a growing concern affecting adolescents, exacerbated by the impact of recent COVID-19 restrictions. The World Health Organization has recently included gaming disorder in the 11th International Classification of Diseases (ICD-11). However, there is still an ongoing debate about the validity and reliability of the proposed clinical criteria, despite growing neurobiological evidence in this cohort. Systematic reviews in this area have focused mainly on adults or mixed adult/adolescent populations. Therefore, this systematic review explored the neuroimaging literature in adolescents (under 18 years old) with gaming disorder.

METHODS

Using PRISMA 2020 guidelines, 3288 primary studies were identified from PubMed, CINAHL Plus, PsycINFO and Web of Science. After applying inclusion and exclusion criteria (appropriate title, abstract, comparison group used within study, English-language, neuroimaging and mean age under 18), 24 studies were included in this review.

RESULTS

Functional and structural brain alterations in adolescent gaming disorder were noted across several imaging modalities, including electroencephalogram (EEG), functional magnetic resonance imaging (fMRI) and structural magnetic resonance imaging (MRI). Compared with healthy controls, adolescents with gaming disorder demonstrated neurological changes comparable to substance addiction, namely impairments in emotional regulation, reward-seeking, inhibition and increased risky decision-making. Positive brain adaptations in the areas of visuospatial processing and memory were observed.

CONCLUSIONS

A number of key brain regions are affected in adolescent gaming disorder. These findings can help clinicians understand adolescent presentations with gaming disorder from a neurobiological perspective. Future studies should focus on forming a robust neurobiological and clinical framework for adolescent gaming disorder.

Positive youth development attributes, mental disorder, and problematic online behaviors in adolescents: a longitudinal study amidst the COVID-19 pandemic

Introduction

During the COVID-19 pandemic, adolescents have increasingly suffered from online problem behaviors and mental disorders. But little research has paid attention to the protective factors among adolescents. Therefore, the present study attempted to investigate the role of positive youth development (PYD) attributes in adolescents' depression, internet gaming disorder (IGD) and cyberbullying/victimization (CBV).

Methods

A total of 995 Chinese adolescents (M_age = 15.97 years, SD = 0.77, 325 boys) from two public high schools in Hubei province were recruited to participate in the three-wave longitudinal study over the span of 1 year during the pandemic (Time 1: November, 2020; Time 2: May, 2021; Time 3: November, 2021).

Results

T1 PYD attributes negatively predicted T2 depression and T3 online problematic behaviors. T2 depression positively predicted IGD at T3. T3 IGD significantly predicted greater involvement in T3 CBV, and vice versa. Moreover, depression and one online problem behavior mediated the relationships between PYD attributes and the other online problem behavior, separately and sequentially.

Discussion

These findings demonstrated the protective role of PYD attributes in prevention of mental disorders and online problem behaviors among adolescents during the COVID-19 pandemic. Comprehensive measures should be taken to assist young people to develop more PYD attributes to promote healthy growth.

Functional MRI of inhibitory control processing in problematic mobile video gamers

With the development of mobile technology, mobile video games provide people with a more convenient way of entertainment, but problematic playing could also bring some negative consequences. Prior studies have indicated that Internet gaming addicts were accompanied by impaired inhibitory control. However, as a relatively new form of problematic game usage based on mobile devices, little is known about the neurobiological underpinnings of inhibitory control in problematic mobile video game (PMVG) users. Adopting an event-related fMRI Stroop task, the present study aimed to examine the different neural correlates of inhibitory control between PMVG and healthy control (HC) subjects. Compared with HC group, PMVG group showed greater brain activities in the right dorsolateral prefrontal cortex (DLPFC) during the Stroop process. Moreover, correlation analysis showed that brain activities extracted from the voxel in the DLPFC cluster had a significantly negative correlation with reward sensitivity. Our current findings may suggest the compensating effect in key brain regions of inhibitory control in problematic mobile video gamers relative to healthy controls.

Risk and protective factors for (internet) gaming disorder: A meta-analysis of pre-COVID studies

This large-scale meta-analysis aimed to provide the most comprehensive synthesis to date of the available evidence from the pre-COVID period on risk and protective factors for (internet) gaming disorder (as defined in the DSM-5 or ICD-11) across all studied populations. The risk/protective factors included demographic characteristics, psychological, psychopathological, social, and gaming-related factors. In total, we have included 1,586 effects from 253 different studies, summarizing data from 210,557 participants. Apart from estimating these predictive associations and relevant moderating effects, we implemented state-of-the-art adjustments for publication bias, psychometric artifacts, and other forms of bias arising from the publication process. Additionally, we carried out an in-depth assessment of the quality of underlying evidence by examining indications of selective reporting, statistical inconsistencies, the typical power of utilized study designs to detect theoretically relevant effects, and performed various sensitivity analyses. The available evidence suggests the existence of numerous moderately strong and highly heterogeneous risk factors (e.g., male gender, depression, impulsivity, anxiety, stress, gaming time, escape motivation, or excessive use of social networks) but only a few empirically robust protective factors (self-esteem, intelligence, life satisfaction, and education; all having markedly smaller effect sizes). We discuss the theoretical implications of our results for prominent theoretical models of gaming disorder and for the existing and future prevention strategies. The impact of various examined biasing factors on the available evidence seemed to be modest, yet we identified shortcomings in the measurement and reporting practices.

Gaming disorder: A summary of its characteristics and aetiology

The emergence, development, and maintenance of gaming disorder (GD) is the result of an interplay between gaming-related factors, individual factors, and environmental factors. None of these alone are sufficient to cause a disordered state, but it is the interactive co-occurrence of all these factors, which in some cases leads to GD. The goal of the present paper is to discuss in detail these three factors based on relevant and recent findings of the literature. Among gaming-related factors, we discuss online vs. offline videogames, the role of game genres, structural characteristics, game design elements, as well as some important monetization techniques. Among individual factors demographic risk factors, personality traits, motivational factors, comorbid psychopathology, genetic predisposition, and neurobiological processes are considered. Finally, among environmental factors we discuss family factors, early life experiences, the role of peers and school-related factors, as well as the broader context of culture including the popularity of esports.

Is Nomophobia Problematic or Functional? A Perspective from Bifactor Structure

With the extensive use of mobile phones globally, some people engage in excessive or problematic phone use behaviors. However, little is known regarding the latent structure of problematic mobile phone use. The current study employed the Chinese versions of the Nomophobia Questionnaire, Mobile Phone Addiction Tendency Scale, and Depression-Anxiety-Stress Scale-21 to explore the latent psychological structure of problematic mobile phone use and nomophobia and their associations with mental health symptoms. Results showed that a bifactor latent model best fit nomophobia, which contained a general factor and four unique factors involving the fear of being unable to access information, losing convenience, losing contact, and losing one's Internet connection. Results also showed significant correlations among latent factors of nomophobia, problematic mobile phone use, and mental health symptoms. Through these findings, we can conclude that two problematic mobile phone use behaviors share a common factor concerning excessive use, and nomophobia has independent unique factors concerning usable function. This study clarifies the structure of problematic mobile phone use, and it implies that we can distinguish problematic mobile phone use from functional use; further investigation of problematic mobile phone use is warranted.

Emotion dysregulation mediates the relationship between adverse childhood experiences and problematic gaming

Gaming disorder (i.e., gaming addiction) is a relatively common mental health disorder with a worldwide prevalence rate of 3.05%. In the present research, we examined whether emotion dysregulation mediates the relation between adverse childhood experiences and problematic gaming in two samples of current video game players. The first sample consisted of 1,262 students recruited from five universities across Canada. The second sample comprised 417 community adults residing in Canada. Both samples of participants completed an online survey which included measures of adverse childhood experiences, problematic gaming, and emotion dysregulation. A total of 45.64% (n = 576) in the university sample and 49.76% (n = 205) in the community sample met the threshold for problematic gaming. In the student sample, adverse childhood experiences were positively associated with problematic gaming. In contrast, there was no significant association between adverse childhood experiences and problematic gaming in the community sample. In both samples, adverse childhood experiences were positively associated with emotion dysregulation, and emotion dysregulation was positively associated with problematic gaming. Importantly for the present research, emotion dysregulation mediated the relationship between adverse childhood experiences and problematic gaming in both the university and community sample. Although adverse childhood experiences are distal and static risk factors for problematic gaming, emotion dysregulation is a more proximal and modifiable risk factor. The results suggest that increasing adaptive emotion regulation skills may decrease the risk of problematic gaming among individuals who have experienced an adverse childhood experience.

Psychological Effects of FIFA, PES, and Clash of Clans Games on Young Men at Risk of Developing Internet Gaming Disorder

BACKGROUND

The present study aimed to investigate the psychological effects of FIFA, PES, and Clash of Clans games on young men at risk of developing internet gaming disorder (IGD).

METHODS

The sample consisted of 150 young men, 50 of whom were in the FIFA and PES group, 50 in the Clash of Clans group, and 50 in the control group. Two groups of young men at risk of developing IGD were compared with a control group. The participants completed the General Health Questionnaire (GHQ), Quality of Relationships Inventory (QRI), Game Addiction Scale, and Behavior Rating Inventory of Executive Function (BRIEF).

FINDINGS

The results of the study showed that the scores of mental health problems, conflict with friends, and executive function problems in the Clash of Clans group were significantly higher than those of the FIFA, PES, and control groups. Concerning conflict with parents, the FIFA group had a higher score than the Clash of Clans and control groups. In addition, the results indicated that gaming addiction affects mental health by affecting executive functions.

CONCLUSION

The Clash of Clans game has more negative effects on psychological functions.

Personality traits and their role as risk modifiers in gaming disorder and internet use disorders

PURPOSE OF REVIEW

After its initial recognition in the DSM-5, Gaming Disorder has now officially been included as a mental disorder in the ICD-11 as a behavioral addiction. In the past decades, research on this phenomenon has increased and in particular theories on its etiopathology have been suggested. In that respect, underlying factors, including neurobiological, social, and psychological factors, have been described. One commonly discussed etiological factor is supposed in specific personality traits. Knowing more about underlying personality factors of Gaming Disorder and other subtypes of internet use disorders would allow for a construction of more sophisticated etiological models, tailored prevention approaches, and would affect the specificity of treatment strategies. This overview provides information on current research on the role of the Big Five personality traits in Gaming Disorder as potential risk modifiers and maintaining factors.

RECENT FINDINGS

Research has especially identified high neuroticism and low conscientiousness as correlates of Gaming Disorder. Yet, results based on prospective studies are lacking largely, although there is the first evidence that personality traits might not only act as risk modifying factors but could also be influenced by Gaming Disorder.

SUMMARY

Suggestions for future research and the need for a more pronounced perspective taking into account the changing dynamics of personality are presented in this contribution. Addressing personality traits in treatment programs could be a promising approach in preventing patients from premature treatment termination and later relapse.

Internet and Video Games: Causes of Behavioral Disorders in Children and Teenagers

Even though video games have been present among children for many years, children are using them more continuously and in an abusive and indiscriminate way nowadays because of the "technological boom". It is affecting the behavior of children and adolescents. This is the reason why we are carrying out this systematic review. The main objective of this article is to investigate literature that directly connects the continuous and undifferentiated use of video games with the emergence of behavioral disorders in children and young people. The PRISMA statement was followed in the process of this article. We used SCOPUS, Web of Science and PubMed as databases, moreover, we searched studies with a scoping review. The results indisputably supported six out of seven of our hypotheses. We find that the excessive use of video games causes addiction to technology, aggressive behaviors, sleep disorders, and poor school performance. In addition, it hinders social relationships and the development of emotional intelligence. To conclude, it is necessary to correctly use video games in particular, and technologies in general, adapting their content to children's age, as well as the amount of time that they dedicate to use them.

Coping and Co-Occurrence of Gaming Disorder and Substance Use in Recovering Substance Users

BACKGROUND

There are a wide range of negative effects associated with both substance use disorders and behavioural disorders and their co-occurrence. Understanding the way in which at-risk populations (e.g., substance-abstinent users) interact with potentially addictive behaviours (e.g., gaming) and substance use-while navigating life stressors through differing coping styles-can inform preventative strategies.

METHODS

Therefore, the present study investigated 64 clinical participants and 138 general population participants. Each cohort was required to complete a battery of psychometric scales exploring problematic behaviours, problematic substance use, co-occurrence, and coping styles. Additional exploratory direct comparisons of gamers in the clinical cohort and gamers in the general cohort were carried out.

RESULTS

The study's findings suggest that gamers from different populations (i.e., general and clinical) share similar at-risk behaviours. These problematic behaviours were more pronounced among abstinent substance use gamers, and more specifically among poly-substance use gamers.

CONCLUSIONS

The findings of the present study add to the literature and suggest that dysfunctional coping style and the co-occurrence of problematic behaviours may have an impact on the assessment and potential treatment of substance abstinent gamers. The findings offer support for an integrated treatment approach, wherein both substance use and the other problematic behaviours (e.g., gaming) are considered in tandem.

Influences of Emotional Information on Response Inhibition in Gaming Disorder: Behavioral and ERP Evidence from Go/Nogo Task

BACKGROUND

Gaming disorder (GD) may impair executive functions such as response inhibition. According to the tripartite neurocognitive model, the interoceptive system generates a state of craving that exacerbates the dysfunction of GD. We speculate that emotional information may play an important role in the mechanism, which leads to impaired response inhibition in people with GD.

METHODS

A three-factor mixed experimental design was adopted in this go/nogo task. The between-subject factor was group (GD or control group), and the within-subject factors were two types of emotional information, task relevance (related or unrelated) and emotional valence (negative or positive).

RESULTS

The GD group had lower nogo accuracies than the control group in the task-unrelated condition and also in the negative condition. Parallelly, the GD group showed faster reactions and lower accuracy in the go trials than the control group under task-unrelated negative conditions. At the neural level, the GD group had smaller amplitudes of nogo-N2 and larger amplitudes of nogo-P3 than the control group in the task-unrelated condition.

CONCLUSIONS

The findings prove the hypothesis of this study that emotional information could be a factor leading to impaired response inhibition in GD individuals. The response inhibition abilities of GD are weakened when processing task-unrelated or negative information, which may be caused by failure of behavioral inhibition and weakened conflict control, resulting in more cognitive resources to complete response suppression under specific conditions. This study provides evidence for weaker response inhibition in GD individuals from the perspective of cognitive-emotional interaction and provides more detailed information for interventions for GD.

Predicting the severity of internet gaming disorder with resting-state brain features: A multi-voxel pattern analysis

BACKGROUND

Internet gaming disorder (IGD) has become a worldwide mental health concern; however, the neural mechanism underlying this disorder remains unclear. Multivoxel pattern analysis (MVPA), a newly developed data-driven approach, can be used to investigate the neural features of IGD based on massive neural data.

METHODS

Resting-state fMRI data from four hundred and two participants with varying levels of IGD severity were recruited. Regional homogeneity (ReHo) and the amplitude of low-frequency fluctuation (ALFF) were calculated and subsequently decoded by applying MVPA. The highly weighted regions in both predictive models were selected as regions of interest for further graph theory and Granger causality analysis (GCA) to explore how they affect IGD severity.

RESULTS

The results revealed that the neural patterns of ReHo and ALFF can independently and significantly predict IGD severity. The highly weighted regions that contributed to both predictive models were the right precentral gyrus and left postcentral gyrus. Moreover, topological properties of the right precentral gyrus were significantly correlated with IGD severity; further GCA revealed effective connectivity from the right precentral gyrus to left precentral gyrus and dorsal anterior cingulate cortex, both of which were significantly associated with IGD severity.

CONCLUSIONS

The present study demonstrated that IGD has distinctive neural patterns, and this pattern could be found by machine learning. In addition, the neural features in the right precentral gyrus play a key role in predicting IGD severity. The current study revealed the neural features of IGD and provided a potential target for IGD interventions using brain modulation.

Opposing associations of Internet Use Disorder symptom domains with structural and functional organization of the striatum: A dimensional neuroimaging approach

BACKGROUND

Accumulating evidence suggests brain structural and functional alterations in Internet Use Disorder (IUD). However, conclusions are strongly limited due to the retrospective case-control design of the studies, small samples, and the focus on general rather than symptom-specific approaches.

METHODS

We here employed a dimensional multi-methodical MRI-neuroimaging design in a final sample of n = 203 subjects to examine associations between levels of IUD and its symptom-dimensions (loss of control/time management, craving/social problems) with brain structure, resting state and task-based (pain empathy, affective go/no-go) brain function.

RESULTS

Although the present sample covered the entire range of IUD, including normal, problematic as well as pathological levels, general IUD symptom load was not associated with brain structural or functional alterations. However, the symptom-dimensions exhibited opposing associations with the intrinsic and structural organization of the brain, such that loss of control/time management exhibited negative associations with intrinsic striatal networks and hippocampal volume, while craving/social problems exhibited a positive association with intrinsic striatal networks and caudate volume.

CONCLUSIONS

Our findings provided the first evidence for IUD symptom-domain specific associations with progressive alterations in the intrinsic structural and functional organization of the brain, particularly of striatal systems involved in reward, habitual and cognitive control processes.

Advances in problematic usage of the internet research - A narrative review by experts from the European network for problematic usage of the internet

Global concern about problematic usage of the internet (PUI), and its public health and societal costs, continues to grow, sharpened in focus under the privations of the COVID-19 pandemic. This narrative review reports the expert opinions of members of the largest international network of researchers on PUI in the framework of the European Cooperation in Science and Technology (COST) Action (CA 16207), on the scientific progress made and the critical knowledge gaps remaining to be filled as the term of the Action reaches its conclusion. A key advance has been achieving consensus on the clinical definition of various forms of PUI. Based on the overarching public health principles of protecting individuals and the public from harm and promoting the highest attainable standard of health, the World Health Organisation has introduced several new structured diagnoses into the ICD-11, including gambling disorder, gaming disorder, compulsive sexual behaviour disorder, and other unspecified or specified disorders due to addictive behaviours, alongside naming online activity as a diagnostic specifier. These definitions provide for the first time a sound platform for developing systematic networked research into various forms of PUI at global scale. Progress has also been made in areas such as refining and simplifying some of the available assessment instruments, clarifying the underpinning brain-based and social determinants, and building more empirically based etiological models, as a basis for therapeutic intervention, alongside public engagement initiatives. However, important gaps in our knowledge remain to be tackled. Principal among these include a better understanding of the course and evolution of the PUI-related problems, across different age groups, genders and other specific vulnerable groups, reliable methods for early identification of individuals at risk (before PUI becomes disordered), efficacious preventative and therapeutic interventions and ethical health and social policy changes that adequately safeguard human digital rights. The paper concludes with recommendations for achievable research goals, based on longitudinal analysis of a large multinational cohort co-designed with public stakeholders.

Aberrant intrinsic neural network strength in individuals with "smartphone addiction": An MRI data fusion study

BACKGROUND AND OBJECTIVES

Excessive smartphone use, also referred to as "smartphone addiction" (SPA), has increasingly attracted neuroscientific interest due to its similarities with other behavioral addictions, particularly internet gaming disorder. Little is known about the neural mechanisms underlying smartphone addiction. We explored interrelationships between brain structure and function to specify neurobiological correlates of SPA on a neural system level.

METHODS

Gray matter volume (GMV) and intrinsic neural activity (INA) were investigated in individuals with SPA (n = 20) and controls (n = 24), using multimodal magnetic resonance imaging and multivariate data fusion techniques, that is, parallel independent component analysis.

RESULTS

The joint analysis of both data modalities explored shared information between GMV and INA. In particular, two amplitudes of low frequency fluctuations-based independent neural systems significantly differed between individuals with SPA and controls. A medial/dorsolateral prefrontal system exhibited lower functional network strength in individuals with SPA versus controls, whereas the opposite pattern was detected in a parietal cortical/cerebellar system. Neural network strength was significantly related to duration of smartphone use and sleep difficulties.

DISCUSSION AND CONCLUSIONS

We show modality-specific associations of the brain's resting-state activity with distinct and shared SPA symptom dimensions. In particular, the data suggest contributions of aberrant prefrontal and parietal neural network strength as a possible signature of deficient executive control in SPA.

SCIENTIFIC SIGNIFICANCE

This study suggests distinct neural mechanisms underlying specific biological and behavioral dimensions of excessive smartphone use.

Internet gaming disorder and its correlates among university students, Saudi Arabia

BACKGROUND

Over-indulgence in online/offline video games could result in the development of internet gaming disorder (IGD). Knowledge of the prevalence and correlates of IGD may help to understand its etiology. The aim of the present study was to estimate IGD and its psychological/game-related correlates in Saudi university students.

MATERIALS AND METHODS

For this cross-sectional study, 843 students registered in a university in Saudi Arabia filled an online survey comprising diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), hospital anxiety and depression scale, Rosenberg self-esteem scale, social phobia inventory scale, satisfaction with life scale, and subjective happiness (SH) scale. For data analysis, an independent sample t-test, Pearson correlation coefficient/Chi-square test, and multiple linear regression followed by hierarchical regressions were used.

RESULTS

The frequency of IGD was 21.5%. Total game time/day, years of playing games, and social phobia were significantly higher in subjects with IGD (P = 0.001, <0.001, and <0.001, respectively), whereas SH was significantly lower (P < 0.001). Tendency to IGD had a significant positive correlation with social phobia, total game time/day, and years of playing games and a negative correlation with SH. Total game time/day, years of playing games, and social phobia were significant positive predictors of tendency to IGD, whereas SH was a negative predictor. The rest of all variables were insignificant predictors.

CONCLUSION

The frequency of IGD in Saudi university students identified by DSM-5 criteria was relatively high (21.5%). The prediction of the severity of IGD could be based on social phobia, total game time/day, number of years of playing games, and SH.

Psychometric properties of the Farsi version of the gaming disorder scale for adolescents (GADIS-A)

BACKGROUND

Gaming disorder was added to the 11th version of the international classification of disease by the world health organization in early 2019. Adolescents are the most vulnerable group in this area. Thus, a screening tool for this age range is essential. This study aims to examine the psychometric properties of the gaming disorder scale for adolescents (GADIS-A) in an Iranian male sample.

METHODS

260 male students-7th to 12th grade-from Isfahan city in the academic year 2020-2021 were selected using convenience sampling. The participants responded to the Farsi version of the GADIS-A and problematic online game questionnaire (POGQ). Thirty participants answered the scale again to assess the validity of the retest. Pearson's correlation analysis, Cronbach's alpha, and confirmatory factor analysis were used. The data were analyzed by SPSS version 24 and R software packages psych and lavaan.

RESULTS

Confirmatory factor analysis revealed that the two-factor model, which included cognitive-behavioral symptoms and negative consequences, had good fitness indices. The GADIS-A convergent validity is confirmed by the scale's significant correlation with the POGQ. Cronbach's alpha coefficient was used to determine the scale's validity, which was 0.85 for the full scale and 0.70 and 0.75 for two factors. The validity of the retest after two weeks also showed a correlation of 0.88.

CONCLUSION

The Farsi version of the gaming disorder scale for adolescents has a two-factor structure and is valid for use in Iran.

Current Status of Internet Gaming Disorder (IGD) in Japan: New Lifestyle-Related Disease in Children and Adolescents

The World Health Organization recognizes internet gaming disorder (IGD) as a disorder that causes problems in daily life as a result of excessive interest in online games. The causes of IGD have become more apparent in recent years. Because of prolonged exposure to games, the mechanisms controlling the reward system, such as the prefrontal cortex, limbic system, and amygdala of the cerebrum, do not function properly in IGD. This mechanism is similar to that of various behavioral addictions, such as gambling addiction. IGD is particularly risky in children and adolescents because it easily causes brain dysfunction, especially in the developing brain. IGD should be regarded as a new lifestyle-related disease in younger individuals, and lifestyle modifications, including counseling and family therapy, are critical for its management.

Enhanced resting-state EEG source functional connectivity within the default mode and reward-salience networks in internet gaming disorder

BACKGROUND

The two key mechanisms affected by internet gaming disorder (IGD) are cognitive and reward processing. Despite their significance, little is known about neurophysiological features as determined using resting-state electroencephalography (EEG) source functional connectivity (FC).

METHODS

We compared resting-state EEG source FC within the default mode network (DMN) and reward/salience network (RSN) between patients with IGD and healthy controls (HCs) to identify neurophysiological markers associated with cognitive and reward processing. A total of 158 young male adults (79 patients with IGD and 79 HCs) were included, and the source FC of the DMN and RSN in five spectral bands (delta, theta, alpha, beta, and gamma) were assessed.

RESULTS

Patients with IGD showed increased theta, alpha, and beta connectivity within the DMN between the orbitofrontal cortex and parietal regions compared with HCs. In terms of RSN, patients with IGD exhibited elevated alpha and beta connectivity between the anterior cingulate gyrus and temporal regions compared with HCs. Furthermore, patients with IGD showed negative correlations between the severity of IGD symptoms and/or weekly gaming time and theta and alpha connectivity within the DMN and theta, alpha, and beta connectivity within the RSN. However, the duration of IGD was not associated with EEG source FC.

CONCLUSIONS

Hyper-connectivities within the DMN and RSN may be considered potential state markers associated with symptom severity and gaming time in IGD.

Disorders due to addictive behaviors: Further issues, debates, and controversies •

Two recent papers in the Journal of Behavioral Addictions by Brand et al. (2022), and Sassover and Weinstein (2022) both make interesting additions to the place of behavioral addictions in the more general addictive behaviors field. This commentary discusses some of the further nuances in the debates surrounding whether problematic engagement in social networking, pornography, and buying/shopping should be considered as possible 'disorders due to addictive behaviors' in the ICD-11. Particular emphasis in this commentary is placed on social network use disorder and its delineation. While there is growing evidence that addictions to sex, pornography, social network sites, exercise, work, and buying/shopping may be genuine disorders among a minority of individuals, none of these behaviors is likely to be included in formal psychiatric manuals in the near future until there is more high-quality data on all research fronts (e.g., epidemiological, neurobiological, psychological, and clinical).

Brain structural covariation linked to screen media activity and externalizing behaviors in children

Background and Aims

Screen media activity (SMA) may impact neurodevelopment in youth. Cross-sectionally, SMA has been linked to brain structural patterns including cortical thinning in children. However, it remains unclear whether specific brain structural co-variation patterns are related to SMA and other clinically relevant measures such as psychopathology, cognition and sleep in children.

Methods

Adolescent Brain Cognitive Development (ABCD) participants with useable baseline structural imaging (N = 10,691; 5,107 girls) were analyzed. We first used the Joint and Individual Variation Explained (JIVE) approach to identify cortical and subcortical covariation pattern(s) among a set of 221 brain features (i.e., surface area, thickness, or cortical and subcortical gray matter (GM) volumes). Then, the identified structural covariation pattern was used as a predictor in linear mixed-effect models to investigate its associations with SMA, psychopathology, and cognitive and sleep measures.

Results

A thalamus-prefrontal cortex (PFC)-brainstem structural co-variation pattern (circuit) was identified. The pattern suggests brainstem and bilateral thalamus proper GM volumes covary more strongly with GM volume and/or surface area in bilateral superior frontal gyral, rostral middle frontal, inferior parietal, and inferior temporal regions. This covariation pattern highly resembled one previously linked to alcohol use initiation prior to adulthood and was consistent in girls and boys. Subsequent regression analyses showed that this co-variation pattern associated with SMA (β = 0.107, P = 0.002) and externalizing psychopathology (β = 0.117, P = 0.002), respectively.

Discussion and Conclusions

Findings linking SMA-related structural covariation to externalizing psychopathology in youth resonate with prior studies of alcohol-use initiation and suggest a potential neurodevelopmental mechanism underlying addiction vulnerability.

The Spanish Version of the Video Game Functional Assessment-Revised

It is estimated that 16.8 million in Spain (41% female) are involved in gaming, and approximately 8.3% of Spanish gamers are problematic gamers (i.e., endorsing five or more of the nine criteria for Internet Gaming Disorder [IGD]). Given the high prevalence of IGD in Spain, this study evaluated construct validity and concurrent validity of the Spanish Version of the Video Game Functional Assessment-Revised (SP-VGFA-R), by examining the correlational coefficients with the nine-item Internet Gaming Disorder Scale-Short-Form (IGDS9-SF). A total of 434 adults 18 years of age or older participated in the study (15.1% female). Results showed that the SP-VGFA-R was positively and significantly associated with the IGDS9-SF (bivariate coefficients ranging from 0.411 to 0.610). Four distinct factors in the SP-VGFA-R were identified in confirmatory factor analysis, including (a) social attention, (b) tangible/intangible rewards, (c) escape/avoidance of demands or pain, and (d) sensory stimulation. Other findings showed that IGDS9-SF scores increased as (a) the escape/avoidance of demands or pain function increased and (b) two or more function scores increased. The SP-VGFA-R can be used in combination with the IGDS9-SF to assess Spanish gamers with IGD internationally, and to develop evidence-based behavioral interventions.

Psychometric properties of the Indonesian Ten-item Internet Gaming Disorder Test and a latent class analysis of gamer population among youths

Internet gaming disorder (IGD) is a rising health concern. Indonesia has yet to have any validated instrument specifically designed to screen for this disorder. This study aims to validate the Indonesian version of the Ten-item Internet Gaming Disorder Test (IGDT-10) and conduct a latent class analysis of gamers among the youth. An online survey was conducted between October and December 2020 at two universities in Depok and Jakarta, Indonesia. In total, 1233 respondents (62.6% female and 20.3±1.90 years old) gave valid responses and played video games. Confirmatory factor analysis (CFA) confirmed the unidimensional structure of the scale. Cronbach’s alpha was 0.72 and composite reliability was 0.92. The latent class analysis yielded three distinct classes of gamers. The continuation and negative consequences were highly distinctive for the group at high risk of IGD (class 3). Deception had the lowest endorsement rate (41.7%); while, the continuation domain had the highest endorsement, 91.2%. The IGD prevalence estimate was 1.90% among the respondents. Approximately 70.2% of the gamers did not show IGD symptoms. The adapted Indonesian IGDT-10 was demonstrated as valid and reliable among Indonesian youths. Consistent with previous studies, the deception domain had a low endorsement rate. The detected IGD rates were comparable to the global range. The majority of the current sample disclosed no symptoms; however, a considerable proportion would benefit from early preventive measures.

Proactive and reactive inhibitory control are differently affected by video game addiction: An event-related potential study

INTRODUCTION

Video game addiction (VGA) is associated with physical and mental disorders, one of which is problem in executive function, particularly inhibitory control. The present study aimed to investigate reactive and proactive inhibitory controls by event-related potential (ERP).

METHODS

Thirty video game (action video games)-addicted subjects and 30 matched healthy controls participated in the study, who were tested by the selective stop-signal task.

RESULTS

The main results revealed that the VGA group had significantly more problems in preparatory processes and proactive stop trials, showing that VGA has a negative effect on proactive inhibition.

CONCLUSION

Finding the problem in proactive inhibitory control might be helpful in developing new treatments and rehabilitation methods in these fields.

Internet Gaming Disorder: Evidence for a Risk and Resilience Approach

Although previous research has noted a range of factors that predict developing Problematic Video Game Use (PVGU) and Internet Gaming Disorder (IGD), few studies have looked at risk and protective factors together, and there is scant empirical evidence examining whether risk for PVGU or IGD increases or decreases as risk or protective factors accumulate in the individual. The aim of the current study was to examine both issues using predictors from three demonstrated PVGU and IGD risk categories: executive dysfunction, unmet needs in everyday life, and unhelpful family environment. In a survey of N = 866 12–17-year-old school students, the risk/protective factors that most strongly predicted severity of IGD symptomology and meeting IGD diagnostic criteria were self-control and social exclusion. Other significant predictors included impulsivity, self-esteem, mastery, control of one’s external environment, and better parent-child attachment quality. Trend analyses revealed a linear increase in the risk of PVGU as risk and net-risk factors accumulated, and a decrease as protective and net-protective factors accumulated. Thus, a net accumulation of issues around impulse control and unmet needs in everyday life may predispose adolescents to PVGU or IGD. Results support a ‘risk and resilience’ approach to adolescent screen-based disorders and suggest potential benefits to a risk factor focus in treatment.

Risk and protective factors of Internet gaming disorder among Chinese people: A meta-analysis

OBJECTIVES

Effective prevention and intervention of Internet gaming disorder require the identification of risk and protective factors. This study aims to exhaustively review the risk and protective factors of Internet gaming disorder among Chinese people.

METHOD

We searched for articles published from database inception to February 2020 in MEDLINE, PsycINFO, Embase, PubMed, Web of Science and two Chinese databases, CNKI and Wanfang Data. Studies were included in the meta-analysis if they addressed Internet gaming disorder, sampled people in China, presented correlational factors of Internet gaming disorder and reported the effect sizes for correlations. Reviewers independently selected the studies, assessed their validity and extracted the data. Pooled Pearson's correlations were calculated using the random effects model.

RESULT

In the meta-analysis, 153 studies covering 115,975 subjects were included. We identified 56 risk factors and 28 protective factors. Most risk factors strongly correlated with Internet gaming disorder fell into the category of maladaptive cognitions and motivations. Other factors that showed high effect sizes fell into various categories, including psychopathological characteristics, personality traits, cognition emotion regulation style and gaming-related factors. The only protective factor strongly correlated with Internet gaming disorder was self-control. We found that the factors related to the 'environments' show modest effect sizes compared to those related to the individual. The pooled effect sizes for most factors were not influenced by outliers and publication bias.

CONCLUSION

Factors strongly correlated with Internet gaming disorder, especially maladaptive cognitions and motivations, are more likely to be proximal correlates of Internet gaming disorder and may be considered the focus of interventions. We encourage further empirical and experimental studies to examine the causal pathway and the treatment efficacy.