Altered Heart Rate Variability During Gameplay in Internet Gaming Disorder: The Impact of Situations During the Game

Altered Heart Rate Variability During Mobile Game Playing and Watching Self-Mobile Gaming in Individuals with Problematic Mobile Game Use: Implications for Cardiac Health

Introduction

The surge in mobile gaming, fueled by smartphone and internet accessibility, lacks a comprehensive understanding of physiological changes during gameplay.

Methods

This study, involving 93 participants (average age 21.75 years), categorized them into Problematic Mobile Gaming (PMG) and non-problematic Mobile Gaming (nPMG) groups based on Problematic Mobile Gaming Questionnaire (PMGQ) scores. The PMGQ is a 12-item scale developed in Taiwan to assess symptoms of problematic mobile gaming. The research delved into heart rate variability (HRV) alterations during real-time mobile gaming and self-gaming video viewing.

Results

Results showed that the PMG group significantly presents a lower root mean square of successive differences (RMSSD), and High Frequency (lnHF) than does the nPMG group (F=4.73, p=0.03; F=10.65, p=0.002, respectively) at the baseline. In addition, the PMG group significantly displayed elevated HF and low-frequency to high-frequency (LF/HF) in the mobile-gaming (F=7.59, p=0.007; F=9.31, p=0.003) condition as well as in the watching self-gaming videos (F=9.75, p=0.002; F=9.02, p=0.003) than did the nPMG.

Conclusion

The study suggests targeted interventions to mitigate autonomic arousal, offering a potential avenue to address adverse effects associated with problematic mobile gaming behavior. The PMG group displayed increased craving scores after real-time mobile gaming and watching self-gaming video excerpts, unlike the nPMG group. Elevated LF/HF ratios in frequent gaming cases heightened autonomic arousal, presenting challenges in relaxation after mobile gaming. These findings contribute to a nuanced understanding of the complex interplay between mobile gaming activities, physiological responses, and potential intervention strategies.

Cardiology and Neurophysiological Stimulation of Internet Gaming Disorders: A Systematic Review

BACKGROUND

Internet Gaming Disorder (IGD) is recognized as a mental health condition associated with excessive video gaming, leading to functional impairments. The inclusion of IGD in the DSM-5 has underscored the importance of comprehensively understanding its physiological and psychological effects.

OBJECTIVE

This systematic review aims to analyze and synthesize existing literature on the cardiophysiological and neurophysiological activities of individuals diagnosed with IGD, with a focus on identifying patterns, trends, and implications for clinical practice and future research.

METHODS

A systematic search was conducted in PubMed and Scopus databases to identify relevant studies published up to 2023. The search strategy included terms related to IGD, cardiophysiology, neurophysiology, and relevant measurement techniques. Inclusion criteria encompassed peer-reviewed research articles and clinical trials examining cardiophysiological (e.g., heart rate variability, blood pressure) and neurophysiological (e.g., brain imaging, electroencephalography) parameters in individuals with IGD. Exclusion criteria were applied to ensure methodological rigor and relevance to the research question.

RESULTS

The initial search yielded 1320 papers related to IGD, of which twenty studies met the eligibility criteria and were included in the review. Data extraction and synthesis focused on key cardiophysiological and neurophysiological outcomes observed in individuals with IGD compared to healthy controls. Findings revealed decreased Heart Rate Variability (HRV), increased sympathetic activity, and executive control deficits in IGD individuals based on Electrocardiogram (ECG) recordings and cognitive assessments. Neuroimaging studies demonstrated heightened brain activation in the lateral and prefrontal cortex, altered reward processing, and impulse control mechanisms among IGD subjects. Gender-specific differences were noted, with males exhibiting distinct thalamic activation striatum and decreased Regional Homogeneity (ReHo) in the right Posterior Cingulate (rPCC) compared to females.

DISCUSSION

The synthesized evidence indicates a complex interplay between excessive gaming and cardiophysiological/neurophysiological changes, highlighting the need for multidimensional assessments in diagnosing and managing IGD. Implications for clinical practice include early detection using ECG, EEG, and advanced neuroimaging techniques, as well as personalized interventions tailored to individual characteristics and gender-specific differences.

CONCLUSION

This systematic review provides a comprehensive overview of the cardiophysiological and neurophysiological activities associated with Internet Gaming Disorder. The findings underscore the need for further research to elucidate underlying mechanisms, develop standardized diagnostic protocols, and optimize targeted interventions for individuals with IGD.

Effects of Game-Related Tasks for the Diagnosis and Classification of Gaming Disorder

Gaming disorder (GD) is an addictive behavior characterized by an insatiable need to play video games and shares similar symptoms with the failure of self-control due to a decline in cognitive function. Current GD diagnostic and screening tools rely on questionnaires and behavioral observations related to cognitive functions to assess an individual's capacity to maintain self-control in everyday life. However, current GD screening approaches rely on subjective symptoms, and a reliable diagnosis requires long-term clinical follow-up. Recent studies have measured biosignals along with cognitive functional tasks to provide objectivity to GD diagnosis and to acquire immediate results. However, people with GD are hypersensitive to game-related cues, so their responses may vary depending on the type of stimuli, and the difference in response to stimuli might manifest as a difference in the degree of change in the biosignal. Therefore, it is critical to choose the correct stimulus type when performing GD diagnostic tasks. In this study, we investigated the task dependence of cognitive decline in GD by comparing two cognitive functional tasks: a continuous performance task (CPT) and video game play. For this study, 69 young male adults were classified into either the gaming disorder group (GD, n = 39) or a healthy control group (HC, n = 30). CPT score, EEG signal (theta, alpha, and beta), and HRV-HF power were assessed. We observed differences in the left frontal region (LF) of the brain between the GD and HC groups during online video game play. The GD group also showed a significant difference in HF power of HRV between CPT and online video gaming. Furthermore, LF and HRV-HF significantly correlated with Young's Internet Addiction Test (Y-IAT) score, which is positively associated with impulsivity score. The amount of change in theta band activity in LF and HRV-HF-both biomarkers for changes in cognitive function-during online video game play suggests that people with GD express task-dependent cognitive decline compared with HC. Our results demonstrate the feasibility of quantifying individual self-regulation ability for gaming and underscore its importance for GD classification.

Heart Rate Variability during Online Video Game Playing in Habitual Gamers: Effects of Internet Addiction Scale, Ranking Score and Gaming Performance

Previous studies have demonstrated that individuals with internet gaming disorder (IGD) display abnormal autonomic activities at rest and during gameplay. Here, we examined whether and how in-game autonomic activity is modulated by human characteristics and behavioral performance of the player. We measured heart rate variability (HRV) in 42 male university student habitual gamers (HGs) when they played a round of League of Legends game online. Short-term HRV indices measured in early, middle and late phases of the game were compared between the players at high risk of developing IGD and those at low risk, as assessed by the revised Chen Internet addiction scale (CIAS-R). Multiple linear regression (MLR) was used to identify significant predictors of HRV measured over the whole gameplay period (WG), among CIAS-R, ranking score, hours of weekly playing and selected in-game performance parameters. The high-risk players showed a significantly higher low-frequency power/high-frequency power ratio (LF/HF) relative to the low-risk players, regardless of game phase. MLR analysis revealed that LF/HF measured in WG was predicted by, and only by, CIAS-R. The HRV indicators of sympathetic activity were found to be predicted only by the number of slain in WG (NSlain), and the indicators of parasympathetic activity were predicted by both CIAS-R and NSlain. Collectively, the results demonstrated that risk of developing IGD is associated with dysregulated autonomic balance during gameplay, and in-game autonomic activities are modulated by complex interactions among personal attributes and in-game behavioral performance of the player, as well as situational factors embedded in game mechanics.

Severity identification for internet gaming disorder using heart rate variability reactivity for gaming cues: a deep learning approach

Background

The diminished executive control along with cue-reactivity has been suggested to play an important role in addiction. Hear rate variability (HRV), which is related to the autonomic nervous system, is a useful biomarker that can reflect cognitive-emotional responses to stimuli. In this study, Internet gaming disorder (IGD) subjects' autonomic response to gaming-related cues was evaluated by measuring HRV changes in exposure to gaming situation. We investigated whether this HRV reactivity can significantly classify the categorical classification according to the severity of IGD.

Methods

The present study included 70 subjects and classified them into 4 classes (normal, mild, moderate and severe) according to their IGD severity. We measured HRV for 5 min after the start of their preferred Internet game to reflect the autonomic response upon exposure to gaming. The neural parameters of deep learning model were trained using time-frequency parameters of HRV. Using the Class Activation Mapping (CAM) algorithm, we analyzed whether the deep learning model could predict the severity classification of IGD and which areas of the time-frequency series were mainly involved.

Results

The trained deep learning model showed an accuracy of 95.10% and F-1 scores of 0.995 (normal), 0.994 (mild), 0.995 (moderate), and 0.999 (severe) for the four classes of IGD severity classification. As a result of checking the input of the deep learning model using the CAM algorithm, the high frequency (HF)-HRV was related to the severity classification of IGD. In the case of severe IGD, low frequency (LF)-HRV as well as HF-HRV were identified as regions of interest in the deep learning model.

Conclusion

In a deep learning model using the time-frequency HRV data, a significant predictor of IGD severity classification was parasympathetic tone reactivity when exposed to gaming situations. The reactivity of the sympathetic tone for the gaming situation could predict only the severe group of IGD. This study suggests that the autonomic response to the game-related cues can reflect the addiction status to the game.

The use of heart rate variability in esports: A systematic review

Heart rate variability (HRV) is a psychophysiological measure of particular interest in esports due to its potential to monitor player self-regulation. This study aimed to systematically review the utilisation of HRV in esports. Consideration was given to the methodological and theoretical underpinnings of previous works to provide recommendations for future research. The protocol was made available on the Open Science Framework. Inclusion criteria were empirical studies, examining HRV in esports, using esports players, published in English. Exclusion criteria were non-peer-reviewed studies, populations with pre-existing clinical illness other than Internet Gaming Disorder (IGD), opinion pieces or review papers. In November 2022 a search of Web of Science, PubMed, and EBSCOHost identified seven studies using HRV in esports. Risk of bias was assessed using the Mixed Methods Appraisal Tool. Narrative review identified two primary uses of HRV in esports; stress response and IGD. A lack of theoretical and methodological underpinning was identified as a major limitation of current literature. Further investigation is necessary before making recommendations regarding the use of HRV in esports. Future research should employ sound theoretical underpinning such as the use of vagally mediated HRV and the robust application of supporting methodological guidelines when investigating HRV in esports.

Can heart rate variability data from the Apple Watch electrocardiogram quantify stress?

Chronic stress has become an epidemic with negative health risks including cardiovascular disease, hypertension, and diabetes. Traditional methods of stress measurement and monitoring typically relies on self-reporting. However, wearable smart technologies offer a novel strategy to continuously and non-invasively collect objective health data in the real-world. A novel electrocardiogram (ECG) feature has recently been introduced to the Apple Watch device. Interestingly, ECG data can be used to derive Heart Rate Variability (HRV) features commonly used in the identification of stress, suggesting that the Apple Watch ECG app could potentially be utilized as a simple, cost-effective, and minimally invasive tool to monitor individual stress levels. Here we collected ECG data using the Apple Watch from 36 health participants during their daily routines. Heart rate variability (HRV) features from the ECG were extracted and analyzed against self-reported stress questionnaires based on the DASS-21 questionnaire and a single-item LIKERT-type scale. Repeated measures ANOVA tests did not find any statistical significance. Spearman correlation found very weak correlations (p < 0.05) between several HRV features and each questionnaire. The results indicate that the Apple Watch ECG cannot be used for quantifying stress with traditional statistical methods, although future directions of research (e.g., use of additional parameters and Machine Learning) could potentially improve stress quantification with the device.

Measurement of craving among gamers with internet gaming disorder using repeated presentations of game videos: a resting-state electroencephalography study

BACKGROUND

Internet gaming disorder (IGD) is receiving increasing attention owing to its effects on daily living and psychological function.

METHODS

In this study, electroencephalography was used to compare neural activity triggered by repeated presentation of a stimulus in healthy controls (HCs) and those with IGD. A total of 42 adult men were categorized into two groups (IGD, n = 21) based on Y-IAT-K scores. Participants were required to watch repeated presentations of video games while wearing a head-mounted display, and the delta (D), theta (T), alpha (A), beta (B), and gamma (G) activities in the prefrontal (PF), central (C), and parieto-occipital (PO) regions were analyzed.

RESULTS

The IGD group exhibited higher absolute powers of D_C, D_PO, T_C, T_PO, B_C, and B_PO than HCs. Among the IGD classification models, a neural network achieves the highest average accuracy of 93% (5-fold cross validation) and 84% (test).

CONCLUSIONS

These findings may significantly contribute to a more comprehensive understanding of the neurological features associated with IGD and provide potential neurological markers that can be used to distinguish between individuals with IGD and HCs.

Can Heart Rate Variability be Viewed as a Biomarker of Problematic Internet Use? A Systematic Review and Meta-Analysis

Heart rate variability (HRV) has been used to explore the parasympathetic activity of individuals with problematic Internet use (PIU), but the results are controversial. We conducted a systematic review and meta-analysis of studies comparing HRV in PIU individuals and healthy participants from several databases. HRV was analyzed according to the parasympathetic activity in hierarchical order (primary analysis), and the total variability (secondary analysis). The baseline HRV and HRV reactivity were both considered. Of the 106 studies screened, 12 were included in the quantitative analysis. Significant differences were observed for baseline HRV in PIU individuals compared to the controls. Regarding HRV reactivity, PIU individuals did not have a significantly lower HRV value during pleasant or unpleasant stimuli. In summary, PIU individuals and healthy subjects had significantly different resting state parasympathetic activity. The finding of HRV reactivity in PIU individuals awaits further investigation.

Extended classifier system with continuous real-coded variables for feature extraction of instantaneous pulse-rate variability and respiration of individuals with gaming disorder

Background

Individuals with gaming disorder (GD) exhibit autonomic nervous system responses that indicate dysfunctional emotion regulation. Pulse rate variability (PRV) is a valuable biomarker for investigating the autonomic function of patients with mental disorders. Because individuals with GD dynamically regulate emotions during gaming, the PRV response relating to GD is not well understood. To investigate the dynamic PRV responses of individuals with GD, this study proposed the indexes of instantaneous PRV (iPRV) and instantaneous respiratory frequency (IF_resp) of arterial blood pressure signals using empirical mode decomposition and normalized direct-quadrature algorithms. iPRV consists of low-frequency (LF), high-frequency (HF), and very high-frequency (VHF) bands. Moreover, a novel method of extended classifier system with continuous real-coded variables (XCSR) was used to detect GD and extract GD-related iPRV features using iPRV and IF_resp as input data.

Results

A total of 32 college students without depressive and anxiety symptoms or cardiovascular diseases were recruited in this study. Participants were grouped into the high-risk GD and low-risk GD using both Chen Internet Addiction Scale and Internet Gaming Disorder Questionnaire. Their arterial blood pressures signals were measured while they watched gameplay videos with negative or positive emotional stimuli. Seven participants with high-risk GD exhibited significantly increased normalized VHF (nVHF) PRV and IF_resp readings and significantly decreased normalized LF (nLF) PRV readings and LF/HF PRV ratios (from baseline) during negative or positive gameplay videos stimuli. These participants also exhibited higher nVHF PRV and lower nLF PRV readings and LF/HF PRV ratios when they experienced negative gameplay video stimuli relative to 17 participants with low-risk GD. The classification accuracy of the XCSR reached 90% for both negative and positive video stimuli, and nVHF PRV was most frequently used to detect GD risk.

Conclusions

iPRV and IF_resp can be used to detect GD and analyze the autonomic mechanism of individuals with GD.

Análise da variabilidade da frequência cardíaca em crianças submetidas a jogos eletrônicos

Objetivo: avaliar a função autonômica do coração de crianças sadias em situações de jogos eletrônicos, mediante a análise de Variabilidade da Frequência cardíaca.Métodos: participaram deste estudo 60 crianças sadias, que foram monitoradas por um monitor de frequência cardíaca digital e submetidas ao experimento com o jogo eletrônico. A análise da Variabilidade da Frequência cardíaca foi calculadacom emprego da transformada Wavelet Contínua.Resultados: pode-se observar um aumento na intensidade dos valores de baixa frequência/alta frequência, sugerindo influência das fases do protocolo, de modo que houve uma elevação nos valores da fase de Repouso para a fase de Jogo, mas não foi encontrado um valor significativo. Entre as fases de Repouso (1,52±0,97 ms²) e Recuperação (1,89±1,04 ms²) houve um aumento significativo obtendo um valor de p=0,003. Comparando os valores de baixa frequência/alta frequência entre as fases Jogo 2,37±1,20 ms² e Recuperação 1,89±1,04 ms², verificou-se uma redução significativa da relação (p = 0,016).Conclusão: conclui-se que Jogos eletrônicos podem provocar um aumento da atividade simpática, diminuindo a Variabilidade da Frequência cardíaca das crianças estudadas, sugerindo uma situação estressante.

Instantaneous Respiratory Response of Gamer with High-Risk Internet Gaming Disorder during Game-Film Stimuli by Using Complementary Ensemble Empirical Mode Decomposition

Gamers with Internet gaming disorder (IGD) dynamically regulate their psychophysiological responses during playing; however, analyzing instantaneous psychophysiological responses in these gamers has been limited by a lack of appropriate methods. We propose combining the Complementary Ensemble Empirical Mode Decomposition and Direct Quadrature methods to overcome this limitation. The related effect of abdominal breathing (AB) training (as a relaxing psychology method) on the distribution of instantaneous frequency (IF) was investigated by calculating median (IF_med), kurtosis (IF_kurt) and skewness (IF_skew), and 19 participants with high-risk IGD (HIGD) were found to have increased IF_med [massively multiplayer online role-playing game (MMORPG): 0.36 ± 0.08; first-person shooter game (FPSG): 0.34 ± 0.08] but decreased IF_kurt (MMORPG: 5.98 ± 2.31; FPSG: 6.84 ± 4.61) and IF_skew (MMORPG: 0.40 ± 0.69; FPSG: 0.64 ±1.04) during game-film stimuli compared with baseline and recovery states. After AB training, IF_med of these 19 participants (MMORPG: 0.24 ± 0.11; FPSG: 0.18 ± 0.06) decreased significantly. This study is firstly to observe the IF distribution of respiratory signal in gamers with HIGD; thus, this distribution may be used as a respiratory physiological marker of IGD risk.

Diminished Frontal Theta Activity During Gaming in Young Adults With Internet Gaming Disorder

Cognitive control is essential for flexible, top-down, goal-directed behavior. Individuals with Internet gaming disorder (IGD) are characterized by impaired prefrontal cortex function and cognitive control. This results in an increase in stimulus-driven habitual behavior, particularly related to pathological gaming. In the present study, we investigated the electroencephalographic (EEG) activity in individuals with IGD. Twenty-four individuals with IGD and 35 healthy control (HC) subjects were recruited. We analyzed their EEG activity while the subjects played their favorite game (30–40 min duration). We compared the band power between the two groups. During gaming, the left frontal theta, alpha, and beta band activities were lower in subjects with IGD than in HCs. Moreover, the left frontal theta power negatively correlated with IGD severity. These results indicate that left frontal theta power could be used as a neurophysiological biomarker for the detection of diminished cognitive control patterns in individuals with IGD.

Problematic Internet Use: The Relationship Between Resting Heart Rate Variability and Emotional Modulation of Inhibitory Control

A growing literature suggests that problematic Internet use (PIU) is associated with defective inhibitory control. In this study, we sought to investigate the ability to inhibit prepotent motor responses in an emotional context in individuals with PIU, and to examine the relationship between inhibitory control and resting heart rate variability (HRV), which is regarded as a measure of self-regulation and adaptability. Problematic users (PU, n = 20) and nonproblematic users (non-PU, n = 20) completed an emotional Go/NoGo task, involving the presentation of unpleasant, pleasant, and neutral pictures. The electrocardiogram was recorded at rest for a 3-minute period. PU showed lower resting HRV, relative to non-PU. Although reaction times (RTs) to Go task stimuli were not faster in PU, relative to non-PU, accuracy rates were significantly lower among PU, irrespective of pictures' emotional content. Only among PU did lower resting HRV predict lower response accuracy in pleasant and unpleasant Go trials and less efficient task performance (combining RTs to Go trials and accuracy to NoGo trials) upon presentation of unpleasant stimuli. Our findings suggest that reduced HRV is a potential indicator of defective inhibitory control in an emotional context in PIU.