Error processing and response inhibition in excessive computer game players: an event-related potential study

Neurobiological Correlates in Internet Gaming Disorder: A Systematic Literature Review

Internet Gaming Disorder (IGD) is a potential mental disorder currently included in the third section of the latest (fifth) edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) as a condition that requires additional research to be included in the main manual. Although research efforts in the area have increased, there is a continuing debate about the respective criteria to use as well as the status of the condition as mental health concern. Rather than using diagnostic criteria which are based on subjective symptom experience, the National Institute of Mental Health advocates the use of Research Domain Criteria (RDoC) which may support classifying mental disorders based on dimensions of observable behavior and neurobiological measures because mental disorders are viewed as biological disorders that involve brain circuits that implicate specific domains of cognition, emotion, and behavior. Consequently, IGD should be classified on its underlying neurobiology, as well as its subjective symptom experience. Therefore, the aim of this paper is to review the neurobiological correlates involved in IGD based on the current literature base. Altogether, 853 studies on the neurobiological correlates were identified on ProQuest (in the following scholarly databases: ProQuest Psychology Journals, PsycARTICLES, PsycINFO, Applied Social Sciences Index and Abstracts, and ERIC) and on MEDLINE, with the application of the exclusion criteria resulting in reviewing a total of 27 studies, using fMRI, rsfMRI, VBM, PET, and EEG methods. The results indicate there are significant neurobiological differences between healthy controls and individuals with IGD. The included studies suggest that compared to healthy controls, gaming addicts have poorer response-inhibition and emotion regulation, impaired prefrontal cortex (PFC) functioning and cognitive control, poorer working memory and decision-making capabilities, decreased visual and auditory functioning, and a deficiency in their neuronal reward system, similar to those found in individuals with substance-related addictions. This suggests both substance-related addictions and behavioral addictions share common predisposing factors and may be part of an addiction syndrome. Future research should focus on replicating the reported findings in different cultural contexts, in support of a neurobiological basis of classifying IGD and related disorders.

Established risk factors for addiction fail to discriminate between healthy gamers and gamers endorsing DSM-5 Internet gaming disorder

Background and aims The DSM-5 includes criteria for diagnosing Internet gaming disorder (IGD) that are adapted from substance abuse and widely used in research and clinical contexts, although evidence supporting their validity remains scarce. This study compared online gamers who do or do not endorse IGD criteria regarding self-control-related abilities (impulsivity, inhibitory control, and decision-making), considered the hallmarks of addictive behaviors. Method A double approach was adopted to distinguish pathological from recreational gamers: The first is the classic DSM-5 approach (≥5 criteria required to endorse the IGD diagnosis), and the second consists in using latent class analysis (LCA) for IGD criteria to distinguish gamers' subgroups. We computed comparisons separately for each approach. Ninety-seven volunteer gamers from the community were recruited. Self-reported questionnaires were used to measure demographic- and game-related characteristics, problematic online gaming (with the Problematic Online Gaming Questionnaire), impulsivity (with the UPPS-P Impulsive Behavior Scale), and depression (with the Beck Depression Inventory-II). Experimental tasks were used to measure inhibitory control (Hybrid-Stop Task) and decision-making abilities (Game of Dice Task). Results Thirty-two participants met IGD criteria (33% of the sample), whereas LCA identified two groups of gamers [pathological (35%) and recreational]. Comparisons that used both approaches (DSM-5 and LCA) failed to identify significant differences regarding all constructs except for variables related to actual or problematic gaming behaviors. Discussion The validity of IGD criteria is questioned, mostly with respect to their relevance in distinguishing high engagement from pathological involvement in video games.

Response Inhibition and Internet Gaming Disorder: A Meta-analysis

Previous research has demonstrated that Internet Gaming Disorder (IGD) has multiple negative effects in psychological functioning and health. This makes the identification of its underpinnings, such as response inhibition, essential for the development of relevant interventions that target these core features of the disorder resulting in more effective treatment. Several empirical studies have evaluated the relationship between response inhibition deficits and IGD using neurocognitive tasks, but provided mixed results. In this study, we conducted a meta-analysis of studies using three neurocognitive tasks, the Go/No Go, the Stroop, and the Stop-Signal tasks, to integrate existing research and estimate the magnitude of this relationship. We found a medium overall effect size (d=0.56, 95% CI [0.32, 0.80]) indicating that compared with healthy individuals, individuals with IGD are more likely to exhibit impaired response inhibition. This finding is in alignment with literature on inhibition and addictive and impulsive behaviors, as well as with neuroimaging research. Theoretical implications regarding the conceptualization of IGD as a clinical disorder, shared commonalities with externalizing psychopathology, and clinical implications for treatment are discussed.

Cognitive control in young adults with cannabis use disorder: An event-related brain potential study

Contemporary models of substance use disorders emphasize the role of cognitive control, which has been linked to difficulties in resisting the use of substances. In the present study, we measured two aspects of cognitive control, response inhibition (operationalized by a Go/NoGo Task) and performance monitoring (operationalized by an Eriksen Flanker Task), in a group of young cannabis-use disorder (CUD) patients and compared these functions with two control groups (i.e. a group of cigarette smokers and a group of non-smokers). We employed both behavioural and electrophysiological measures. The results indicate that CUD patients displayed reduced NoGo-P3 event-related potentials compared with non-smoking controls, but not compared with smoking controls. In addition, CUD patients were slower on Go trials than both control groups. No other between-group electrophysiological or behavioural differences were observed. These results seem to suggest that CUD patients have problems related to response inhibition, but performance monitoring seems relatively unaffected.

Cognitive control in young heavy drinkers: An ERP study

Substance use disorders have been frequently linked to an impaired cognitive control system. Whether this impaired control is also present in young adults who heavily drink alcohol is still subject to debate. The present study investigated possible impairments in cognitive control in heavy drinkers using behavioral and electrophysiological (EEG) measures. We studied behavioral performance on an inhibitory control and an error-processing task, using a GoNogo task and an Eriksen Flanker task respectively, while ERPs (Nogo-N2/P3 and ERN/Pe) were measured in a group of heavy alcohol drinkers (n=48) and a healthy control group of light drinkers (n=49). Results showed very few impairments in the heavy drinking group either at the behavioral or physiological level. One exception was the error-related Pe amplitude. This ERP component was reduced in heavy drinkers as compared to controls. Given that the Pe reflects a motivational component (i.e., the salience attributed to the making of errors) rather than a basic cognitive deficit, it can be concluded that heavy drinking in this population is not associated with major impaired cognitive control, but rather with impairments that are associated with aberrant attribution of salience to the making of errors. The present EEG findings are consistent with recent reviews and large scale epidemiological studies showing that heavy drinking, in contrast to substance use disorders, in young persons is not necessarily associated with major behavioral impairments in cognitive control.

Neurophysiological correlates of altered response inhibition in internet gaming disorder and obsessive-compulsive disorder: Perspectives from impulsivity and compulsivity

Although internet gaming disorder (IGD) and obsessive-compulsive disorder (OCD) represent opposite ends of the impulsivity and compulsivity dimensions, the two disorders share common neurocognitive deficits in response inhibition. However, the similarities and differences in neurophysiological features of altered response inhibition between IGD and OCD have not been investigated sufficiently. In total, 27 patients with IGD, 24 patients with OCD, and 26 healthy control (HC) subjects participated in a Go/NoGo task with electroencephalographic recordings. N2-P3 complexes elicited during Go and NoGo condition were analyzed separately and compared among conditions and groups. NoGo-N2 latency at the central electrode site was delayed in IGD group versus the HC group and correlated positively with the severity of internet game addiction and impulsivity. NoGo-N2 amplitude at the frontal electrode site was smaller in OCD patients than in IGD patients. These findings suggest that prolonged NoGo-N2 latency may serve as a marker of trait impulsivity in IGD and reduced NoGo-N2 amplitude may be a differential neurophysiological feature between OCD from IGD with regard to compulsivity. We report the first differential neurophysiological correlate of the altered response inhibition in IGD and OCD, which may be a candidate biomarker for impulsivity and compulsivity.

Is the Internet gaming-addicted brain close to be in a pathological state?

Internet gaming addiction (IGA) is becoming a common and widespread mental health concern. Although IGA induces a variety of negative psychosocial consequences, it is yet ambiguous whether the brain addicted to Internet gaming is considered to be in a pathological state. We investigated IGA-induced abnormalities of the brain specifically from the network perspective and qualitatively assessed whether the Internet gaming-addicted brain is in a state similar to the pathological brain. Topological properties of brain functional networks were examined by applying a graph-theoretical approach to analyzing functional magnetic resonance imaging data acquired during a resting state in 19 IGA adolescents and 20 age-matched healthy controls. We compared functional distance-based measures, global and local efficiency of resting state brain functional networks between the two groups to assess how the IGA subjects' brain was topologically altered from the controls' brain. The IGA subjects had severer impulsiveness and their brain functional networks showed higher global efficiency and lower local efficiency relative to the controls. These topological differences suggest that IGA induced brain functional networks to shift toward the random topological architecture, as exhibited in other pathological states. Furthermore, for the IGA subjects, the topological alterations were specifically attributable to interregional connections incident on the frontal region, and the degree of impulsiveness was associated with the topological alterations over the frontolimbic connections. The current findings lend support to the proposition that the Internet gaming-addicted brain could be in the state similar to pathological states in terms of topological characteristics of brain functional networks.

A Tripartite Neurocognitive Model of Internet Gaming Disorder

Playing Internet games has emerged as a growing in prevalence leisure activity. In some cases, excess gaming can lead to addiction-like symptoms and aversive outcomes that may be seen by some as manifestations of a behavioral addiction. Even though agreement regarding the pathologizing of excessive video gaming is not yet achieved and perhaps because the field requires more research, many works have examined the antecedents and outcomes of what is termed internet gaming disorder (IGD). In this article, we aim at summarizing perspectives and findings related to the neurocognitive processes that may underlie IGD and map such findings onto the triadic-system that governs behavior and decision-making, the deficits in which have been shown to be associated with many addictive disorders. This tripartite system model includes the following three brain systems: (1) the impulsive system, which often mediates fast, automatic, unconscious, and habitual behaviors; (2) the reflective system, which mediates deliberating, planning, predicting future outcomes of selected behaviors, and exerting inhibitory control; and (3) the interoceptive awareness system, which generates a state of craving through the translation of somatic signals into a subjective state of drive. We suggest that IGD formation and maintenance can be associated with (1) a hyperactive "impulsive" system; (2) a hypoactive "reflective" system, as exacerbated by (3) an interoceptive awareness system that potentiates the activity of the impulsive system, and/or hijacks the goal-driven cognitive resources needed for the normal operation of the reflective system. Based on this review, we propose ways to improve the therapy and treatment of IGD and reduce the risk of relapse among recovering IGD populations.

Do Elite and Amateur Soccer Players Outperform Non-Athletes on Neurocognitive Functioning? A Study Among 8-12 Year Old Children

AIM

Research suggested a positive association between physical fitness and neurocognitive functioning in children. Aim of the present study is to investigate possible dose-response relationships between diverse daily physical activities and a broad range of neurocognitive functions in preadolescent children. Furthermore, the relationship between several sedentary behaviours, including TV-watching, gaming and computer time, and neurocognitive functioning will be investigated in this group of children.

METHODS

A total of 168 preadolescent boys, aged 8 to 12 years, were recruited from various locations, including primary schools, an amateur soccer club, and a professional soccer club, to increase variability in the amount of participation in sports. All children performed neurocognitive tasks measuring inhibition, short term memory, working memory, attention and information processing speed. Regression analyses examined the predictive power of a broad range of physical activities, including sports, active transport to school, physical education (PE), outdoor play, and sedentary behaviour such as TV-watching and gaming, for neurocognitive functioning.

RESULTS

Time spent in sports significantly accounted for the variance in inhibition, short term memory, working memory and lapses of attention, where more time spent in sports was associated with better performance. Outdoor play was also positively associated with working memory. In contrast, time spent on the computer was negatively associated with inhibition.

CONCLUSIONS

Results of the current study suggest a positive relationship between participation in sports and several important neurocognitive functions. Interventions are recommended to increase sports participation and to reduce sedentary behaviour in preadolescent children.

Delay discounting, risk-taking, and rejection sensitivity among individuals with Internet and Video Gaming Disorders

Background and aims There is a previous evidence for impulsivity in individuals with Internet and Video Gaming Disorders. The aim of this study was to examine whether Internet and video game addictions are associated with experiential delay discounting, risk-taking, and sensitivity to social rejection using computerized tasks and questionnaires. Methods Twenty participants (mean age 24, SD = 1.55) with high score on the Problematic Online Gaming Questionnaire (POGQ) were compared with 20 participants (mean age 24.8, SD = 1.34) with low score on the POGQ. They performed on computerized Balloon Analog Risk Task and Experiential Delay discounting Task (EDT), and filled in the sensitivity to social rejection questionnaire. Results Participants with high POGQ scores had lower measures of delay discounting, higher measures of risk-taking, and higher measures of sensitivity to social rejection compared with participants with low POGQ scores. Discussion The results of this study support the previous evidence of risk-taking and provide new evidence for difficulties in delay discounting and sensitivity to social rejection among those who score high on Internet and video games. Conclusions The results suggest that Internet- and video game-addicted individuals seek immediate gratification and cannot wait for later reward. Furthermore, these individuals spend time in the virtual world, where they feel safe, and avoid social interactions presumably due to fears of social rejection.

Internet Addiction and Other Behavioral Addictions

The Internet is increasingly influential in the lives of adolescents. Although there are many positives, there are also risks related to excessive use and addiction. It is important to recognize clinical signs and symptoms of Internet addiction (compulsive use, withdrawal, tolerance, and adverse consequences), treat comorbid conditions (other substance use disorders, attention deficit hyperactivity disorder, anxiety, depression, and hostility), and initiate psychosocial interventions. More research on this topic will help to provide consensus on diagnostic criteria and further clarify optimal management.

Impulsivity in Multiplayer Online Battle Arena Gamers: Preliminary Results on Experimental and Self-Report Measures

Background and aims Multiplayer Online Battle Arena (MOBA) games have become the most popular type of video games played worldwide, superseding the playing of Massively Multiplayer Online Role-Playing Games and First-Person Shooter games. However, empirical studies focusing on the use and abuse of MOBA games are still very limited, particularly regarding impulsivity, which is an indicator of addictive states but has not yet been explored in MOBA games. In this context, the objective of the present study is to explore the associations between impulsivity and symptoms of addictive use of MOBA games in a sample of highly involved League of Legends (LoL, currently the most popular MOBA game) gamers. Methods Thirty-six LoL gamers were recruited and completed both experimental (Single Key Impulsivity Paradigm) and self-reported impulsivity assessments (s-UPPS-P Impulsive Behavior Scale, Barratt Impulsiveness Scale), in addition to an assessment of problematic video game use (Problematic Online Gaming Questionnaire). Results Results showed links between impulsivity-related constructs and signs of excessive MOBA game involvement. Findings indicated that impaired ability to postpone rewards in an experimental laboratory task was strongly related to problematic patterns of MOBA game involvement. Although less consistent, several associations were also found between self-reported impulsivity traits and signs of excessive MOBA game involvement. Conclusions Despite these results are preliminary and based upon a small (self-selected) sample, the present study highlights potential psychological factors related to the addictive use of MOBA games.

General Deficit in Inhibitory Control of Excessive Smartphone Users: Evidence from an Event-Related Potential Study

With the popularity of smartphones, the problem of excessive use has drawn increasing attention. However, it is not clear whether there is an inhibitory deficit in excessive smartphone users. Using a modified Go/NoGo task with three types of context (blank, neutral, and smartphone-related), the present study combined measures of behavior and electrophysiology [event-related potentials (ERPs)] to examine general and specific inhibitory control in an excessive smartphone use group and a normal use group. Results showed that participants in both groups had larger amplitude of N2 and P3 on NoGo trials than Go trials. NoGo N2, an ERP component associated with inhibitory control, was more negative in the excessive smartphone use group than the normal use group. These results suggest that in the early stage of inhibition processing, excessive smartphone users experience more conflicts and show a general deficit that does not depend on smartphone-related cues. Moreover, the study provides further neuroscience evidence of the physiological correlates of excessive smartphone use.

Dysfunctional information processing during an auditory event-related potential task in individuals with Internet gaming disorder

Internet gaming disorder (IGD) leading to serious impairments in cognitive, psychological and social functions has gradually been increasing. However, very few studies conducted to date have addressed issues related to the event-related potential (ERP) patterns in IGD. Identifying the neurobiological characteristics of IGD is important to elucidate the pathophysiology of this condition. P300 is a useful ERP component for investigating electrophysiological features of the brain. The aims of the present study were to investigate differences between patients with IGD and healthy controls (HCs), with regard to the P300 component of the ERP during an auditory oddball task, and to examine the relationship of this component to the severity of IGD symptoms in identifying the relevant neurophysiological features of IGD. Twenty-six patients diagnosed with IGD and 23 age-, sex-, education- and intelligence quotient-matched HCs participated in this study. During an auditory oddball task, participants had to respond to the rare, deviant tones presented in a sequence of frequent, standard tones. The IGD group exhibited a significant reduction in response to deviant tones compared with the HC group in the P300 amplitudes at the midline centro-parietal electrode regions. We also found a negative correlation between the severity of IGD and P300 amplitudes. The reduced amplitude of the P300 component in an auditory oddball task may reflect dysfunction in auditory information processing and cognitive capabilities in IGD. These findings suggest that reduced P300 amplitudes may be candidate neurobiological marker for IGD.

Behavioral addictions in addiction medicine: from mechanisms to practical considerations

Recent progress has been made in our understanding of nonsubstance or "behavioral" addictions, although these conditions and their most appropriate classification remain debated and the knowledge basis for understanding the pathophysiology of and treatments for these conditions includes important gaps. Recent developments include the classification of gambling disorder as a "Substance-Related and Addictive Disorder" in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and proposed diagnostic criteria for Internet Gaming Disorder in Section 3 of DSM-5. This chapter reviews current neuroscientific understandings of behavioral addictions and the potential of neurobiological data to assist in the development of improved policy, prevention, and treatment efforts.

Impaired decision-making under risk is associated with gaming-specific inhibition deficits among college students with Internet gaming disorder

A growing body of evidence indicates that both inhibition and decision-making deficits play essential roles in the development and maintenance of Internet gaming disorder (IGD). Clarifying whether impaired decision-making among individuals with IGD is related to poor inhibition will advance our understanding of IGD and contribute to intervention development. However, the relationship between these two functions remains unclear. In this study, we sought to systemically examine inhibitory processes, decision-making and the relationship between the two among individuals with IGD. Thirty-four individuals with IGD and 32 matched healthy controls (HCs) were recruited. In comparison to HCs, IGD subjects demonstrated inhibition deficits during performance of the gaming-related Go/No-Go task and impaired decision-making under risk. In addition, errors on No-Go trials during the gaming-related Go/No-Go task were positively associated with decision-making impairments under risk but not under ambiguity among IGD subjects. These results suggest individuals with IGD are impaired in some aspects of inhibition and decision-making functions, and that decision-making deficits under risk are linked to poor inhibition specifically related to gaming cues, which has implications for the development of novel intervention.

Possible End to an Endless Quest? Cognitive Bias Modification for Excessive Multiplayer Online Gamers

Cognitive biases have previously been recognized as key mechanisms that contribute to the development, maintenance, and relapse of addictive behaviors. The same mechanisms have been recently found in problematic computer gaming. The present study aims to investigate whether excessive massively multiplayer online role-playing gamers (EG) demonstrate an approach bias toward game-related cues compared to neutral stimuli; to test whether these automatic action tendencies can be implicitly modified in a single session training; and to test whether this training affects game urges and game-seeking behavior. EG (n=38) were randomly assigned to a condition in which they were implicitly trained to avoid or to approach gaming cues by pushing or pulling a joystick, using a computerized intervention (cognitive bias modification via the Approach Avoidance Task). EG demonstrated an approach bias for gaming cues compared with neutral, movie cues. Single session training significantly decreased automatic action tendencies to approach gaming cues. These effects occurred outside subjective awareness. Furthermore, approach bias retraining reduced subjective urges and intentions to play, as well as decreased game-seeking behavior. Retraining automatic processes may be beneficial in changing addictive impulses in EG. Yet, large-scale trials and long-term follow-up are warranted. The results extend the application of cognitive bias modification from substance use disorders to behavioral addictions, and specifically to Internet gaming disorder. Theoretical implications are discussed.

Neuroscience of Internet Pornography Addiction: A Review and Update

Many recognize that several behaviors potentially affecting the reward circuitry in human brains lead to a loss of control and other symptoms of addiction in at least some individuals. Regarding Internet addiction, neuroscientific research supports the assumption that underlying neural processes are similar to substance addiction. The American Psychiatric Association (APA) has recognized one such Internet related behavior, Internet gaming, as a potential addictive disorder warranting further study, in the 2013 revision of their Diagnostic and Statistical Manual. Other Internet related behaviors, e.g., Internet pornography use, were not covered. Within this review, we give a summary of the concepts proposed underlying addiction and give an overview about neuroscientific studies on Internet addiction and Internet gaming disorder. Moreover, we reviewed available neuroscientific literature on Internet pornography addiction and connect the results to the addiction model. The review leads to the conclusion that Internet pornography addiction fits into the addiction framework and shares similar basic mechanisms with substance addiction. Together with studies on Internet addiction and Internet Gaming Disorder we see strong evidence for considering addictive Internet behaviors as behavioral addiction. Future research needs to address whether or not there are specific differences between substance and behavioral addiction.

How Has the Internet Reshaped Human Cognition?

Throughout our evolutionary history, our cognitive systems have been altered by the advent of technological inventions such as primitive tools, spoken language, writing, and arithmetic systems. Thirty years ago, the Internet surfaced as the latest technological invention poised to deeply reshape human cognition. With its multifaceted affordances, the Internet environment has profoundly transformed our thoughts and behaviors. Growing up with Internet technologies, "Digital Natives" gravitate toward "shallow" information processing behaviors characterized by rapid attention shifting and reduced deliberations. They engage in increased multitasking behaviors that are linked to increased distractibility and poor executive control abilities. Digital natives also exhibit higher prevalence of Internet-related addictive behaviors that reflect altered reward-processing and self-control mechanisms. Recent neuroimaging investigations have suggested associations between these Internet-related cognitive impacts and structural changes in the brain. Against mounting apprehension over the Internet's consequences on our cognitive systems, several researchers have lamented that these concerns were often exaggerated beyond existing scientific evidence. In the present review, we aim to provide an objective overview of the Internet's impacts on our cognitive systems. We critically discuss current empirical evidence about how the Internet environment has altered the cognitive behaviors and structures involved in information processing, executive control, and reward-processing.

Blunted feedback processing during risk-taking in adolescents with features of problematic Internet use

While the conceptualization of problematic Internet use (PIU) as a "behavioral addiction" resembling substance-use disorders is debated, the neurobiological underpinnings of PIU remain understudied. This study examined whether adolescents displaying features of PIU (at-risk PIU; ARPIU) are more impulsive and exhibit blunted responding in the neural mechanisms underlying feedback processing and outcome evaluation during risk-taking. Event-related potentials (ERPs) elicited by positive (i.e. reward) and negative (i.e. loss) feedback were recorded during performance on a modified version of the Balloon Analogue Risk Task (BART) among ARPIU (n=39) and non-ARPIU subjects (n=27). Compared to non-ARPIU, ARPIU adolescents displayed higher levels of urgency and lack of perseverance on the UPPS Impulsive Behavior Scale. Although no between-group difference in BART performance was observed, ERPs demonstrated overall decreased sensitivity to feedback in ARPIU compared to non-ARPIU adolescents, as indexed by blunted feedback-related negativity (FRN) and P300 amplitudes to both negative and positive feedback. The present study provides evidence for feedback processing during risk-taking as a neural correlate of ARPIU. Given recent concerns regarding the growing prevalence of PIU as a health concern, future work should examine the extent to which feedback processing may represent a risk factor for PIU, a consequence of PIU, or possibly both.

An fMRI study of cognitive control in problem gamers

A small proportion of video game players develop uncontrolled gaming behavior. A dysfunctional cognitive control circuit may explain this excessive behavior. Therefore, the current study investigated whether problem gamers are characterized by deficits in various aspects of cognitive control (inhibitory control, error processing, attentional control) by measuring brain activation using functional magnetic resonance imaging during Go-NoGo and Stroop task performance. In addition, both impulsivity and attentional control were measured using self-reports. Participants comprised 18 problem gamers who were compared with 16 matched casual gaming controls. Results indicate significantly increased self-reported impulsivity levels and decreased inhibitory control accompanied by reduced brain activation in the left inferior frontal gyrus (IFG) and right inferior parietal lobe (IPL) in problem gamers relative to controls. Significant hypoactivation in the left IFG in problem gamers was also observed during Stroop task performance, but groups did not differ on behavioral and self-reported measures of attentional control. No evidence was found for reduced error processing in problem gamers. In conclusion, the current study provides evidence for reduced inhibitory control in problem gamers, while attentional control and error processing were mostly intact. These findings implicate that reduced inhibitory control and elevated impulsivity may constitute a neurocognitive weakness in problem gamers.

Imbalanced functional link between executive control network and reward network explain the online-game seeking behaviors in Internet gaming disorder

Literatures have shown that Internet gaming disorder (IGD) subjects show impaired executive control and enhanced reward sensitivities than healthy controls. However, how these two networks jointly affect the valuation process and drive IGD subjects' online-game-seeking behaviors remains unknown. Thirty-five IGD and 36 healthy controls underwent a resting-states scan in the MRI scanner. Functional connectivity (FC) was examined within control and reward network seeds regions, respectively. Nucleus accumbens (NAcc) was selected as the node to find the interactions between these two networks. IGD subjects show decreased FC in the executive control network and increased FC in the reward network when comparing with the healthy controls. When examining the correlations between the NAcc and the executive control/reward networks, the link between the NAcc - executive control network is negatively related with the link between NAcc - reward network. The changes (decrease/increase) in IGD subjects' brain synchrony in control/reward networks suggest the inefficient/overly processing within neural circuitry underlying these processes. The inverse proportion between control network and reward network in IGD suggest that impairments in executive control lead to inefficient inhibition of enhanced cravings to excessive online game playing. This might shed light on the mechanistic understanding of IGD.

Error-related brain activity in the age of RDoC: A review of the literature

The ability to detect and respond to errors is critical to successful adaptation to a changing environment. The error-related negativity (ERN), an event-related potential (ERP) component, is a well-validated neural response to errors and reflects the error monitoring activity of the anterior cingulate cortex (ACC). Additionally, the ERN is implicated in several processes key to adaptive functioning. Abnormalities in error-related brain activity have been linked to multiple forms of psychopathology and individual differences. As such, the component is likely to be useful in NIMH's Research Domain Criteria (RDoC) initiative to establish biologically-meaningful dimensions of psychological dysfunction, and currently appears as a unit of measurement in three RDoC domains: Positive Valence Systems, Negative Valence Systems, and Cognitive Systems. In this review paper, we introduce the ERN and discuss evidence related to its psychometric properties, as well as important task differences. Following this, we discuss evidence linking the ERN to clinically diverse forms of psychopathology, as well as the implications of one unit of measurement appearing in multiple RDoC dimensions. And finally, we discuss important future directions, as well as research pathways by which the ERN might be leveraged to track the ways in which dysfunctions in multiple neural systems interact to influence psychological well-being.

Post-error action control is neurobehaviorally modulated under conditions of constant speeded response

Post-error slowing (PES) is an error recovery strategy that contributes to action control, and occurs after errors in order to prevent future behavioral flaws. Error recovery often malfunctions in clinical populations, but the relationship between behavioral traits and recovery from error is unclear in healthy populations. The present study investigated the relationship between impulsivity and error recovery by simulating a speeded response situation using a Go/No-go paradigm that forced the participants to constantly make accelerated responses prior to stimuli disappearance (stimulus duration: 250 ms). Neural correlates of post-error processing were examined using event-related potentials (ERPs). Impulsivity traits were measured with self-report questionnaires (BIS-11, BIS/BAS). Behavioral results demonstrated that the commission error for No-go trials was 15%, but PES did not take place immediately. Delayed PES was negatively correlated with error rates and impulsivity traits, showing that response slowing was associated with reduced error rates and changed with impulsivity. Response-locked error ERPs were clearly observed for the error trials. Contrary to previous studies, error ERPs were not significantly related to PES. Stimulus-locked N2 was negatively correlated with PES and positively correlated with impulsivity traits at the second post-error Go trial: larger N2 activity was associated with greater PES and less impulsivity. In summary, under constant speeded conditions, error monitoring was dissociated from post-error action control, and PES did not occur quickly. Furthermore, PES and its neural correlate (N2) were modulated by impulsivity traits. These findings suggest that there may be clinical and practical efficacy of maintaining cognitive control of actions during error recovery under common daily environments that frequently evoke impulsive behaviors.

A critical review of "Internet addiction" criteria with suggestions for the future

AIMS

In the last 5 years a deluge of articles on the topic of Internet addiction (IA) has proposed many candidate symptoms as evidence of this proposed disease. We critically reviewed the current approach to the measurement and identification of this new excessive behavior syndrome.

METHODS

Three popular models of IA were discussed: Griffith’s components model; Young’s Internet Addiction Test (IAT); and the criteria by Tao et al. (2010). We selected these models because they are widely cited and propose specific criteria for IA disorder. Our approach is not meant to provide an exhaustive review, but to discuss and critique the most salient trends in the field.

RESULTS

The models of Internet addiction share some criteria, including feeling a loss of control over Internet use; ensuing psychological, social, or professional conflict or problems; and preoccupation when not using the Internet. Other criteria inconsistently mentioned include: mood management, tolerance, withdrawal, and craving/anticipation. The models studied here share the assumption that the Internet can produce a qualitative shift to a diseased state in humans.

CONCLUSIONS

We critically discussed the above criteria and concluded that the evidence base is currently not strong enough to provide support for an Internet addiction disorder. Future research areas are suggested: (1) Focusing on common impaired dimensions, (2) exploring neuroimaging as a model building tool, and (3) identifying shifts in the rewarding aspects of Internet use. Given the lack of consensus on the subject of Internet addiction, a focus on problem behaviors appears warranted.

Altered brain activation during response inhibition and error processing in subjects with Internet gaming disorder: a functional magnetic imaging study

The aim of the present study was to evaluate the impulsivity and brain correlates of response inhibition and error processing among subjects with Internet gaming disorder (IGD). We evaluated the response inhibition and error processing by functional magnetic resonance imaging (fMRI) in subjects with IGD and controls. Twenty-six men with IGD for at least 2 years and 23 controls with no history of IGD were recruited as the IGD and control groups, respectively. All subjects performed the event-related designed Go/No-go task under fMRI and completed questionnaires related to Internet addiction and impulsivity. The IGD group exhibited a higher score for impulsivity than the control group. The IGD group also exhibited higher brain activation when processing response inhibition over the left orbital frontal lobe and bilateral caudate nucleus than controls. Both the IGD and control groups exhibited activation of the insula and anterior cingulate cortex during error processing. The activation over the right insula was lower in the subjects with IGD than the control group. Our results support the fact that the fronto-striatal network involved in response inhibition, and the salience network, anchored by the anterior cingulate and insula, contributes to error processing. Further, adults with IGD have impaired insular function in error processing and greater activation of the fronto-striatal network in order to maintain their response inhibition performance.

Risk assessment and reward processing in problem gambling investigated by event-related potentials and fMRI-constrained source analysis

BACKGROUND

The temporo-spatial dynamics of risk assessment and reward processing in problem gamblers with a focus on an ecologically valid design has not been examined previously.

METHODS

We investigated risk assessment and reward processing in 12 healthy male occasional gamblers (OG) and in 12 male problem gamblers (PG) with a combined EEG and fMRI approach to identify group-differences in successively activated brain regions during two stages within a quasi-realistic blackjack game.

RESULTS

Both groups did not differ in reaction times but event-related potentials in PG and OG produced significantly different amplitudes in middle and late time-windows during high-risk vs. low-risk decisions. Applying an fMRI-constrained regional source model during risk assessment resulted in larger source moments in PG in the high-risk vs. low-risk comparison in thalamic, orbitofrontal and superior frontal activations within the 600-800 ms time window. During reward processing, PG showed a trend to enhanced negativity in an early time window (100-150 ms) potentially related to higher rostral anterior cingulate activity and a trend to centro-parietal group-differences in a later time window (390-440 ms) accompanied by increased superior-frontal (i.e., premotor-related) source moments in PG vs. OG.

CONCLUSIONS

We suggest that problem gambling is characterized by stronger cue-related craving during risk assessment. Reward processing is associated with early affective modulation followed by increased action preparation for ongoing gambling in PG.

Internal consistency of event-related potentials associated with cognitive control: N2/P3 and ERN/Pe

Recent studies in psychophysiology show an increased attention for examining the reliability of Event-Related Potentials (ERPs), which are measures of cognitive control (e.g., Go/No-Go tasks). An important index of reliability is the internal consistency (e.g., Cronbach's alpha) of a measure. In this study, we examine the internal consistency of the N2 and P3 in a Go/No-Go task. Furthermore, we attempt to replicate the previously found internal consistency of the Error-Related Negativity (ERN) and Positive-Error (Pe) in an Eriksen Flanker task. Healthy participants performed a Go/No-Go task and an Eriksen Flanker task, whereby the amplitudes of the correct No-Go N2/P3, and error trials for ERN/Pe were the variables of interest. This study provides evidence that the N2 and P3 in a Go/No-Go task are internally consistent after 20 and 14 trials are included in the average, respectively. Moreover, the ERN and Pe become internally consistent after approximately 8 trials are included in the average. In addition guidelines and suggestions for future research are discussed.

Evaluation of the diagnostic criteria of Internet gaming disorder in the DSM-5 among young adults in Taiwan

The DSM-5 proposed the diagnostic criteria of Internet gaming disorder (IGD) and suggested that more evidence is necessary before it is included as a standard disorder in the DSM system. The aims of this study were to: 1) evaluate the diagnostic validity of individual criteria of IGD in the DSM-5 and the criteria of craving and irritability; 2) determine the optimal cut-off point for the IGD criteria in the DSM-5. We recruited 75 subjects with IGD, 75 without IGD, and 75 in remission from IGD based on the Diagnostic Criteria of Internet Addiction for College Students (DC-IA-C). All participants underwent a diagnostic interview based on the diagnostic criteria of IGD in the DSM-5 and completed the CIAS and QGU-B. Except for the "deceiving" and "escape" criteria, all criteria of IGD had diagnostic accuracy ranging from 77.3% to 94.7% to differentiate university students with IGD from remitted students. The criterion of craving had diagnostic accuracy of 88% and the criteria of irritability had an accuracy of 68.7%. Fulfilling 5 or more criteria of IGD in the DSM-5 was the best cut-off point to differentiate young adults with IGD from healthy or remitted users.

Systematic review of ERP and fMRI studies investigating inhibitory control and error processing in people with substance dependence and behavioural addictions

BACKGROUND

Several current theories emphasize the role of cognitive control in addiction. The present review evaluates neural deficits in the domains of inhibitory control and error processing in individuals with substance dependence and in those showing excessive addiction-like behaviours. The combined evaluation of event-related potential (ERP) and functional magnetic resonance imaging (fMRI) findings in the present review offers unique information on neural deficits in addicted individuals.

METHODS

We selected 19 ERP and 22 fMRI studies using stop-signal, go/no-go or Flanker paradigms based on a search of PubMed and Embase.

RESULTS

The most consistent findings in addicted individuals relative to healthy controls were lower N2, error-related negativity and error positivity amplitudes as well as hypoactivation in the anterior cingulate cortex (ACC), inferior frontal gyrus and dorsolateral prefrontal cortex. These neural deficits, however, were not always associated with impaired task performance. With regard to behavioural addictions, some evidence has been found for similar neural deficits; however, studies are scarce and results are not yet conclusive. Differences among the major classes of substances of abuse were identified and involve stronger neural responses to errors in individuals with alcohol dependence versus weaker neural responses to errors in other substance-dependent populations.

LIMITATIONS

Task design and analysis techniques vary across studies, thereby reducing comparability among studies and the potential of clinical use of these measures.

CONCLUSION

Current addiction theories were supported by identifying consistent abnormalities in prefrontal brain function in individuals with addiction. An integrative model is proposed, suggesting that neural deficits in the dorsal ACC may constitute a hallmark neurocognitive deficit under lying addictive behaviours, such as loss of control.

Neuroimagem na dependência de jogos eletrônicos: uma revisão sistemática

Objetivo: Realizar revisão sistemática de manuscritos que utilizaram a neuroimagem no estudo da dependência de jogos eletrônicos, a fim de identificar as principais regiões cerebrais alteradas. Métodos: Foram realizadas buscas nos seguintes bancos de dados: ScieELO, BVS, Lilacs, Science Direct On Line e PubMed. Não houve data mínima para a pesquisa, sendo considerados os artigos encontrados até julho de 2013. Os descritores utilizados para a presente revisão sistemática da literatura foram: “PET”, “SPECT”, “MRI”, “DTI”, “EEG”, “imaging”, “neuroimaging”, “spectroscopy”, “functional magnetic ressonance”, “structural magnetic ressonance”, “tractography”, “voxel” e “brain”, individualmente cruzados com os descritores “gaming” e “video game addiction”. Resultados: Dos 52 artigos encontrados, 16 foram selecionados: nove usaram fMRI, quatro usaram sRMI, um usou PET e dois usaram EEG. Em relação às alterações funcionais e estruturais, elas foram mais observadas no lobo frontal (córtex pré-frontal dorsolateral, córtex orbitofrontal, giro pré-frontal, giro frontal médio), parietal, temporal (giro para-hipocampal), núcleos da base, tálamo, ínsula e cerebelo. Conclusão: A despeito dos métodos utilizados, os estudos apontaram convergências quanto às reciprocidades cerebrais. Essas alterações neurais são semelhantes às observadas em pacientes dependentes de substâncias e de internet, especialmente durante o estado de fissura. Apesar de apenas recentemente pesquisas de neuroimagem em dependentes de jogos eletrônicos terem sido realizadas, contamos no momento com achados significativos alinhados à compreensão dos mecanismos neurais associados à dependência de jogos eletrônicos e respectiva inserção como categoria nosológica no âmbito psiquiátrico.

Neurophysiological correlates of response inhibition predict relapse in detoxified alcoholic patients: some preliminary evidence from event-related potentials

BACKGROUND

Alcohol dependence is a chronic relapsing disease. The impairment of response inhibition and alcohol-cue reactivity are the main cognitive mechanisms that trigger relapse. Despite the interaction suggested between the two processes, they have long been investigated as two different lines of research. The present study aimed to investigate the interaction between response inhibition and alcohol-cue reactivity and their potential link with relapse.

MATERIALS AND METHODS

Event-related potentials were recorded during a variant of a "go/no-go" task. Frequent and rare stimuli (to be inhibited) were superimposed on neutral, nonalcohol-related, and alcohol-related contexts. The task was administered following a 3-week detoxification course. Relapse outcome was measured after 3 months, using self-reported abstinence. There were 27 controls (seven females) and 27 patients (seven females), among whom 13 relapsed during the 3-month follow-up period. The no-go N2, no-go P3, and the "difference" wave (P3d) were examined with the aim of linking neural correlates of response inhibition on alcohol-related contexts to the observed relapse rate.

RESULTS

Results showed that 1) at the behavioral level, alcohol-dependent patients made significantly more commission errors than controls (P<0.001), independently of context; 2) through the subtraction no-go P3 minus go P3, this inhibition deficit was neurophysiologically indexed in patients with greater P3d amplitudes (P=0.034); and 3) within the patient group, increased P3d amplitude enabled us to differentiate between future relapsers and nonrelapsers (P=0.026).

CONCLUSION

Our findings suggest that recently detoxified alcoholics are characterized by poorer response-inhibition skills that demand greater neural resources. We propose that event-related potentials can be used in conjunction with behavioral data to predict relapse; this would identify patients that need a higher level of neural resources when suppressing a response is requested.

Internet gaming addiction: current perspectives

In the 2000s, online games became popular, while studies of Internet gaming addiction emerged, outlining the negative consequences of excessive gaming, its prevalence, and associated risk factors. The establishment of specialized treatment centers in South-East Asia, the US, and Europe reflects the growing need for professional help. It is argued that only by understanding the appeal of Internet gaming, its context, and neurobiologic correlates can the phenomenon of Internet gaming addiction be understood comprehensively. The aim of this review is to provide an insight into current perspectives on Internet gaming addiction using a holistic approach, taking into consideration the mass appeal of online games, the context of Internet gaming addiction, and associated neuroimaging findings, as well as the current diagnostic framework adopted by the American Psychiatric Association. The cited research indicates that the individual’s context is a significant factor that marks the dividing line between excessive gaming and gaming addiction, and the game context can gain particular importance for players, depending on their life situation and gaming preferences. Moreover, the cultural context is significant because it embeds the gamer in a community with shared beliefs and practices, endowing their gaming with particular meaning. The cited neuroimaging studies indicate that Internet gaming addiction shares similarities with other addictions, including substance dependence, at the molecular, neurocircuitry, and behavioral levels. The findings provide support for the current perspective of understanding Internet gaming addiction from a disease framework. The benefits of an Internet gaming addiction diagnosis include reliability across research, destigmatization of individuals, development of efficacious treatments, and the creation of an incentive for public health care and insurance providers. The holistic approach adopted here not only highlights empirical research that evidences neurobiologic correlates of Internet gaming addiction and the establishment of a preliminary diagnosis, but also emphasizes the necessity of an indepth understanding of the meaning, context, and practices associated with gaming.

Impaired decisional impulsivity in pathological videogamers

Background

Pathological gaming is an emerging and poorly understood problem. Impulsivity is commonly impaired in disorders of behavioural and substance addiction, hence we sought to systematically investigate the different subtypes of decisional and motor impulsivity in a well-defined pathological gaming cohort.

Methods

Fifty-two pathological gaming subjects and age-, gender- and IQ-matched healthy volunteers were tested on decisional impulsivity (Information Sampling Task testing reflection impulsivity and delay discounting questionnaire testing impulsive choice), and motor impulsivity (Stop Signal Task testing motor response inhibition, and the premature responding task). We used stringent diagnostic criteria highlighting functional impairment.

Results

In the Information Sampling Task, pathological gaming participants sampled less evidence prior to making a decision and scored fewer points compared with healthy volunteers. Gaming severity was also negatively correlated with evidence gathered and positively correlated with sampling error and points acquired. In the delay discounting task, pathological gamers made more impulsive choices, preferring smaller immediate over larger delayed rewards. Pathological gamers made more premature responses related to comorbid nicotine use. Greater number of hours played also correlated with a Motivational Index. Greater frequency of role playing games was associated with impaired motor response inhibition and strategy games with faster Go reaction time.

Conclusions

We show that pathological gaming is associated with impaired decisional impulsivity with negative consequences in task performance. Decisional impulsivity may be a potential target in therapeutic management.

Disordered gambling: a behavioral addiction

Developments in psychiatry have ratified the existence of behavioral addictions, that certain activities such as gambling or video-game play may be considered addictive in the absence of exogenous (i.e. drug-induced) stimulation of brain reinforcement circuitry. This article describes recent advances in understanding the neurobiological basis of behavioral addiction, with a focus on pathological gambling as the prototypical disorder. We describe positron emission tomography (PET) studies characterizing dopaminergic transmission, and functional imaging studies of reward processing and gambling-related cognitive distortions. The current evidence not only indicates changes in pathological gamblers in core circuitry implicated in drug addiction, but also highlights some subtle differences. Behavioral addictions can also provide experimental traction on distinguishing vulnerability markers for addictions from the active detrimental effects of chronic drug use.

Impaired error-monitoring function in people with Internet addiction disorder: an event-related fMRI study

BACKGROUND

Internet addiction disorder (IAD) is rapidly becoming a prevalent mental health concern around the world. The neurobiological underpinnings of IAD should be studied to unravel the potential heterogeneity. This study was set to investigate the error-monitoring ability in IAD subjects.

METHODS

Fifteen IAD subjects and 15 healthy controls (HC) participated in this study. Participants were asked to perform a fast Stroop task that may show error responses. Behavioral and neurobiological results in relation to error responses were compared between IAD subjects and HC.

RESULTS

Compared to HC, IAD subjects showed increased activation in the anterior cingulate cortex (ACC) and decreased activation in the orbitofrontal cortex following error responses. Significant correlation was found between ACC activation and the Internet addiction test scores.

CONCLUSIONS

IAD subjects show an impaired error-monitoring ability compared to HC, which can be detected by the hyperactivation in ACC in error responses.

Internet and gaming addiction: a systematic literature review of neuroimaging studies

In the past decade, research has accumulated suggesting that excessive Internet use can lead to the development of a behavioral addiction. Internet addiction has been considered as a serious threat to mental health and the excessive use of the Internet has been linked to a variety of negative psychosocial consequences. The aim of this review is to identify all empirical studies to date that used neuroimaging techniques to shed light upon the emerging mental health problem of Internet and gaming addiction from a neuroscientific perspective. Neuroimaging studies offer an advantage over traditional survey and behavioral research because with this method, it is possible to distinguish particular brain areas that are involved in the development and maintenance of addiction. A systematic literature search was conducted, identifying 18 studies. These studies provide compelling evidence for the similarities between different types of addictions, notably substance-related addictions and Internet and gaming addiction, on a variety of levels. On the molecular level, Internet addiction is characterized by an overall reward deficiency that entails decreased dopaminergic activity. On the level of neural circuitry, Internet and gaming addiction led to neuroadaptation and structural changes that occur as a consequence of prolonged increased activity in brain areas associated with addiction. On a behavioral level, Internet and gaming addicts appear to be constricted with regards to their cognitive functioning in various domains. The paper shows that understanding the neuronal correlates associated with the development of Internet and gaming addiction will promote future research and will pave the way for the development of addiction treatment approaches.