Attentional bias in excessive massively multiplayer online role-playing gamers using a modified Stroop task

Blunted neural response to real-life social reward anticipation in internet gaming disorder: An event-related potential study

Recent research indicates that individuals with Internet gaming disorder (IGD) exhibit impaired social reward processing, evidenced by reduced neural sensitivity to real-life social reward. The aim of the present study is to further investigate the impaired processing of social reward anticipation and reward consumption in individuals with IGD, and explore the relationship between these two components. Using a social incentive delay task with game-related and real-life versions, combined with event-related potential (ERP) technology, we examined 25 individuals with IGD and 25 matched healthy game players. The results showed that, at the behavioral level, individuals with IGD showed significantly slower reaction times to real-life target stimuli compared with game-related target stimuli, which is not observed in healthy controls. At the neural level, the Cue-P3 elicited by real-life incentive cues in individuals with IGD was significantly smaller than that elicited by game-related incentive cues. However, these effects were no longer significant after adding depression and anxiety scores as covariates. There was no significant difference in reward positivity (RewP) elicited between the two types of reward consumption. Furthermore, individuals with IGD showed a positive correlation between Cue-P3 elicited by game-related social incentive cue and RewP elicited by game-related social reward. However, this effect was not observed in the healthy controls. In conclusion, the present study suggests that the blunted allocation of motivated neural attention resources to real-life social incentive cues in individuals with IGD may be the key mechanism underlying their impaired social reward processing. This impairment may be influenced by the higher levels of depression and anxiety symptoms commonly observed in individuals with IGD.

The role of attentional control in moderating attentional bias towards game-related stimuli in individuals with a high tendency for internet gaming addiction

Background

The aim of this study was to elucidate individual difference factors that modulate the attentional processing of game stimuli to explain the heterogeneity of extant findings. The current study examined whether individual differences in components of attentional control (AC-shifting and AC-focusing) moderated the link between internet gaming addiction symptom and attentional engagement to and disengagement biases from game-relevant cues.

Methods

A total of 75 male undergraduate students who have played League of Legend (LOL) for more than 2 years completed well-established self-report questionnaires of internet gaming disorder symptoms and attentional control. The attentional bias toward game stimuli was measured for attentional engagement and disengagement using the attentional response to the distal vs. proximal emotional information (ARDPEI) task.

Results

The results revealed that attentional control was a significant moderator of the relationship between internet game addiction symptoms and attentional disengagement bias. Further analyses revealed a positive relationship between internet game addiction symptoms and attentional disengagement bias only among those with low levels of AC-shifting ability. Contrary to our expectations, AC-shifting also moderated the relationship between internet gaming disorder and attentional engagement bias. The positive relationship between internet game addiction symptoms and attentional engagement bias only appeared among those with low levels of AC-shifting ability. Individual differences in AC-focusing did not moderate the relationship between internet gaming disorder and any attentional bias.

Conclusion

This study confirmed that the greater the symptoms of game addiction, the stronger the attentional bias, especially in individuals with low AC-shifting ability. Therefore, it is necessary to examine sub-factors of AC in understanding the nature of attentional bias mechanisms in the development of internet game addiction and consider it as a psychological intervention to improve attentional bias.

Attentional biases and daily game craving dynamics: An ecological momentary assessment study

BACKGROUND AND AIMS

Theories posit that the combination of external (e.g. cue exposure) and internal (e.g. attention biases) factors contributes to the development of game craving. Nevertheless, whether different components of attentional biases (namely, engagement bias and disengagement bias) play separate roles on game craving has not been fully elucidated. We aimed to examine the associations between two facets of attentional biases and game craving dynamics under a daily life setting.

METHODS

Participants (110 regular internet game players) accomplished the modified attentional assessment task in the laboratory, after which they entered a 10-day ecological momentary assessment (EMA) to collect data on their momentary game craving and occurrence of game-related events at five different time points per day.

RESULTS

We found that occurrence of game-related events was significantly associated with increased game craving. Moreover, attentional disengagement bias, instead of engagement bias, bore on the occasional level variations of game craving as moderating variables. Specifically, attentional disengagement bias, not engagement bias, was associated with a greater increase in game craving immediately after encountering a game-related event; however, neither attentional engagement bias nor disengagement bias was associated with the craving maintenance after a relatively long period.

DISCUSSION AND CONCLUSIONS

The present study highlights the specific attentional processes involved in game craving dynamics, which could be crucial for designing interventions for attentional bias modification (ABM) in Internet Gaming Disorder (IGD) populations.

The convergent effects of primary school physical activity, sleep, and recreational screen time on cognition and academic performance in grade 9

Lab-based experiments and randomized controlled trials consistently demonstrate improvements in youth cognition following physical activity (PA), while cross-sectional studies suggest that sedentary behavior (especially recreational screen time [RST]) and poor sleep are inversely related to cognition. However, little is known about how these 24-h movement behaviors—sleep, PA, and sedentary behavior—converge to affect youth cognition. Therefore, the purpose of this study is to test the associations between childhood 24-h movement behaviors and adolescent cognition using a longitudinal design and examine moderating effects of each behavior. This study utilized structural equation modeling with data from the NICHD Study of Early Child Care and Youth Development (N = 1,364, 52% female, 80% White). Independent variables—sleep, RST, and PA—were collected in grade 5. Dependent variables of cognitive and academic performance were collected at grade 9, including the Stroop task, Woodcock-Johnson, and Tower of London. Grade 5 PA was inversely associated with grade 9 cognition, but this relationship was no longer significant once grade 5 cognition was controlled for in analyses. Grade 5 sleep was positively related to grade 9 cognition, whether baseline cognition was controlled for or not. Finally, grade 5 RST was inversely related to cognition and academic performance, regardless of whether baseline values were controlled. Moderation analyses showed the relationship between grade 5 RST and grade 9 cognition was moderated by grade 5 PA, while the relationship between grade 5 PA and grade 9 cognition was moderated by grade 5 sleep. In each case, more PA and sleep blunted the negative relationships. These findings extend evidence that greater sleep promotes cognition and greater RST impairs cognition, by affirming these relationships over a longer period. They extend the evidence by demonstrating that the longitudinal relationship between individual 24-h movement behavior and cognition is moderated by other behaviors.

Effects of excessive violent video game playing on verbal memory: an event-related brain potentials study

The goal of the study was to investigate temporal dynamics of excessive violent game playing. We compared behavioral data and event-related potentials (ERPs) of excessive video game players (EVGPs, n = 21) and non-players (NPs, n = 21) using a classical learning, cued recall and recognition paradigm, featuring violent and non-violent words. During the recognition phase, EVGPs performed better for violent words, but worse for non-violent words compared to NPs. Also, EVGPs showed slower reaction times than NPs when responding to new violent words. We found significant group differences in parietal P300 and FN400 amplitudes. The EVGP group showed larger P300 amplitudes for violent words, and more negative FN400 amplitudes for new violent words compared to NPs. The results imply that EVGPs differ from NPs in their cognitive and ERP responses to violent and non-violent verbal stimuli. The cognitive processes of EVGPs are consistent with a model of attention and memory bias rather than with desensitization to violence.

Impaired disengagement of attention from computer-related stimuli in Internet Gaming Disorder: Behavioral and electrophysiological evidence

BACKGROUND AND AIMS

Attentional biases contribute to the maintenance of addictive behaviors. For the problematic use of online gaming - recognized as Internet Gaming Disorder (IGD) - first evidence points to a bias towards in-game stimuli. This study aimed to provide behavioral and electrophysiological evidence for a generalized bias towards computer-related stimuli, and to identify the specific attentional processes contributing to this bias: facilitated attention deployment, impaired disengagement or failed suppression.

METHOD

Twenty participants with IGD and 23 casual gamers performed a visual search task with photographs of real-world objects. Either the target or a to-be-ignored distractor was addiction-relevant (computer-related), whereas all other items were addiction-irrelevant (related to cars or sport). Event-related potential components associated with facilitated attentional deployment to the target (NT), its post-selection processing (SPCN), and suppression of irrelevant information (PD) were analyzed.

RESULTS

Unlike casual gamers, gamers with IGD exhibited prolonged reaction times and increased SPCN amplitudes for computer-related stimuli, reflecting their continued attentional processing. At the individual level, larger SPCN amplitudes were associated with longer delays in reaction time.

DISCUSSION AND CONCLUSIONS

This pattern of results indicates that the disengagement of attention from computer-related stimuli is impaired in IGD. More generally, our findings demonstrate that conditioning processes occur in IGD, and thus open up new avenues for treatment.

A Case-Control Study on Behavioral Addictions and Neurocognition: Description of the BANCO and BANCO2 Protocols

INTRODUCTION

Only two behavioral addictions (BAs) are currently recognized in international classifications (gambling disorder: GbD; gaming disorder: GmD), while some of them await further investigation (food addiction: FA; sexual addiction: SA). Neurocognitive functioning is considered a risk factor for BAs. Research is quite abundant for GbD and highlights specific deficits in several cognitive functions. Nevertheless, grey areas still exist. The aim of this research programme is to investigate the neurocognitive profiles of patients presenting with various BAs and to establish parallels between different forms of BA to achieve a common addiction concept.

METHODS AND ANALYSIS

This research program is composed of two studies sharing the same methodology but focusing on different samples: the BANCO study aims to include 30 individuals with a GbD, whereas the BANCO2 study aims to include 30 individuals with a GmD, 30 with a SA, and 30 with a FA. Moreover, for each BA group, 30 healthy controls will be recruited, matched by sex, age and education level. Several cognitive tasks will be completed by participants. Cue reactivity and physiological responses, as well as clinical data regarding addiction characteristics and personality, will also be investigated. A composite score based on the cognitive tasks will be computed using principal component analysis (PCA). Overall cognitive performance and detailed performance on the different cognitive tasks will be compared between individuals with BAs and their matched healthy controls using linear models with random effects. Comparisons will also be made between BA groups to investigate specific alterations associated with each disorder.

DISCUSSION

The results of this research programme will impact both research and clinical areas by (i) providing new knowledge for discussions regarding the inclusion of BAs under the spectrum of addictive disorders; (ii) improving understanding of addiction mechanisms in general; (iii) providing clarity in the grey areas in neurocognitive research on BAs and improving the understanding of less studied BAs, (iv) guiding clinicians to propose therapeutic alternatives and complementary programmes.

TRIAL REGISTRATION

BANCO study (ClinicalTrials.gov NCT03202290); BANCO2 study (ClinicalTrials.gov NCT03967418).

The Potential Interaction Between Time Perception and Gaming: A Narrative Review

Compromised time control is a variable of interest among disordered gamers because time spent on videogames can directly affect individuals’ lives. Although time perception appears to be closely associated with this phenomenon, previous studies have not systematically found a relationship between time perception and gaming. Therefore, the purpose of this narrative review is to explore how gaming disorder may be associated with time perception. It has been found that gamers exhibit a stronger attentional focus as well as an improved working memory compared with non-gamers. However, gamers (and especially disordered gamers) exhibit a stronger reaction to gaming cues which—coupled with an altered emotion regulation observed among disordered gamers—could directly affect their time perception. Finally, “'flow states”' direct most of the attentional resources to the ongoing activity, leading to a lack of resources allocated to the time perception. Therefore, entering a flow state will result in an altered time perception, most likely an underestimation of duration. The paper concludes that the time loss effect observed among disordered gamers can be explained via enhanced emotional reactivity (facilitated by impaired emotion regulation).

Automatic detection advantage of problematic Internet users for Wi-Fi signal cues and the moderating effect of negative affect: An event-related potential study

Cognitive bias toward Internet-related cues is an important factor of the formation and maintenance of the addictive behavior of problematic Internet users (PIUs). The development of fiber-optic communication and smartphones has ushered human society into the era of wireless networks. The Wi-Fi signal, the symbol of wireless network connection, represents not only network access but also a channel for communication with others anywhere at any time. Therefore, the Wi-Fi signal cues should be an effective inducer of the addictive behaviors of PIUs. We used images of Wi-Fi signal as Internet-related cues to explore the automatic detection advantage of PIUs for these cues and to determine whether negative affect, another predisposing factor for addiction, can enhance this advantage. We utilized an intergroup design in this study. The PIU and control groups each comprised 30 participants and were randomly assigned to negative or neutral affect priming group. Mismatch negativity (MMN) was induced through the deviant-standard reverse oddball paradigm. Wi-Fi signal cues and neutral cues were used as standard and deviant stimuli, respectively. Results show that the MMN induced by Wi-Fi signal cues in the PIU group was larger than that in the control group. Meanwhile, the MMN induced by Wi-Fi signal cues was considerably enhanced in the PIU group under negative affect priming relative to that in the PIU group under neutral affect priming. Overall, PIUs have an automatic detection advantage for Wi-Fi signal cues, and negative affect can enhance this advantage. Our results suggest that the MMN elicited by Wi-Fi signal cues function as a sensitive neurobiological marker tracing the change of addiction motivation for PIUs.

Attentional bias in Internet users with problematic use of social networking sites

BACKGROUND AND AIMS

Evidence from the field of addictive disorders suggests that attentional bias for stimuli related to a substance or activity of abuse (e.g., gambling) exacerbates the addictive behavior. However, evidence regarding attentional bias in PIU is sparse. This study aims to investigate whether individuals who express problematic tendencies toward social networking sites (SNS), a subtype of PIU, show attentional bias for stimuli associated with social media.

METHODS

Sixty-five participants performed Visual Dot-Probe and Pleasantness Rating Tasks containing SNS-related and matched control images during eye movements were recorded, providing a direct measure of attention. Participants were assessed on their levels of SNS Internet use (ranging from problematic to non-problematic) and their levels of urges to be online (high vs. low).

RESULTS

Problematic SNS users and, in particular, a subgroup expressing higher levels of urges to be online showed an attentional bias for SNS-related images compared to control images.

CONCLUSION

These results suggest that attentional bias is a common mechanism associated with problematic Internet use as well as other addictive disorders.

Automatic detection advantage of problematic Internet users for Wi-Fi signal cues and the moderating effect of negative affect: An event-related potential study

Cognitive bias toward Internet-related cues is an important factor of the formation and maintenance of the addictive behavior of problematic Internet users (PIUs). The development of fiber-optic communication and smartphones has ushered human society into the era of wireless networks. The Wi-Fi signal, the symbol of wireless network connection, represents not only network access but also a channel for communication with others anywhere at any time. Therefore, the Wi-Fi signal cues should be an effective inducer of the addictive behaviors of PIUs. We used images of Wi-Fi signal as Internet-related cues to explore the automatic detection advantage of PIUs for these cues and to determine whether negative affect, another predisposing factor for addiction, can enhance this advantage. We utilized an intergroup design in this study. The PIU and control groups each comprised 30 participants and were randomly assigned to negative or neutral affect priming group. Mismatch negativity (MMN) was induced through the deviant-standard reverse oddball paradigm. Wi-Fi signal cues and neutral cues were used as standard and deviant stimuli, respectively. Results show that the MMN induced by Wi-Fi signal cues in the PIU group was larger than that in the control group. Meanwhile, the MMN induced by Wi-Fi signal cues was considerably enhanced in the PIU group under negative affect priming relative to that in the PIU group under neutral affect priming. Overall, PIUs have an automatic detection advantage for Wi-Fi signal cues, and negative affect can enhance this advantage. Our results suggest that the MMN elicited by Wi-Fi signal cues function as a sensitive neurobiological marker tracing the change of addiction motivation for PIUs.

Group independent component analysis reveals alternation of right executive control network in Internet gaming disorder

OBJECTIVE

Previous studies have demonstrated that individuals with Internet gaming disorder (IGD) showed attentional bias toward gaming-related cues and exhibited impaired executive functions. The purpose of this study was to explore the alternations in related functional brain networks underlying attentional bias in IGD subjects.

METHODS

Eighteen IGD subjects and 19 healthy controls (HC) were scanned with functional magnetic resonance imaging while they were performing an addiction Stroop task. Networks of functional connectivity were identified using group independent component analysis (ICA).

RESULTS

ICA identified 4 functional networks that showed differences between the 2 groups, which were related to the right executive control network and visual related networks in our study. Within the right executive control network, in contrast to controls, IGD subjects showed increased functional connectivity in the temporal gyrus and frontal gyrus, and reduced functional connectivity in the posterior cingulate cortex, temporal gyrus, and frontal gyrus.

CONCLUSION

These findings suggest that IGD is related to abnormal functional connectivity of the right executive control network, and may be described as addiction-related abnormally increased cognitive control processing and diminished response inhibition during an addiction Stroop task. The results suggest that IGD subjects show increased susceptibility towards gaming-related cues but weakened strength of inhibitory control.

Tendencies toward Internet-pornography-use disorder: Differences in men and women regarding attentional biases to pornographic stimuli

BACKGROUND AND AIMS

Several authors consider Internet-pornography-use disorder (IPD) as addictive disorder. One of the mechanisms that has been intensively studied in substance- and non-substance-use disorders is an enhanced attentional bias toward addiction-related cues. Attentional biases are described as cognitive processes of individual's perception affected by the addiction-related cues caused by the conditioned incentive salience of the cue itself. It is assumed in the I-PACE model that in individuals prone to develop IPD symptoms implicit cognitions as well as cue-reactivity and craving arise and increase within the addiction process.

METHODS

To investigate the role of attentional biases in the development of IPD, we investigated a sample of 174 male and female participants. Attentional bias was measured with the Visual Probe Task, in which participants had to react on arrows appearing after pornographic or neutral pictures. In addition, participants had to indicate their sexual arousal induced by pornographic pictures. Furthermore, tendencies toward IPD were measured using the short-Internetsex Addiction Test.

RESULTS

The results of this study showed a relationship between attentional bias and symptom severity of IPD partially mediated by indicators for cue-reactivity and craving. While men and women generally differ in reaction times due to pornographic pictures, a moderated regression analysis revealed that attentional biases occur independently of sex in the context of IPD symptoms.

DISCUSSION

The results support theoretical assumptions of the I-PACE model regarding the incentive salience of addiction-related cues and are consistent with studies addressing cue-reactivity and craving in substance-use disorders.

Interference with Processing Negative Stimuli in Problematic Internet Users: Preliminary Evidence from an Emotional Stroop Task

Although it has been proposed that problematic Internet use (PIU) may represent a dysfunctional coping strategy in response to negative emotional states, there is a lack of experimental studies that directly test how individuals with PIU process emotional stimuli. In this study, we used an emotional Stroop task to examine the implicit bias toward positive and negative words in a sample of 100 individuals (54 females) who also completed questionnaires assessing PIU and current affect states. A significant interaction was observed between PIU and emotional Stroop effects (ESEs), with participants who displayed prominent PIU symptoms showing higher ESEs for negative words compared to other participants. No significant differences were found on the ESEs for positive words among participants. These findings suggest that PIU may be linked to a specific emotional interference with processing negative stimuli, thus supporting the view that PIU is a dysfunctional strategy to cope with negative affect. A potential treatment implication for individuals with PIU includes a need to enhance the capacity to process and regulate negative feelings.

Automatic detection advantage of network information among Internet addicts: behavioral and ERP evidence

Converging evidence has proved the attentional bias of Internet addicts (IAs) on network information. However, previous studies have neither explained how characteristics of network information are detected by IAs with priority nor proved whether this advantage is in line with the unconscious and automatic process. To answer the two questions, this study aims to investigate whether IAs prioritize automatic detection of network information from the behavior and cognitive neuroscience aspects. 15 severe IAs and 15 matching healthy controls were selected using Internet Addiction Test (IAT). Dot-probe task with mask was used in the behavioral experiment, while deviant-standard reverse oddball paradigm was used in the event-related potential (ERP) experiment to induce mismatch negativity (MMN). In the dot-probe task, when the probe location appeared on the Internet-related picture's position, the IAs had significantly shorter reaction time than do the controls; in the ERP experiment, when Internet-related picture appeared, MMN was significantly induced in the IAs relative to the controls. Both experiments show that IAs can automatically detect network information.

Similarities and Differences in Psychology

Addiction is marked by repeating a certain behavior while ignoring the potential physical or mental consequences. Non-substance addiction provides an ideal model for researching the emergence and development of addiction's basic mechanism. Comparative studies of substance and non-substance addiction are helpful to reveal the common basis of addiction development. This article explores this topic from a psychological angle, touching upon sensation seeking, inhibitory control, attentional bias, intertemporal choice and environment. A review of previous literature urges future research to propose a biopsychosocial model of addiction and consider addiction's effect on basic cognitive function alongside cognitive neuroscience technology.

Using two web-based addiction Stroops to measure the attentional bias in adults with Internet Gaming Disorder

Background and aims People with substance abuse and pathological gamblers show an attentional bias. In a laboratory setting, we found an attentional bias using an addiction Stroop in adults with Internet Gaming Disorder (IGD). We aimed at investigating this effect using two web-based experiments. Methods Study 1: Gamers with IGD, casual gamers, and non-gamers (N = 81, 28.1 ± 7.8 years) completed a web-based addiction Stroop with a fully randomized word order. They saw computer-related and neutral words in four colors and indicated the word color via keypress. Study 2: Gamers with IGD, casual gamers, and non-gamers (N = 87, 23.4 ± 5.1 years) completed a web-based addiction Stroop and a classical Stroop (incongruent color and neutral words), which both had a block design. We expected that in both studies, only the gamers with IGD would react more slowly to computer-related words in the addiction Stroop. All groups were expected to react more slowly to incongruent color words in the classical Stroop. Results In neither study did the gamers with IGD differ in their reaction times to computer-related words compared to neutral words. In Study 2, all groups reacted more slowly to incongruent color words than to neutral words confirming the validity of the online reaction time assessment. Discussion Gamers with IGD did not show a significant attentional bias. IGD may differ from substance abuse and pathological gambling in this respect; alternatively experimenting on the Internet may have introduced error variance that made it harder to detect a bias.

Cue-induced craving for Internet among Internet addicts

Intense craving is a core feature of addictive disorder, and cue-induced craving is believed to be a key factor in the maintenance and relapse of addictive behaviors. With the rapid development of the Internet, Internet addiction has become a widespread behavioral problem accompanied by many negative effects. This study used the cue-reactivity paradigm to examine cue-induced craving for the Internet among Internet addicts and non-addicts. Participants were exposed to Internet-related words, and asked to report their craving for the Internet. Results indicated that Internet-related words aroused cue-induced craving for the Internet among both Internet addicts and non-addicts; however, the craving was more intense among Internet addicts. These results suggest that craving may not be a unipolar, all or none state found only in addicts, but may also be present among non-addicts. They indicate that Internet-related words may be able to induce craving for the Internet, and that Internet addiction and other addictions may share similar underlying mechanisms. This finding has important implications for designing interventions for Internet addiction.

Integrating psychological and neurobiological considerations regarding the development and maintenance of specific Internet-use disorders: An Interaction of Person-Affect-Cognition-Execution (I-PACE) model

Within the last two decades, many studies have addressed the clinical phenomenon of Internet-use disorders, with a particular focus on Internet-gaming disorder. Based on previous theoretical considerations and empirical findings, we suggest an Interaction of Person-Affect-Cognition-Execution (I-PACE) model of specific Internet-use disorders. The I-PACE model is a theoretical framework for the processes underlying the development and maintenance of an addictive use of certain Internet applications or sites promoting gaming, gambling, pornography viewing, shopping, or communication. The model is composed as a process model. Specific Internet-use disorders are considered to be the consequence of interactions between predisposing factors, such as neurobiological and psychological constitutions, moderators, such as coping styles and Internet-related cognitive biases, and mediators, such as affective and cognitive responses to situational triggers in combination with reduced executive functioning. Conditioning processes may strengthen these associations within an addiction process. Although the hypotheses regarding the mechanisms underlying the development and maintenance of specific Internet-use disorders, summarized in the I-PACE model, must be further tested empirically, implications for treatment interventions are suggested.

Brain Activity toward Gaming-Related Cues in Internet Gaming Disorder during an Addiction Stroop Task

Background and Aims: Attentional bias for drug-related stimuli is a key characteristic for drug addiction. Characterizing the relationship between attentional bias and brain reactivity to Internet gaming-related stimuli may help in identifying the neural substrates that critical to Internet gaming disorder (IGD).

Methods: 19 IGD and 21 healthy control (HC) subjects were scanned with functional magnetic resonance imaging while they were performing an addiction Stroop task.

Results: Compared with HC group, IGD subjects showed higher activations when facing Internet gaming-related stimuli in regions including the inferior parietal lobule, the middle occipital gyrus and the dorsolateral prefrontal cortex. These brain areas were thought to be involved in selective attention, visual processing, working memory and cognitive control.

Discussion and Conclusions: The results demonstrated that compared with HC group, IGD subjects show impairment in both visual and cognitive control ability while dealing with gaming-related words. This finding might be helpful in understanding the underlying neural basis of IGD.

Cue-induced Behavioral and Neural Changes among Excessive Internet Gamers and Possible Application of Cue Exposure Therapy to Internet Gaming Disorder

Internet gaming disorder (IGD) may lead to many negative consequences in everyday life, yet there is currently no effective treatment for IGD. Cue-reactivity paradigm is commonly used to evaluate craving for substance, food, and gambling; cue exposure therapy (CET) is applied to treating substance use disorders (SUDs) and some other psychological disorders such as pathological gambling (PG). However, no study has explored CET's application to the treatment of IGD except two articles having implied that cues' exposure may have therapeutic effect on IGD. This paper reviews studies on cue-induced behavioral and neural changes in excessive Internet gamers, indicating that behavioral and neural mechanisms of IGD mostly overlap with those of SUD. The CET's effects in the treatment of SUDs and PG are also reviewed. We finally propose an optimized CET paradigm, which future studies should consider and investigate as a probable treatment of IGD.

Attentional bias in excessive Internet gamers: Experimental investigations using an addiction Stroop and a visual probe

Background and aims Internet Gaming Disorder is included in the Diagnostic and statistical manual of mental disorders (5^th edition) as a disorder that merits further research. The diagnostic criteria are based on those for Substance Use Disorder and Gambling Disorder. Excessive gamblers and persons with Substance Use Disorder show attentional biases towards stimuli related to their addictions. We investigated whether excessive Internet gamers show a similar attentional bias, by using two established experimental paradigms. Methods We measured reaction times of excessive Internet gamers and non-gamers (N = 51, 23.7 ± 2.7 years) by using an addiction Stroop with computer-related and neutral words, as well as a visual probe with computer-related and neutral pictures. Mixed design analyses of variance with the between-subjects factor group (gamer/non-gamer) and the within-subjects factor stimulus type (computer-related/neutral) were calculated for the reaction times as well as for valence and familiarity ratings of the stimulus material. Results In the addiction Stroop, an interaction for group × word type was found: Only gamers showed longer reaction times to computer-related words compared to neutral words, thus exhibiting an attentional bias. In the visual probe, no differences in reaction time between computer-related and neutral pictures were found in either group, but the gamers were faster overall. Conclusions An attentional bias towards computer-related stimuli was found in excessive Internet gamers, by using an addiction Stroop but not by using a visual probe. A possible explanation for the discrepancy could lie in the fact that the visual probe may have been too easy for the gamers.

Physiological arousal deficits in addicted gamers differ based on preferred game genre

BACKGROUND/AIMS

There has been significant discussion surrounding the psychopathology of excessive gaming and whether it constitutes an addiction. The current study investigated physiological and subjective levels of arousal in gamers of two genres and the relationship between sensation seeking and gaming addiction.

METHODS

Heart rate (HR), blood pressure (BP) and skin conductance were recorded at baseline, during gaming for 15 min and after gaming in 30 massively multiplayer online role-playing game (MMORPG) and 30 first-person shooter (FPS) male gamers. Gamers were identified as addicted using the Addiction-Engagement Questionnaire. Sensation seeking was measured using the Arnett Inventory of Sensation Seeking.

RESULTS

Addicted MMORPG gamers (n=16) displayed significant decreases in cardiovascular activity during gaming compared to baseline and showed significant increases after gaming. Addicted FPS gamers (n=13) had significant increases in BP during gaming which decreased significantly after gaming. In comparison, non-addicted MMORPG gamers (n=14) had significant decreases in HR during gaming, whereas BP in non-addicted MMORPG and FPS gamers (n=17) increased during gaming and after gaming. There were no significant relationships between sensation seeking and addiction.

CONCLUSION

There are physiological arousal deficits in addicted gamers, and these patterns differ according to the genre of game played.

Toward a consensus definition of pathological video-gaming: a systematic review of psychometric assessment tools

Pathological video-gaming, or its proposed DSM-V classification of "Internet Use Disorder", is of increasing interest to scholars and practitioners in allied health disciplines. This systematic review was designed to evaluate the standards in pathological video-gaming instrumentation, according to Cicchetti (1994) and Groth-Marnat's (2009) criteria and guidelines for sound psychometric assessment. A total of 63 quantitative studies, including eighteen instruments and representing 58,415 participants, were evaluated. Results indicated that reviewed instrumentation may be broadly characterized as inconsistent. Strengths of available measures include: (i) short length and ease of scoring, (ii) excellent internal consistency and convergent validity, and (iii) potentially adequate data for development of standardized norms for adolescent populations. However, key limitations included: (a) inconsistent coverage of core addiction indicators, (b) varying cut-off scores to indicate clinical status, (c) a lack of a temporal dimension, (d) untested or inconsistent dimensionality, and (e) inadequate data on predictive validity and inter-rater reliability. An emerging consensus suggests that pathological video-gaming is commonly defined by (1) withdrawal, (2) loss of control, and (3) conflict. It is concluded that a unified approach to assessment of pathological video-gaming is needed. A synthesis of extant research efforts by meta-analysis may be difficult in the context of several divergent approaches to assessment.

Cue reactivity and its inhibition in pathological computer game players

Despite a rising social relevance of pathological computer game playing, it remains unclear whether the neurobiological basis of this addiction-like behavioral disorder and substance-related addiction are comparable. In substance-related addiction, attentional bias and cue reactivity are often observed. We conducted a functional magnetic resonance study using a dot probe paradigm with short-presentation (attentional bias) and long-presentation (cue reactivity) trials in eight male pathological computer game players (PCGPs) and nine healthy controls (HCs). Computer game-related and neutral computer-generated pictures, as well as pictures from the International Affective Picture System with positive and neutral valence, served as stimuli. PCGPs showed an attentional bias toward both game-related and affective stimuli with positive valence. In contrast, HCs showed no attentional bias effect at all. PCGPs showed stronger brain responses in short-presentation trials compared with HCs in medial prefrontal cortex (MPFC) and anterior cingulate gyrus and in long-presentation trials in lingual gyrus. In an exploratory post hoc functional connectivity analyses, for long-presentation trials, connectivity strength was higher between right inferior frontal gyrus, which was associated with inhibition processing in previous studies, and cue reactivity-related regions (left orbitofrontal cortex and ventral striatum) in PCGPs. We observed behavioral and neural effects in PCGPs, which are comparable with those found in substance-related addiction. However, cue-related brain responses were depending on duration of cue presentation. Together with the connectivity result, these findings suggest that top-down inhibitory processes might suppress the cue reactivity-related neural activity in long-presentation trials.