Functional magnetic resonance imaging of internet addiction in young adults

Large-scale network abnormality in behavioral addiction

BACKGROUND

Researchers have endeavored to ascertain the network dysfunction associated with behavioral addiction (BA) through the utilization of resting-state functional connectivity (rsFC). Nevertheless, the identification of aberrant patterns within large-scale networks pertaining to BA has proven to be challenging.

METHODS

Whole-brain seed-based rsFC studies comparing subjects with BA and healthy controls (HC) were collected from multiple databases. Multilevel kernel density analysis was employed to ascertain brain networks in which BA was linked to hyper-connectivity or hypo-connectivity with each prior network.

RESULTS

Fifty-six seed-based rsFC publications (1755 individuals with BA and 1828 HC) were included in the meta-analysis. The present study indicate that individuals with BAs exhibit (1) hypo-connectivity within the fronto-parietal network (FN) and hypo- and hyper-connectivity within the ventral attention network (VAN); (2) hypo-connectivity between the FN and regions of the VAN, hypo-connectivity between the VAN and regions of the FN and default mode network (DMN), hyper-connectivity between the DMN and regions of the FN; (3) hypo-connectivity between the reward system and regions of the sensorimotor network (SS), DMN and VAN; (4) hypo-connectivity between the FN and regions of the SS, hyper-connectivity between the VAN and regions of the SS.

CONCLUSIONS

These findings provide impetus for a conceptual framework positing a model of BA characterized by disconnected functional coordination among large-scale networks.

Adverse childhood experience and young adult's problematic Internet use: The role of hostility and loneliness

BACKGROUND

Few studies have explored the relationship between adverse childhood experiences (ACEs) and problematic Internet use (PIU) during young adulthood. Moreover, even fewer studies have explored the roles of loneliness (social and emotional) and hostility in this relationship.

METHODS

This study used data from the Taiwan Youth Project (2011-2017). The analytical sample included 1885 participants (mean age = 31.3 years). PIU was measured using the short form of Chen's Internet Addiction Scale (2017). ACEs were assessed at the baseline of the adolescent phase (mean age = 14.3 years); this indicator has undergone recent revision. Hostility (three items from the Symptom Checklist-90-Revised) and loneliness (six items from the De Jong Gierveld scale) were measured in 2011 and 2014, respectively.

RESULTS

ACEs were associated with hostility and loneliness (emotional and social). Additionally, hostility (β = 0.62, p < .01) and emotional loneliness (β = 0.44, p < .01) were significantly associated with PIU. Most mediating paths (e.g., ACE → hostility → PIU) were significant, based on the bootstrapping results.

CONCLUSIONS

This study suggests that ACEs have a long-term shadow effect on PIU in young adults. ACEs show an indirect association with PIU through both hostility and loneliness, as well as involving the relationship between them.

Control dilemma: Evidence of the stability-flexibility trade-off

Cognitive control can be applied flexibly when task goals or environments change (i.e., cognitive flexibility), or stably to pursue a goal in the face of distraction (i.e., cognitive stability). Whether these seemingly contradictory characteristics have an inverse relationship has been controversial, as some studies have suggested a trade-off mechanism between cognitive flexibility and cognitive stability, while others have not found such reciprocal associations. This study investigated the possible antagonistic correlation between cognitive flexibility and stability using a novel version of the flexibility-stability paradigm and the classic cued task switching paradigm. In Experiment 1, we showed that cognitive flexibility was inversely correlated with cognitive stability, as increased distractor proportions were associated with decreased cognitive flexibility and greater cognitive stability. Moreover, cognitive flexibility and stability were regulated by a single control system instead of two independent control mechanisms, as the model selection results indicated that the reciprocally regulated model with one integration parameter outperformed all other models, and the model parameter was inversely linked to cognitive flexibility and stability. We found similar results using the classic cued task switching paradigm in Experiment 2. Therefore, a trade-off between cognitive flexibility and stability was observed from the paradigms used in this study.

Social support as the mediator for the relationship between internet gaming disorder and psychological problems among university students

BACKGROUND

There has been increasing recognition of internet gaming disorder as a psychiatric problem that is linked with serious impairment and distress and correlated with psychological reactions and social consequences. Thus, this study proposed that psychological problems (stress, anxiety, and depression) and social support could be associated with IGD and social support had a mediating role between these psychological problems and IGD among university students in Jordan.

METHODS

A cross-sectional, descriptive correlational design was adopted. The university students (N = 1020) were selected randomly from four universities (two public and two private) in Jordan. A self-structured questionnaire was used to collect data using the Internet Gaming Disorder Test (IGD-20 Test), Depression Anxiety Stress Scales-21 (DASS-21), Multidimensional Social Support Scale (MSPSS), and sociodemographic data.

FINDINGS

Findings of this study found that the mean age of the participants was 21.38 (S.D ± 2.12) and 55.9% of them were males The prevalence of internet gaming disorder was 12.16% among the participants, where the cut-off point for internet gaming disorder was 71 out of 100. Internet gaming disorder was significantly correlated with stress, anxiety, social support, and depression. However, stress, anxiety, and social support had a direct effect on internet gaming disorder, while social support had the strongest effect on internet gaming disorder. It was found that social support had a mediating role between anxiety and stress (β = -0.172, T-Statistics = 3.92, p < 0.001; β = -0.268, T-Statistics = 5.45, p < 0.001, respectively) and internet gaming disorder (p < 0.001).

CONCLUSION

This study can help policymakers and instructors develop health education programs and/or health training programs that focus on using social support as a coping method when experiencing psychological problems including stress and anxiety and adopt social support in management programs for excessive use of internet gaming.

Neurobiological risk factors for problematic social media use as a specific form of Internet addiction: A narrative review

Problematic social media use (PSMU) is a behavioral addiction, a specific form of problematic Internet use associated with the uncontrolled use of social networks. It is typical mostly for modern adolescents and young adults, which are the first generations fully grown up in the era of total digitalization of society. The modern biopsychosocial model of the formation of behavioral addictions, postulating the impact of a large number of biological, psychological, and social factors on addictive behavior formation, may be quite applicable to PSMU. In this narrative review, we discussed neurobiological risk factors for Internet addiction with a focus on current evidence on the association between PSMU and structural/ functional characteristics of the brain and autonomic nervous system, neurochemical correlations, and genetic features. A review of the literature shows that the vast majority of the mentioned neurobiological studies were focused on computer games addiction and generalized Internet addiction (without taking into account the consumed content). Even though a certain number of neuroimaging studies have been conducted for PSMU, there is practically no research on neuropeptide and genetic associations for PSMU to date. This fact points to the extremely high relevance of such studies.

A Systematic Review of Structural and Functional MRI Studies Investigating Social Networking Site Use

An understanding of the neurocognitive profile underlying the use of social networking sites (SNSs) can help inform decisions about the classification of problematic SNS use as an addictive disorder and elucidate how/when 'SNS addiction' might develop. The present review aimed to synthesize structural and functional MRI research investigating problematic/compulsive forms of SNS use or regular (non-addicted) SNS use behaviours. We conducted a systematic search for research articles published in English using the Web of Science, PubMed, and Scopus databases up to October 2022. Studies meeting our inclusion criteria were assessed for quality and a narrative synthesis of the results was conducted. Twenty-eight relevant articles were identified comprising structural MRI (n = 9), resting-state fMRI (n = 6) and task-based fMRI studies (n = 13). Current evidence suggests that problematic SNS use might be characterised by (1) reduced volume of the ventral striatum, amygdala, subgenual anterior cingulate cortex, orbitofrontal cortex and posterior insula; (2) increased ventral striatum and precuneus activity in response to SNS cues; (3) abnormal functional connectivity involving the dorsal attention network; (4) inter-hemispheric communication deficits. Regular SNS use behaviours appear to recruit regions involved in the mentalising network, the self-referential cognition network, the salience network, the reward network and the default mode network. Such findings are at least partially consistent with observations from the substance addiction literature and provide some provisional support for the addictive potential of SNSs. Nonetheless, the present review is limited by the small number of eligible studies and large heterogeneity in the methods employed, and so our conclusions should remain tentative. Moreover, there is a lack of longitudinal evidence suggesting SNSs cause neuroadaptations and thus conclusions that problematic SNS use represents a disease process akin to substance use addictions are premature. More well-powered longitudinal research is needed to establish the neural consequences of excessive and problematic SNS use.

Treatment Modalities for Internet Addiction in Children and Adolescents: A Systematic Review of Randomized Controlled Trials (RCTs)

BACKGROUND

In recent years, the use of the internet among children and adolescents has dramatically increased, leading to growing concerns regarding the potential risks of excessive internet use and addiction. Addressing these concerns, this systematic review aims to summarize current evidence on the effectiveness of treatment interventions for internet addiction among children and adolescents.

METHOD

We performed a systematic review using PubMed, Web of Science, PsycInfo, and Google Scholar with search terms including "internet addiction", "problematic internet use", "children" or "adolescents", "treatment" and "randomized controlled trial". We found 10 Randomized Controlled Trials (RCTs) meeting the criteria and included them in this systematic review.

RESULTS

This systematic review analyzed 10 randomized controlled trials focused on treatment interventions for internet addiction in adolescents and young adults. The interventions used were diverse, including cognitive-behavioral therapy (CBT), medication, electro-acupuncture (EA), and solution-focused approaches. The measures used to assess the effectiveness of the interventions also varied, but most studies reported moderate to large effect sizes for at least some outcomes. Overall, the studies suggest that interventions such as CBT and EA can be effective in reducing symptoms of internet addiction, internet gaming disorder, and unspecified internet use disorders. School-based programs and brief manualized CBT programs also show promise, though more research is needed to determine their long-term effectiveness.

CONCLUSION

Promising treatment approaches for internet addiction are emerging, but inconsistencies in conceptualization, language, and diagnostic criteria present some challenges. The growing recognition of problematic internet use, as shown by the DSM-5's recognition of Internet Gaming Disorder, highlights the need for a multidisciplinary approach and standardized criteria to facilitate accurate reporting across studies. Continued research is needed to identify effective treatments and diagnostic criteria for internet addiction, with the potential to offer practical insights into effective medications and therapies.

Reduced brain activity and functional connectivity during creative idea generation in individuals with smartphone addiction

Since the coronavirus disease 2019 outbreak, the frequency of smartphone use has surged, which has caused an increase in smartphone addiction among individuals. Smartphone addiction can impair various cognitive abilities. However, to date, the impact of smartphone addiction on creative cognition remains unclear. The current functional near-infrared spectroscopy study compared neural differences between smartphone addiction tendency (SAT) and healthy control (HC) individuals during creative idea generation. In particular, by manipulating a key component of creative cognition, that is, overcoming semantic constraints, we explored whether SAT individuals could overcome semantic constraints. Both the SAT and HC groups completed the alternate uses task (AUT) in semantic constraint and unconstraint conditions. The results indicated that the prefrontal cortex (PFC) and temporal regions were less active during AUT in the SAT group than in the HC group. In the SAT group, the PFC was less active under constraint than unconstraint conditions. Moreover, both task-related and resting-state functional connectivity analyses indicated weaker coupling between the PFC and temporal regions in the SAT than in the HC group. Furthermore, the left dorsolateral PFC mediated the effect of smartphone addiction on creative performance. These findings provide unprecedented neuroimaging evidence on the negative impact of smartphone addiction on creative cognition.

Language processing in Internet use disorder: Task-based fMRI study

Internet use disorder (IUD) is generally conceptualized as a fast-growing behavioral addiction. Several structural and functional brain alterations have been revealed in this condition, but previous behavioral studies indicated that language systems may also be impaired. We used a silent word generation task to induce brain activation in Broca’s area and other parts of the language system. Blood-oxygen-level-dependent activation analysis and psychophysiological interaction analysis were applied to assess functional brain changes. IUD was measured by the Problematic Internet Use Questionnaire and two additional questions concerning usage time and subjective rating of addiction. According to our key findings, areas strongly related to the default mode network were altered in IUD during the task. Moreover, Broca’s area showed altered functional connectivity with other language network and occipital areas in IUD. These findings may address the neural background of decreased verbal fluency performance previously reported in the literature, and we emphasize that beside the brain’s reward and inhibitory control systems, the language system is the next candidate to be involved in the pathogenesis of IUD.

Digital Addiction and Sleep

In 2020, the World Health Organization formally recognized addiction to digital technology (connected devices) as a worldwide problem, where excessive online activity and internet use lead to inability to manage time, energy, and attention during daytime and produce disturbed sleep patterns or insomnia during nighttime. Recent studies have shown that the problem has increased in magnitude worldwide during the COVID-19 pandemic. The extent to which dysfunctional sleep is a consequence of altered motivation, memory function, mood, diet, and other lifestyle variables or results from excess of blue-light exposure when looking at digital device screens for long hours at day and night is one of many still unresolved questions. This article offers a narrative overview of some of the most recent literature on this topic. The analysis provided offers a conceptual basis for understanding digital addiction as one of the major reasons why people, and adolescents in particular, sleep less and less well in the digital age. It discusses definitions as well as mechanistic model accounts in context. Digital addiction is identified as functionally equivalent to all addictions, characterized by the compulsive, habitual, and uncontrolled use of digital devices and an excessively repeated engagement in a particular online behavior. Once the urge to be online has become uncontrollable, it is always accompanied by severe sleep loss, emotional distress, depression, and memory dysfunction. In extreme cases, it may lead to suicide. The syndrome has been linked to the known chronic effects of all drugs, producing disturbances in cellular and molecular mechanisms of the GABAergic and glutamatergic neurotransmitter systems. Dopamine and serotonin synaptic plasticity, essential for impulse control, memory, and sleep function, are measurably altered. The full spectrum of behavioral symptoms in digital addicts include eating disorders and withdrawal from outdoor and social life. Evidence pointing towards dysfunctional melatonin and vitamin D metabolism in digital addicts should be taken into account for carving out perspectives for treatment. The conclusions offer a holistic account for digital addiction, where sleep deficit is one of the key factors.

Functional Neural Alterations in Pathological Internet Use: A Meta-Analysis of Neuroimaging Studies

Previous resting-state functional MRI (fMRI) studies found spontaneous neural activity in the brains of Pathological Internet Use (PIU) subjects. However, the findings were inconsistent in studies using different neuroimaging analyses. This meta-analytic study aimed to identify a common pattern of altered brain activity from different studies. Resting-state fMRI studies, based on whole-brain analysis methods published before July 1, 2021, were searched in multiple databases (PubMed, EMBASE, MEDLINE, and Web of Science). A voxel-based signed differential mapping (SDM) method was used to clarify brain regions, which showed anomalous activity in PIU subjects compared with healthy controls (HCs). Ten eligible publications consisting of 306 PIU subjects and 314 HCs were included in the SDM meta-analysis. Compared with HCs, subjects with PIU showed increased spontaneous neural functional activity in the left temporal pole of the superior temporal cortex, left amygdala, bilateral median cingulate cortex, and right insula. Meanwhile, a decreased spontaneous neural activity was identified in the left dorsolateral superior frontal gyrus and right middle frontal gyrus in the subjects with PIU. These abnormal brain regions are associated with cognitive executive control and emotional regulation. The consistent changes under different functional brain imaging indicators found in our study may provide important targets for the future diagnosis and intervention of PIU.

Systematic Review Registration:www.crd.york.ac.uk/PROSPERO, identifier: CRD42021258119.

Neurophysiologic Reactions during Heart Rate Variability Biofeedback Session in Adolescents with Different Risk of Internet Addiction

The aim of this study was to determine electroencephalogram (EEG) in a session of heart rate variability biofeedback (HRV BF) in adolescents with different Internet addiction (IA) risks. In total, 100 healthy adolescents aged 16–17 years with minimal risk of IA (Group I, 35%), pronounced risk of IA (Group II, 51%), and stable pattern of IA (Group III, 14%) using the Chen Internet Addiction Scale were examined. HRV and EEG parameters were determined at baseline (5 min), and then during the short-term HRV BF session (5 min), in order to increase the total power (TP, ms²) of the HRV spectrum. Against the background of an increase in the TP and a decrease in sympathetic activity, an increase in alpha EEG was revealed, especially in Groups I and II. The greatest increase in the power of beta₁-activity of EEG in the frontal, central, and temporal brain regionswas found in Groups I and II. In adolescents with a pronounced risk of IA, HRV BF is accompanied by a severe activation of the brain systems, while in persons with a stable type of IA, the least brain reactivity is shown, especially in the beta₁ EEG band.

The Comparative Efficacy of Treatments for Children and Young Adults with Internet Addiction/Internet Gaming Disorder: An Updated Meta-Analysis

Internet gaming disorder (IGD) is a formal mental disorder leading to bad outcomes for children and adolescents. This study comprehensively compared the estimated effect of various pharmacotherapy and psychosocial interventions for IGD from randomized controlled trials (RCT) through updated meta-analysis, using meta-regression. A search of PubMed/MEDLINE, Cochrane Library, and Airiti Library between 2000 and 2017 was conducted for various IA/IGD intervention modalities. A total of 124 studies from 29 selected papers involving 5601 children and young adults with IA/IGD were found. Meta-analyzing the pooled standardized mean difference (SMD) revealed a preliminary random effect of 1.399 with a 95% confidence interval of 1.272–1.527, suggesting highly effective treatment of IA/IGD. After adjusting for the confounding risks of age, publication year, type of subjects, and type of study, this study revealed that combining pharmacotherapy with cognitive behavioral therapy (CBT) or multi-level counseling (MLC) was the most effective treatment option. Using a scale of time spent online or a severity of IA symptoms scale was a more effective measurement, with p-values = 0.006 and 0.002, respectively. IA/IGD patients with comorbid depression showed worse outcomes than youth with another comorbidity. The corresponding model goodness-of-fit indices were τ² = 1.188; I²-Residual = 89.74%; and Adjusted-R² = 16.10%. This systematic review indicates that pharmacotherapy combined with CBT or MLC might be an effective therapeutic strategy for youth with gaming disorder.

Association of Internet gaming disorder symptoms with anxiety and depressive symptoms and substance use: an international cross-sectional study

Background

Problematic Internet gaming is an increasingly recognized global mental health problem. This multicultural cross-sectional study examined the association between Internet gaming disorder (IGD) symptoms and anxiety and depressive symptoms and substance use within a sample of young Internet users. In total, 3529 college/university students (1260 (35.7%) males; mean age 21 ± 3 years) were surveyed online. We assessed online gaming patterns using the Internet Gaming Disorder Self-report for College/University Students (ICMH-IGD), symptoms of depression using the Patient Health Questionnaire-9, and symptoms of anxiety using the Generalized Anxiety Disorder scale-7.

Results

IGD symptoms were associated with symptoms of depression, anxiety, and substance use, independent of time spent online, psychiatric diagnosis, culture, or sociodemographic characteristics. For males, more significant IGD symptoms were associated with more extended Internet browsing per day time and higher levels of anxiety and depressive symptoms, while for females, with more extended Internet browsing per day time, marihuana use, and higher levels of depressive symptoms.

Conclusions

Our study found that more overt symptoms of IGD were associated with higher levels of anxiety and depressive symptoms and substance use. Still, these associations differed among males and females, suggesting that gender differences should be considered when planning specific treatments.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43045-022-00180-6.

The modulation of mRNA levels of MAOA by electroacupuncture and psychotherapy in patients with pathological internet use

OBJECTIVE

The aim of this study was to observe the efficacy of electroacupuncture (EA) and psychotherapy (PT) effect on the mental status, sleep quality and impulsive trait in patients with pathological internet use, and to observe the changes of Monoamine oxidase type A (MAOA) messenger Ribonucleic acid (mRNA) levels in each group.

METHODS

A total of 60 PIU patients were included for the present study. These patients were randomly divided into two groups: EA group and PT group. Baihui, Sishencong, Hegu, Neiguan, Shenmen, Taichong, Sanyinjiao and Xuanzhong were selected for acupuncture in the EA group, while group psychotherapy combined with individual psychotherapy was used for intervention in patients in the PT group. Young's Internet addiction Test (IAT), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Barratt Impulse Scale (BIS-11) and Pittsburgh Sleep Quality Index (PSQI) were used to observe the severity of Internet addiction, mental status, sleep quality and impulsive trait of all patients at baseline and 40th days of treatment; and MAOA mRNA data were collected at baseline and 40th days of treatment.

RESULTS

Electroacupuncture and psychological intervention effectively reduced IAT, SAS, SDS, Y-BOCS, BIS and PSQI scores of PIU patients. After 40 days treatment, the MAOA expression of the PT group was increased, and there was no significant change in EA group. The correlation analysis indicated that IAT scores were positively correlated with SAS, SDS, Y-BOCS, BIS and PSQI at baseline. In addition, after treatment the EA group showed that the change in IAT scores was positively correlated with the change in Y-BOCS and BIS scores, and the PT group showed that the change in IAT scores was positively correlated with the change in SDS, BIS and PSQI scores.

CONCLUSION

The present study showed that electroacupuncture and psychological intervention can improve severity of Internet addiction, mental status, sleep quality and impulsive trait of PIU patients. Simultaneously, neurobiological changes may be the underlying mechanisms of psychotherapy for internet additcion.

Brain structures and activity during a working memory task associated with internet addiction tendency in young adults: A large sample study

The structural and functional brain characteristics associated with the excessive use of the internet have attracted substantial research attention in the past decade. In current study, we used voxel-based morphometry (VBM) and multiple regression analysis to assess the relationship between internet addiction tendency (IAT) score and regional gray and white matter volumes (rGMVs and rWMVs) and brain activity during a WM task in a large sample of healthy young adults (n = 1,154, mean age, 20.71 ± 1.78 years). We found a significant positive correlation between IAT score and gray matter volume (GMV) of right supramarginal gyrus (rSMG) and significant negative correlations with white matter volume (WMV) of right temporal lobe (sub-gyral and superior temporal gyrus), right sublobar area (extra-nuclear and lentiform nucleus), right cerebellar anterior lobe, cerebellar tonsil, right frontal lobe (inferior frontal gyrus and sub-gyral areas), and the pons. Also, IAT was significantly and positively correlated with brain activity in the default-mode network (DMN), medial frontal gyrus, medial part of the superior frontal gyrus, and anterior cingulate cortex during a 2-back working memory (WM) task. Moreover, whole-brain analyses of rGMV showed significant effects of interaction between sex and the IAT scores in the area spreading around the left anterior insula and left lentiform. This interaction was moderated by positive correlation in women. These results indicate that IAT is associated with (a) increased GMV in rSMG, which is involved in phonological processing, (b) decreased WMV in areas of frontal, sublobar, and temporal lobes, which are involved in response inhibition, and (c) reduced task-induced deactivation of the DMN, indicative of altered attentional allocation.

A pilot study using ecological momentary assessment via smartphone application to identify adolescent problematic internet use

For some youth, pathologic Internet use can cause significant distress and dysfunction, a phenomenon known as Problematic Internet Use (PIU). PIU has been associated with poorer health outcomes in adolescents with existing psychiatric illness but understanding PIU has been challenging due to research methodologies using cross-sectional, self-report data. This study assessed the feasibility of using app-based ecological momentary assessment (EMA) to provide more ecologically-valid data to identify and characterize the relationship between mood symptoms and PIU in adolescents in active mental health treatment. 25 youth (aged 12-23) were recruited to use an EMA app for 6 weeks. 96% of participants completed the study and the majority of participants completed surveys at least once weekly. Youth with anxiety disorders endorsed significantly greater benefit from using the app to monitor PIU. While PIU severity was positively correlated with worsened anxiety and depression, analyses of the temporal relationships between PIU and mood symptoms showed that anxiety symptoms were significantly improved after episodes of PIU. Overall results suggest that app-based EMA may be both acceptable and feasible to understand PIU in this population. Follow-up studies should consider personalization of study protocols and use of digital phenotyping methodology to collect more objective measurements of behavior.

Bio-psychosocial factors of children and adolescents with internet gaming disorder: a systematic review

Previous large-scale studies suggest that internet gaming disorder (IGD) among children and adolescents has become an important public concern. Minors are known to be particularly susceptible to problematic internet gaming use owing to age-related underdevelopment of cognitive control. It has been shown that precursors of addictions appear during adolescence; therefore, prevention efforts must be established targeting minors who have their first experience with addictive substances and behaviors during pubescence. Since the DSM-5 classification of IGD in 2013, studies on IGD have drastically increased in number. Thus, we performed an updated review of studies of IGD in children and adolescents to assess the clinical implications of IGD. The search included all publication years, using PubMed, MEDLINE, and PsycINFO. Across studies, the presence of IGD had a negative effect on sleep and schoolwork in minors. Additionally, family factors, including the quality of parent-child relationships, were important social factors in minors with IGD. Brain imaging studies indicate that impaired cognitive control in minors with IGD is associated with abnormal function in the prefrontal cortex and striatum. Persistent pathological online game use from childhood may aggravate abnormal brain function; therefore, preventive care and early intervention are increasingly important. Although extant research supports the effectiveness of cognitive behavioral therapy for minors with IGD, effective psychological intervention for minors with IGD is an urgent issue that requires further research. This review, which presents updated findings of IGD in minors, is expected to contribute to the development of future research and be useful in clinical practice in the field of child and adolescent psychiatry.

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.

Internet Addiction and Attention-Deficit/Hyperactivity Disorder Traits among Female College Students in Japan

Objectives:

Previous studies have reported that internet addiction (IA) is associated with attention-deficit/hyperactivity disorder (ADHD) consistently. However, in terms of gender, there are controversial findings. We aimed to investigate the relation between IA and self-acknowledged ADHD traits among female college students in Japan.

Methods:

The study questionnaire consisted of questions about demographics, Adult ADHD Self-Report Scale-V1.1 Part A (ADHD screener) and Young’s Internet Addiction Test (IAT). When four or more items are more frequent than the cut-off on ADHD screener, the subject was categorized into students with a positive ADHD screen. We defined students with total IAT score of 70 and higher as IA.

Results:

A total number of respondents was 369 (mean age: 19.0±0.7 years). Seventy-seven subjects were screened positive on ADHD screener (20.9%). Students with a positive ADHD screen scored significantly higher on the IAT (54.2±14.2 vs. 42.5±11.3). The rates of IA in students with and without a positive ADHD screen were 18.2% and 1.0%, respectively.

Conclusion:

Results of this study demonstrated the relation between IA and self-evaluated ADHD traits among female college students in Japan. Appropriate education for students on how to use the internet properly will be necessary to prevent IA.

Diffusion-weighted MRI measures suggest increased white-matter integrity in Internet gaming disorder: Evidence from the comparison with recreational Internet game users

Several studies have suggested that Internet gaming disorder (IGD) is related to altered brain white matter integrity. However, seeming inconsistencies exist and may reflect comparison groups not matched well for certain gaming characteristics. In order to address this possible concern, we recruited in the present study individuals with recreational Internet game use (RGU) comprised of individuals who spend similar amounts of time as IGD subjects playing online games without developing IGD. Diffusion tensor imaging data were collected from 42 IGD and 44 RGU subjects. Whole-brain comparisons showed that IGD subjects demonstrated increased fractional anisotropy (FA) in the bilateral anterior thalamic radiation, anterior limb of the internal capsule, bilateral corticospinal tract, bilateral inferior fronto-occipital fasciculus, corpus callosum, and bilateral inferior longitudinal fasciculus. In addition, Internet-addiction severity was positively correlated with FA values. Taken together, we conclude that IGD is associated with measures of increased white-matter integrity in tracts linking reward circuitry and sensory and motor control systems.

Alterations in White Matter Integrity in Young Adults with Smartphone Dependence

Smartphone dependence (SPD) is increasingly regarded as a psychological problem, however, the underlying neural substrates of SPD is still not clear. High resolution magnetic resonance imaging provides a useful tool to help understand and manage the disorder. In this study, a tract-based spatial statistics (TBSS) analysis on diffusion tensor imaging (DTI) was used to measure white matter integrity in young adults with SPD. A total of 49 subjects were recruited and categorized into SPD and control group based on their clinical behavioral tests. To localize regions with abnormal white matter integrity in SPD, the voxel-wise analysis of fractional anisotropy (FA) and mean diffusivity (MD) on the whole brain was performed by TBSS. The correlation between the quantitative variables of brain structures and the behavior measures were performed. Our result demonstrated that SPD had significantly lower white matter integrity than controls in superior longitudinal fasciculus (SLF), superior corona radiata (SCR), internal capsule, external capsule, sagittal stratum, fornix/stria terminalis and midbrain structures. Correlation analysis showed that the observed abnormalities in internal capsule and stria terminalis were correlated with the severity of dependence and behavioral assessments. Our finding facilitated a primary understanding of white matter characteristics in SPD and indicated that the structural deficits might link to behavioral impairments.

Merging Theoretical Models and Therapy Approaches in the Context of Internet Gaming Disorder: A Personal Perspective

Although, it is not yet officially recognized as a clinical entity which is diagnosable, Internet Gaming Disorder (IGD) has been included in section III for further study in the DSM-5 by the American Psychiatric Association (APA, 2013). This is important because there is increasing evidence that people of all ages, in particular teens and young adults, are facing very real and sometimes very severe consequences in daily life resulting from an addictive use of online games. This article summarizes general aspects of IGD including diagnostic criteria and arguments for the classification as an addictive disorder including evidence from neurobiological studies. Based on previous theoretical considerations and empirical findings, this paper examines the use of one recently proposed model, the Interaction of Person-Affect-Cognition-Execution (I-PACE) model, for inspiring future research and for developing new treatment protocols for IGD. The I-PACE model is a theoretical framework that explains symptoms of Internet addiction by looking at interactions between predisposing factors, moderators, and mediators in combination with reduced executive functioning and diminished decision making. Finally, the paper discusses how current treatment protocols focusing on Cognitive-Behavioral Therapy for Internet addiction (CBT-IA) fit with the processes hypothesized in the I-PACE model.

Structural alterations in the prefrontal cortex mediate the relationship between Internet gaming disorder and depressed mood

Adaptive gaming use has positive effects, whereas depression has been reported to be prevalent in Internet gaming disorder (IGD). However, the neural correlates underlying the association between depression and Internet gaming remain unclear. Moreover, the neuroanatomical profile of the striatum in IGD is relatively less clear despite its important role in addiction. We found lower gray matter (GM) density in the left dorsolateral prefrontal cortex (DLPFC) in the IGD group than in the Internet gaming control (IGC) group and non-gaming control (NGC) group, and the GM density was associated with lifetime usage of Internet gaming, depressed mood, craving, and impulsivity in the gaming users. Striatal volumetric analysis detected a significant reduction in the right nucleus accumbens (NAcc) in the IGD group and its association with lifetime usage of gaming and depression. These findings suggest that alterations in the brain structures involved in the reward system are associated with IGD-related behavioral characteristics. Furthermore, the DLPFC, involved in cognitive control, was observed to serve as a mediator in the association between prolonged gaming and depressed mood. This finding may provide insight into an intervention strategy for treating IGD with comorbid depression.

Comorbidity of Internet gaming disorder and alcohol use disorder: A focus on clinical characteristics and gaming patterns

BACKGROUND AND OBJECTIVES

Although Internet gaming disorder (IGD), which has been considered as a behavioral addiction in DSM-5, shares core features with alcohol use disorder (AUD), there has been minimal research on the clinical implications of the comorbidity between IGD and AUD. The purpose of this study is to investigate clinical psychopathologies and Internet game usage patterns of IGD, AUD, and their comorbid status.

METHODS

Participants (n = 1819) completed a cross-sectional web-based survey. The survey questionnaire included socio-demographic data, the IGD scale according to DSM-5 criteria, the Korean version of Alcohol Use Disorders Identification Test for AUD, the Dickman Impulsivity Inventory (DII)-short version for impulsivity, the Brief Self-Control Scale (BSCS) for self-control, the subscales of the Symptom Check-List 90 Items-Revised (SCL-90-R) for depression and anxiety, and the Behavioral Inhibition System/Behavioral Approach System Scale, and the Internet game usage patterns.

RESULTS

The comorbidity group had substantially more severe clinical features such as impulsivity, impaired self-control, and mood symptoms than either IGD or AUD only. Especially the depression scale for the comorbidity group (26.0) is considerably higher than 13.0 for IGD and 16.0 for AUD alone. Furthermore, the comorbidity group spent twice as much money on Internet gaming as IGD alone (all p < .05).

CONCLUSIONS AND SIGNIFICANCE

The findings of this study indicate that the comorbidity between IGD with AUD showed more severe psychopathological impairments, and the respective persons spent more money on gaming than either IGD or AUD alone. These particular characteristics may serve as feasible therapeutic targets in clinical settings. (Am J Addict 2017;26:326-334).

Neural correlate of Internet use in patients undergoing psychological treatment for Internet addiction

BACKGROUND

The new version of Diagnostic and Statistical Manual of Mental Disorders (DSM-5th) proposed the Internet Gaming Disorder for the diagnosis of Internet addiction (IA) considering the neurobiological evidence of the craving.

AIMS

The aim was to test the neural correlate in response to the Internet cue in patients with IA.

METHODS

Sixteen males with IA diagnosis (clinical group) and 14 healthy male (control group) were recruited for an experimental visual task composed of Internet images and emotional images. During the visual presentation of Internet cue, electroencefalographic data were recorded using Net Station 4.5.1 with a 256-channels HydroCel Geodesic Sensor Net. Event-related potential (ERP) components and low-resolution electromagnetic tomography (sLoreta) were analysed.

RESULTS

sLoreta analyses showed that patients from the clinical group presented a higher primary somatosensorial cortex and lower paralimbic, temporal and orbito-frontal activation in response to both Internet and emotional images compared to those of the control group.

CONCLUSIONS

These results suggest that clinically recognized pathological use of Internet could be linked to dissociative symptoms.

An Update Overview on Brain Imaging Studies of Internet Gaming Disorder

There are a growing number of studies on structural and functional brain mechanisms underlying Internet gaming disorder (IGD). Recent functional magnetic resonance imaging studies showed that IGD adolescents and adults had reduced gray matter volume in regions associated with attention motor coordination executive function and perception. Adolescents with IGD showed lower white matter (WM) integrity measures in several brain regions that are involved in decision-making, behavioral inhibition, and emotional regulation. IGD adolescents had also disruption in the functional connectivity in areas responsible for learning memory and executive function, processing of auditory, visual, and somatosensory stimuli and relay of sensory and motor signals. IGD adolescents also had decreased functional connectivity of PFC-striatal circuits, increased risk-taking choices, and impaired ability to control their impulses similar to other impulse control disorders. Recent studies indicated that altered executive control mechanisms in attention deficit hyperactivity disorder (ADHD) would be a predisposition for developing IGD. Finally, patients with IGD have also shown an increased functional connectivity of several executive control brain regions that may related to comorbidity with ADHD and depression. The behavioral addiction model argues that IGD shows the features of excessive use despite adverse consequences, withdrawal phenomena, and tolerance that characterize substance use disorders. The evidence supports the behavioral addiction model of IGD by showing structural and functional changes in the mechanisms of reward and craving (but not withdrawal) in IGD. Future studies need to investigate WM density and functional connectivity in IGD in order to validate these findings. Furthermore, more research is required about the similarity in neurochemical and neurocognitive brain circuits in IGD and comorbid conditions such as ADHD and depression.

Internet addiction and self-evaluated attention-deficit hyperactivity disorder traits among Japanese college students

AIM

Internet addiction (IA), also referred to as Internet use disorder, is a serious problem all over the world, especially in Asian countries. Severe IA in students may be linked to academic failure, attention-deficit hyperactivity disorder (ADHD), and forms of social withdrawal, such as hikikomori. In this study, we performed a survey to investigate the relation between IA and ADHD symptoms among college students.

METHODS

Severity of IA and ADHD traits was assessed by self-report scales. Subjects were 403 college students (response rate 78%) who completed a questionnaire including Young's Internet Addiction Test (IAT) and the Adult ADHD Self-Report Scale-V1.1.

RESULTS

Out of 403 subjects, 165 were male. The mean age was 18.4 ± 1.2 years, and mean total IAT score was 45.2 ± 12.6. One hundred forty-eight respondents (36.7%) were average Internet users (IAT < 40), 240 (59.6%) had possible addiction (IAT 40-69), and 15 (3.7%) had severe addiction (IAT ≥ 70). Mean length of Internet use was 4.1 ± 2.8 h/day on weekdays and 5.9 ± 3.7 h/day on the weekend. Females used the Internet mainly for social networking services while males preferred online games. Students with a positive ADHD screen scored significantly higher on the IAT than those negative for ADHD screen (50.2 ± 12.9 vs 43.3 ± 12.0).

CONCLUSION

Our results suggest that Internet misuse may be related to ADHD traits among Japanese youth. Further investigation of the links between IA and ADHD is warranted.

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.