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Problematic risk-taking involving emerging technologies: A stakeholder framework to minimize harms

Author(s): Thomas B. Swanton,Alexander Blaszczynski,Cynthia Forlini,Vladan Starčević,Sally M. Gainsbury / Language(s): English Issue: 4/2020

Background and aims: Despite the many benefits of technological advancements, problematic use of emerging technologies may lead to consumers experiencing harms. Substantial problems and behavioral addictions, such as gambling and gaming disorders, are recognized to be related to Internet-based technologies, including the myriad of new devices and platforms available. This review paper seeks to explore problematic risk-taking behaviors involving emerging technologies (e.g., online gambling and gaming, online sexual behaviors, and oversharing of personal information via social networking sites) that have the potential to lead to problematic outcomes for individuals. Results and discussion: Previous research has focused on policy frameworks for responding to specific issues (e.g., online gambling), but a broader framework is needed to address issues as they emerge, given lags in governments and regulators responding to dynamically evolving technological environments. In this paper, key terms and issues involved are identified and discussed. We propose an initial framework for the relative roles and responsibilities of key stakeholder groups involved in addressing these issues (e.g., industry operators, governments and regulators, community groups, researchers, treatment providers, and individual consumers/end users). Conclusion: Multidisciplinary collaboration can facilitate a comprehensive, unified response from all stakeholders that balances individual civil liberties with societal responsibilities and institutional duty of care.

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Personal choice is a nuanced concept – Lessons learned from the gambling field. • Commentary on: Problematic risk-taking involving emerging technologies: A Stakeholder framework to minimize harms (Swanton et al., 2019)

Author(s): David C. Hodgins / Language(s): English Issue: 4/2020

This thoughtful framework to minimize the harm associated with emerging technologies by encouraging collaborations among stakeholders would benefit from adopting the WHO precautionary principle in order to keep public health issues at the core of discussions. It would also be helpful to acknowledge and make transparent the differences in stakeholder priorities, the power differentials among stakeholders, and the importance of institutional duty of care.

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Applying fairness in labeling various types of internet use disorders

Author(s): Jon D. Elhai,Haibo Yang,Jason C. Levine / Language(s): English Issue: 4/2020

We comment on arguments about internet and smartphone use disorders by Montag, Wegmann, Sariyska, Demetrovics, and Brand (2020). Although not currently official diagnoses, we emphasize that for some individuals, excessive internet/smartphone use can have dangerous consequences. We discuss the challenges with ICD-11 codifying only internet gaming as an internet use-related disorder, neglecting other types of excessive internet users. Montag et al.'s approach to classifying a broader range of internet use disorders seems more fair than the current system in aiding individuals needing treatment resources for excessive internet use.

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Two-dimensional taxonomy of internet addiction and assessment of smartphone addiction with diagnostic criteria and mobile apps

Author(s): Yi-Lun Wu,Sheng-Hsuan Lin,Yu-Hsuan Lin / Language(s): English Issue: 4/2020

A recent review by Montag et al. raised a taxonomical argument about internet addiction. We propose a two-dimensional taxonomy of internet addiction by both the device and the content as the solution. For the assessment of smartphone addiction, measurements should be based on functional impairment and validated by diagnostic criteria rather than solely on self-reported questionnaires. We detail the potential of mobile applications (apps) to improve the assessment of smartphone addiction. App-generated indicators could fulfill the unmet need of assessment of smartphone addiction and facilitate future assessment and treatment planning of smartphone addiction.

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Internet use disorders: What's new and what's not?

Author(s): Mark D. Griffiths / Language(s): English Issue: 4/2020

This commentary critiques the recent paper by Montag et al. (2019) and (i) argues that there are a number of issues that are presented as contemporary but have been discussed in the internet addiction literature for over 20 years, (ii) argues that generalized internet use disorder (IUD)/smartphone use disorder (SmUD) and specific IUD/SmUD may mean different things to different scholars, (iii) suggests that online activities that involve content creation often utilize nonmobile devices, and (iv) suggests that there are some potentially problematic online behaviors that are not included as major activities in the proposed in Montag et al.‘s taxonomy of internet-related problematic behaviors.

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Mobile and non-mobile Internet Use Disorder: Specific risks and possible shared Pavlovian conditioning processes

Author(s): Tania Moretta,Shubao Chen,Marc N. Potenza / Language(s): English Issue: 4/2020

This commentary addresses a recent article by Montag et al. (2019) about the relevance of distinguishing between mobile and non-mobile Internet Use Disorder (IUD). In response to the review, we reflect on the clinical relevance of this distinction and, in parallel, we propose some Pavlovian conditioning processes as possible mechanisms underlying different IUDs. We believe that, from a clinical point of view, it is of fundamental importance assessing both specific “forms” of IUDs and the underlying mechanisms that would be shared across different IUDs, like multiple and parallel classes of Pavlovian responses and the influences of Internet cues on Internet-related addictive behaviors that may be influenced by the probability of obtaining Internet rewards.

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Addressing taxonomic challenges for Internet Use Disorders in light of changing technologies and diagnostic classifications

Author(s): Hans-Jürgen Rumpf,Dillon T. Browne,Dominique Brandt,Florian Rehbein / Language(s): English Issue: 4/2020

Drawing a distinction between mobile and non-mobile Internet Use Disorders is an important step to clarify blurred current concepts in the field of behavioral addictions. Similarly, future technological advances related to virtual or augmented reality, artificial intelligence or the Internet of things might lead to further modifications or new taxonomies. Moreover, diagnostic specifiers like offline/online might change with technological advances and trends of use. An important taxonomical approach might be to look for common structural characteristics of games and applications that will be amenable to new technical developments. Diagnostic and taxonomical approaches based on empirical evidence are important goals in the study of behavioral addictions.

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Work addiction and personality: A meta-analytic study

Author(s): Bernadette Kun,Zsófia Katalin Takács,Mara J. Richman,Mark D. Griffiths,Zsolt Demetrovics / Language(s): English Issue: 4/2020

Background. During the past three decades, research interest in work addiction has increased significantly. Most definitions concerning work addiction have specifically contained personality-related elements. However, the results of empirical studies concerning personality and work addiction are both few and mixed. The aim of the present study was to explore the role of personality in the background of work addiction. Methods. The present study systematically reviewed and empirically carried out a meta-analysis on all the published studies examining the association between personality variables and work addiction (n = 28). Results. The results of the meta-analysis indicated that perfectionism, global and performance-based self-esteem, and negative affect had the strongest and most robust associations as personality risk factors of work addiction. Among the Big Five traits, extraversion, conscientiousness, and intellect/imaginations showed positive relationships with work addiction. However, these associations were weak. Conclusions. Based on the meta-analysis, personality appears to explain only a small amount of the variance of work addiction and further studies are needed to assess the interaction between individual and environmental factors.

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A daily diary investigation on the job-related affective experiences fueled by work addiction

Author(s): Cristian Balducci,Paola Spagnoli,Lorenzo Avanzi,Malissa Clark / Language(s): English Issue: 4/2020

Background and aims. We studied the quality of the job-related emotional experiences associated with work addiction. We hypothesized that work addiction would fuel both a higher level of daily job-related negative affect and a lower level of daily job-related positive affect and that such affective experiences would mediate the relationship between work addiction and emotional exhaustion reported at the end of the working day. Additionally, in light of typical behaviors and cognitions associated with work addiction, we also hypothesized that work addiction would modify the relationships between day workload and same day emotional strain reactions (i.e., job-related negative affect and job-related positive affect). Methods. Participants were 213 workers (42.5% female), most of whom holding a high-profile job position, who were followed for 10 consecutive working days in the context of a daily diary study. Results. Multilevel analyses controlling for neuroticism revealed that work addiction was uniquely and positively related to daily job-related negative affect and that the latter mediated the relationship between work addiction and daily emotional exhaustion. On the other hand, work addiction was not negatively related to daily job-related positive affect; this relationship emerged only when removing neuroticism from the model. Additionally, work addiction strengthened the relationship between day workload and day job-related negative affect. Discussion. Results indicate that work addicted are characterized by the experience of a negatively connotated affect during work, and that this kind of affect may be a mechanism explaining the work addiction-burnout relationship.

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Treatment outcomes of a CBT-based group intervention for adolescents with Internet use disorders

Author(s): Carolin SZÁSZ-JANOCHA,Eva Vonderlin,Katajun LINDENBERG / Language(s): English Issue: 4/2020

Background and aims. Instances of Internet use disorders (IUD) including Internet gaming disorder (IGD) and non-gaming pathological Internet use (ng-PIU) have the extent that they are now a growing mental health issue. Individuals suffering from IUD show a large range of symptoms, high comorbidities and impairments in different areas of life. To date there is a lack of efficient and evidence-based treatment programs for such adolescents. The present registered single-arm trial (Clinical Trials.gov: NCT03582839) aimed to investigate the long-term effects of a brief manualized cognitive behavioral therapy (CBT) program for adolescents with IUD. Methods. N = 54 patients (16.7% female), aged 9–19 years (M = 13.48, SD = 1.72) received the CBT group program PROTECT+. IUD symptom severity (primary outcome variable) as well as comorbid symptoms, risk-related variables and potentially protective skills (secondary outcome variables) were assessed at pretest, posttest, as well as 4 and 12 months after admission. Results. Patients showed a significant reduction in IUD symptom severity at the 12-month follow-up. Effect sizes were medium to large depending on the measure. Beyond the statistical significance, the clinical significance was confirmed using the reliable change index. Secondary outcome variables showed a significant reduction in self-reported depression, social anxiety, performance anxiety and school anxiety as well as in parental-reported general psychopathology. Discussion and conclusions. The present study shows long-term effects of a manual-based CBT treatment for adolescents suffering from IUD. The results indicate that even a 4-session brief intervention can achieve a medium to large effect over 12 months. Future work is needed to confirm the efficacy within a randomized controlled trial (RCT).

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The role of inhibitory control and decision-making in the course of Internet gaming disorder

Author(s): Anja Kräplin,Stefan Scherbaum,Eva-Maria Kraft,Florian Rehbein,Gerhard Bühringer,Thomas Goschke,Thomas Mößle / Language(s): English Issue: 4/2020

Background and aims. Internet gaming disorder (IGD) is associated with impaired inhibitory control and more impulsive decision-making. However, it remains unclear whether these associations are cross-sectional or predictive. We aimed to test the hypotheses that lower inhibitory control and more impulsive decision-making correlate with, are predicted by and predict more time spent on gaming and higher IGD severity. Methods. A stratified convenience sample of 70 male participants (18–21 years) was recruited to achieve broad data variability for hours spent on gaming and IGD severity. In three annual assessments (T1, T2, T3), we measured gaming behaviour and IGD severity using the Video Game Dependency Scale (CSAS-II). Both gaming-related measures were correlates (T1), predictors (T2), or outcomes (T3) of inhibitory control and decision making, which were assessed at T2 using a go/no-go task and an intertemporal-choice task, respectively. Results. Higher IGD severity at T1 predicted more impulsive decision-making at T2 (β = 0.45, 95% CI = 0.14–0.76). Lower inhibitory control at T2 predicted more hours spent on gaming at T3 (β = −0.13, 95% CI = −0.25 to −0.02). We found weak or no evidence for the other associations. Discussion and conclusions. Lower inhibitory control predicts more time spent gaming, possibly due to insufficient top-down regulation of the behaviour. Impulsive decision-making is rather a consequence of IGD than a predictor, which may be due to altered reward learning. One-dimensional etiological assumptions about the relationship between neurocognitive impairments and IGD seem not to be appropriate for the complexity of the disorder.

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Mediating effects of rumination and bedtime procrastination on the relationship between Internet addiction and poor sleep quality

Author(s): Zhiqi You,Weijie Mei,Na Ye,Lu Zhang,Frank Andrasik / Language(s): English Issue: 4/2020

Background and aims. Numerous studies have shown that people who have Internet addiction (IA) are more likely to experience poor sleep quality than people who do not. However, few studies have explored mechanisms underlying the relation between IA and poor sleep quality. As a first attempt to address this knowledge gap, a cross-sectional design was applied, and structural equation modeling was used to explore the direct relationship between IA and poor sleep quality, as well as the potential mediating roles of rumination and bedtime procrastination. Methods. A convenience sample, consisting of 1,104 Chinese University students (696 females or 63%), completed an online survey that included the following measures: Young’s 8-item Internet Addiction Diagnosis Questionnaire, the Pittsburgh Sleep Quality Index, the Ruminative Responses Scale, and the Bedtime Procrastination Scale. Results. While the direct path between IA and poor sleep quality was not found to be significant, rumination and bedtime procrastination were each shown to separately mediate the predictive effect of IA on poor sleep quality. However, the greatest level of support was found for the sequential mediating effects of rumination and bedtime procrastination between IA and poor sleep quality. Conclusion. While rumination and bedtime procrastination were both shown to be important independent mediators for the relation between IA and poor sleep quality, their combined effect was as great as either alone.

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A network analysis of problematic smartphone use symptoms in a student sample

Author(s): Shunsen Huang,Xiaoxiong Lai,Ye Xue,Cai Zhang,Yun Wang / Language(s): English Issue: 4/2020

Background and aims. Previous research has established risk factors for problematic smartphone use (PSU), but few studies to date have explored the structure of PSU symptoms. This study capitalizes on network analysis to identify the core symptoms of PSU in a large sample of students. Methods. This research investigated 26,950 grade 4 students (male = 13,271) and 11,687 grade 8 students (male = 5,739) using the smartphone addiction proneness scale (SAPS). The collected data were analyzed using a network analysis method, which can provide centrality indexes to determine the core symptoms of PSU. The two networks from the different groups were compared using a permutation test. Results. The results indicated that the core symptoms of students' problematic smartphone use were the loss of control and continued excessive use across the two samples. Discussion and conclusions. These findings suggest that loss of control is a key feature of problematic smartphone use. The results also provide some evidence relevant to previous research from the perspective of network analysis and some suggestions for future treatment or prevention of students' problematic smartphone use.

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Gambling disorder is associated with reduced sensitivity to expected value during risky choice

Author(s): Eve H. Limbrick-Oldfield,Mariya V. Cherkasova,Dawn Kennedy,Caylee-Britt Goshko,Dale Griffin,Jason J.S. Barton,Luke Clark / Language(s): English Issue: 4/2020

Background and aims. Individuals with gambling disorder display increased levels of risk-taking, but it is not known if it is associated with an altered subjective valuation of gains and/or losses, perception of their probabilities, or integration of these sources of information into expected value. Methods. Participants with gambling disorder (n = 48) were compared with a healthy comparison group (n = 35) on a two-choice lottery task that involved either gains-only or losses-only gambles. On each trial, two lotteries were displayed, showing the associated probability and magnitude of the possible outcome for each. On each trial, participants chose one of the two lotteries, and the outcome was revealed. Results. Choice behaviour was highly sensitive to the expected value of the two gambles in both the gain and loss domains. This sensitivity to expected value was attenuated in the group with gambling disorder. The group with gambling disorder used both probability and magnitude information less, and this impairment was greater for probability information. By contrast, they used prior feedback (win vs loss) to inform their next choice, despite the independence of each trial. Within the gambling disorder group, problem gambling severity and trait gambling-related cognitions independently predicted reduced sensitivity to expected value. The majority of observed effects were consistent across both gain and loss domains. Discussion and Conclusions. Our results provide a thorough characterization of decision processes in gain and loss domains in gambling disorder, and place these problems in the context of theoretical constructs from behavioural economics.

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Different cultures, similar daydream addiction? An examination of the cross-cultural measurement equivalence of the Maladaptive Daydreaming Scale

Author(s): Nirit Soffer-Dudek,Eli Somer,Hisham M. Abu-Rayya,Barış Metin,Adriano Schimmenti / Language(s): English Issue: 4/2020

Background and aims. Maladaptive Daydreaming (MD) is a proposed mental disorder, in which absorption in rich, narrative fantasy becomes addictive and compulsive, resulting in emotional, social, vocational, or academic dysfunction. Most studies on MD were carried out on aggregated international samples, using translated versions of the Maladaptive Daydreaming Scale (MDS-16). However, it is unknown whether the properties of MD are affected by culture. Thus, we investigated the cross-cultural measurement invariance of the MDS-16. Methods. We recruited both individuals self-identified as suffering from MD and non-clinical community participants from four countries: the USA, Italy, Turkey, and the UK (N = 1,081). Results. Configural invariance was shown, suggesting that the hypothesized four-factor structure of the MDS-16 (including Yearning, Impairment, Kinesthesia, and Music) holds across cultures. Metric invariance was shown for Impairment, Kinesthesia, and Music, but not for Yearning, suggesting that the psychological meaning of the latter factor may be understood differently across cultures. Scalar invariance was not found, as MD levels were higher in the USA and UK, probably due to the over-representation of English-speaking members of MD communities, who volunteered for the study. Discussion and conclusions. We conclude that the urge to be absorbed in daydreaming and the fantasies’ comforting and addictive properties may have different meanings across countries, but the interference of MD to one’s daily life and its obstruction of long-term goals may be the central defining factor of MD.

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Problematic shopping and self-injurious behaviors in adolescents

Author(s): Norman R. Greenberg,Zu Wei Zhai,Rani A. Hoff,Suchitra Krishnan-Sarin,Marc N. Potenza / Language(s): English Issue: 4/2020

Background and aims. Self-injurious behaviors (SIBs) and problematic shopping (PS) are both prevalent in adolescents. These behaviors have been proposed as behavioral addictions and linked to impulsivity (Imp) and sensation-seeking (SS). They are also associated with negative mental health and psychosocial measures. This study examined relationships between PS and SIB in adolescents. It also examined how PS and SIB relate to Imp and SS, and interactions between PS and SIB in relation to health/functioning measures. Methods. Survey data from 2,624 Connecticut high-school students were evaluated using chi-square analyses. Next, logistic regression models were used to assess relationships between PS and measures of SIB. T-tests compared Imp and SS in adolescents with and without PS and SIB. Interaction analyses assessed effects of PS on relationships between SIB and health/functioning measures. Results. Adolescents with PS had 3.43-fold higher odds of endorsing lifetime SIB than those without PS, and were more likely to exhibit severe SIB and disruption due to SIB. PS and SIB were associated with elevated Imp and SS. Interaction analyses revealed that in adolescents with PS, the relationships between SIB and substance use was weaker than in adolescents without PS. This suggests PS accounts for variance in relationships between SIB and substance use. Discussion and conclusions. PS is strongly related to SIB prevalence, severity, and impairment in adolescents, and weakens associations between SIB and substance use. PS should therefore be considered for prevention efforts for SIB. Further research should investigate mechanisms connecting PS and SIB and explore possible interventions targeting associated features like Imp and SS.

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Eating disorder characteristics among Hungarian medical students: Changes between 1989 and 2011

Author(s): Ferenc Tury,Pál Szabó,Szilvia Dukay-Szabó,Irena Szumska,Dávid Simon,Günther Rathner / Language(s): English Issue: 4/2020

Background and aims. There are contradictory findings on time changes in the prevalence of eating disorders (EDs). The first epidemiological studies in Hungary were carried out in the late 1980s. The objective of the present study was to follow the changes in the prevalence of EDs in medical students after a period of 22 years. Methods. A questionnaire survey was conducted in 1989 and in 2010. The sample comprised medical students: 538 subjects (248 males and 290 females) in 1989 and 969 subjects (261 males and 708 females) in 2010. The questionnaire contained sociodemographic and anthropometric items, the Eating Behaviour Severity Scale, the General Health Questionnaire, the Anorexia Nervosa Inventory for Self-Rating, and the Eating Disorder Inventory (EDI). In the second wave, three subscales of the EDI-2 and the SCOFF questionnaire were added. Results. Current and desired body mass index were significantly higher in the second study. Binge eating at least once a week was reported less frequently (2.7% vs 6.8% in males, 6.1% vs 13% in females) in 2010. The proportion of subclinical anorexia nervosa was higher among females in 2011 (2.5% vs 0.3%, P < 0.01). Among males, the proportion of counterregulatory behaviours increased significantly (from 8.9 to 14.6%). Discussion and conclusions. The increase of the proportion of subclinical anorexia nervosa and that of male EDs may relate to the importance of the changes in the sociocultural background. Further representative studies are proposed in other countries of Central and Eastern Europe among medical students and in the general population.

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A pilot study of mindfulness-based relapse prevention for compulsive sexual behaviour disorder

Author(s): Paweł Holas,Małgorzata Draps,Ewelina Kowalewska,Karol Lewczuk,Mateusz Gola / Language(s): English Issue: 4/2020

Compulsive sexual behaviour disorder (CSBD) is a medical condition that can impair social and occupational functioning and lead to severe distress. To date, treatment effectiveness studies of CSBD are under-developed; typically, treatment for CSBD is based on guidelines for substance or other behavioural addictions. Mindfulness-based relapse prevention (MBRP) is an evidence-based treatment for substance addiction aimed at, among other things, reducing craving and negative affect—i.e. processes that are implicated in the maintenance of problematic sexual behaviours. However, to our knowledge no prior research has been published evaluating mindfulness-based intervention (MBI) in the treatment of CSBD, except two clinical case reports. Therefore, the aim of the current pilot study was to examine whether MBRP can lead to clinical improvement in CSBD. Methods: Participants were 13 adult males with a diagnosis of CSBD. Before and after the eight-week MBRP intervention, participants completed a booklet of questionnaires including measurements of porn viewing, masturbation and emotional distress. Results: As expected, we found that after MBRP participants spent significantly less time engaging in problematic pornography use and exhibited a decrease in anxiety, depression and obsessive-compulsive (OC) symptoms. Discussion and Conclusions: The findings indicate that MBRP could be beneficial for CSBD individuals. Further clinical effectiveness studies with bigger sample sizes, delayed post-training measurements and randomised control trial design are warranted. In conclusion, MBRP leads to a decrease in time spent watching porn and a decrease in emotional distress in CSBD patients.

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The prevalence of loyalty program use and its association with higher risk gambling in Australia

Author(s): Paul H. Delfabbro,Daniel L. King / Language(s): English Issue: 4/2020

Background and aims. Loyalty programs are implemented widely by gambling operators to provide customers with additional prizes and benefits for consistent patronage. The aim of this paper was to examine whether loyalty programs were more commonly reported by higher risk gamblers in large population studies conducted in Australia. Method. This paper examines the prevalence of loyalty program use and the association with problem gambling in Australia using data from seven out of 13 public gambling prevalence surveys conducted over the last decade. Results. Evidence drawn from six of these seven studies showed consistent positive association between loyalty card use and higher risk gambling in venue-based gamblers. At least 40% of problem gamblers reported loyalty card use compared with only around 10% of gamblers in general. Discussion. These observations suggest that there is a need to conduct more focused investigations on the utilisation of loyalty programs by higher risk gamblers. Conclusions. It will be important to examine whether loyalty programs encourage or extend gambling sessions, but also how they can be used to facilitate responsible gambling initiatives and inform further behavioural research.

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Substitute addictions in the context of the COVID-19 pandemic

Author(s): Deborah Louise Sinclair,Wouter Vanderplasschen,Shazly Savahl,Maria Florence,David Best,Steve Sussman / Language(s): English Issue: 4/2020

The global spread of COVID-19, subsequent stay-at-home requirements, spatial distancing measures, and long-term isolation present additional challenges for persons in recovery. Using an illustrative case from South Africa, we discuss COVID-19 related pornography use through the lens of relapse and substitute addiction. South Africa is the epicenter of the pandemic in Africa, and has issued an alcohol and cigarette ban. Historical examples suggest that responses to forced abstinence may include compliance and abstinence, but also seeking alternatives to the original addiction and substitution. Substitution of alternative activities/objects may provide similar appetitive effects to fill the void of the terminated addictive behavior, temporarily or in the long-term. While substitutes do not necessarily portend a relapse, coupled with isolation and reduced recovery support, they can potentiate relapse to the former or ‘new’ addictive behavior. Addiction professionals should be aware of the potential for such negative impacts during and after the COVID-19 pandemic.

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