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Effects of transcranial direct current stimulation on addictive behavior and brain glucose metabolism in problematic online gamers

Author(s): Hyeonseok Jeong,Jin Kyoung Oh,Eun Kyoung Choi,Jooyeon Jamie Im,Sujung Yoon,Helena Knotkova,Marom Bikson,In-Uk Song,Sang Hoon Lee,Yong-An Chung / Language(s): English Issue: 4/2020

Background and aims. Some online gamers may encounter difficulties in controlling their gaming behavior. Previous studies have demonstrated beneficial effects of transcranial direct current stimulation (tDCS) on various kinds of addiction. This study investigated the effects of tDCS on addictive behavior and regional cerebral metabolic rate of glucose (rCMRglu) in problematic online gamers. Methods. Problematic online gamers were randomized and received 12 sessions of either active (n = 13) or sham tDCS (n = 13) to the dorsolateral prefrontal cortex over 4 weeks (anode F3/cathode F4, 2 mA for 30 min, 3 sessions per week). Participants underwent brain 18F-fluoro-2-deoxyglucose positron emission tomography scans and completed questionnaires including the Internet Addiction Test (IAT), Brief Self-Control Scale (BSCS), and Behavioral Inhibition System/Behavioral Activation System scales (BIS/BAS) at the baseline and 4-week follow-up. Results. Significant decreases in time spent on gaming (P = 0.005), BIS (P = 0.03), BAS-fun seeking (P = 0.04), and BAS-reward responsiveness (P = 0.01), and increases in BSCS (P = 0.03) were found in the active tDCS group, while decreases in IAT were shown in both groups (P < 0.001). Group-by-time interaction effects were not significant for these measures. Increases in BSCS scores were correlated with decreases in IAT scores in the active group (β = −0.85, P < 0.001). rCMRglu in the left putamen, pallidum, and insula was increased in the active group compared to the sham group (P for interaction < 0.001). Discussion and conclusions. tDCS may be beneficial for problematic online gaming potentially through changes in self-control, motivation, and striatal/insular metabolism. Further larger studies with longer follow-up period are warranted to confirm our findings.

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Internet gaming as a coping method among schizophrenic patients facing psychological distress

Author(s): Yun-Hsuan Chang,Kun-Chia Chang,Wen-Li Hou,Chung-Ying Lin,Mark D. Griffiths / Language(s): English Issue: 4/2020

Background and aims. Patients with schizophrenia are known to use potentially addictive psychoactive substances as self-medication and to ease psychological distress. Other potentially addictive behaviors such as online gaming are also used to self-medicate and ease psychological distress. However, the role of online gaming and problematic gaming (in the form of internet gaming disorder [IGD]) has not previously been investigated for patients with schizophrenia facing distress. Methods. One hundred and four participants diagnosed with schizophrenia were recruited and completed a number of psychometric scales including the Personal and Social Performance Scale (PSPS), Internet Gaming Disorder Scale-Short Form (IGDS-SF9), Self-Stigma Scale-Short (SSS-S), and Depression, Anxiety, Stress Scale (DASS-21). Results. The results showed significant negative associations between PSPS, IGDS-SF9, and DASS-21, and significant positive correlations between the IGDS-SF-9, SSS-S and DASS-21. Moreover, IGD did not mediate the association between self-stigma and depression. However, IGD significantly mediated the association between self-stigma and anxiety, and the association between self-stigma and stress. In addition, (i) age and self-stigma were significant predictors for IGD; (ii) social function and self-stigma were significant predictors for depression; (iii) social function, self-stigma, and IGD were significant predictors for anxiety; and (iv) self-stigma and IGD were significant predictors for stress. Conclusion. The findings suggest that online gaming may be a coping strategy for individuals with schizophrenia with psychological stress and self-stigma and that for some of these individuals, their gaming may be problematic.

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Comment on: Problematic online gaming and the COVID-19 pandemic – The role of exergames

Author(s): Ricardo B. Viana,Rodrigo L. Vancini,Wellington F Silva,Naiane S. Morais,Vinnycius N. de Oliveira,Marília S. Andrade,Claudio A. B. de Lira / Language(s): English Issue: 1/2021

Although significant increases in gaming may not always be beneficial, exergames (a new generation of video games also known as exergaming or active video games) appear as an alternative, feasible, attractive, and safe way to perform physical exercise for most clinical and nonclinical populations. Therefore, it is important to recognize that exergames can be considered a useful tool for coping with the COVID-19 outbreak and the recommended social distancing period.

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Theoretical conceptualisations of problematic exercise in psychometric assessment instruments: A systematic review

Author(s): Álvaro Sicilia,Adrian Paterna,Manuel Alcaraz-Ibáñez,Mark D. Griffiths / Language(s): English Issue: 1/2021

Background and aims: The aim of the present systematic review was to identify psychometric tools developed to assess problematic exercise in order to identify and compare their theoretical conceptualisations on which they are based. Methods: A systematic literature search was conducted in the electronic databases Web of Science, Scielo, PsychINFO, PsycTEST and SCOPUS from their inception to January 2020. Results: Seventeen assessment instruments met the eligibility criteria to be included in the present review. The instruments were classified according to their conceptualisation into five groups: (i) problematic exercise as an end of an exercise continuum, (ii) problematic exercise as a means of regulating body size and weight, (iii) problematic exercise as dependence, (iv) problematic exercise as a behavioural addiction and (v) no clear conceptualisation. Discussion: The results suggest that the conceptualisations of the assessment instruments have resulted in a strong dichotomy in relation to the primary or secondary character of the problematic exercise that might be limiting the capacity of the instruments to adequately capture the multidimensionality of this construct. Conclusions: Given the interest in understanding the complexity surrounding the problematic exercise, future research should develop more comprehensive definitions of this construct. This would allow a greater conceptual consensus to be reached that would allow progress to be made in the study of the problematic exercise.

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The identification of Australian low-risk gambling limits: A comparison of gambling-related harm measures

Author(s): Nicki A. Dowling,Christopher J. Greenwood,Stephanie S. Merkouris,George J. Youssef,Matthew Browne,Matthew J. Rockloff,Paul Myers / Language(s): English Issue: 1/2021

Background and aims. Problem gambling severity and gambling-related harm are closely coupled, but conceptually distinct, constructs. The primary aim was to compare low-risk gambling limits when gambling-related harm was defined using the negative consequence items of the Problem Gambling Severity Index (PGSI-Harm) and the Short Gambling Harms Scale items (SGHS-Harm). A secondary aim was compare low-risk limits derived using a definition of harm in which at least two harms across different domains (e.g. financial and relationship) were endorsed with a definition of harm in which at least two harms from any domain were endorsed. Methods. Data were collected from dual-frame computer-assisted telephone interviews of 5,000 respondents in the fourth Social and Economic Impact Study (SEIS) of Gambling in Tasmania. Receiver operating characteristic (ROC) curve analyse were conducted to identify low-risk gambling limits. Results. PGSI-Harm and SGHS-Harm definitions produced similar overall limits: 30–37 times per year; AUD$510–$544 per year; expenditure comprising no more than 10.2–10.3% of gross personal income; 400–454 minutes per year; and 2 types of gambling activities per year. Acceptable limits (AUC ≥0.70) were identified for horse/dog racing, keno, and sports/other betting using the PGSI definition; and electronic gaming machines, keno, and bingo using the SGHS definition. The requirement that gamblers endorse two or more harms across different domains had a relatively negligible effect. Discussion and conclusions. Although replications using alternative measures of harm are required, previous PGSI-based limits appear to be robust thresholds that have considerable potential utility in the prevention of gambling-related harm.

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Young people who purchase loot boxes are more likely to have gambling problems: An online survey of adolescents and young adults living in NSW Australia

Author(s): Matthew J. Rockloff,Alex M.T. Russell,Nancy Greer,Lisa Lole,Nerilee Hing,Matthew Browne / Language(s): English Issue: 1/2021

Background and aims. Loot boxes are a common feature in video games where players win, buy or are gifted a virtual box or other container that is unwrapped to reveal virtual items of value, such as skins, weapons, in-game currency or special abilities. The current study aimed to relate the use of loot boxes to gambling problems and harm. Methods. An online survey was conducted with 1,954 adolescents and young adults from NSW Australia, 59.9% female (aged 12–24), recruited by online panel aggregator, Qualtrics. Results. Buying and selling loot boxes was associated with higher 12-month gambling frequency and gambling problems in young adults, aged 18–24 (Problem Gambling Severity Index). Young adults who bought loot boxes additionally had more gambling-related harms (Short Gambling Harms Screen). Young women, aged 18–24, who opened, bought and/or sold loot boxes spent more money in the last 12 months on gambling. In adolescents, aged 12–17, buying loot boxes was similarly associated with gambling problems (DSM-IV-MR-J). Furthermore, adolescent girls who bought and/or sold loot boxes viewed gambling more positively than other girls (Attitudes Towards Gambling Scale). There was no evidence, however, that longer-term experience in opening or purchasing loot boxes, a differentiating feature of the survey, is associated with current gambling problems. Discussion and conclusions. This study suggests that loot boxes may be attractive to people who are already predisposed to engage in other gambling, and females who use loot boxes may have unique vulnerabilities to gambling problems that could be explored in future research.

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Five-year follow-up on a sample of gamblers: predictive factors of relapse

Author(s): Marie Grall-Bronnec,Morgane Guillou-Landrea,Lucia Romo,Caroline Dubertret,Irène Codina,Isabelle Chéreau-Boudet,Christophe Lancon,Marc Auriacombe,Jean-Benoit Hardouin,Gaélle Challet-Bouju / Language(s): English Issue: 1/2021

Background and Aims. Few studies have been conducted on the long-term evolution of gambling disorder (GD). The aim of this study was to identify factors that could predict GD relapse. Methods. Data were part of a dataset from a large 5-year cohort of gamblers who were assessed at inclusion and each year thereafter. Participants were recruited from an outpatient addiction treatment center, from various gambling places and through the press. For this specific study, inclusion criteria included (i) transitioning from GD to recovery at a follow-up time and (ii) undergoing at least one follow-up visit afterwards. Participants were evaluated using a structured clinical interview and self-report questionnaires assessing sociodemographic, gambling and clinical characteristics. “Relapse” was defined as the presence of GD (according to the DSM-5) at the N+1th visit following the absence of GD at the Nth visit. A Markov model-based approach was employed to examine predictive factors associated with relapse at a subsequent follow-up visit. Results. The sample consisted of 87 participants, aged 47.6 years (sd = 12.6), who were predominantly male (65%). Among the participants, 49 remained in recovery, whereas 38 relapsed. Participants who reported not having experienced at least one month of abstinence and those with a low level of self-directedness at the previous follow-up visit were more likely to relapse. Conclusions. Our findings suggest the existence of factors that are predictive of relapse in individuals with GD who had previously achieved recovery. These results can inspire the development of measures to promote long-term recovery.

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White matter microstructural and Compulsive Sexual Behaviors Disorder – Diffusion Tensor Imaging study

Author(s): Małgorzata Draps,Natalia Kowalczyk-Grębska,Artur Marchewka,Feng Shi,Mateusz Gola / Language(s): English Issue: 1/2021

Background and aims. Even though the Compulsive Sexual Behavior Disorder (CSBD) was added to the ICD-11 under the impulse control category in 2019, its neural mechanisms are still debated. Researchers have noted its similarity both to addiction and to Obssesive-Compulsive Disorder (OCD). The aim of our study was to address this question by investigating the pattern of anatomical brain abnormalities among CSBD patients. Methods. Reviewing 39 publications on Diffusion Tensor Imaging (DTI) we have identified main abnormalities specific for addictions and OCD. Than we have collected DTI data from 36 heterosexual males diagnosed with CSBD and 31 matched healthy controls. These results were then compared to the addiction and OCD patterns. Results. Compared to controls, CSBD individuals showed significant fractional anisotropy (FA) reduction in the superior corona radiata tract, the internal capsule tract, cerebellar tracts and occipital gyrus white matter. Interestingly, all these regions were also identified in previous studies as shared DTI correlates in both OCD and addiction. Discussion and conclusions. Results of our study suggest that CSBD shares similar pattern of abnormalities with both OCD and addiction. As one of the first DTI study comparing structural brain differences between CSBD, addictions and OCD, although it reveals new aspects of CSBD, it is insufficient to determine whether CSBD resembles more an addiction or OCD. Further research, especially comparing directly individuals with all three disorders may provide more conclusive results.

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Sexual incentive delay in the scanner: Sexual cue and reward processing, and links to problematic porn consumption and sexual motivation

Author(s): Charlotte Markert,Sanja Klein,Jana Strahler,Onno Kruse,Rudolf Stark / Language(s): English Issue: 1/2021

Background and aims. The use of pornography, while unproblematic for the majority, can grow into addiction-like behavior which in its extreme form is labeled as compulsive sexual behavioral disorder in the ICD-11 (WHO, 2018). The aim of this study was to investigate the addiction-specific reactivity to cues in order to better understand underlying mechanisms in the development of this disorder. Methods. We have used an optimized Sexual Incentive Delay Task to study brain activity in reward associated brain areas during an anticipation phase (with cues predicting pornographic videos, control videos or no videos) and a corresponding delivery phase in healthy men. Correlations to indicators of problematic pornography use, the time spent on pornography use, and trait sexual motivation were analyzed. Results. The results of 74 men showed that reward-related brain areas (amygdala, dorsal cingulate cortex, orbitofrontal cortex, nucleus accumbens, thalamus, putamen, caudate nucleus, and insula) were significantly more activated by both the pornographic videos and the pornographic cues than by control videos and control cues, respectively. However, we found no relationship between these activations and indicators of problematic pornography use, time spent on pornography use, or with trait sexual motivation. Discussion and conclusions. The activity in reward-related brain areas to both visual sexual stimuli as well as cues indicates that optimization of the Sexual Incentive Delay Task was successful. Presumably, associations between reward-related brain activity and indicators for problematic or pathological pornography use might only occur in samples with increased levels and not in a rather healthy sample used in the present study.

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

Author(s): Anna Heuer,Manuel Mennig,Anna Schubö,Antonia Barke / Language(s): English Issue: 1/2021

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.

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Differences in resting-state functional connectivity according to the level of impulsiveness in patients with internet gaming disorder

Author(s): Soo-Jeong Kim,Min-Kyeong Kim,Yu-Bin Shin,Hesun Erin Kim,Jun Hee Kwon,Jae-Jin Kim / Language(s): English Issue: 1/2021

Background and aims. Impulsiveness is an important factor in the pathophysiology of Internet gaming disorder (IGD), and regional brain functions can be different depending on the level of impulsiveness. This study aimed to demonstrate that different brain mechanisms are involved depending on the level of impulsiveness among patients with IGD. Methods. Resting-state functional MRI data were obtained from 23 IGD patients with high impulsivity, 27 IGD patients with low impulsivity, and 22 healthy controls, and seed-based functional connectivity was compared among the three groups. The seed regions were the ventromedial prefrontal cortex (vmPFC), dorsolateral prefrontal cortex, nucleus accumbens (NAcc), and amygdala. Results. Connectivity of the vmPFC with the left temporo-parietal junction (TPJ) and NAcc-left insula connectivity were significantly decreased in the patients with high impulsivity, compared with the patients with low impulsivity and healthy controls. On the other hand, amygdala-based connectivity with the left inferior frontal gyrus showed decreases in both patient groups, compared with the healthy controls. Conclusion. These findings may suggest a potential relationship between impulsivity and deficits in reward-related social cognition processes in patients with IGD. In particular, certain interventions targeted at vmPFC-TPJ connectivity, found to be impulsivity-specific brain connectivity, are likely to help with addiction recovery among impulsive patients with IGD.

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Enhanced neural responses in specific phases of reward processing in individuals with Internet gaming disorder

Author(s): Lingxiao Wang,Guochun Yang,Ya Zheng,Zhenghan Li,Yue Qi,Qi Li,Xun Liu / Language(s): English Issue: 1/2021

Background and aims. Internet gaming disorder (IGD) has become a global health problem. The self-regulation model noted that a shift to reward system, whether due to overwhelming reward-seeking or impaired control, can lead to self-regulation failures, e.g., addiction. The present study focused on the reward processing of IGD, aiming to provide insights into the etiology of IGD. Reward processing includes three phases: reward anticipation, outcome monitoring and choice evaluation. However, it is not clear which phases of reward processing are different between individuals with IGD and healthy controls (HC). Methods. To address this issue, the present study asked 27 individuals with IGD and 26 HC to complete a roulette task during a functional MRI scan. Results. Compared with HC, individuals with IGD preferred to take risks in pursuit of high rewards behaviorally and showed exaggerated brain activity in the striatum (nucleus accumbens and caudate) during the reward anticipation and outcome monitoring but not during the choice evaluation. Discussion. These results reveal that the oversensitivity of the reward system to potential and positive rewards in college students with IGD drives them to approach risky options more frequently although they are able to assess the risk values of options and the correctness of decisions properly as HC do. Conclusions. These findings provide partial support for the application of the self-regulation model to the IGD population. Moreover, this study enriches this model from the perspective of three phases of reward processing and provides specific targets for future research regarding effective treatment of IGD.

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Altered functional network activities for behavioral adjustments and Bayesian learning in young men with Internet gaming disorder

Author(s): Shan-Shan Ma,Chiang-Shan R. Li,Sheng Zhang,Patrick D. Worhunsky,Nan Zhou,Jin-Tao Zhang,Lu Liu,Yuan-Wei Yao,Xiao-Yi Fang / Language(s): English Issue: 1/2021

Background and aims. Deficits in cognitive control represent a core feature of addiction. Internet Gaming Disorder (IGD) offers an ideal model to study the mechanisms underlying cognitive control deficits in addiction, eliminating the confounding effects of substance use. Studies have reported behavioral and neural deficits in reactive control in IGD, but it remains unclear whether individuals with IGD are compromised in proactive control or behavioral adjustment by learning from the changing contexts. Methods. Here, fMRI data of 21 male young adults with IGD and 21 matched healthy controls (HC) were collected during a stop-signal task. We employed group independent component analysis to investigate group differences in temporally coherent, large-scale functional network activities during post-error slowing, the typical type of behavioral adjustments. We also employed a Bayesian belief model to quantify the trial-by-trial learning of the likelihood of stop signal – P(Stop) – a broader process underlying behavioral adjustment, and identified the alterations in functional network responses to P(Stop). Results. The results showed diminished engagement of the fronto-parietal network during post-error slowing, and weaker activity in the ventral attention and anterior default mode network in response to P(Stop) in IGD relative to HC. Discussion and conclusions. These results add to the literatures by suggesting deficits in updating and anticipating conflicts as well as in behavioral adjustment according to contextual information in individuals with IGD.

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Gender-related differences in frontal-parietal modular segregation and altered effective connectivity in internet gaming disorder

Author(s): Ningning Zeng,Min Wang,Hui Zheng,Jialin Zhang,Haohao Dong,Marc N. Potenza,Guang-Heng Dong / Language(s): English Issue: 1/2021

Background. Although previous studies have revealed gender-related differences in executive function in internet gaming disorder (IGD), neural mechanisms underlying these processes remain unclear, especially in terms of brain networks. Methods. Resting-state fMRI data were collected from 78 subjects with IGD (39 males, 20.8 ± 2.16 years old) and 72 with recreational game use (RGU) (39 males, 21.5 ± 2.56 years old). By utilizing graph theory, we calculated participation coefficients among brain network modules for all participants and analyzed the diagnostic-group-by-gender interactions. We further explored possible causal relationships between networks through spectral dynamic causal modeling (spDCM) to assess differences in between-network connections. Results. Compared to males with RGU, males with IGD demonstrated reduced modular segregation of the frontal-parietal network (FPN). Male IGD subjects also showed increased connections between the FPN and cingulo-opercular network (CON); however, these differences were not found in female subjects. Further spDCM analysis indicated that the causal influence from CON to FPN in male IGD subjects was enhanced relative to that of RGU males, while this influence was relatively reduced in females with IGD. Conclusions. These results suggest poor modular segmentation of the FPN and abnormal FPN/CON connections in males with IGD, suggesting a mechanism for male vulnerability to IGD. An increased “bottom-up” effect from the CON to FPN in male IGD subjects could reflect dysfunction between the brain networks. Different mechanisms may underlie in IGD, suggesting that different interventions may be optimal in males and females with IGD.

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Problematic internet-related behaviors mediate the associations between levels of internet engagement and distress among schoolchildren during COVID-19 lockdown: A longitudinal structural equation modeling study

Author(s): I-Hua Chen,Chao-Ying Chen,Amir H. Pakpour,Mark D. Griffiths,Chung-Ying Lin,Xu-Dong Li / Language(s): English Issue: 1/2021

Background and aims. Due to the rapid spread of the novel coronavirus disease 2019 (COVID-19), policies based on the nature of “spatial distancing” have been implemented and have resulted in school suspensions and online learning among schoolchildren. In order to examine the impact of such policies on schoolchildren, the aims of the present study were to (i) assess changes in the level of engagement in three internet-related activities (smartphone use, social media use, and gaming) before and during the COVID-19 outbreak, including prolonged and problematic engagement in these activities; (ii) investigate the differences of psychological distress before and after COVID-19 outbreak; and (iii) to use structural equation modeling to investigate the mediating roles of problematic internet-related behaviors in the causal relationships of psychological distress and time spent on internet-related activities. Methods. Self-report measures were used to assess internet-related activities and psychological distress. Time spent on internet-related activities, problematic use of internet-related activities, and psychological distress were collected from primary school students (N = 535; 265 boys; M age = 10.32 years [SD = 0.84]). The data were first collected before the COVID-19 outbreak (i.e., early November 2019) and then collected again during the school suspension due to COVID-19 outbreak (i.e., end of March 2020) for comparisons of changes. Results. Schoolchildren spent significantly more time on the smartphone (increased 1.02 h daily; P < 0.001) and social media (increased 0.73 h daily; P < 0.001) but not gaming (increased 0.14 h daily; P = 0.07) during the school suspension compared to the baseline. Schoolchildren who increased by 15 or 30 min daily on internet-related activities showed an increased level of psychological distress. The association between problematic use of social media and psychological distress was stronger during the school suspension (β = 0.584) than at the baseline (β = 0.451; P < 0.001). Conclusion. Increased problematic use of internet-related activities among schoolchildren was associated with greater psychological distress. Parents should therefore monitor internet-related activities and psychological distress of their children to support their mental health.

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Application of the eleventh revision of the International Classification of Diseases gaming disorder criteria to treatment-seeking patients

Author(s): Susumu Higuchi,Hideki Nakayama,Takanobu Matsuzaki,Satoko Mihara,Takashi Kitayuguchi / Language(s): English Issue: 1/2021

The World Health Organization included gaming disorder (GD) in the eleventh revision of International Classification of Diseases in 2019. Due to the lack of diagnostic tools for GD, a definition has not been adequately applied. Therefore, this study aimed to apply an operationalized definition of GD to treatment-seekers. The relationship between the diagnoses of GD and Internet gaming disorder (IGD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders was also examined. Methods: Study participants comprised 241 treatment-seekers who had engaged in excessive gaming and experienced related problems. Psychiatrists applied the GD diagnostic criteria to the participants using a diagnostic form developed for this study. Information on gaming behavior and functional impairment was obtained through face-to-face interviews conducted by clinical psychologists. Results: In total, 78.4 and 83.0% of the participants fulfilled the GD and IGD diagnostic criteria, respectively. The sensitivity and specificity of GD diagnosis were both high when the IGD diagnosis was used as the gold standard. Participants with GD preferred online PC and console games, spent significantly more time gaming, and showed a higher level of functional impairment compared to those who did not fulfill the GD diagnostic criteria. Discussion and Conclusion: The definition of GD can be successfully applied to treatment-seekers with excessive gaming and related problems. A high concordance of GD and IGD diagnoses was found in those participants with relatively severe symptoms. The development and validation of a diagnostic tool for GD should be explored in future studies.

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Assessing ICD-11 gaming disorder in adolescent gamers by parental ratings: Development and validation of the Gaming Disorder Scale for Parents (GADIS-P)

Author(s): Kerstin Paschke,Maria Isabella Austermann,Rainer Thomasius / Language(s): English Issue: 1/2021

Background and aims. The addiction to digital games is associated with substantial impairments in daily functioning and adolescents are particularly at risk. Screening instruments for the new ICD-11 diagnosis Gaming Disorder (GD) are rare and only include self-ratings thus far. Since adolescents' insight might be limited due to young age or symptom denial, external ratings are essential. We therefore aimed to develop and validate the Gaming Disorder Scale for Parents (GADIS-P) in a representative sample of parents and young gamers. Methods. GADIS-P was developed as an adaptation of a recently published self-rating scale. It was validated in 800 parents and their frequently gaming children between 10 and 17 years with standardized questionnaires in an online survey. Item structure was investigated by confirmatory factorial analysis. Gaming time, pathological gaming according to DSM-5, emotional dysregulation, and academic performance were used to derive criterion validity. Accordance with self-ratings was determined. ROC-Analyses were computed to determine cut-off values. Results. A presumed two-factorial structure of GADIS-P could be confirmed describing cognitive-behavioral symptoms and negative consequences. The instrument showed good to excellent internal consistency (Cronbach's α = 0.89–0.92, McDonald's ω = 0.92–0.95) and criterion validity with moderate to strong correlations regarding gaming behavior (r/ϱ = 0.35–0.76), excellent discriminatory power, and moderate accordance with the adolescents' self-ratings (kappa = 0.47–0.58). Discussion and conclusions. As the first successfully validated tool for the assessment of ICD-11 GD in adolescents by parental judgment, GADIS-P can make an important contribution to reliable GD screening in clinical and research settings.

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Depression and anxiety symptoms associated with internet gaming disorder before and during the COVID-19 pandemic: A longitudinal study

Author(s): Zhaojun Teng,Halley M. Pontes,Qian Nie,Mark D. Griffiths,Cheng Guo / Language(s): English Issue: 1/2021

Background. The coronavirus disease-2019 (COVID-19) pandemic has profoundly impacted aspects of human life globally. Playing videogames has been encouraged by several organizations to help individuals cope with the COVID-19 pandemic and associated restrictive measures. This longitudinal study was the first to examine gaming in the context of the pandemic and its association with depressive and anxiety symptoms. Methods. The sample comprised 1,778 children and adolescents (50.7% male) who were part of the Project of School Mental Health in Southwest China. Data were collected at two-time intervals: before the COVID-19 pandemic (October to November 2019 – [T1]) and during the COVID-19 pandemic (April to May 2020 – [T2]). Data were collected on perceived COVID-19 impacts, videogame use, Internet Gaming Disorder (IGD), and depressive and anxiety symptoms. Cross-lagged panel models were computed to examine longitudinal relationships. Results. The results indicated that both videogame use and IGD increased significantly for adolescents at T2. The cross-lagged panel model results suggested that depressive and anxiety symptoms at T1 positively predicted IGD and videogame use at T2 (especially for boys), but not inversely. Perceived COVID-19 impacts mediated the relationship between depressive and anxiety symptoms at T1 and IGD at T2. Conclusion. Children and adolescents both increased videogame use at T2, but only adolescents significantly increased IGD severity at T2. The findings supported the compensatory hypothesis, and are consistent with the Interaction of Person-Affect-Cognition-Execution model as individual responses to COVID-19 may function as a mediator between personal predisposing variables and IGD.

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A test of the pathway model of problematic smartphone use

Author(s): Natale Canale,Tania Moretta,Luca Pancani,Giulia Buodo,Alessio Vieno,Mario Dalmaso,Joël Billieux / Language(s): English Issue: 1/2021

Background and aims. Problematic smartphone use (PSU) has been described as a growing public health issue. In the current study, we aimed to provide a unique and comprehensive test of the pathway model of PSU. This model posits three distinct developmental pathways leading to PSU: (1) the excessive reassurance pathway, (2) the impulsive pathway and (3) the extraversion pathway. Methods. Undergraduate students (n = 795, 69.8% female, mean age = 23.80 years, sd = 3.02) completed online self-report measures of PSU (addictive use, antisocial use and dangerous use) and the psychological features (personality traits and psychopathological symptoms) underlying the three pathways. Results. Bayesian analyses revealed that addictive use is mainly driven by the excessive reassurance pathway and the impulsive pathway, for which candidate etiopathological factors include heightened negative urgency, a hyperactive behavioural inhibition system and symptoms of social anxiety. Dangerous and antisocial use are mainly driven by the impulsive pathway and the extraversion pathway, for which candidate etiopathological factors include specific impulsivity components (lack of premeditation and sensation seeking) and primary psychopathy (inclination to lie, lack of remorse, callousness and manipulativeness). Discussion and conclusions. The present study constitutes the first comprehensive test of the pathway model of PSU. We provide robust and original results regarding the psychological dimensions associated with each of the postulated pathways of PSU, which should be taken into account when considering regulation of smartphone use or tailoring prevention protocols to reduce problematic usage patterns.

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Problematic Internet Use in early adolescence: The role of attachment and negative beliefs about worry

Author(s): Tatiana Marci,Claudia Marino,Chiara Sacchi,Xiaoyu Lan,Marcantonio M. Spada / Language(s): English Issue: 1/2021

Background and aims. Problematic Internet Use (PIU) might be a potential mental health problem. Few studies have investigated the relative contribution of individual and family factors in the development of PIU in early adolescence. The aim of the current study was to model the relationship between attachment styles, negative beliefs about worry, and PIU in early adolescence. Methods. Five hundred and thirty-eight Italian early adolescents (51% females, M age = 12.7 years, SD = 0.87) were included in this study. The pattern of relationships specified by the theoretical model was examined through path analysis. Results. Results showed that avoidance (mother) and anxiety (father) were directly associated with PIU. Anxiety (mother) and avoidance (father) were indirectly associated with PIU via negative beliefs about worry. Discussion and conclusions. Overall, our findings show that attachment toward mother and father are differently linked to PIU and that negative beliefs about worry may play a mediating role in the association between attachment and PIU. Findings are discussed within clinical and preventive implications.

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