Internet Gaming Disorder as a formative construct: Implications for conceptualization and measurement.

Some people have serious problems controlling their Internet and video game use. The DSM-5 now includes a proposal for 'Internet Gaming Disorder' (IGD) as a condition in need of further study. Various studies aim to validate the proposed diagnostic criteria for IGD and multiple new scales have been introduced that cover the suggested criteria. Using a structured approach, we demonstrate that IGD might be better interpreted as a formative construct, as opposed to the current practice of conceptualizing it as a reflective construct. Incorrectly approaching a formative construct as a reflective one causes serious problems in scale development, including: (i) incorrect reliance on item-to-total scale correlation to exclude items and incorrectly relying on indices of inter-item reliability that do not fit the measurement model (e.g., Cronbach's α); (ii) incorrect interpretation of composite or mean scores that assume all items are equal in contributing value to a sum score; and (iii) biased estimation of model parameters in statistical models. We show that these issues are impacting current validation efforts through two recent examples. A reinterpretation of IGD as a formative construct has broad consequences for current validation efforts and provides opportunities to reanalyze existing data. We discuss three broad implications for current research: (i) composite latent constructs should be defined and used in models; (ii) item exclusion and selection should not rely on item-to-total scale correlations; and (iii) existing definitions of IGD should be enriched further.

Mapping attention during gameplay: Assessment of behavioral and ERP markers in an auditory oddball task.

Video games are enjoyed most when the level and speed of the game match the players' skills. An optimal balance between challenges and skills triggers the subjective experience of "flow," a focused motivation leading to a feeling of spontaneous joy. The present research investigates the behavioral and neural correlates of a paradigm aimed to assess the players' subjective experience during gameplay. Attentional engagement changes were assessed first at the behavioral level and in a second stage by means of EEG recordings. An auditory novelty oddball paradigm was implemented as a secondary task while subjects played in three conditions: boredom, frustration, and flow. We found higher reaction times and error rates in the flow condition. In a second stage, EEG time domain analysis revealed a significantly delayed response-locked frontocentral negative deflection during flow, likely signaling the reallocation of attentional resources. Source reconstruction analyses showed that the brain regions responsible for the genesis of this negativity were located within the medial frontal cortex. Frequency domain analyses showed a significant power increase only in the alpha band for the flow condition. Our results showed that this alpha power enhancement was correlated with faster reaction times. This suggests that frontal alpha changes recorded as maximal at the midfrontal lines during flow might be related to inhibitory top-down cognitive control processes.

Gamified Cognitive Control Training for Remitted Depressed Individuals: User Requirements Analysis.

BACKGROUND: The high incidence and relapse rates of major depressive disorder demand novel treatment options. Standard treatments (psychotherapy, medication) usually do not target cognitive control impairments, although these seem to play a crucial role in achieving stable remission. The urgent need for treatment combined with poor availability of adequate psychological interventions has instigated a shift toward internet interventions. Numerous computerized programs have been developed that can be presented online and offline. However, their uptake and adherence are oftentimes low. OBJECTIVE: The aim of this study was to perform a user requirements analysis for an internet-based training targeting cognitive control. This training focuses on ameliorating cognitive control impairments, as these are still present during remission and can be a risk factor for relapse. To facilitate uptake of and adherence to this intervention, a qualitative user requirements analysis was conducted to map mandatory and desirable requirements. METHODS: We conducted a user requirements analysis through a focus group with 5 remitted depressed individuals and individual interviews with 6 mental health care professionals. All qualitative data were transcribed and examined using a thematic analytic approach. RESULTS: Results showed mandatory requirements for the remitted sample in terms of training configuration, technological and personal factors, and desirable requirements regarding knowledge and enjoyment. Furthermore, knowledge and therapeutic benefits were key requirements for therapists. CONCLUSIONS: The identified requirements provide useful information to be integrated in interventions targeting cognitive control in depression.

A weak scientific basis for gaming disorder: Let us err on the side of caution.

We greatly appreciate the care and thought that is evident in the 10 commentaries that discuss our debate paper, the majority of which argued in favor of a formalized ICD-11 gaming disorder. We agree that there are some people whose play of video games is related to life problems. We believe that understanding this population and the nature and severity of the problems they experience should be a focus area for future research. However, moving from research construct to formal disorder requires a much stronger evidence base than we currently have. The burden of evidence and the clinical utility should be extremely high, because there is a genuine risk of abuse of diagnoses. We provide suggestions about the level of evidence that might be required: transparent and preregistered studies, a better demarcation of the subject area that includes a rationale for focusing on gaming particularly versus a more general behavioral addictions concept, the exploration of non-addiction approaches, and the unbiased exploration of clinical approaches that treat potentially underlying issues, such as depressive mood or social anxiety first. We acknowledge there could be benefits to formalizing gaming disorder, many of which were highlighted by colleagues in their commentaries, but we think they do not yet outweigh the wider societal and public health risks involved. Given the gravity of diagnostic classification and its wider societal impact, we urge our colleagues at the WHO to err on the side of caution for now and postpone the formalization.

Effect of video lag on laparoscopic surgery: correlation between performance and usability at low latencies.

BACKGROUND: Few telesurgery studies assess the impact of latency on user experience, low latencies are often not studied despite evidence of negative effects, and some studies recruit inexperienced subjects instead of surgeons without evidence that latency affects both groups similarly. METHODS: Fifteen trainees and fourteen laparoscopic surgeons conducted two tasks on a laparoscopy home-trainer at six latencies below 200 milliseconds (ms). Completion time and usability (perceived awareness of latency, inefficiency, disturbance, adaptability, and impact on patient safety) were measured. RESULTS: Weak correlation between completion time and usability was found. There was significant deterioration in performance and user experience at 105 ms added latency. Surgeons were more negatively affected. CONCLUSION: Objective measures insufficiently describe the impact of latency therefore standard measures of user experience should be incorporated in studies. Even low latencies may be detrimental to laparoscopic surgery. Results from non-experts cannot predict the impact of latency on experienced surgeons. Copyright © 2016 John Wiley & Sons, Ltd.

Scholars' open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal.

Concerns about problematic gaming behaviors deserve our full attention. However, we claim that it is far from clear that these problems can or should be attributed to a new disorder. The empirical basis for a Gaming Disorder proposal, such as in the new ICD-11, suffers from fundamental issues. Our main concerns are the low quality of the research base, the fact that the current operationalization leans too heavily on substance use and gambling criteria, and the lack of consensus on symptomatology and assessment of problematic gaming. The act of formalizing this disorder, even as a proposal, has negative medical, scientific, public-health, societal, and human rights fallout that should be considered. Of particular concern are moral panics around the harm of video gaming. They might result in premature application of diagnosis in the medical community and the treatment of abundant false-positive cases, especially for children and adolescents. Second, research will be locked into a confirmatory approach, rather than an exploration of the boundaries of normal versus pathological. Third, the healthy majority of gamers will be affected negatively. We expect that the premature inclusion of Gaming Disorder as a diagnosis in ICD-11 will cause significant stigma to the millions of children who play video games as a part of a normal, healthy life. At this point, suggesting formal diagnoses and categories is premature: the ICD-11 proposal for Gaming Disorder should be removed to avoid a waste of public health resources as well as to avoid causing harm to healthy video gamers around the world.

Challenging the other: exploring the role of opponent gender in digital game competition for female players.

Abstract The present study investigated the effect of opponent gender on the game experience of female players. Concretely, it looked into skill perception and player emotions of women in same gender and cross-gender game competition. We set up a 2×2×2 (male vs. female opponent×low vs. high competitive women×lost vs. won game) experimental design in which women were instructed to play against a proclaimed male and female competitor. Unknowingly, however, participants played against an AI, which was configured to produce a winning and a losing condition for each opponent by manipulating difficulty. Results indicated that opponent gender only had an effect on perceived stress, which was higher with male opponents. Moreover, players evaluated their own gaming skills as lower and the skills of presumed male opponents as higher when they thought they were playing against men. Importantly, our results also showed that the above described pattern for self-perceived skills and perceived opponent skills was modulated by trait competitiveness with a larger effect size for low competitive women. Overall, this study illustrates that gender dynamics affect the play experience of women in cross-gender gaming competition. Implications and suggestions for future research are discussed.