Decision making and executive functions in problematic pornography use.

Introduction: Previous research on cognitive functions in Compulsive Sexual Behavior Disorder (CSBD) and problematic pornography use (PPU) reported inconsistent findings and mostly included sexual pictures in the used tasks. The role of general executive functions and cognitive competences (without the presence of appetitive stimuli) in the context of PPU is largely unexplored. Methods: This study investigated differences between individuals with high versus low problem severity of PPU regarding decision making and executive functions. The sample of the laboratory study consisted of N = 102 male adults. Besides measures of trait impulsivity, we used standard neuropsychological tests (Trail Making Test and three-back working memory task) and an intertemporal risky choice paradigm, the Cards & Lottery Task (CLT). Results: The results show heightened impulsivity (urgency and deficits in perseverance) in individuals with high PPU, but no differences regarding performance in the CLT and executive function tasks. Discussion: The findings indicate that PPU might be associated with impulsive behavior when experiencing strong emotions (urgency) and deficient cognitive performance especially in the presence of sexual stimuli but not in general.

Cue-reactivity to distal cues in individuals at risk for gaming disorder.

BACKGROUND: Gaming disorder (GD) is a disorder due to addictive behaviors (ICD-11). Cue-reactivity and craving are relevant mechanisms in the development and maintenance of addictive behaviors. When confronted with cues showing in-game content (proximal cues) individuals with higher symptom severity show increased cue-reactivity. Based on conditioning and addiction theories on incentive sensitization, cue-reactivity responses may generalize to more distal cues, e.g. when individuals at risk of developing a GD are confronted with a starting page of an online game. In cue-reactivity paradigms so far, only proximal gaming cues have been used. METHODS: We investigated the effect of distal gaming cues compared to gaming-unrelated control cues on cue-reactivity and craving in 88 individuals with non-problematic use of online games (nPGU) and 69 individuals at risk for GD (rGD). The distal cues showed the use of an electronic device (e.g., desktop PC or smartphone) whose screen showed starting pages of either games (target cues), shopping- or pornography sites (control cues) from a first-person perspective. FINDINGS: We found significantly higher urge and arousal ratings as well as longer viewing times for gaming-related compared to gaming-unrelated control cues in rGD compared to nPGU. Valence ratings did not differ between groups. INTERPRETATION: The results demonstrate that already distal gaming-specific cues lead to cue-reactivity and craving in rGD. This finding indicates that based on conditioning processes, cue-reactivity and craving develop during the course of GD and generalize to cues that are only moderately related to the specific gaming activity.

Update on treatment studies for compulsive buying-shopping disorder: A systematic review.

Background and aims: Compulsive buying-shopping disorder (CBSD) is mentioned as an example of other specified impulse control disorders in the ICD-11 coding tool, highlighting its clinical relevance and need for treatment. The aim of the present work was to provide a systematic update on treatment studies for CBSD, with a particular focus on online CBSD. Method: The preregistered systematic review (PROSPERO, CRD42021257379) was performed in accordance with the PRISMA 2020 statement. A literature search was conducted using the PubMed, Scopus, Web of Science and PsycInfo databases. Original research published between January 2000 and December 2022 was included. Risk of reporting bias was evaluated with the CONSORT guideline for randomized controlled trials. Effect sizes for primary CBSD outcomes were calculated. Results: Thirteen studies were included (psychotherapy: 2 open, 4 waitlist control design; medication: 2 open, 3 placebo-controlled, 2 open-label phase followed by a double-blind discontinuation phase; participants treatment/control 349/149). None of the studies addressed online CBSD. Psychotherapy studies suggest that group cognitive-behavioral therapy is effective in reducing CBSD symptoms. Pharmacological studies with selective serotonin re-uptake inhibitors or topiramate did not indicate superiority over placebo. Predictors of treatment outcome were rarely examined, mechanisms of change were not studied at all. Risk of reporting bias was high in most studies. Discussion: Poor methodological and low quality of reporting of included studies reduce the reliability of conclusions. There is a lack of studies targeting online CBSD. More high-quality treatment research is needed with more emphasis on the CBSD subtype and mechanisms of change.

A systematic review and meta-analysis of risky decision-making in specific domains of problematic use of the internet: Evidence across different decision-making tasks.

This systematic review summarizes empirical evidence on risky decision-making (objective risk and ambiguity) in specific domains of problematic use of the internet (PUI) focusing on online addictive behaviors. We conducted a pre-registered (PROSPERO: CRD42020188452) PubMed search for PUI domains: gaming, social-network use, online buying-shopping, online pornography use, and unspecified PUI. We used the Newcastle-Ottawa Scale for quality assessment. Relevant studies were identified only for gaming (n = 19), social-network use (n = 8), unspecified PUI (n = 7), and online gambling (n = 1). The meta-analyses included 25 studies (2498 participants) comparing PUI and control groups regarding decision-making performance under objective risk and ambiguity. Across PUI domains, individuals with PUI compared to control participants showed more disadvantageous decision-making in measures of objective risk (g = -0.42 [-0.69, -0.16], p = .002) but not ambiguity (g = -0.22 [-0.47, -0.04], p = .096). PUI domain and gender were significant moderators. In the risk domain, effects were particularly present in gaming disorder, especially in exclusively male samples. Overall, the paucity of empirical studies in the considered area necessitates further research to identify probable gender- and disorder-specific cognitive relationships.

Connectome-based prediction of craving in gambling disorder and cocaine use disorder.

INTRODUCTION: Craving, involving intense and urgent desires to engage in specific behaviours, is a feature of addictions. Multiple studies implicate regions of salience/limbic networks and basal ganglia, fronto-parietal, medial frontal regions in craving in addictions. However, prior studies have not identified common neural networks that reliably predict craving across substance and behavioural addictions. METHODS: Functional magnetic resonance imaging during an audiovisual cue-reactivity task and connectome-based predictive modelling (CPM), a data-driven method for generating brain-behavioural models, were used to study individuals with cocaine-use disorder and gambling disorder. Functions of nodes and networks relevant to craving were identified and interpreted based on meta-analytic data. RESULTS: Craving was predicted by neural connectivity across disorders. The highest degree nodes were mostly located in the prefrontal cortex. Overall, the prediction model included complex networks including motor/sensory, fronto-parietal, and default-mode networks. The decoding revealed high functional associations with components of memory, valence ratings, physiological responses, and finger movement/motor imagery. CONCLUSIONS: Craving could be predicted across substance and behavioural addictions. The model may reflect general neural mechanisms of craving despite specificities of individual disorders. Prefrontal regions associated with working memory and autobiographical memory seem important in predicting craving. For further validation, the model should be tested in diverse samples and contexts.

License to look? The role of permissive beliefs, desire thinking, and self-control in predicting the use of social networking sites.

Permissive beliefs are considered the most proximal predictor of actual behavior. Whereas they have frequently been researched in substance-use disorders, the field of social networking sites (SNS) use is missing the investigation as to how relevant permissive beliefs might be in this context, what might be causal precursors of permissive beliefs (i.e., desire thinking), and which processes might influence the effect that permissive beliefs have on actual behavior (i.e., self-control). To answer these questions, 116 people who use SNS participated in an online survey that contained an experimental manipulation of desire thinking and questionnaires measuring permissive beliefs, self-control, and severity of problematic SNS use. In a one-week follow-up, 85 participants reported their SNS usage times. Results showed that the association between permissive beliefs and tendencies to use SNS problematically was not significant. The experimental manipulation led to a decrease in permissive beliefs in the control condition, but did not increase permissive beliefs in the desire thinking condition. Permissive beliefs predicted SNS use in the follow-up assessment, which was not moderated by self-control. The results suggest that permissive beliefs seem to be unrelated to addictive tendencies of SNS use, but are nevertheless associated with daily use. Desire thinking does not appear to activate permissive beliefs in this study, possibly because the use of social networks is less often experienced as conflicting. Due to its ubiquitous availability, the use of social networks itself might quickly resolve the conflict between desires and possible regulatory attempts, making good reasons for use unnecessary.

Treatments and interventions for compulsive sexual behavior disorder with a focus on problematic pornography use: A preregistered systematic review.

Background and aims: Compulsive sexual behavior disorder (CSBD) which includes problematic pornography use (PPU) is a clinically relevant syndrome that has been included in the ICD-11 as impulse control disorder. The number of studies on treatments in CSBD and PPU increased in the last years. The current preregistered systematic review aimed for identifying treatment studies on CSBD and PPU as well as treatment effects on symptom severity and behavior enactment. Methods: The study was preregistered at Prospero International Prospective Register of Systematic Reviews (CRD42021252329). The literature search done in February 2022 at PubMed, Scopus, Web of Science, and PsycInfo, included original research published in peer-reviewed journals between 2000 to end 2021. The risk of bias was assessed with the CONSORT criteria. A quantitative synthesis based on effect sizes was done. Results: Overall 24 studies were identified. Four of these studies were randomized controlled trials. Treatment approaches included settings with cognitive behavior therapy components, psychotherapy methods, and psychopharmacological therapy. Receiving treatment seems to improve symptoms of CSBD and PPU. Especially, evidence for the efficacy of cognitive behavior therapy is present. Discussion and conclusions: There is first evidence for the effectiveness of treatment approaches such as cognitive behavior therapy. However, strong conclusions on the specificity of treatments should be drawn with caution. More rigorous and systematic methodological approaches are needed for future studies. Results may be informative for future research and the development of specific treatment programs for CSBD and PPU.

Screen Time and Attention Subdomains in Children Aged 6 to 10 Years.

Using digital media has become the most popular leisure activity for children and adolescents. The effects of digital media use on the developing brain and cognitive processes of children are subject to debate. Here, we examine the effect of digital media use on attention subdomains in children aged 6 to 10 years. In total, 77 children participated in the study. Selective and divided attention as well as switching between attentional subdomains were quantified by the SwAD-task. Parents were asked to assess the screen time of their children (smartphone, laptop/PC, game console, tablet, TV). Results show no main or interaction effects of screen time on any of the attention conditions investigated. Based on the present findings as well as previous studies, we suggest a possible non-linear relationship between the amount of screen time and attention function. Furthermore, we emphasize the relevance of considering the socio-economic background of children and a need for longitudinal studies.

The experience of gratification and compensation in addictive behaviors: How can these experiences be measured systematically within and across disorders due to addictive behaviors?

BACKGROUND: Beyond gaming disorder and gambling disorder, pornography-use disorder, buying-shopping disorder, and social-networksuse disorders are discussed as further disorders due to addictive behaviors. For addictive behaviors, it is assumed that the experience of gratification and the experience of compensation due to the specific behavior represent reinforcing processes involved in the development and maintenance of the problematic behaviors. We aimed to develop two questionnaires that capture the experienced gratification and experienced compensation while using online activities. We additionally assume significant relationships with further addiction-related constructs such as symptom severity, use expectancies, and craving experiences. METHODS: We conducted three studies for the development of the "Experience of Gratification Scale" (EGS) and the "Experience of Compensation Scale" (ECS). In each study, participants answered the questionnaires modified for their preferred online activity (gaming, gambling, buying-shopping, social-networks use, pornography use). Additional questionnaires were used, assessing further addiction-related constructs. RESULTS: The results of the gradual approach by using exploratory and confirmatory factor analyses indicated for both scales a two-factor solution resulting in "gratification of needs" and "experience of pleasure" for the EGS, and "compensation of needs" and "experience of relief from negative feelings" for the ECS. The factors were significantly correlated with each other as well as with craving experiences, use expectancies, and symptom severity. Moreover, we found significant differences in the experienced gratification and experienced compensation for specific online behaviors. CONCLUSION: The theoretically plausible specific factors for experienced gratification and experienced compensation could be identified and were related to constructs considered important in addictive online behaviors. Further studies should investigate the relevance of these constructs for different types of addictive behaviors, but also within the addiction process addressing specific needs and motives as well as further positive and negative reinforcement mechanisms.

Neurobiology of cue-reactivity, craving, and inhibitory control in non-substance addictive behaviors.

Non-substance addictive behaviors may involve repetitive rewarding behaviors including gambling, gaming, sexual activities, internet-use, and buying-shopping. In addictions, there exists diminished control over participation in the behaviors and continuation of the behaviors despite experiencing negative consequences. Addictive participation in behaviors typically results in distress and functional impairment in personal, relational, occupational, educational, or other life domains. Increases in cue-reactivity and craving and decreases in inhibitory control may represent pivotal mechanisms in addictions, especially when behavior-specific cues are present. Similar to substance-use disorders, alterations in brain networks related to reward processing, executive functioning, salience attribution, and habit formation and in neurochemical pathways that may include dopamine, serotonin, opioids, and other neurotransmitters may represent neurobiological factors involved in the development and maintenance of addictive behaviors. Although there has been substantial progress in research on the neurobiologies of addictive behaviors, science is still at an early stage of understanding the potential neurobiological mechanisms related to specific non-substance addictive behaviors. Considerations for future directions in research on non-substance addictive behaviors, with a view on common and distinct neurobiological foundations of specific disorders, are discussed.

The SwAD-Task - An Innovative Paradigm for Measuring Costs of Switching Between Different Attentional Demands.

Task switching paradigms are frequently used to identify costs of switching between modalities, spatiality, attributes, rules, etc., but switching between different attentional demands has been somehow neglected. The present study introduces an innovative paradigm, that allows to test single attentional demands (such as selective and divided attention), and more importantly the process of switching between these demands. We examined the feasibility of the paradigm by focusing on the demands of selective and divided attention with a sample of 94 people (age: M = 21.44 years, SD = 2.68; 76 women). In addition, we tested correlations between the implemented single attentional demands and commonly used measures of selective and divided attention. Results show no general difference between individual assessments under single demand conditions. Reaction times under divided attention are significantly higher compared to selective attention. In the switching condition, reaction times in both demands increase with increased switching. Furthermore, switching costs significantly increase in selective but not in divided attention. Means of selective and divided attention in single and switching conditions significantly correlate with a commonly used measure of selective attention. Means of divided attention under single demand significantly correlate with performance in a commonly used dual-task paradigm. Summarizing the present findings, it can be stated that the introduced paradigm comprises a feasible way for quantifying the process of switching attention between different demands.

Facets of impulsivity and related aspects differentiate among recreational and unregulated use of Internet pornography.

BACKGROUND AND AIMS: Unregulated Internet pornography (IP) use is discussed as a clinically significant disorder. Because of its primarily rewarding nature, IP is a predestinated target for addictive behaviors. However, not every user develops an unregulated usage pattern. In fact, most users tend to use IP recreationally. Impulsivity-related constructs have been identified as promoters of addictive behaviors. It is unclear whether these impulsivity-related constructs are specific for unregulated IP use or also play a role in recreational but frequent behaviors. In this study, we investigated impulsive tendencies (trait impulsivity, delay discounting, and cognitive style), craving toward IP, attitude regarding IP, and coping styles in individuals with recreational-occasional, recreational-frequent, and unregulated IP use. METHODS: A total of 1,498 heterosexual males participated in an online survey. Groups of individuals with recreational-occasional use (n = 333), recreational-frequent use (n = 394), and unregulated use (n = 225) of IP were identified by screening instruments. RESULTS: Craving and attitude regarding IP as well as delay discounting and cognitive and coping styles differed between groups. Individuals with unregulated use showed the highest scores for craving, attentional impulsivity, delay discounting, and dysfunctional coping, and lowest scores for functional coping and need for cognition. Recreational-frequent users had the most positive attitude toward IP. Motor and non-planning impulsivity did not differ between groups. DISCUSSION AND CONCLUSIONS: The results indicate that some facets of impulsivity and related factors such as craving and a more negative attitude are specific for unregulated IP users. The results are also consistent with models on specific Internet use disorders and addictive behaviors.

Strategies of selective changing: Preparatory neural processes seem to be responsible for differences in complex inhibition.

Selective inhibition describes the stopping of an action while other actions are further executed. It can be differentiated between two strategies to stop selectively: the fast but global stop all, then discriminate strategy and the slower but more selective first discriminate, then stop strategy. It is assumed that the first discriminate, then stop strategy is especially used when information regarding which action might have to be stopped is already available beforehand. Moreover, it is supposed that both strategies differ in matters of basal ganglia pathways used for their execution. Aim of the present study was to investigate the use of the two strategies in situations requiring selective changing of an action. Eighteen healthy male participants performed a selective stop-change task with informative and uninformative cues during fMRI. Behavioral results show that informative cues led to a benefit in both inhibition times and selectivity. FMRI data revealed that the same cortico-subcortical pathway was used with informative and uninformative cues. Behavioral and neuronal results indicate that participants used the first discriminate, then stop strategy for selective inhibition irrespective of the amount of previously available information. Moreover, the neural activity data indicate that the benefit in the informed condition was produced by an efficient preparation for the concrete change process. Possible factors that might affect which strategy is used for selective stopping are the level of previously available information (foreknowledge) and the experimental set-up, as e.g. task complexity.

Stopping Speed in the Stop-Change Task: Experimental Design Matters!

Previous research comparing the speed of inhibiting a motor response in no-foreknowledge vs. foreknowledge conditions revealed inconsistent findings. While some studies found stopping to be faster in the no-foreknowledge condition, others reported that it was faster in the foreknowledge condition. One possible explanation for the heterogeneous results might be differences in experimental design between those studies. Given this, we wanted to scrutinize whether it makes any difference if foreknowledge and no-foreknowledge are investigated in a context in which both conditions are presented separated from each other (block design) vs. in a context in which both conditions occur intermingled (event-related design). To address this question a modified stop-change task was used. In Experiment 1 no-foreknowledge and foreknowledge trials were imbedded in a block design, while Experiment 2 made use of an event-related design. We found that inhibition speed as measured with the stop signal reaction time (SSRT) was faster in the foreknowledge as compared to the no-foreknowledge condition of the event-related study, whereas no differences in SSRT between both conditions were revealed in the block design study. Analyses of reaction times to the go stimulus reflect that participants tended to slow down their go responses in both experimental contexts. However, in the foreknowledge condition of the event-related study, this strategic slowing was especially pronounced, a finding we refer to as strategic delay effect (SDE), and significantly correlated with SSRT. In sum our results suggest that inhibition speed is susceptible to strategic bias resulting from differences in experimental setup.

Cue-reactivity in behavioral addictions: A meta-analysis and methodological considerations.

Background and aims Recent research has applied cue-reactivity paradigms to behavioral addictions. The aim of the current meta-analysis is to systematically analyze the effects of learning-based cue-reactivity in behavioral addictions. Methods The current meta-analysis includes 18 studies (29 data sets, 510 participants) that have used a cue-reactivity paradigm in persons with gambling (eight studies), gaming (nine studies), or buying (one study) disorders. We compared subjective, peripheral physiological, electroencephal, and neural responses toward addiction-relevant cues in patients versus control participants and toward addiction-relevant cues versus control cues in patients. Results Persons with behavioral addictions showed higher cue-reactivity toward addiction-relevant cues compared with control participants: subjective cue-reactivity (d = 0.84, p = .01) and peripheral physiological and electroencephal measures of cue-reactivity (d = 0.61, p < .01). Increased neural activation was found in the caudate nucleus, inferior frontal gyrus, median cingulate cortex, subgenual cingulate, and precentral gyrus. Persons with gambling, gaming, or buying disorders also showed higher cue-reactivity toward addiction-relevant cues compared with control cues: subjective cue-reactivity (d = 0.39, p = .11) and peripheral physiological and electroencephal measures of cue-reactivity (d = 0.47, p = .05). Increased neural activation was found in the caudate nucleus, inferior frontal gyrus, angular gyrus, inferior network, and precuneus. Discussion and conclusions Cue-reactivity not only exists in substance-use disorders but also in gambling, gaming, and buying disorders. Future research should differentiate between cue-reactivity in addictive behaviors and cue-reactivity in functional excessive behaviors such as passions, hobbies, or professions.

Trait and state impulsivity in males with tendency towards Internet-pornography-use disorder.

INTRODUCTION: Impulsivity has been identified to be involved in the development and maintenance of specific Internet-use disorders (IUD). It can be differentiated between relatively stable trait impulsivity and state impulsivity which is dependent on environmental and affective factors such as craving. Following the I-PACE (Interaction of Person-Affect-Cognition-Execution) model, both trait and state impulsivity may play an interactive role in IUD. The present study aimed to investigate the relationship between trait and state impulsivity and symptom severity of Internet-pornography-use disorder (IPD) as one form of IUD. METHODS: Fifty heterosexual males participated in this study. State impulsivity was measured with reaction times in a modified stop-signal task. Each participant conducted two blocks of this task which included neutral and pornographic pictures. Moreover, current subjective craving, trait impulsivity, and symptom severity of IPD were assessed using several questionnaires. RESULTS: Results indicate that trait impulsivity was associated with higher symptom severity of IPD. Especially those males with higher trait impulsivity and state impulsivity in the pornographic condition of the stop-signal task as well as those with high craving reactions showed severe symptoms of IPD. CONCLUSION: The results indicate that both trait and state impulsivity play a crucial role in the development of IPD. In accordance with dual-process models of addiction, the results may be indicative of an imbalance between the impulsive and reflective systems which might be triggered by pornographic material. This may result in loss of control over the Internet-pornography use albeit experiencing negative consequences.