Inhibitory Control and Problematic Internet-Pornography Use - The Important Balancing Role of the Insula

BACKGROUND AND AIMS: Diminished control over a specific behavior is a core characteristic in addictive behaviors such as problematic Internet-pornography (IP) use. First studies suggest that a hyperactivity of the impulsive system is one reason for impulsive behaviors in the context of problematic IP use. The tripartite-process theory of addiction explains neurocognitive mechanisms beyond common dual-process theories in addictive behaviors. However, the role of the reflective and interoceptive system is still unresolved. METHODS: The study comprised a stop-signal task (SST) including neutral and pornographic images during fMRI and questionnaires to investigate associations between symptoms of problematic IP use, craving, and neural activity of the impulsive, reflective, and interoceptive system. We examined 28 heterosexual males with varying symptom severity of problematic IP use. RESULTS: Data indicates that individuals with more symptoms of problematic IP use showed better performance in the SST which was linked to decreased insula and inferior frontal gyrus activity during pornographic image processing. An increase in craving was associated with lower activity of the ventral striatum during pornographic image processing. The interoceptive system showed varying effects. Increased insula activity during inhibitory control and decreased activity during pornographic image processing were associated with higher inhibitory control performance. DISCUSSION AND CONCLUSION: Effects of tolerance and motivational aspects may explain the better inhibitory control performance in individuals with higher symptom severity which was associated with differential activity of the interoceptive and reflective system. Diminished control over IP use presumably results from the interaction between the impulsive, reflective, and interoceptive systems

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  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

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

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

Diagnostic and Classification Considerations Related to Compulsive Sexual Behavior Disorder and Problematic Pornography Use

Purpose of Review: There are ongoing debates about specific features of compulsive sexual behavior disorder (CSBD) relating to classification and diagnoses. We aim to address current discussions relating to potential subtypes of CSBD, the aspect of compulsivity in CSBD, and the aspect of moral incongruence and CSBD. Recent Findings: CSBD includes multiple specific sexual behaviors that might be related to specific psychological processes. Problematic pornography use may be considered a subtype of CSBD, which may have multiple parallels with addictive behaviors. The feature of compulsivity in CSBD may be different from compulsivity in other disorders and may be differently involved in early versus later stages of CSBD. Moral incongruence is important to consider in the context of CSBD, although moral disapproval is not a general exclusion criterion for diagnosing CSBD. Considering the current debates of specific features of CSBD, future research and clinical practice may benefit from a trans-diagnostic approach to contribute to a more fine-grained understanding of the multiple facets of CSBD

Explaining and predicting moments of impaired control in individuals with the aim to regulate their gaming behaviour or pornography use: A multi-method study approach

A moment of impaired control can be understood as behavioral response contrary to the intention to limit or refrain from the behavior. Gaming disorder (GD) and pornography-use disorder (PUD) are clinically relevant conditions. Although GD and PUD have been differently classified within the ICD-11, they share the characteristic of impaired control over the behavior. Impaired control in GD and PUD has rarely been investigated beyond the retrospective and selfreported symptom level. Accordingly, the true behavioral pattern within the natural environment and underlying mechanisms are unknown. Based on theories on addictive behaviors, failures of both self-control and self-regulation contribute to moments of impaired control, where their effects can vary between early and later stages of the addictive behavior. Self-control, which is relevant when directly exposed to specific stimuli, is influenced by mechanisms such as cue-reactivity, craving, approach action tendencies, and behavior-related inhibitory control. These mechanisms are associated with symptoms of GD and PUD and may also directly contribute to the occurrence of a moment of impaired control in the natural environment. Beyond this narrow definition of self-control also self-regulation mechanisms should be considered including the intrinsic motivation to regulate, the use of self-regulation strategies, and permissive beliefs. Studies that specifically focus on explaining and predicting moments of impaired control in GD and PUD in the natural environment are missing. However, knowledge on the mechanisms behind impaired control is important to identify individuals at risk for developing addictive behaviors such as GD or PUD and to develop prevention and intervention programs that help individuals to regain control over their behavior. The current project aims to 1) characterize the actual behavioral pattern of impaired control shown in the natural environment in both early and later stages of GD and PUD, 2) explain moments of impaired control in the natural environment by identifying relevant self-control and self-regulation mechanisms, and 3) predict the occurrence of moments of impaired control in the natural environment based on these mechanisms. The research project examines four groups of individuals: 1) regular/risky gamers, 2) pathological gamers, 3) regular/risky pornography users, 4) pathological pornography users in a multi-method approach. Laboratory measures as well as an ambulatory assessment over seven days will be combined to get a comprehensive and ecologically valid understanding of relevant mechanisms. Besides inferential statistics to explain impaired control, machine learning methods will be applied to predict the occurrence of moments of impaired control in GD and PUD within the natural environment

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

Integrating Desire Thinking into the I-PACE Model: a Special Focus on Internet-Use Disorders

Purpose of Review This manuscript aims to propose an integration of desire thinking into the Interaction of Person-Affect-Cognition-Execution (I-PACE) model based on theoretical considerations within the Elaborated Intrusion Theory of Desire and Self-Regulatory Execution Function model and empirical evidence from the field of internet-use disorders. Recent Findings Theory and research on desire thinking in the context of internet-use disorders suggest considerable relations to craving, metacognitive beliefs, and emphasizes its nature when initiated as a reaction towards unpleasant triggers. Accordingly, we postulate that desire thinking may be located at the position for affective and cognitive reactions towards triggers within the I-PACE model. Summary The suggested integration of desire thinking into the I-PACE model specifically implies the assumption of a relief-oriented and pleasure-oriented entry pathway into desire thinking and a feedback loop between desire thinking and the experience of gratification and compensation. The model pathways proposed here may serve as a theoretical basis for future research and need further empirical verification

Gaming Disorder: How to Translate Behavioral Neuroscience Into Public Health Advances

<jats:title>Abstract</jats:title><jats:sec> <jats:title>Purpose of Review</jats:title> <jats:p>Gaming disorder (GD), meanwhile classified as a mental disorder in both DSM-5 and ICD-11, is a current public health issue. Theoretical models assume core psychological processes, such as cue reactivity, craving, reward processing, decision-making, cognitive biases, inhibitory control, and stress relief, to be crucially involved in the development and maintenance of GD. This review summarizes neuroscientific findings on these processes in the context of GD as well as treatments and intervention programs addressing these processes.</jats:p> </jats:sec><jats:sec> <jats:title>Recent Findings</jats:title> <jats:p>We identified overlaps regarding the involvement of neural structures and networks related to psychological processes which may be targeted by public health programs. Complex interactions between executive control, salience, reward, and habit networks are crucially linked to processes involved in GD and public health programs respectively.</jats:p> </jats:sec><jats:sec> <jats:title>Summary</jats:title> <jats:p>We point at the difficulties of making one to one assignments of neural networks to psychological processes or interventions. Furthermore, new treatment and prevention programs of GD are discussed pointing at possible future directions for neuroscientific research and treatment programs for GD.</jats:p> </jats:sec&gt