The word “Internet addiction” is estimated to make most parents worry about their children’s performance, temper, eyesight, sleeplessness, running away from home, smoking and drinking, boredom, truancy, indifference, weakness of will, online love and early love a series of problems have come out, and some have even embarked on the path of crime.
If a child at home is addicted to the Internet, parents using the usual way of teaching is likely to have little effect, some anxious parents may send their children to the so-called Internet addiction school, it is estimated that many of these schools are for profit, the ability and qualifications of some of the so-called teachers can be imagined, the media continue to explode the incident of the violent death of teenagers in Internet addiction school, a time that has caused widespread concern in society.
Recently, a questionnaire survey conducted by the Capital Internet Association for 4005 teenagers in the city found that 53% of children choose to go online after school, with online games (46.7%) ranking first in the online behavior of secondary school students. Another survey also showed that 80 or 68% of Guangzhou secondary school students started to access online games in elementary school or even in early childhood, and more than 60 or 1% of them were senior players for more than 3 years.
According to the third survey report of China Youth Internet Association, currently, 14.1% of urban youth Internet users in China are Internet-addicted youths, and the number of them is about 24.042 million. Among urban non-Internet-addicted teenagers, about 12.7% of them have the tendency of Internet addiction, and the number of them is about 18.58 million. Among them, the proportion of Internet addiction among teenagers aged 18-23 (15.6%) is the highest, followed by those aged 24-29 (14.6%) and those aged 13-17 (14.3%). In response to the current situation of Internet addiction in China, Dong Guangheng et al. from the School of Psychology, Zhejiang Normal University published a review on the cognitive-behavioral model of online game addiction, which was recently published in the Journal of Psychiatric Research and is compiled below by Clove Psychiatric Channel.
Based on the drug addiction model and the extant literature on online gaming disorder (IGD), the authors propose a conceptualized cognitive-behavioral model of IGD that focuses on three domains and their role in addictive behavior. These three domains include motivational drives related to reward seeking and stress reduction, behavioral control related to executive inhibition, and trade-off decisions involving engagement in motivated behaviors. Based on this model, the authors propose how behavioral therapies can target these three domains in IGD.
1. Background
Internet addiction (IAD, or Internet addiction) or problematic Internet use has been proposed as a psychiatric diagnosis and has been studied for more than 10
years. However, a standardized definition of this disorder remains controversial to date. Although there are no formal diagnostic criteria for this mental state characterized by excessive use, the excessive interference pattern of Internet use has been included in the DSM-IV. The DSM-5 committee considered substance use and addiction as criteria for the production of IGD, a condition also described in the DSM-5.
Given recent changes in the DSM, excessive involvement in online gaming, online gaming addiction, and pathological online gaming addiction will be addressed in this article, although it is recognized that the term and diagnosis may be ambiguous and that the current criteria for IGD have not been systematically examined. Unlike drug addiction or substance abuse, IAD or IGD does not involve chemical or substance ingestion, although excessive Internet use may lead to physical dependence similar to other addictions.
However, this observation suggests that people’s online experiences with the Internet may alter their brain structure and function, as well as and related cognitive processes. Although it has been proposed that excessive Internet use may involve at least 3 subtypes related to online gaming, sexual attention, and email/text messaging and other subtypes that may exist (e.g., those involving other types of behaviors, social networking, or motivations that may shape Internet use, such as those associated with positive or negative reinforcement).
While further work is needed to identify clinically meaningful subtypes, a model describing the cognitive domain, the interrelationship of the cognitive domain, and how this cognitive domain may be targeted to treat IGD and be of substantial help in related research. The precise characteristics that may lead to excessive or compulsive network use in some individuals have yet to be addressed. igd may be driven by experiences involving intense emotions. Such frequent, repetitive behavioral experiences behavior may alter brain structure and function in potentially specific cognitive processes.
In this paper, the authors present a model of IGD cognitive behavior based on the extant literature. Although only a few studies have examined the effectiveness and tolerability of IGD pharmacotherapy, IGD treatment may be considered in terms of psychological or cognitive processes as potential targets for pharmacological or behavioral interventions. Based on the proposed cognitive-behavioral model, the authors discuss possible treatments for IGD, with a focus on behavioral therapies.
2. Cognitive-behavioral model of IGD
A central part of addiction involves seeking rewards. For example, the central reward model focuses on the pleasure of drug use and suggests that drugs may “hijack” the brain’s reward circuitry. The drug addiction model, on the other hand, suggests that “addiction” to a drug is distinct from “wanting” a drug. A “reward deficit syndrome model” hypothesizes that addicted individuals engage in addictive behaviors to compensate for diminished reward signals in the limbic dopamine pathway of the midbrain.
Negative reinforcement models suggest that alleviating aversive states (e.g., associated stress) may drive individuals to engage in addictive behaviors. Motivation-focused models propose that addiction can be thought of as a misguided motivational disorder that indulges in substance use. These and other models suggest that diminished executive control functions that govern motivation-driven behaviors may lead individuals to engage in addictive behavioral decisions.
As with the drug addiction model, the authors propose that motivation-driven behaviors related to reward seeking lead to IGD and that impaired executive control that governs motivation-driven behaviors may lead individuals to engage in addictive behavioral decision making. In Figure 1, the authors label possible targeted therapies that will also be mentioned below (although these relationships in the figure remain largely untested). Nevertheless, this proposed model is presented to provide a theoretical basis for validating mechanistic studies and therapeutic developments in IGD.
2, 1 Reward and motivation in IGD
Given the role of reward processes in behavior and drug addiction, researchers have investigated reward sensitivity in IGD. By performing a guessing task, the study found that individuals with IGD had increased reward sensitivity and moderate decreases in attrition sensitivity, extreme victory and defeat situation sensitivity. While the control and achievement achieved by individuals through online behaviors may be perceived as beneficial by individuals, IGD’s enhanced reward sensitivity may be based on the desire to use the Internet, which in turn motivates individuals to engage in longer online gaming behaviors. In this way, enhanced reward sensitivity and reduced attrition sensitivity may lead individuals to develop IGD.
2,2 Executive control: inhibited physiological desires and limits to excessive Internet use
The executive system enhances cognitive and behavioral control of motivation-driven behaviors and can inhibit individual desires and to some extent control individual engagement in rewarding behaviors, characteristics that are important for the development of IGD. the Go/No-Go test, the Stroop effect (Stroop), and the switching task demonstrate a reduced tendency or ability for response inhibition and cognitive control in individuals with IGD, respectively. The IGD group performed worse in the game switching task relative to those who did not respond to online game stimuli on the Web, and this tendency to respond was influenced by stimuli associated with online games on the Web.
These findings suggest that cognitive bias is similar to other addiction conditions and, importantly, that it may involve altered stereotype shifts in addictive compulsive behaviors. stereotype shifts and cognitive control deficits in IGD may be related to inefficient processing of neural circuits for these processes, which is consistent with results on the severity of neural network addiction.
Taken together, the available findings suggest that attentional, response inhibition, and behavioral resilience neural processing in individuals with IGD are related to the severity of IGD, but the extent to which these findings may reflect susceptibility factors or neural functioning in IGD (occurring at the stage of IGD development) is, to date, unclear.
2,3 Decision making: measuring short-term pleasure versus long-term negative outcomes
Exemption from excessive participation in recreational activities because of reduced cognitive ability or willingness may contribute to the development of multiple clinical problems, including addiction disorders, such as gambling and substance abuse disorders.
Research has shown that when performing decision-making tasks, individuals with IGD have locally enhanced activity in functional brain areas. Research data also show that individuals with IGD have diminished activity in functional brain areas when making future decisions. Individuals with IGD may show a lack of foresight into the future when making decisions about engaging in immediately rewarding experiences (e.g., online gaming) and long-term negative outcomes (e.g., spending a lot of time playing online games instead of spending it on their career plans).
Decision-making is arguably the final “checkpoint” for engaging in addictive behavior before the behavior occurs. Therefore, future research should determine the extent to which decision-making deficits may develop into IGD, and whether decision-making ability is impaired during the development of IGD.
2.4 Interactions between cognitive domains
Increased experiences of victory and pleasure may enhance the desire to play online for individuals with IGD. At the same time, impairments in executive control may result in individuals with IGD having less control over desires, and such impairments may allow individuals to dictate such demands, desires, or cravings, and lead to excessive online use.
This unbalanced mechanism can drive IGD individuals to make unfavorable behavioral decisions, causing individuals to pursue fleeting pleasures rather than maximizing long-term benefits. Reward-seeking behaviors may thus be reinforced through short-term online experiences, and these may further interfere with the executive control functions of individuals with IGD, which in turn leads to this vicious cycle of Internet-addictive behaviors.
3. Clinical implications
Currently, some categories of behavioral interventions have been shown to be effective for gambling and or drug addiction treatment through randomized controlled trial interventions, and these interventions may alter the decision-making processing of individuals focused on future weighted goal management.
In addition, there are other treatments that initially support addiction, as well as support cognitive domain therapies targeted at facilitating the management of addictive behaviors. For example, positive thinking therapy, which improves mood and reduces stress, has been shown to support drug addiction treatment, and this approach is particularly effective for individuals motivated by negative reinforcement. With the proposed cognitive-behavioral model of IGD and evidence-based treatments for drug addiction and stress reduction, potentially effective treatments for IGD may target one or more of the following cognitive domains.
(1) suppressing the desire to play games or otherwise overuse the Internet; (2) strengthening the cognitive ability to inhibit behaviors involved in Internet use; and (3) overcoming the lack of discriminatory decision making due to transient pleasures by emphasizing long-term goals. It should be noted that the limited data from randomized clinical trials should determine the extent to which these treatments can support the treatment of IGD or, alternatively, how the active ingredients of the medications work for the treatment of IGD or the proposed model.
3.1 Cognitive Behavioral Therapy (CBT)
CBT is one of the relatively few empirically supported therapies that is an effective treatment for a range of substance use disorders. Research suggests that the recognized “active ingredients” of CBT may play a role in the executive control of behavior, given that the acquisition of these types of skills in CBT is associated with better long-term outcomes. It is now commonly used in the treatment of IGD because of its benefits, including helping individuals with IGD improve inhibitory control, identify maladaptive cognitions, and use more adaptive decision-making.
However, unlike CBT for drug addiction, there are no studies to date that have confirmed the efficacy of CBT for IGD, nor are there manualized treatment protocols that have systematically evaluated IGD treatment in randomized clinical trials. Therefore, future research in this area remains to be explored.
3.2 Cognitive Enhancement Therapy (CET)
Individuals with IGD often present with cognitive deficits associated with increased impulsivity, impaired cognitive control, and lack of cognitive flexibility. CET typically involves repeated practice of cognitive tasks including: problem solving, response inhibition, visual tracking, and discrimination skills. Several hours of CET practice per week over several months can significantly improve impulsivity and delay discounting in aroused individuals, and similar strategies need to be considered for the cognitive functioning of individuals with IGD.
3.3 Cognitive Bias Modification (CBM)
It has been shown that individuals with IGD have an attentional bias toward Internet use and that treatments targeting this attentional bias may be effective in treating individuals with IGD. CBM primarily targets unconscious or implicit processes, such as attentional bias and attitudinal bias. In addition, CBM has been effective in treating alcohol use disorders and other psychiatric disorders, but further research is needed to determine whether it is effective in treating IGD.
3.4 Positive Stress Reduction (MBSR)
Stress is strongly associated with IGD, so interventions such as MBSR that target stress reduction may be helpful in the treatment of IGD. On the other hand, stress is also associated with addictive behaviors in women, so MBSR is also particularly applicable to women with IGD, but this hypothesis needs to be tested.
3,5 Combination therapy
Preliminary treatment studies suggest that the combined application of different forms (e.g., group, individual, family therapy, and school-based interventions) of multiple psychotherapies may be more effective than single therapies, such as CBT, CBM, CET, and/or MBSR. In addition, the combined application of behavioral therapies and pharmacotherapy needs to be considered and tested in randomized clinical trials.
4. Conclusion
Recent studies have demonstrated neurocognitive differences between individuals with and without IGD. individuals with IGD have several characteristics of drug addiction, including: increased impulsivity, lack of cognitive flexibility, and attentional bias. However, the extent to which these characteristics reflect pre-existing triggers of IGD, triggers that arise from excessive online gaming, or both, is unknown. Although data from studies of substance addiction suggest that both of these causes are related.
However, direct validation of these possibilities for IGD is still necessary and may be achieved through longitudinal studies. This model will also become more refined over time as more valid data become available. Nonetheless, existing research findings suggest that theoretical models of IGD and specific cognitive domains may have targeted specific psychotherapies. Future research should also test the effectiveness of treating this type of psychotherapy for IGD and examine specific cognitive functions that may improve the treatment of individuals with IGD.