Internet and Gaming Addiction: A Systematic Literature Review of Neuroimaging Studies Daria J. Kuss * and Mark D. Griffiths International Gaming Research Unit, Nottingham Trent University, Nottingham NG1 4BU, UK; E-Mail: mark. ac. uk * Author to whom correspondence should be addressed; E-Mail: daria. ac. uk; Tel. : +44-789-111-94-90. Received: 28 June 2012; in revised form: 24 August 2012 / Accepted: 28 August 2012 / Published: 5 September 2012 Abstract: In the past decade, research has accumulated suggesting that excessive Internet use can lead to the development of a behavioral addiction.
Internet addiction has been considered as a serious threat to mental health and the excessive use of the Internet has been linked to a variety of negative psychosocial consequences. The aim of this review is to identify all empirical studies to date that used neuroimaging techniques to shed light upon the emerging mental health problem of Internet and gaming addiction from a neuroscientific perspective. Neuroimaging studies offer an advantage over traditional survey and behavioral research because with this method, it is possible to distinguish particular brain areas that are involved in the development and maintenance of addiction.
A systematic literature search was conducted, identifying 18 studies. These studies provide compelling evidence for the similarities between different types of addictions, notably substance-related addictions and Internet and gaming addiction, on a variety of levels. On the molecular level, Internet addiction is characterized by an overall reward deficiency that entails decreased dopaminergic activity. On the level of neural circuitry, Internet and gaming addiction led to neuroadaptation and structural changes that occur as a consequence of prolonged increased activity in brain areas associated with addiction.
The Essay on Addiction to Video Gaming
The impact of video games in the society has caused evident trend of addiction among the adolescents and young adults. It is essential to determine the contributing factors of such phenomena in sociological and psychological perspective in order to comprehend the reality of the vastly progressing trend of video addiction. Problem and its Background The greatest impact of video games in twenty- ...
On a behavioral level, Internet and gaming addicts appear to be constricted with regards to their cognitive functioning in various domains. The paper shows that understanding the neuronal correlates associated with the development of Internet and gaming addiction will promote future research and will pave the way for the development of addiction treatment approaches. Brain Sci. 2012, 2 348 Keywords: Internet addiction; gaming addiction; neuroimaging; literature review 1. Introduction
In the past decade, research has accumulated suggesting that excessive Internet use can lead to the development of a behavioral addiction (e. g. , [1–4]).
Clinical evidence suggests that Internet addicts experience a number of biopsychosocial symptoms and consequences [5]. These include symptoms traditionally associated with substance-related addictions, namely salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse [6]. Internet addiction comprises a heterogeneous spectrum of Internet activities with a potential illness value, such as gaming, shopping, gambling, or social networking.
Gaming represents a part of the postulated construct of Internet addiction, and gaming addiction appears to be the most widely studied specific form of Internet addiction to date [7]. Mental health professionals’ and researchers’ extensive proposals to include Internet addiction as mental disorder in the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) will come to fruition as the American Psychiatric Association accepted to include Internet use disorder as mental health problem worthy of further scientific investigation [8].
The excessive use of the Internet has been linked to a variety of negative psychosocial consequences. These include mental disorders such as somatization, obsessive-compulsive and other anxiety disorders, depression [9], and dissociation [10], as well as personality traits and pathology, such as introversion and psychoticism [11]. Prevalence estimates range from 2% [12] to 15% [13], depending on the respective sociocultural context, sample, and assessment criteria utilized.
The Essay on Internet and Online Gaming
Online gaming is a video game played over some form of a computer network. This network is frequently the internet. The growth of online gaming has mirrored the overall growth of computer networks from small local networks to the internet and the overall development of internet access itself. (Anonymous, 2014) Local exchange network interfaces connect with online gaming systems in several ...
Internet addiction has been considered as serious threat to mental health in Asian countries with extensive broadband usage, particularly South Korea and China [14]. 1. 1. The Rise of Neuroimaging In accordance with Cartesian dualism, the French philosopher Descartes advocated the view that the mind is an entity that is separate from the body [15]. However, the cognitive neurosciences have proved him wrong and reconcile the physical entity of the body with the rather elusive entity of the mind [16]. Modern neuroimaging techniques link cognitive processes (i. e. , Descartes’ thinking mind) to actual behavior (i.
e. , Descartes’ moving body) by measuring and picturing brain structure and activity. Altered activity in brain areas associated with reward, motivation, memory, and cognitive control has been associated with addiction [17]. Research has addressed the neural correlates of drug addiction development via classical and operant conditioning [18,19]. It has been found that during the initial stages of the voluntary and controlled usage of a substance, the decision to use the drug is made by specific brain regions, namely the prefrontal cortex (PFC) and ventral striatum (VS).
As habituation to use and compulsion develops, brain activity changes in that the dorsal regions of the striatum (DS) become increasingly activated via dopaminergic innervation (i. e. , dopamine release) [20]. Long term drug use leads to changes in the brain dopaminergic pathways (specifically the anterior cingulate (AC), orbitofrontal cortex (OFC), and the nucleus accumbens (NAc) which may lead to a reduction of sensitivity to biological rewards and it Brain Sci. 2012, 2 349 decreases the individual’s control over seeking and eventually taking drugs. [21,22]. On a molecular level, the long-term depression (LTD; i. e.
, the reduction) of synaptic activity has been linked to the adaptation of the brain as a result of substance-related addictions [23]. Drug addicts become sensitized to the drug because in the course of prolonged intake, the synaptic strength in the ventral tegmental area increases, and so does the LTD of glutamate in the nucleus accumbens, which will result in craving [24]. At the same time, the brain (i. e. , NAc, OFC, DLPFC) becomes increasingly responsive to drug cues (e. g. , availability, particular context) via craving [21,25]. Craving for drug use involves a complex interaction between a variety of brain regions.
The Essay on Drug addiction 2
Drug addiction is a dependence on an illegal drug or medication. Many people confuse it with drug dependency, which is when a person needs a drug to function normally. The difference between drug addiction and drug dependence is drug dependence is when a person needs a drug to function normally, like some blood pressure medications can cause a physical dependence, but the person is not addicted to ...
Activity in the nucleus accumbens following recurrent drug intake leads to learning associations between drug cues and the reinforcing effects of the drug [26]. In addition, the orbitofrontal cortex, important for the motivation to engage in behaviors, the amygdala (AMG) and the hippocampus (Hipp), as main brain regions associated with memory functions, play a role in intoxication and craving for a substance [17]. Natural rewards, such as food, praise, and/or success gradually lose their hedonic valence. Due to habituation to rewarding behaviors and intake of drugs, a characteristic addiction symptom develops (i. e. , tolerance).
Increasing amounts of the substance or increasing engagement in the respective behaviors are needed in order to produce the desired effect. As a result, the reward system becomes deficient. This leads to the activation of the antireward system that decreases the addict’s capacity for experiencing biological reinforcers as pleasurable. Instead, he requires stronger reinforcers, i. e. , their drug or behavior of choice, in larger amounts (i. e. , tolerance develops) to experience reward [27]. In addition, the lack of dopamine in the mesocorticolimbic pathways during abstinence explains characteristic withdrawal symptoms.
These will be countered with renewed drug intake [17]. Relapse and the development of a vicious behavioral cycle are the result [28]. Prolonged drug intake and/or engagement in a rewarding behavior leads to changes in the brain, including dysfunctions in prefrontal regions, such as the OFC and the cingulate gyrus (CG) [17,29]. Research indicates that brain activity alterations commonly associated with substance-related addictions occur following the compulsive engagement in behaviors, such as pathological gambling [30]. In line with this, it is conjectured that similar mechanisms and changes are involved in Internet and gaming addiction.
The aim of this review is therefore to identify all peer-reviewed empirical studies to date that used neuroimaging techniques to shed light upon the emerging mental health problem of Internet and gaming addiction from a neuroscientific perspective. Neuroimaging broadly includes a number of distinct techniques. These are Electroencephalogram (EEG), Positron Emission Tomography (PET), SPECT Single Photon Emission Computed Tomography (SPECT), functional Magnetic Resonance Imaging (fMRI), and structural magnetic resonance imaging (sMRI), such as Voxel-based Morphometry (VBM), and Diffusion-Tensor Imaging (DTI).
The Term Paper on The Study of Internet Addiction
A STUDY INVESTIGATING THE EXTENT OF INTERNET USE, LEVELS OF INTERNET ADDICTION, AND RELATIONSHIPSAs we enter into a new millennium, the Internet has provided us a new medium of communication that enables us to access vast amounts of information across a breadth of topics. Even though the Internet started of with the US department of defense and its attempt to establish a secure mode of ...
These are briefly explained in turn before examining the studies that have utilized these techniques for studies on Internet and gaming addiction. 1. 2. Types of Neuroimaging Used to Study Addictive Brain Activity Electroencephalogram (EEG): With an EEG, neural activity in the cerebral cortex can be measured. A number of electrodes are fixed to specific areas (i. e. , anterior, posterior, left and right) of the participant’s head. These electrodes measure voltage fluctuations (i. e. , current flow) between pairs of Brain Sci. 2012, 2 350 electrodes that are produced by the excitation of neuronal synapses [31].
With event-related potentials (ERPs), the relationships between the brain and behavior can be measured via an electrophysiological neuronal response to a stimulus [32]. Positron Emission Tomography (PET): PET is a neuroimaging method that allows for the study of brain function on a molecular level. In PET studies, metabolic activity in the brain is measured via photons from positron emissions (i. e. , positively charged electrons).
The subjected is injected with a radioactive 2-deoxyglucose (2-DG) solution that is taken up by active neurons in the brain.
The amounts of 2-DG in neurons and positron emissions are used to quantify metabolic activity in the brain. Thus, neuronal activity can be mapped during the performance of a particular task. Individual neurotransmitters can be distinguished with PET, which makes the latter advantageous over MRI techniques. It can measure activity distribution in detail. Limitations to PET include relatively low spatial resolution, time needed to obtain a scan, as well as potential radiation risk [33]. Single Photon Emission Computed Tomography (SPECT): SPECT is a subform of PET.
The Term Paper on Video Games Essay
This generation is so dead. Parents would ask their children, “ What are you doing this weekend?’ and they’ll be playing video games or watching TV, instead of playing outside in the nice outdoors, playing with other children in the park or do homework for the next upcoming week of school. The younger generation is surrounded by the Internet, apps, and video games. Our technology is getting ...
Similar to PET, a radioactive substance (a “tracer”) is injected into the blood stream that rapidly travels to the brain. The stronger the metabolic activity in specific brain regions, the stronger the enrichment of gamma rays. The emitted radiation is measured in accordance with brain layers, and metabolic activity is imaged using computerized techniques. Unlike PET, SPECT allows for counting individual photons, however, its resolution is poorer because with SPECT, resolution depends on the proximity of the gamma camera that measures neuronal radioactivity [34].
Functional Magnetic Resonance Imaging (fMRI): With fMRI, changes in the levels of blood oxygen in the brain are measured that are indicative of neuronal activity. Specifically, the ratio of oxyhemoglobin (i. e. , hemoglobin that contains oxygen in the blood) to deoxyhemoglobin (i. e. , hemoglobin that has released oxygen) in the brain is assessed because blood flow in “active” brain areas increases to transport more glucose, also bringing in more oxygenated hemoglobin molecules. The assessment of this metabolic activity in the brain allows for finer and more detailed imaging of the brain relative to structural MRI.
In addition to this, the advantages of fMRI include speed of brain imaging, spatial resolution, and absence of potential health risk relative to PET scans [35]. Structural Magnetic Resonance Imaging (sMRI): sMRI uses a variety of techniques to image brain morphology [36]. One such technique is Voxel-Based Morphometry (VBM).
VBM is used to compare the volume of brain areas and the density of gray and white matter [37]. Another sMRI technique is Diffusion-Tensor Imaging (DTI).
DTI is a method used for picturing white matter. It assesses the diffusion of water molecules in the brain which helps to identify interconnected brain
structures by using fractional anisotropy (FA).
This measure is an indicator of fiber density, axonal diameter, and myelination in white matter [38]. 2. Method A comprehensive literature search was conducted using the database Web of Knowledge. The following search terms (and their derivatives) were entered with regards to Internet use: “addiction”, “excess”, “problem”, and “compulsion”. Moreover, additional studies were identified from supplementary sources, such as Google Scholar, and these were added in order to generate a more inclusive literature review.
The Homework on The Effects Of Internet Addiction
... addicted to the internet. Delimitation, this study does not cover about the meaning of internet addiction, it also does not cover about the kinds of internet addiction ... e-mail, and online games have most commonly been associated with Internet addiction among youth, (According ... Addictive Internet Use Restructure the Brain?”, scientificamerican.com, June 17, 2011). 1.3 Significance of the Study Computer ...
Studies were selected in accordance with the following inclusion criteria. Studies had to Brain Sci. 2012, 2 351 (i) assess Internet or online gaming addiction or direct effects of gaming on neurological functioning, (ii) use neuroimaging techniques, (iii) be published in a peer-reviewed journal, and (iv) be available as full text in English language. No time period was specified for the literature search because neuroimaging techniques are relatively new, so that the studies were expected to be recent (i. e. , almost all having been published between 2000 and 2012).
3. Results
A total of 18 studies were identified that fulfilled the inclusion criteria. Of those, the method of data acquisition was fMRI in eight studies [39–46] and sMRI in two studies [47,48], two studies used PET scans [49,50], one of which combined it with an MRI [49], one used SPECT [51], and six studies utilized EEG [52–57]. It should also be noted that two of these were actually the same study with one published as a letter [53] and one published as a full paper [54]. One study [57] met all the criteria but was excluded because the diagnosis details of Internet addiction were insufficient to make valid conclusions.
Furthermore, two studies did not directly assess Internet and gaming addiction [43,50], but assessed the direct effects of gaming on neurological activity using an experimental paradigm, and were therefore retained in the review. Detailed information on the included studies are presented in Table 1. 3. 1. fMRI Studies Hoeft et al. [43] investigated gender differences in the mesocorticolimbic system during computer-game play among 22 healthy students (age range = 19–23 years; 11 females).
All participants underwent fMRI (3.
0-T Signa scanner (General Electric, Milwaukee, WI, USA), completed the Symptom Checklist 90-R [58], and the NEO-Personality Inventory-R [59]. FMRI was carried out during 40 blocks of either a 24-s ball game with the goal being to gain space or a similar control condition that did not include a specific game goal (as based on its structural makeup).
Results indicated that there was an activation of neural circuitries that are involved in reward and addiction in the experimental condition (i. e.
, insula, NAc, DLPFC, and OFC).
Consequently, the presence of an actual game goal (a characteristic of most conventional online games that are rule-based rather than pure role-playing games), modified brain activity via behavior. Here, a clear cause and effect relationship is evident, which adds strength to the findings. Results also showed that male participants had a larger activation (in rNAc, blOFC, rAMG) and functional connectivity (lNAc, rAMG) in the mesocorticolimbic reward system when compared to females.
The results furthermore indicated that playing the game activated the right insula (rI; signals autonomic arousal), right dorso-lateral PFC (maximize reward or change behavior), bilateral premotor cortices (blPMC; preparation for reward) and the precuneus, lNAc, and the rOFC (areas involved in visual processing, visuo-spatial attention, motor function, and sensori-motor transformation) compared to the resting state [43]. The insula has been implicated in conscious craving for addictive substances by implicating decision-making processes involving risk and reward.
Insula dysfunction may explain neurological activities indicative of relapse [60]. Due to its experimental nature, this study was able to provide insight into idiosyncratic brain activation as a consequence of gaming in a healthy (i. e. , non-addicted) population. Brain Sci. 2012, 2 352 Table 1. Included studies. Study (Year) Dong, Huang & Du [39] Dong, Zhou & Zhao [52] Main Aims Sample [Design/Method] Examined reward and punishment processing in Internet addicts versus healthy controls 14 male Internet addicts 13 healthy males Investigated executive control ability of Internet addicts 17 male Internet addicts
17 male healthy university students [Reality-simulated fMRI quasi-experimental guessing task for money gain or loss situation using playing cards] Internet addiction diagnosis Internet Addiction Test [61]; Chinese Internet Addiction Test [62,63] Investigated neurological response inhibition in Internet addicts 12 male Internet addicts 12 male healthy control university students Internet addicts had longer reaction time and more response errors in incongruent conditions than controls; reduced medial frontal negativity (MFN) deflection in incongruent conditions than controls Internet Addiction Test [65] Internet addicts had (i) lower NoGo-N2
amplitudes (represent response inhibition-conflict monitoring), higher NoGo-P3 amplitudes (inhibitory processes—response evaluation), (ii) longer NoGo-P3 peak latency than controls, and (iii) less efficient information processing and lower impulse control Internet Addiction Test [64] Study found similar results for Internet addicts as compared to other substance-related addicts; Cognitive dysfunctions associated with Internet addiction can be improved Internet addicts had longer P300 latencies relative to controls [Quasi-experimental EEG study: Recordings of event-related brain potentials (ERPs) via EEG
during a quasi-experimental go/NoGo task] Ge, Ge, Xu, Zhang, Zhao & Kong [66] Investigated association between P300 component and Internet addiction disorder 38 Internet addiction patients (21 males) 48 healthy college student controls (25 males) [Quasi-experimental EEG study; P300 ERP measured using standard auditory oddball task using American Nicolet BRAVO instrument] Internet addiction associated with increased activation in orbitofrontal cortex in gain trials, decreased anterior cingulate activation in loss trials compared to normal controls; Enhanced reward sensitivity and decreased loss sensitivity than normal controls
Internet Addiction Test [64] [Measured event-related potentials (ERP) via electroencephalogram (EEG) during a quasi-experimental color-word Stroop task] Dong, Lu, Zhou & Zhao [53] Main Results Brain Sci. 2012, 2 353 Table 1. Cont. Han, Lyoo & Renshaw [40] Compared regional gray matter volumes in patients with online game addiction (POGA) and professional gamers (PGs) 20 patients with online game addiction 17 pro-gamers 18 healthy male controls Tested effects of bupropion sustained release treatment on brain activity for online video game addicts 11 male Internet video game addicts 8 healthy male controls Han, Kim, Lee,
Min & Renshaw [42] Assessed differences in brain activity between baseline and video game play 21 university students (14 males) Hoeft, Watson, Kesler, Bettin-ger & Reiss [43] Investigated gender differences in mesocorti-colimbic system during computer-game play 22 healthy students (11 males) Han, Hwang & Renshaw [41] Young’s Internet Addiction Scale [67] POGA had higher impulsiveness, perseverative errors, volume in left thalamus gray matter, decreased gray matter volume in inferior temporal gyri, right middle occipital gyrus, left inferior occipital gyrus relative to HC; PGs had increased gray matter volume in left
cingulate gyrus, decreased in left middle occipital gyrus and right inferior temporal gyrus relative to HC, and increased in left cingulate gyrus and decreased left thalamus gray relative to POGA Young’s Internet Addiction Scale [67]; Craving for Internet Video Game Play Scale During exposure to game cues, IGA had more brain activation in left occipital lobe cuneus, left dorsolateral prefrontal cortex, left parahippocampal gyrus relative to H; After treatment, craving, play time, and cue-induced brain activity decreased in IAG Young’s Internet Addiction Scale [67]; Craving for Internet Video Game Play Scale
Brain activity in anterior cingulate and orbitofrontal cortex increased in excessive Internet game playing group (EIGP) following exposure to Internet video game cues relative to general players (GP); Increased craving for Internet video games correlated with increased activity in anterior cingulate for all participants Addiction not assessed via self-report Activation of neural circuitries involved in reward and addiction (i. e. , nucleus accumbens, amygdala, dorso-lateral prefrontal cortex, insular cortex, and orbitofrontal cortex); Males had a larger activation (in right nucleus accumbens, bilateral
orbitofrontal cortex, right amygdala) and functional connectivity (left nucleus accumbens and right amygdala) in mesocorticolimbic reward system relative to females [fMRI study with voxel-wise comparisons of gray matter volume] [Quasi-experimental fMRI study at baseline and after six weeks of treatment] [Quasi-experimental fMRI study at baseline and after six weeks of videogame play] [Experimental fMRI study performed with 3. 0-T Signa scanner (General Electric, Milwaukee, WI, USA) 40 blocks of either 24 s ball game or control condition] Brain Sci. 2012, 2 354 Table 1. Cont. Hou, Jia, Hu, Fan, Sun, Sun & Zhang [51]
Examined reward circuitry dopamine transporter levels in Internet addicts compared to controls 5 male Internet addicts 9 healthy age-matched male controls Kim, Baik, Park, Kim, Choi & Kim [49] Tested if Internet addiction is associated with reduced levels of dopaminergic receptor availability in the striatum 5 male Internet addicts 7 male controls Ko, Liu, Hsiao, Yen, Yang, Lin, Yen & Chen [44] Identified neural substrates of online gaming addiction by assessing brain areas involved in urge 10 male online gaming addicts [SPECT study: 99mTc-TRODAT-1 single photon emission computed tomography (SPECT) brain scans using Siemens Diacam/e.
cam/icon double detector] [PET study: Radiolabeled ligand [11C]raclopride and positron emission tomorgraphy via ECAT EXACT scanner used to test dopamine D2 receptor binding potential; fMRI using General Electric Signa version 1. 5T MRI scanner; Method for assessing D2 receptor availability: regions of interest (ROI) analysis in ventral striatum, dorsal caudate, dorsal putamen] [Quasi-experimental fMRI study: Presentation of gaming-related and paired mosaic pictures during fMRI scanning (3T MRscanner); Contrasts in BOLD signals in both conditions analysed; Cue reactivity paradigm] [70] Young’s Internet Addiction Diagnostic
Questionnaire [64]; Internet addictive Disorder Diagnostic Criteria [68] Reduced dopamine transporters indicate addiction: similar neurobiological abnormalities with other behavioural addictions; Striatal dopamine transporter (DAT) levels decreased in Internet addicts (necessary for regulation of striatal dopamine levels) and volume, weight, and uptake ratio of the corpus striatum were reduced; Dopamine levels similar in people with substance addiction Internet Addiction Test [69]; Internet Addictive Disorder Diagnostic Criteria [68] Internet addicts had reduced dopamine D2 receptor availability in striatum (i. e. , bilateral
dorsal caudate, right putamen); Negative correlation of dopamine receptor availability with Internet addiction severity; Internet addiction found to be related to neurobiological abnormalities in the dopaminergic system as found in substancerelated addictions Chen Internet Addiction Scale (CIAS) [71] Dissimilar brain activation in gaming addicts: right orbitofrontal cortex, right nucleus accumbens, bilateral anterior cingulate, medial frontal cortex, right dorsolateral prefrontal cortex, right caudate nucleus and this correlated with gaming urge and recalling of gaming experience; Cue induced craving common in substance
dependence: similar biological basis of different addictions including online gaming addiction Brain Sci. 2012, 2 355 Table 1. Cont. Koepp, Gunn, Law-rence, Cunning-ham, Dagher, Jones, Brooks, Bench & Grasby [50] Provided evidence for striatal dopamine release during a video game play 8 males Lin, Zhou, Du, Qin, Zhao, Xu & Lei [48] Investigated white matter integrity in adolescent Internet addicts 17 Internet addicts (14 males) 16 healthy controls (14 males) [Experimental PET study 953B-Siemens/CTIPET camera; Positron emission tomography (PET) during video game play and under resting condition; Region-of-interest (ROI) analysis;
Extracellular dopamine levels measured via differences in [11C]RAC-binding potential to dopamine D2 receptors in ventral and dorsal striata] Addiction not assessed via self-report Reduction of binding of raclopride to dopamine receptors in striatum during video game play relative to baseline; Correlation between performance level and reduced binding potential in all striatal regions; First study to show that dopamine is released during particular behaviours; Ventral and dorsal striata associated with goaldirected behaviour Modified Young’s Internet Addiction Test [72] Internet addicts had lower FA throughout the
brain (orbito-frontal white matter corpus callosum, cingulum, inferior fronto-occipital fasciculus, corona radiation, internal and external capsules); Negative correlations between FA in left genu of corpus callosum and emotional disorders, and FA in left external capsule and Internet addiction; Similarities in brain structures between Internet and substance addicts Videogame Addiction Test (VAT) [73] Similarities with substance dependence and impulse control disorders regarding poor inhibition, high impulsivity in excessive gamers; Excessive gamers: reduced fronto-central ERN amplitudes following incorrect trials in
comparison to correct trials leading to poor error-processing [Whole brain voxel-wise analysis of fractional anisotropy (FA) by tract-based spatial statistics (TBSS) and volume of interest analysis were performed using diffusion tensor imaging (DTI) via a 3. 0-Tesla Phillips Achieva medical scanner] Littel, Luijten, van den Berg, van Rooij, Kee-mink & Franken [56] Investigated errorprocessing and response inhibition in excessive gamers 25 excessive gamers (23 males) 27 controls (10 males) [Electroencephalography (EEG): Go/NoGo paradigm using EEG and ERP recordings] Brain Sci. 2012, 2 356 Table 1. Cont. Applied regional
homogeneity method to analyse encephalic functional characteristic of Internet addicts in resting state 19 college students with Internet addiction (11 males and 8 females) 19 controls (gender matched) Yuan, Qin, Wang, Zeng, Zhao, Yang, Liu, Liu, Sun, von Deneen, Gong, Liu & Tian [46] Investigated effects of Internet addiction on the microstructural integrity of major neuronal fiber pathways and microstructural changes with duration of Internet addiction 18 students with Internet addiction (12 males) 18 control subjects (gender matched) Zhou, Lin, Du, Qin, Zhao, Xu & Lei [47] Investigated brain gray matter density (GMD)
changes in adolescents with Internet addiction using voxel-based morphometry (VBM) analysis on high-resolution T1-weighted structural magnetic resonance images 18 adolescents with Internet addiction (2 females) 15 healthy controls (2 females) Liu, Gao, Osunde, Li, Zhou, Zheng & Li [45] [fMRI study: Functional magnetic resonance image using 3. 0T Siemens Tesla Trio Tim scanner; Assessed resting state fMRI; Regional homogeneity (ReHo) indicates temporal homogeneity of regional BOLD signal rather than its density] [fMRI study: Optimised voxel-based morphometry (VBM) technique. Analysed white matter fractional anisotropy (FA) changes by
using diffusion tensor imaging (DTI) to associate brain structural changes to Internet addiction length] [MRI study: Used high-resolution T1-weighted MRIs performed on a 3T MR scanner (3T Achieva Philips), scanned MPRAGE pulse sequences for gray and white matter contrasts; VBM analysis to compare GMD between groups] Modified Diagnostic Questionnaire for Internet Addiction [72] Internet addicts suffer from functional brain changes leading to abnormalities in regional homogeneity in Internet addicts relative to controls; Internet addicts had increased brain regions in ReHo in resting state (cerebellum,
brainstem, right cingulate gyrus, bilateral parahippocampus, right frontal lobe, left superior frontal gyrus, right inferior temporal gyrus, left superior temporal gyrus and middle temporal gyrus) Modified Diagnostic Questionnaire for Internet Addiction [72] Increased FA of left posterior limb of internal capsule (PLIC) and reduced FA in white matter in right parahippocampal gyrus (PHG); Correlation between gray matter volumes in DLPFC, rACC, SMA, and white matter FA changes of PLIC with Internet addiction length; Internet addiction results in changes in brain structure Modified Diagnostic Questionnaire for Internet Addiction [72]
Structural brain changes in adolescents with Internet addiction; Internet addicts had lower GMD in left anterior cingulate cortex (necessary for motor control, cognition, motivation), left posterior cingulate cortex (self-reference), left insula (specifically related to craving and motivation) Brain Sci. 2012, 2 357 Ko et al. [44] attempted to identify the neural substrates of online gaming addiction by assessing brain areas involved in urge to engage in online games among ten male online gaming addicts (playing World of Warcraft for more than 30 h a week) compared to ten male controls (whose online use was less than two hours a day).
All participants completed the Diagnostic Criteria for Internet Addiction for College Students (DCIA-C; [74]), the Mini-International Neuropsychiatric Interview [75], the Chen Internet Addiction Scale (CIAS) [71], the Alcohol Use Disorder Identification Test (AUDIT) [76], and the Fagerstrom Test for Nicotine Dependence (FTND) [77]. The authors presented gaming-related and paired mosaic pictures during fMRI scanning (3T MRscanner), and contrasts in BOLD signals in both conditions were analyzed using a cue reactivity paradigm [25]. The results indicated cue induced craving that is common among those with substance dependence.
There was a dissimilar brain activation among gaming addicts following the presentation of game relevant cues as compared to controls and compared to the presentation of mosaic pictures, including the rOFC, rNAc, blAC, mFC, rDLPFC, and the right caudate nucleus (rCN).
This activation correlated with gaming urge and a recalling of gaming experience. It was argued that there is a similar biological basis of different addictions including online gaming addiction. The quasi-experimental nature of this study that artificially induced craving in an experimental and controlled setting
allowed the authors to make conclusions as based on group differences, and thus linking online gaming addiction status to the activation of brain areas associated with symptoms of more traditional (i. e. , substance-related) addictions. Han et al. [42] assessed the differences in brain activity before and during video game play in university students playing over a seven-week period. All participants completed the Beck Depression Inventory [78], the Internet Addiction Scale [67], and a 7-point visual analogue scale (V
