Studies demonstrating Internet use or porn use "causing" symptoms or neurological changes

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COMMENTS: The majority of human studies on various addictions, including internet addiction, are correlational. Below are the growing number of studies strongly suggesting that internet use (porn, gaming, etc.) causes mood alterations or mental disorders, and addiction-related brain changes.

Pornography studies suggesting or demonstrating causation:

The debate about the existence of porn-induced sexual dysfunctions is over. The first 5 studies listed here demonstrate porn use causing sexual problems as participants eliminated porn use and healed chronic sexual dysfunctions.

Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports (2016)

An extensive review of the literature related to porn-induced sexual problems. Involving 7 US Navy doctors (urologists, psychiatrists, and a MD with PhD in neuroscience) the review provides the latest data revealing a tremendous rise in youthful sexual problems. It also reviews the neurological studies related to porn addiction and sexual conditioning via Internet porn. The doctors provide 3 clinical reports of men who developed porn-induced sexual dysfunctions. Two of the three men healed their sexual dysfunctions by eliminating porn use. The third man experienced little improvement as he was unable to abstain from porn use. Excerpt:

Traditional factors that once explained men’s sexual difficulties appear insufficient to account for the sharp rise in erectile dysfunction, delayed ejaculation, decreased sexual satisfaction, and diminished libido during partnered sex in men under 40. This review (1) considers data from multiple domains, e.g., clinical, biological (addiction/urology), psychological (sexual conditioning), sociological; and (2) presents a series of clinical reports, all with the aim of proposing a possible direction for future research of this phenomenon. Alterations to the brain's motivational system are explored as a possible etiology underlying pornography-related sexual dysfunctions. This review also considers evidence that Internet pornography’s unique properties (limitless novelty, potential for easy escalation to more extreme material, video format, etc.) may be potent enough to condition sexual arousal to aspects of Internet pornography use that do not readily transition to real-life partners, such that sex with desired partners may not register as meeting expectations and arousal declines. Clinical reports suggest that terminating Internet pornography use is sometimes sufficient to reverse negative effects, underscoring the need for extensive investigation using methodologies that have subjects remove the variable of Internet pornography use.

Male masturbation habits and sexual dysfunctions (2016)

It's by a French psychiatrist who is the current president of the European Federation of Sexology. The paper revolves around his clinical experience with 35 men who developed erectile dysfunction and/or anorgasmia, and his therapeutic approaches to help them. The author states that most of his patients used porn, with several being addicted to porn. The abstract points to internet porn as the primary cause of the problems. 19 of the 35 men saw significant improvements in sexual functioning. The other men either dropped out of treatment or are still trying to recover. Excerpts:

Intro: Harmless and even helpful in his usual form widely practiced, masturbation in its excessive and pre-eminent form, generally associated today to pornographic addiction, is too often overlooked in the clinical assessment of sexual dysfunction it can induce.

Results: Initial results for these patients, after treatment to “unlearn” their masturbatory habits and their often associated addiction to pornography, are encouraging and promising. A reduction in symptoms was obtained in 19 patients out of 35. The dysfunctions regressed and these patients were able to enjoy satisfactory sexual activity.

Conclusion: Addictive masturbation, often accompanied by a dependency on cyber-pornography, has been seen to play a role in the etiology of certain types of erectile dysfunction or coital anejaculation. It is important to systematically identify the presence of these habits rather than conduct a diagnosis by elimination, in order to include habit-breaking deconditioning techniques in managing these dysfunctions.

Unusual masturbatory practice as an etiological factor in the diagnosis and treatment of sexual dysfunction in young men (2014)

One of the 4 case studies in this paper reports on a man with porn-induced sexual problems (low libido, fetishes, anorgasmia). The sexual intervention called for a 6-week abstinence from porn and masturbation. After 8 months the man reported increased sexual desire, successful sex and orgasm, and enjoying “good sexual practices. This is the first peer-reviewed chronicling of a recovery from porn-induced sexual dysfunctions. Excerpts from the paper:

When asked about masturbatory practices, he reported that in the past he had been masturbating vigorously and rapidly while watching pornography since adolescence. The pornography originally consisted mainly of zoophilia, and bondage, domination, sadism, and masochism, but he eventually got habituated to these materials and needed more hardcore pornography scenes, including transgender sex, orgies, and violent sex. He used to buy illegal pornographic movies on violent sex acts and rape and visualized those scenes in his imagination to function sexually with women. He gradually lost his desire and his ability to fantasize and decreased his masturbation frequency.

In conjunction with weekly sessions with a sex therapist, the patient was instructed to avoid any exposure to sexually explicit material, including videos, newspapers, books, and internet pornography.

After 8 months, the patient reported experiencing successful orgasm and ejaculation. He renewed his relationship with that woman, and they gradually succeeded in enjoying good sexual practices.

How difficult is it to treat delayed ejaculation within a short-term psychosexual model? A case study comparison (2017)

This is a report on two "composite cases" illustrating the etiology and treatments for delayed ejaculation (anorgasmia). "Patient B" represented several young men treated by the therapist. Interestingly, the paper states that Patient B's "porn use had escalated into harder material", "as is often the case". The paper says that porn-related delayed ejaculation is not uncommon, and on the rise. The author calls for more research on porn's effects of sexual functioning. Patient B's delayed ejaculation was healed after 10 weeks of no porn. Excerpts:

The cases are composite cases taken from my work within the National Health Service in Croydon University Hospital, London. With the latter case (Patient B), it is important to note that the presentation reflects a number of young males who have been referred by their GPs with a similar diagnosis. Patient B is a 19-year-old who presented because he was unable to ejaculate via penetration. When he was 13, he was regularly accessing pornography sites either on his own through internet searches or via links that his friends sent him. He began masturbating every night while searching his phone for image…If he did not masturbate he was unable to sleep. The pornography he was using had escalated, as is often the case (see Hudson-Allez, 2010), into harder material (nothing illegal)…

Patient B was exposed to sexual imagery via pornography from the age of 12 and the pornography he was using had escalated to bondage and dominance by the age of 15.

We agreed that he would no longer use pornography to masturbate. This meant leaving his phone in a different room at night. We agreed that he would masturbate in a different way….

Patient B was able to achieve orgasm via penetration by the fifth session; the sessions are offered fortnightly in Croydon University Hospital so session five equates to approximately 10 weeks from consultation. He was happy and greatly relieved. In a three-month follow-up with Patient B, things were still going well.

Patient B is not an isolated case within the National Health Service (NHS) and in fact young men in general accessing psychosexual therapy, without their partners, speaks in itself to the stirrings of change.

This article therefore supports previous research that has linked masturbation style to sexual dysfunction and pornography to masturbation style. The article concludes by suggesting that the successes of psychosexual therapists in working with DE are rarely recorded in the academic literature, which has allowed the view of DE as a difficult disorder to treat remain largely unchallenged. The article calls for research into pornography usage and its effect on masturbation and genital desensitisation.

Situational Psychogenic Anejaculation: A Case Study (2014)

The details reveal a case of porn-induced anejaculation. The husband's only sexual experience prior to marriage was frequent masturbation to pornography - where he was able to ejaculate. He also reported sexual intercourse as less arousing than masturbation to porn. The key piece of information is that "re-training" and psychotherapy failed to heal his anejaculation. When those interventions failed, therapists suggested a complete ban on masturbation to porn. Eventually this ban resulted in successful sexual intercourse and ejaculation with a partner for the first time in his life. A few excerpts:

A is a 33-year-old married male with heterosexual orientation, a professional from a middle socio-economic urban background. He has had no premarital sexual contacts. He watched pornography and masturbated frequently. His knowledge about sex and sexuality was adequate. Following his marriage, Mr. A described his libido as initially normal, but later reduced secondary to his ejaculatory difficulties. Despite thrusting movements for 30-45 minutes, he had never been able to ejaculate or achieve orgasm during penetrative sex with his wife.

What didn't work:

Mr. A's medications were rationalized; clomipramine and bupropion were discontinued, and sertraline was maintained at a dose of 150 mg per day. Therapy sessions with the couple were held weekly for the initial few months, following which they were spaced to fortnightly and later monthly. Specific suggestions including focusing on sexual sensations and concentrating on the sexual experience rather than ejaculation were used to help reduce performance anxiety and spectatoring. Since problems persisted despite these interventions, intensive sex therapy was considered.

Eventually they instituted a complete ban on masturbation (which means he continued to masturbate to porn during the above failed interventions):

A ban on any form of sexual activity was suggested. Progressive sensate focus exercises (initially non-genital and later genital) were initiated. Mr. A described an inability to experience the same degree of stimulation during penetrative sex as compared to that which he experienced during masturbation. Once the ban on masturbation was enforced, he reported an increased desire for sexual activity with his partner.

After an unspecified amount of time, the ban on masturbation to porn lead to success:

Meanwhile, Mr. A and his wife decided to go ahead with Assisted Reproductive Techniques (ART) and underwent two cycles of intrauterine insemination. During a practice session, Mr. A ejaculated for the first time, following which he has been able to ejaculate satisfactorily during a majority of the couple's sexual interactions.

How Abstinence Affects Preferences (2016) [preliminary results] – Excerpts from the article:

Results of the First Wave - Main Findings

  1. The length of the longest streak participants performed before taking part in the survey correlates with time preferences. The second survey will answer the question if longer periods of abstinence render participants more able to delay rewards, or if more patient participants are more likely to perform longer streaks.
  2. Longer periods of abstinence most likely cause less risk aversion (which is good). The second survey will provide the final proof.
  3. Personality correlates with length of streaks. The second wave will reveal if abstinence influences personality or if personality can explain variation in the length of streaks.

Results of the Second Wave - Main Findings

  1. Abstaining from pornography and masturbation increases the ability to delay rewards
  2. Participating in a period of abstinence renders people more willing to take risks
  3. Abstinence renders people more altruistic
  4. Abstinence renders people more extroverted, more conscientious, and less neurotic

Early adolescent boys’ exposure to internet pornography: Relationships to pubertal timing, sensation seeking, and academic performance (2014)

An increase in porn use was followed by a decrease in academic performance. An excerpt:

This two-wave panel study aimed to test an integrative model in early adolescent boys (Mean age = 14.10; N = 325) that (a) explains their exposure to Internet pornography by looking at relationships with pubertal timing and sensation seeking, and (b) explores the potential consequence of their exposure to Internet pornography for their academic performance. An integrative path model indicated that pubertal timing and sensation seeking predicted the use of Internet pornography. Boys with an advanced pubertal stage and boys high in sensation seeking more frequently used Internet pornography. Moreover, an increased use of Internet pornography decreased boys’ academic performance six months later. The discussion focuses on the consequences of this integrative model for future research on Internet pornography.

A Love That Doesn't Last: Pornography Consumption and Weakened Commitment to One's Romantic Partner (2012)

We examined whether the consumption of pornography affects romantic relationships, with the expectation that higher levels of pornography consumption would correspond to weakened commitment in young adult romantic relationships.

Study 1 (n = 367) found that higher pornography consumption was related to lower commitment, and

Study 2 (n = 34) replicated this finding using observational data.

Study 3 (n = 20) participants were randomly assigned to either refrain from viewing pornography or to a self-control task. Those who continued using pornography reported lower levels of commitment than control participants.

The intervention proved effective at reducing or eliminating pornography consumption for the duration of the three-week study, yet did not deter control participants from continuing their consumption. Our hypothesis was supported as participants in the pornography consumption condition reported a substantial reduction in commitment compared to participants in the abstain from pornography condition.

COMMENTS: Subjects abstained from porn use (only 3 weeks). Comparing the two groups, those who continued using pornography reported lower levels of commitment than control participants. What might have occurred if they abstained for 3 months instead of 3 weeks?

Trading Later Rewards for Current Pleasure: Pornography Consumption and Delay Discounting (2015)

Introduction of paper:

Internet pornography is a multi-billion-dollar industry that has grown increasingly accessible. Delay discounting involves devaluing larger, later rewards in favor of smaller, more immediate rewards. The constant novelty and primacy of sexual stimuli as particularly strong natural rewards make Internet pornography a unique activator of the brain's reward system, thereby having implications for decision-making processes. Based on theoretical studies of evolutionary psychology and neuroeconomics, two studies tested the hypothesis that consuming Internet pornography would relate to higher rates of delay discounting.

Study 1 used a longitudinal design. Participants completed a pornography use questionnaire and a delay discounting task at Time 1 and then again four weeks later. Participants reporting higher initial pornography use demonstrated a higher delay discounting rate at Time 2, controlling for initial delay discounting.

Study 2 tested for causality with an experimental design. Participants were randomly assigned to abstain from either their favorite food or pornography for three weeks. Participants who abstained from pornography use demonstrated lower delay discounting than participants who abstained from their favorite food. The finding suggests that Internet pornography is a sexual reward that contributes to delay discounting differently than other natural rewards. Theoretical and clinical implications of these studies are highlighted.

This paper contains two longitudinal studies examining the effects of Internet porn on "delay discounting." Delay discounting happens when people choose ten dollars right now rather than 20 dollars in a week. It's the inability to delay immediate gratification for a more valuable reward in the future.

Think of the famous Stanford marshmallow experiment, where 4 and 5 year olds were told if they delayed eating their one marshmallow while the researcher stepped out, they would be rewarded with a second marshmallow when the researcher returned. Watch this funny video of kids struggling with this choice.

The first study (median subject age 20) correlated subjects' pornography use with their scores on a delayed gratification task. The results:

The more pornography that participants consumed, the more they saw the future rewards as worth less than the immediate rewards, even though the future rewards were objectively worth more.

Put simply, more porn use correlated with less ability to delay gratification for larger future rewards. In the second part of this study researchers assessed the subjects delayed discounting 4 weeks later and correlated with their porn use.

These results indicate that continued exposure to the immediate gratification of pornography is related to higher delay discounting over time.

Continued porn use resulted in greater delayed discounting 4 weeks later. This strongly suggests that porn use causes inability to delay gratification, rather than the inability to delay gratification leading to porn use. But the second study drove the nail into the coffin.  

A second study (median age 19) was performed to assess if porn use causes delayed discounting, or the inability to delay gratification. Researchers divided current porn users into two groups:

  1. One group abstained from porn use for 3 weeks,
  2. A second group abstained from their favorite food for 3 weeks.

All participants were told the study was about self-control, and they were randomly chosen to abstain from their assigned activity.

The clever part was that the researchers had the second group of porn users abstain from eating their favorite food. This ensured that 1) all subjects engaged in a self-control task, and 2) the second group's porn use was unaffected.

At the end of the 3 weeks, participants were involved in a task to assess delay discounting. Important note: While the "porn abstinence group" viewed significantly less porn than the "favorite food abstainers", most did not completely abstain from porn viewing. The results:

As predicted, participants who exerted self-control over their desire to consume pornography chose a higher percentage of larger, later rewards compared to participants who exerted self-control over their food consumption but continued consuming pornography.

The group that cut back on their porn viewing for 3 weeks displayed less delay discounting than the group that abstained from their favorite food. Put simply, abstaining from internet porn increases porn users' ability to delay gratification. From the study:

Thus, building on the longitudinal findings of Study 1, we demonstrated that continued pornography consumption was causally related to a higher rate of delay discounting. Exercising self-control in the sexual domain had a stronger effect on delay discounting than exercising self-control over another rewarding physical appetite (e.g., eating one’s favorite food).

The take-aways:

  1. It wasn't exercising self-control that increased the ability to delay gratification. Reducing porn use was the key factor.
  2. Internet porn is a unique stimulus.
  3. Internet porn use, even in non-addicts, has long-term effects.

What's so important about delay discounting (the ability to delay gratification)? Well, delay discounting has been linked to substance abuse, excessive gambling, risky sexual behavior and internet addiction.

Back to the 1972 "marshmallow experiment": Researchers reported that the children who were willing to delay gratification and waited to receive the second marshmallow ended up having higher SAT scores, lower levels of substance abuse, lower likelihood of obesity, better responses to stress, better social skills as reported by their parents, and generally better scores in a range of other life measures (the follow-up studies here, here, and here). The ability to delay gratification was critical for success in life.

This new porn study turns everything on its head. While the marshmallow studies point to the ability to delay gratification as an unchangeable characteristic, this study demonstrates it's fluid, to some degree. The surprising finding is that exercising willpower was not the key factor. Instead, exposure to Internet porn affected subjects' ability to delay gratification. From the study:

"Our results also bolster findings that differences in delay discounting are largely due to behavior rather than genetic predispositions."


"While developmental and biological predisposition may play a major role in one’s discounting and impulsivity tendencies, both behavior and the nature of stimuli and rewards also contribute to the development of such tendencies."

Two important points: 1) the subjects were not asked to abstain from masturbation or sex - only porn, and 2) the subjects were not compulsive porn users or addicts. The findings clearly demonstrate that Internet porn is a unique and powerful supernormal stimulus, capable of altering what researchers though was an innate characteristic. From the study:

"Internet pornography is a sexual reward that contributes to delay discounting differently than other natural rewards do, even when use is not compulsive or addictive. This research makes an important contribution, demonstrating that the effect goes beyond temporary arousal."

As thousands of rebooters have revealed, Internet porn use can affect much more than one's sexuality. From the study's conclusion:

"Pornography consumption may provide immediate sexual gratification but can have implications that transcend and affect other domains of a person’s life, especially relationships. It is therefore important to treat pornography as a unique stimulus in reward, impulsivity, and addiction studies and to apply this accordingly in individual as well as relational treatment."

The study also contains a useful discussion of the role of dopamine and cue-driven behavior. In addition, it provides a lot of research on why sexual cues and internet cues (constant novelty) require special consideration. Evolutionarily, the survival advantage of delay discounting for sexual stimuli would be to urge mammals to ‘‘get while the getting is good," thus successfully passing on their genes.

As the researchers said,

"Pornography use in itself may be a harmless activity but, given what we know about the reward system and the primacy of sex as a natural reward and visceral stimulus, it also has the potential to become compulsive or addictive."

The researchers predicted porn consumption would increase impulsivity for 3 reasons:

  1. Sexual urges can be extremely powerful, and have been related to impulsivity in past research
  2. Pornography consumption is a simple replacement for real encounters, can become habitual, and can the condition user to instant gratification
  3. Constant novelty of the internet can lead to repeated stimulation and habituation (decreased responsiveness, driving an need for more stimulation)

Finally, as most of the subjects were still in adolescence, there is a brief discussion of how adolescents may be uniquely vulnerable to internet porn's effects.

"With regard to the current sample of college students (median ages of 19 and 20), it is important to be aware that, biologically, adolescence extends to approximately age 25. Adolescents show more reward sensitivity and less aversion to overconsumption, making them more susceptible to addiction."

Exposure to Sexual Stimuli Induces Greater Discounting Leading to Increased Involvement in Cyber Delinquency Among Men (Cheng & Chiou, 2017)

In two studies exposure to visual sexual stimuli resulted in: 1) greater delayed discounting (inability to delay gratification), 2) greater inclination to engage in cyber-delinquency, 3) greater inclination to purchase counterfeit goods and hack someone's Facebook account. Taken together this indicates that porn use increases impulsivity and may reduce certain executive functions (self-control, judgment, foreseeing consequences, impulse control). Excerpt:

People frequently encounter sexual stimuli during Internet use. Research has shown that stimuli inducing sexual motivation can lead to greater impulsivity in men, as manifested in greater temporal discounting (i.e., a tendency to prefer smaller, immediate gains to larger, future ones).

In conclusion, the current results demonstrate an association between sexual stimuli (e.g., exposure to pictures of sexy women or sexually arousing clothing) and men’s involvement in cyber delinquency. Our findings suggest that men’s impulsivity and self-control, as manifested by temporal discounting, are susceptible to failure in the face of ubiquitous sexual stimuli. Men may benefit from monitoring whether exposure to sexual stimuli is associated with their subsequent delinquent choices and behavior. Our findings suggest that encountering sexual stimuli can tempt men down the road of cyber delinquency

The current results suggest that the high availability of sexual stimuli in cyberspace may be more closely associated with men's cyber-delinquent behavior than previously thought.

Does Viewing Pornography Reduce Marital Quality Over Time? Evidence from Longitudinal Data (2016)

The first longitudinal study on a representative cross-section of married couples. It found significant negative effects of porn use on sexual satisfaction and marriage quality over time.  Excerpt:

This study is the first to draw on nationally representative, longitudinal data (2006-2012 Portraits of American Life Study) to test whether more frequent pornography use influences marital quality later on and whether this effect is moderated by gender. In general, married persons who more frequently viewed pornography in 2006 reported significantly lower levels of marital quality in 2012, net of controls for earlier marital quality and relevant correlates. Pornography's effect was not simply a proxy for dissatisfaction with sex life or marital decision-making in 2006. In terms of substantive influence, frequency of pornography use in 2006 was the second strongest predictor of marital quality in 2012

Till Porn Do Us Part? Longitudinal Effects of Pornography Use on Divorce, (2016)

The study used nationally representative General Social Survey panel data collected from thousands of American adults. Respondents were interviewed three times about their pornography use and marital status -- every two years from 2006-2010, 2008-2012, or 2010-2014. Excerpts:

Beginning pornography use between survey waves nearly doubled one's likelihood of being divorced by the next survey period, from 6 percent to 11 percent, and nearly tripled it for women, from 6 percent to 16 percent. Our results suggest that viewing pornography, under certain social conditions, may have negative effects on marital stability.

Additionally, the researchers found that respondents' initially reported level of marital happiness played an important role in determining the magnitude of pornography's association with the probability of divorce. Among people who reported they were "very happy" in their marriage in the first survey wave, beginning pornography viewership before the next survey was associated with a noteworthy increase -- from 3 percent to 12 percent -- in the likelihood of getting divorced by the time of that next survey.

Internet pornography and relationship quality: A longitudinal study of within and between partner effects of adjustment, sexual satisfaction and sexually explicit internet material among newly-weds (2015)

A longitudinal study. Excerpt:

The data from a considerable sample of newlyweds showed that SEIM use has more negative than positive consequences for husbands and wives. Importantly, husbands’ adjustment decreased SEIM use over time and SEIM use decreased adjustment. Furthermore, more sexual satisfaction in husbands predicted a decrease in their wives’ SEIM use one year later, while wives’ SEIM use did not change their husbands’ sexual satisfaction.

Pornography Use and Marital Separation: Evidence from Two-Wave Panel Data (2017)

Longitudinal study. Excerpts:

Drawing on data from the 2006 and 2012 waves of the nationally representative Portraits of American Life Study, this article examined whether married Americans who viewed pornography in 2006, either at all or in greater frequencies, were more likely to experience a marital separation by 2012. Binary logistic regression analyses showed that married Americans who viewed pornography at all in 2006 were more than twice as likely as those who did not view pornography to experience a separation by 2012, even after controlling for 2006 marital happiness and sexual satisfaction as well as relevant sociodemographic correlates. The relationship between pornography use frequency and marital separation, however, was technically curvilinear. The likelihood of marital separation by 2012 increased with 2006 pornography use to a point and then declined at the highest frequencies of pornography use.

Are Pornography Users More Likely to Experience A Romantic Breakup? Evidence from Longitudinal Data (2017)

Longitudinal study. Excerpts:

This study examined whether Americans who use pornography, either at all or more frequently, are more prone to report experiencing a romantic breakup over time. Longitudinal data were taken from the 2006 and 2012 waves of the nationally representative Portraits of American Life Study. Binary logistic regression analyses demonstrated that Americans who viewed pornography at all in 2006 were nearly twice as likely as those who never viewed pornography to report experiencing a romantic breakup by 2012, even after controlling for relevant factors such as 2006 relationship status and other sociodemographic correlates. This association was considerably stronger for men than for women and for unmarried Americans than for married Americans. Analyses also showed a linear relationship between how frequently Americans viewed pornography in 2006 and their odds of experiencing a breakup by 2012.

Internet & video gaming studies suggesting or demonstrating causation:

Online communication, compulsive internet use, and psychosocial well-being among adolescents: A longitudinal study. (2008)

Lonitudinal study. Excerpts:

The present study investigated the relationships between adolescents' online communication and compulsive Internet use, depression, and loneliness. The study had a 2-wave longitudinal design with an interval of 6 months. The sample consisted of 663 students, 318 male and 345 female, ages 12 to 15 years. Questionnaires were administered in a classroom setting. The results showed that instant messenger use and chatting in chat rooms were positively related to compulsive Internet use 6 months later. Moreover, in agreement with the well-known HomeNet study (R. Kraut et al., 1998), instant messenger use was positively associated with depression 6 months later. Finally, loneliness was negatively related to instant messenger use 6 months later.

Effect of Pathological Use of the Internet on Adolescent Mental Health (2010)

One of the earliest studies to assess Internet users over time. Study suggested that Internet use causes depression in adolescents. Excerpts:

To examine the effect of pathological use of the Internet on the mental health, including anxiety and depression, of adolescents in China. It is hypothesized that pathological use of the Internet is detrimental to adolescents’ mental health.

DESIGN: A prospective study with a randomly generated cohort from the population.

PARTICIPANTS: Adolescents aged between 13 and 18 years.

RESULTS: After adjusting for potential confounding factors, the relative risk of depression for those who used the Internet pathologically was about 21⁄2 times that of those who did not exhibit the targeted pathological internet use behaviors. No significant relationship between pathological use of the Internet and anxiety at follow-up was observed.

Results suggested that young people who are initially free of mental health problems but use the Internet pathologically could develop depression as a consequence. These results have direct implications for the prevention of mental illness in young people, particularly in developing countries.

Precursor or Sequela: Pathological Disorders in People with Internet Addiction Disorder (2011)

A unique study. It follows first year university students to ascertain what percentage develop Internet addiction, and what risk factors may be in play. The unique aspect is that the research subjects had not used the Internet prior to enrolling in college. Hard to believe. After only one year of school, a small percentage were classified as Internet addicts. Those who developed Internet addiction were INITIALLY higher on the obsessive scale, yet lower on scores for anxiety depression, and hostility. Excerpts:

This study aimed to evaluate the roles of pathological disorders in Internet addiction disorder and identify the pathological problems in IAD, as well as explore the mental status of Internet addicts prior to addiction, including the pathological traits that may trigger Internet addiction disorder.

Methods and Findings

59 students were measured by Symptom Check List-90 before and after they became addicted to the Internet. A comparison of collected data from Symptom Checklist-90 before Internet addiction and the data collected after Internet addiction illustrated the roles of pathological disorders among people with Internet addiction disorder. The obsessive-compulsive dimension was found abnormal before they became addicted to the Internet. After their addiction, significantly higher scores were observed for dimensions on depression, anxiety, hostility, interpersonal sensitivity, and psychoticism, suggesting that these were outcomes of Internet addiction disorder. Dimensions on somatisation, paranoid ideation, and phobic anxiety did not change during the study period, signifying that these dimensions are not related to Internet addiction disorder.


We cannot find a solid pathological predictor for Internet addiction disorder. Internet addiction disorder may bring some pathological problems to the addicts in some ways.

The key point is Internet addiction appears to have caused behavioral and emotional changes. From the study:

After developing Internet addiction, significantly higher scores were observed for dimensions of depression, anxiety, hostility, interpersonal sensitivity, and psychoticism, suggesting that these were outcomes of Internet addiction disorder.

We cannot find a solid pathological predictor for Internet addiction disorder. Internet addiction disorder may bring some pathological problems to the addicts in some ways.

Effects of Video-Game Ownership on Young Boys’ Academic and Behavioral Functioning: A Randomized, Controlled Study (2010)

Boys who received the video game system experience a drop in their reading and writing scores. Excerpts:

After baseline assessment of boys’ academic achievement and parent- and teacher-reported behavior, boys were randomly assigned to receive the video-game system immediately or to receive the video-game system after follow-up assessment, 4 months later. Boys who received the system immediately spent more time playing video games and less time engaged in after-school academic activities than comparison children.

Boys who received the system immediately also had lower reading and writing scores and greater teacher-reported academic problems at follow-up than comparison children. Amount of video-game play mediated the relationship between video-game ownership and academic outcomes. Results provide experimental evidence that video games may displace after-school activities that have educational value and may interfere with the development of reading and writing skills in some children.

Brain correlates of craving for online gaming under cue exposure in subjects with Internet gaming addiction and in remitted subjects (2011)

Unlike most studies, this one included both controls and Internet addicts in remission. Researchers found that subjects with Internet addiction presented with a different activation pattern than controls and former Internet addicts. The brain's of Internet Addicts differed from controls and recovery lead to reversal of the addiction-related brain changes. Excerpts:

This study aimed to evaluate brain correlates of cue-induced craving to play online games in subjects with Internet gaming addiction (IGA), subjects in remission from IGA and controls. The craving response was assessed by event-related design of functional magnetic resonance images (fMRIs).

Fifteen subjects with IGA, 15 in remission from IGA and 15 controls were recruited in this study. The subjects were arranged to view the gaming screenshots and neutral images under investigation of fMRIs. The results showed that bilateral dorsolateral prefrontal cortex (DLPFC), precuneus, left parahippocampus, posterior cingulate and right anterior cingulate were activated in response to gaming cues in the IGA group and their activation was stronger in the IGA group than those in the control group.

Their region-of-interest was also positively correlated with subjective gaming urge under cue exposure. These activated brain areas represent the brain circuit corresponding to the mechanism of substance use disorder. Thus, it would suggest that the mechanism of IGA is similar to substance use disorder. Furthermore, the IGA group had stronger activation over right DLPFC and left parahippocampus than did the remission group. The two areas would be candidate markers for current addiction to online gaming and should be investigated in future studies.

P300 change and cognitive behavioral therapy in subjects with Internet addiction disorder: A 3 month follow-up study (2011)

 After 3 months of treatment EEG readings in internet addicts had significantly changed. Excerpts:

The results of the current investigation of ERPs in individuals suffering from IAD were in accordance with the findings of previous studies of other addictions [17-20]. Specifically, we found reduced P300 amplitude and longer P300 latency in individuals exhibiting addictive behaviors compared with healthy controls. These results support the hypothesis that similar pathological mechanisms are involved in different addiction behaviors.

Another major finding of the present study was that the initially prolonged P300 latency in people with IAD decreased significantly after CBT. Considering the scarcity of studies on IAD including treatment and follow-up measures, the association between P300 latency and IAD treatment in our sample should be interpreted with caution. Further research should be conducted to replicate this finding, using larger sample sizes and other treatment types. P300 latency is considered to provide a measure of attentional resource allocation, and prolongation of this ERP component has been discussed as an index of neurodegenerative processes affecting callosal size and the efficiency of interhemispheric transmission[22-23].

Effects of electroacupuncture combined psycho-intervention on cognitive function and event related potentials P300 and mismatch negativity in patients with internet addiction (2012)

Study compared 3 treatment protocols for subjects with Internet addiction. Interesting findings:

  1. After 40 days of treatment all significantly improved in cognitive function.
  2. Internet addiction scores were significantly lowered in all groups, no matter the treatment. 

This strongly suggests that poorer cognitive function was not a pre-existing condition and improved with abstinence. Excerpts:

OBJECTIVE: To observe the effects of comprehensive therapy (CT) with electroacupuncture (EA) in combination with psycho-intervention (PI) on the cognitive function and event-related potentials (ERP), P300 and mismatch negativity (MMN), in patients with internet addiction (IA) for a preliminary exploration of the possible mechanism of the therapy.

METHODS: One hundred and twenty patients with IA were randomly divided into three groups, and a total of 112 subjects reached the final analysis of the trial, the EA group (39 patients), the PI group (36 patients) and the CT group (37 patients). The treatment course for all patients was 40 days. Changes before and after treatment in terms of scoring by the IA self-rating scale, short-term memory capacity, short-term memory span, and the latency and amplitude of P300 and MMN in patients were observed.

RESULTS: After treatment, in all groups, the IA score was lowered significantly and scores of short-term memory capacity and short-term memory span increased significantly, while the decreased IA score in the CT group was more significant than that in the other two groups.

Internet abusers associate with a depressive state but not a depressive trait (2013)

Internet addiction was associated with depressive states, but not with depressive traits. This means that depression was the result of internet use - it was not a pre-existing condition. Excerpts:

The present study investigated three issues: (i) whether Internet abusers display a depressive state without a depressive trait; (ii) which symptoms are shared between Internet abuse and depression; and (iii) which personality characteristics were shown in Internet abusers.

Ninety-nine male and 58 female participants aged 18-24 years were screened with the Chen Internet Addiction Scale.

The present results showed that high-risk Internet abusers exhibited a stronger depressive state than low-risk Internet abusers in the Beck Depression Inventory-II. However, high-risk Internet abusers did not show a depressive trait in the Minnesota Multiphasic Personality Inventory-2 compared to low-risk Internet abusers. Therefore, high-risk Internet abuse participants exhibited a depressive state without a depressive trait.

CONCLUSIONS: In a comparison of the symptoms of depression and Internet abuse, it was found that high-risk Internet abuse participants shared some common behavioral mechanisms with depression, including the psychiatric symptoms of loss of interest, aggressive behavior, depressive mood, and guilty feelings. High-risk Internet abuse participants may be more susceptible to a temporal depressive state but not a permanent depressive trait.

The exacerbation of depression, hostility, and social anxiety in the course of Internet addiction among adolescents: A prospective study (2014)

This study followed students for one year assessing levels of internet addiction and evaluating levels of depression, hostility, and social anxiety. Researchers found that internet addiction exacerbates depression, hostility, and social anxiety, while remission from Internet addiction decreases depression, hostility, and social anxiety. Cause and effect, not just correlation. Excerpts:

In adolescent populations worldwide, Internet addiction is prevalent and is often comorbid with depression, hostility, and social anxiety of adolescents. This study aimed at evaluating the exacerbation of depression, hostility, and social anxiety in the course of getting addiction to Internet or remitting from Internet addiction among adolescents.

This study recruited 2293 adolescents in grade 7 to assess their depression, hostility, social anxiety and Internet addiction. The same assessments were repeated one year later. The incidence group was defined as subjects classified as non-addicted in the first assessment and as addicted in the second assessment. The remission group was defined as subjects classified as addicted in the first assessment and as non-addicted in the second assessment.

Depression and hostility worsen in the addiction process for the Internet among adolescents. Intervention of Internet addiction should be provided to prevent its negative effect on mental health. Depression, hostility, and social anxiety decreased in the process of remission. It suggested that the negative consequences could be reversed if Internet addiction could be remitted within a short duration.

Virtual reality therapy for internet gaming disorder (2014)

Improvements in the cortico-striatal connectivity occurred over time. Excerpts:

Studies using functional magnetic resonance imaging (fMRI) have demonstrated dysfunction in the cortico-limbic circuit in individuals with Internet gaming disorder (IGD). We hypothesized that virtual reality therapy (VRT) for IGD would improve the functional connectivity of the cortico-limbic circuit.

In the Chung-Ang University Hospital, 24 adults with IGD and 12 casual game users were recruited. IGD group was randomly assigned into the cognitive behavior therapy (CBT) group (N = 12) and VRT group (N = 12). The severity of IGD was evaluated with the Young's Internet Addiction Scale (YIAS) before and after the treatment period. Using resting-state fMRI, functional connectivity from posterior cingulate (PCC) seed to other brain areas was investigated.

During the treatment period, both CBT and VRT groups showed significant reductions on the YIAS scores. At baseline, IGD group showed a reduced connectivity in cortico-striatal-limbic circuit. In the CBT group, the connectivity from PCC seed to bilateral lenticular nucleus and cerebellum increased during 8-session CBT. In the VRT group, the connectivity from PCC seed to left thalamus-frontal lobe-cerebellum increased during 8-session VRT.

Treatment of IGD using VRT seemed to improve the severity of IGD, which showed similar effectiveness to CBT, and enhance the balance of the cortico-striatal-limbic circuit.

The Dark Side of Internet Use: Two Longitudinal Studies of Excessive Internet Use, Depressive Symptoms, School Burnout and Engagement Among Finnish Early and Late Adolescents (2016)

Longitudinal study found that excessive internet use can cause "burnout" which leads to depression. Excerpts:

Recent research shows an increased concern with well-being at school and potential problems associated with students' use of socio-digital technologies, i.e., the mobile devices, computers, social media, and the Internet. Simultaneously with supporting creative social activities, socio-digital participation may also lead to compulsive and addictive behavioral patterns affecting both general and school-related mental health problems.

Using two longitudinal data waves gathered among 1702 (53 % female) early (age 12-14) and 1636 (64 % female) late (age 16-18) Finnish adolescents, we examined cross-lagged paths between excessive internet use, school engagement and burnout, and depressive symptoms.

Structural equation modeling revealed reciprocal cross-lagged paths between excessive internet use and school burnout among both adolescent groups: school burnout predicted later excessive internet use and excessive internet use predicted later school burnout. Reciprocal paths between school burnout and depressive symptoms were also found. Girls typically suffered more than boys from depressive symptoms and, in late adolescence, school burnout. Boys, in turn, more typically suffered from excessive internet use. These results show that, among adolescents, excessive internet use can be a cause of school burnout that can later spill over to depressive symptoms.

Press release about study

Effects of craving behavioral intervention on neural substrates of cue-induced craving in Internet gaming disorder (2016)

Treating internet gaming addiction resulted in reduced severity of addiction along with corresponding reversal of addiction-related brain changes. Excerpts:

  • IGD subjects showed altered cue-induced neural activation in reward-related areas.
  • IGD subjects alleviated IGD symptoms after CBI.
  • IGD subjects showed higher insular activation after CBI.
  • IGD subjects showed lower insula-lingual gyrus/precuneus connectivity after CBI.

Internet gaming disorder (IGD) is characterized by high levels of craving for online gaming and related cues. Since addiction-related cues can evoke increased activation in brain areas involved in motivational and reward processing and may engender gaming behaviors or trigger relapse, ameliorating cue-induced craving may be a promising target for interventions for IGD. This study compared neural activation between 40 IGD and 19 healthy control (HC) subjects during an Internet-gaming cue-reactivity task and found that IGD subjects showed stronger activation in multiple brain areas, including the dorsal striatum, brainstem, substantia nigra, and anterior cingulate cortex, but lower activation in the posterior insula.

Furthermore, twenty-three IGD subjects (CBI + group) participated in a craving behavioral intervention (CBI) group therapy, whereas the remaining 17 IGD subjects (CBI − group) did not receive any intervention, and all IGD subjects were scanned during similar time intervals. The CBI + group showed decreased IGD severity and cue-induced craving, enhanced activation in the anterior insula and decreased insular connectivity with the lingual gyrus and precuneus after receiving CBI. These findings suggest that CBI is effective in reducing craving and severity in IGD, and it may exert its effects by altering insula activation and its connectivity with regions involved in visual processing and attention bias.

Changes of quality of life and cognitive function in individuals with Internet gaming disorder: A 6-month follow-up (2016)

After 6 months of treatment internet gaming addicts showed significant improvements in quality of life, executive functioning, working memory, and impulsiveness. Excerpts:

Internet gaming disorder (IGD) contributes to poor quality of life (QOL) and cognitive dysfunction and is increasingly recognized as a social problem in various countries. However, no evidence exists to determine whether QOL and cognitive dysfunction stabilize after appropriate management. The present study addressed improvement in QOL and cognitive functioning associated with changes in addiction symptoms following outpatient management for IGD. A total of 84 young males (IGD group: N = 44, mean age: 19.159 ± 5.216 years; healthy control group: N = 40, mean age: 21.375 ± 6.307 years) participated in this study. We administered self-report questionnaires at baseline to assess clinical and psychological characteristics, and conducted traditional and computerized neuropsychological tests.

Nineteen patients with IGD completed follow-up tests in the same manner after 6 months of outpatient treatment, which included pharmacotherapy with selective serotonin reuptake inhibitors. A baseline comparison of patients with IGD against the healthy control group showed that the IGD patients had more symptoms of depression and anxiety, higher degrees of impulsiveness and anger/aggression, higher levels of distress, poorer QOL, and impaired response inhibition.

After 6 months of treatment, patients with IGD showed significant improvements in the severity of IGD, as well as in QOL, response inhibition, and executive functioning. Additionally, a stepwise multiple regression analysis revealed a favorable prognosis for IGD patients with low working memory functioning and high executive functioning at baseline. These results provide evidence regarding longitudinal changes in QOL and cognitive function following psychiatric intervention for IGD. Furthermore, it appears that response inhibition may be an objective state marker underlying the pathophysiology of IGD.

Effectiveness of Brief Abstinence for Modifying Problematic Internet Gaming Cognitions and Behaviors (2017)

A brief period of abstinence lead to reduction in addictive patterns and symptoms. Excerpts:

OBJECTIVE: This pilot study tested the efficacy of a voluntary 84-hour abstinence protocol for modifying problematic Internet gaming cognitions and behaviors

METHOD: Twenty-four adults from online gaming communities, including 9 individuals who screened positively for Internet gaming disorder (IGD), abstained from Internet games for 84 hours. Surveys were collected at baseline, at daily intervals during abstinence, and at 7-day and 28-day follow-up

RESULTS: Brief voluntary abstinence was successful in reducing hours of gaming, maladaptive gaming cognitions, and IGD symptoms. Abstinence was highly acceptable to participants with total compliance and no study attrition. Clinically significant improvement in IGD symptoms occurred in 75% of the IGD group at 28-day follow-up. Reliable improvement in maladaptive gaming cognitions occurred in 63% of the IGD group, whose cognition score reduced by 50% and was comparable to the non-IGD group at 28-day follow-up

CONCLUSIONS: Despite limitations of sample size, this study provides promising support for brief abstinence as a simple, practical, and cost-effective treatment technique for modifying unhelpful gaming cognitions and reducing Internet gaming problems.

Effect of electro-acupuncture combined with psychological intervention on mental symptoms and P50 of auditory evoked potential in patients with internet addiction disorder (2017)

Treatment lead to reduction of psychological symptoms, which corresponded with EEG changes. Excerpts:

OBJECTIVE: To observe the therapeutic effects of electro-acupuncture (EA) combined with psychological intervention on the symptom of somzatization or obsession and mental symptom of depression or anxiety and P50 of Auditory Evoked Potential (AEP) on internet addiction disorder (IAD).

METHODS: One hundred and twenty cases of IAD were randomly divided into an EA group, a psycho-intervention (PI) group and a comprehensive therapy (EA plus PI) group. Patients in the EA group were treated with EA. Patients in the PI group were treated with cognition and behavior therapy. Patients in the EA plus PI group were treated with electro-acupuncture plus psychological intervention. Scores of IAD, scores of the symptom checklist 90 (SCL-90), latency and amplitude of P50 of AEP were measured before and after treatment.

RESULTS: The scores of IAD after treatment significantly decreased in all groups (P < 0.05), and the scores of IAD in the EA plus PI group were significantly lower than those in the other two groups (P < 0.05). The scores of SCL-90 assembled and each factor after treatment in the EA plus PI group significantly decreased (P < 0.05). After treatment in the EA plus PI group, the amplitude distance of S1P50 and S2P50 (S1-S2) significantly increased (P < 0.05).

CONCLUSION: EA combined with PI could relieve the mental symptoms of IAD patients, and the mechanism is possibly related to the increase of cerebrum sense perception gating function.

Craving Behavior Intervention in Ameliorating College Students' Internet Game Disorder: A Longitudinal Study (2017).

Craving, as a central feature of addiction and a precursor of relapse, is targeted recently in addiction intervention. While Internet gaming disorder (IGD), conceptualized as a behavioral addiction, is lack of effective treatment practice and exploration of its mechanism. This research aims to test the effectiveness and detect the active ingredients of craving behavior intervention (CBI) in mitigation of IGD among young adults. A total of 63 male college students with IGD were assigned into the intervention group (six-session CBI intervention) or the waiting-list control group. Structured questionnaires were administered at pre-intervention (T1), post-intervention (T2), 3-month follow-up (T3), and 6-month follow-up (T4). Compared to the control group, a significant decrease in the severity of IGD in intervention group was found at post-intervention and lasting to 6 months after intervention. The value changes of craving could partially mediate the relationship between intervention and changes of IGD among all effects tests (immediate, T2-T1; short-term, T3-T1; and long-term effects, T4-T1). Further, explorations of the active ingredients of intervention found depression relief and shift of psychological needs from Internet to real life significantly predict craving amelioration at both post-intervention and 6-month follow-up. Although preliminary, the current study provides evidence for the value of craving-aimed intervention practice in IGD treatment and identifies two potential active ingredients for mitigation of craving, and the long-term therapeutic benefits are further conferred.

The Facebook Experiment: Quitting Facebook Leads to Higher Levels of Well-Being (2016)

Taking a break from Facebook improved "life satisfaction" and mood. Excerpts:

The article builds on research from my master thesis. The preliminary results of this study were presented in a publication facilitated by The Happiness Research Institute:

Most people use Facebook on a daily basis; few are aware of the consequences. Based on a 1-week experiment with 1,095 participants in late 2015 in Denmark, this study provides causal evidence that Facebook use affects our well-being negatively. By comparing the treatment group (participants who took a break from Facebook) with the control group (participants who kept using Facebook), it was demonstrated that taking a break from Facebook has positive effects on the two dimensions of well-being: our life satisfaction increases and our emotions become more positive. Furthermore, it was demonstrated that these effects were significantly greater for heavy Facebook users, passive Facebook users, and users who tend to envy others on Facebook.

Differential physiological changes following internet exposure in higher and lower problematic internet users (2017)

An article about the study. Upon cessation of internet use those with problematic internet use experienced withdrawal symptoms and an increased stress response. Excerpt:

PLoS One. 2017 May 25;12(5):e0178480. doi: 10.1371/journal.pone.0178480. eCollection 2017.

Problematic internet use (PIU) has been suggested as in need of further research with a view to being included as a disorder in future Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association, but lack of knowledge about the impact of internet cessation on physiological function remains a major gap in knowledge and a barrier to PIU classification. One hundred and forty-four participants were assessed for physiological (blood pressure and heart rate) and psychological (mood and state anxiety) function before and after an internet session. Individuals also completed a psychometric examination relating to their usage of the internet, as well as their levels of depression and trait anxiety. Individuals who identified themselves as having PIU displayed increases in heart rate and systolic blood pressure, as well as reduced mood and increased state of anxiety, following cessation of internet session. There were no such changes in individuals with no self-reported PIU. These changes were independent of levels of depression and trait anxiety. These changes after cessation of internet use are similar to those seen in individuals who have ceased using sedative or opiate drugs, and suggest PIU deserves further investigation and serious consideration as a disorder.

Reciprocal Relationship between Internet Addiction and Network-Related Maladaptive Cognition among Chinese College Freshmen: A Longitudinal Cross-Lagged Analysis (2017)

Longitudinal study. Excerpts:

This study explored the reciprocal relationship between Internet addiction (IA) and network-related maladaptive cognition (NMC) in Chinese college freshmen. A short-term longitudinal survey with a sample of 213 college freshmen was conducted in Shandong province, China. The results revealed that IA can significantly predict the generation and development of NMCs, and that when such maladaptive cognitions have been established, they can further adversely affect the extent of the students’ IA.

A vicious cycle was observed between these two variables, with IA having predictive priority in its relationship with NMC. This study also determined that the relationship between these two variables was the same for both males and females; therefore, the final model we established can be extensively applied to Chinese college freshmen, regardless of gender. Understanding the reciprocal relationship between these two variables can assist in interventions in IA at the outset of students’ college life.

Depression, anxiety, and smartphone addiction in university students: A cross sectional study (2017)

Demonstrated withdrawals symptoms and tolerance. Excerpts

The study aims to assess prevalence of smartphone addiction symptoms, and to ascertain whether depression or anxiety, independently, contributes to smartphone addiction level among a sample of Lebanese university students, while adjusting simultaneously for important sociodemographic, academic, lifestyle, personality trait, and smartphone-related variables.

A random sample of 688 undergraduate university students (mean age = 20.64 ±1.88 years; 53% men) completed a survey composed of a) questions about socio-demographics, academics, lifestyle behaviors, personality type, and smartphone use-related variables; b) 26-item Smartphone Addiction Inventory (SPAI) Scale; and c) brief screeners of depression and anxiety (PHQ-2 and GAD-2), which constitute the two core DSM-IV items for major depressive disorder and generalized anxiety disorder, respectively.

Prevalence rates of smartphone-related compulsive behavior, functional impairment, tolerance and withdrawal symptoms were substantial. 35.9% felt tired during daytime due to late-night smartphone use, 38.1% acknowledged decreased sleep quality, and 35.8% slept less than four hours due to smartphone use more than once. Whereas gender, residence, work hours per week, faculty, academic performance (GPA), lifestyle habits (smoking and alcohol drinking), and religious practice did not associate with smartphone addiction score; personality type A, class (year 2 vs. year 3), younger age at first smartphone use, excessive use during a weekday, using it for entertainment and not using it to call family members, and having depression or anxiety, showed statistically significant associations with smartphone addiction. Depression and anxiety scores emerged as independent positive predictors of smartphone addiction, after adjustment for confounders.

Association between childhood and adult attention deficit hyperactivity disorder symptoms in Korean young adults with Internet addiction (2017)

Internet addiction symptoms and scores were significantly related to current ADHD symptoms, but not to childhood ADHD symptoms. This indicates that internet addiction might be causing adult ADHD symptoms. Excerpts:

The main finding of this study, which is also consistent with our hypothesis, was that the severity of IA was significantly associated with the level of most dimensions of adult ADHD symptoms even after controlling the childhood ADHD symptom and other psychiatric comorbid conditions. Only SC dimension, which presenting low self-regard and deficit in self-confidence, did not show the significant association with IA severity. This result can be explained by several studies by Chang (2008) and Kim, Lee, Cho, Lee, and Kim (2005), which indicated SC symptom dimension in CAARS-KS as an additional scale evaluating secondary problems caused by core symptoms of ADHD like hyperactivity, inattention, and impulsivity. In this study, only severity of depression symptom significantly predicted the level of SC symptom dimension. Considering these findings, it might be concluded that the severity of IA significantly predicted all core symptom dimensions of adult ADHD.

Another interesting finding was that, unlike the common belief, the severity of childhood ADHD symptom did not show significant associations with most dimensions of adult ADHD symptoms. Only IE dimension demonstrated significant association with childhood ADHD symptom in regression analysis model 2 (see Table 3). However, this significant association of childhood ADHD symptom with IE disappeared after IA severity was included into regression model, indicating that IA severity had more significant association with IE than did childhood ADHD.

Current findings in this study may shed light on the relationship between severity and ADHD. Either two possibilities explaining high comorbidity between IA and ADHD, our results supported the hypothesis indicating the existence of distinct adulthood onset ADHD-like symptoms. Contrary to the conventional concept of adult ADHD regarding as continuation of childhood ADHD condition (Halperin, Trampush, Miller, Marks, & Newcorn, 2008; Lara et al., 2009), recent findings indicated that two distinct childhood onset and adulthood onset ADHD might exist and adult ADHD is not a simple continuation of childhood ADHD (Castellanos, 2015; Moffitt et al., 2015). In line with these findings, this study indicated that the current ADHD symptoms showed more significant associations with IA than the childhood ADHD symptom on WURS. Moreover, childhood ADHD symptom severity itself did not demonstrate significant correlations with core adult ADHD symptom except IE dimension in this study.

Previous studies indicated that the adult ADHD status is linked with the developmental trajectories of cortical components, and white matter alterations of several networks (Cortese et al., 2013; Karama & Evans, 2013; Shaw et al., 2013). Similarly, recent studies have demonstrated that IA might cause functional, structural changes, and abnormalities in brain (Hong et al., 2013a, 2013b; Kuss & Griffiths, 2012; Lin et al., 2012; Weng et al., 2013; Yuan et al., 2011; Zhou et al., 2011). Based on these findings, we might speculate that functional and structural brain abnormalities related to IA might also be related to adult ADHD-like cognitive symptoms, which should be differentiated from an independent ADHD disorder. The high comorbidity between IA and ADHD (Ho et al., 2014) might be accounted by cognitive and behavior symptoms related to IA rather than symptoms of an independent ADHD disorder.

Montreal researchers find 1st link between shooter games, loss of grey matter in hippocampus (2017)

By Stephen Smith, CBC News Posted: Aug 07, 2017

Playing games like this one, Call of Duty: Ghosts, could increase the risk of depression and other neuropsychiatric disorders because of reduced grey matter in the hippocampus, a Montreal study has found. (Activision)

Playing first-person shooter video games causes some users to lose grey matter in a part of their brain associated with the memory of past events and experiences, a new study by two Montreal researchers concludes.

Gregory West, an associate professor of psychology at the Université de Montréal, says the neuroimaging study, published Tuesday in the journal Molecular Psychiatry, is the first to find conclusive evidence of grey matter loss in a key part of the brain as a direct result of computer interaction.

"A few studies have been published that show video games could have a positive impact on the brain, namely positive associations between action video games, first-person shooter games, and visual attention and motor control skills," West told CBC News.

"To date, no one has shown that human-computer interactions could have negative impacts on the brain — in this case the hippocampal memory system."

The four-year study by West and Véronique Bohbot, an associate professor of psychiatry at McGill University, looked at the impact of action video games on the hippocampus, the part of the brain that plays a critical role in spatial memory and the ability to recollect past events and experiences.

Researchers Gregory West and Véronique Bohbot say their study is the first to provide conclusive evidence that video games can have a negative impact on the brain.

The neuroimaging study's participants were all healthy 18- to 30-year-olds with no history of playing video games.

Brain scans conducted on the participants before and after the experiment looked for differences in the hippocampus between players who favour spatial memory strategies and so-called response learners — that is, players whose way of navigating a game favours a part of the brain called the caudate nucleus, which helps us to form habits.

Brain scans show grey matter loss

The study says 85 per cent of gamers who play six or more hours a week have been shown to rely more heavily on this brain structure to find their way in a game.

After 90 hours of playing first-person shooter games such as Call of Duty, Killzone, Medal of Honour and Borderlands 2, the brain scans of response learners showed what West said is "statistically significant" grey matter loss in the hippocampus.

"All people who we call response learners experienced a reduction in grey matter within the hippocampus," West said.

In a news release, the researchers expanded on their finding: "The problem is, the more they use the caudate nucleus, the less they use the hippocampus, and as a result the hippocampus loses cells and atrophies," adding that this could have "major implications" later in life.

This brain scan of a habitual video-game player shows the hippcampus to be smaller in a 'statistically significant manner,' according to West and Bohbot. (submitted by Gregory West)

The hippocampus is a well-understood biomarker for certain neuropsychiatric diseases, West explained.

"People with reduced grey matter in the hippocampus are more at risk for developing post-traumatic stress disorder and depression when they're younger and even Alzheimer's disease when they're older," he said.

Electro-acupuncture treatment for internet addiction: Evidence of normalization of impulse control disorder in adolescents (2017)

Impulsiveness significantly improved in internet addicts. The improvements were reflected in neurochemical changes in the brain. Excerpts:

Thirty-two IA adolescents were allocated to either EA (16 cases) or PI (16 cases) group by a randomized digital table. Subjects in the EA group received EA treatment and subjects in the PI group received cognition and behavior therapy. All adolescents underwent 45-d intervention. Sixteen healthy volunteers were recruited into a control group. Barratt Impulsiveness Scale (BIS-11) scores, Young's Internet Addiction Test (IAT) as well as the ratio of brain N-acetyl aspartate (NAA) to creatine (NAA/Cr) and choline (Cho) to creatine (Cho/Cr) were recorded by magnetic resonance spectroscopy before and after intervention respectively.

The IAT scores and BIS-11 total scores in both EA and PI group were remarkably decreased after treatment (P<0.05), while EA group showed more signifificant decrease in certain BIS-11 sub-factors (P<0.05). Both NAA/Cr and Cho/Cr were signifificantly improved in EA group after treatment (P<0.05); however, there were no signifificant changes of NAA/Cr or Cho/Cr in PI group after treatment (P>0.05).

Both EA and PI had signifificantly positive effect on IA adolescents, especially in the aspects of psychological experiences and behavioral expressions, EA might have an advantage over PI in terms of impulsivity control and brain neuron protection. The mechanism underlying this advantage might be related to the increased NAA and Cho levels in prefrontal and anterior cingulate cortices.

Taking Facebook at face value: why the use of social media may cause mental disorder (2017)


Facebook, the largest social media network, currently has approximately 2 billion monthly users [1], corresponding to more than 25% of the world's population. While the existence of an online social network may seem harmless or even beneficial, a series of recent studies have suggested that use of Facebook and other social media platforms may have a negative influence on mental health [2-5].

In a recent longitudinal study based on three ‘waves’ of data (2013, 2014, and 2015) from more than 5000 participants in the nationally representative Gallup Panel Social Network Study, Shakya and Christakis found that the use of Facebook (which was measured objectively) was negatively associated with self-reported mental well-being [3]. Both clicking ‘like’ on the content of others’ Facebook pages and posting ‘status updates’ on one's own Facebook page were negatively associated with mental well-being. Importantly, these results were robust to two-wave prospective analyses suggesting that the direction of the effect goes from Facebook use to lower mental well-being and not the other way around [3]. However, due to the observational nature of the analyzed data, these results do not represent causal evidence of a harmful effect of Facebook, but probably—due to the longitudinal nature of the study—represent the best available estimate of the effect of Facebook on mental well-being to date [3]. Another recent study supporting that Facebook use could have a negative effect on well-being is that of Tromholt [5] in which the 1095 participants were randomly assigned (or rather randomly urged) to follow one of two instructions: (i) ‘Keep using Facebook as usual in the following week’, or (ii) ‘Do not use Facebook in the following week’ [5]. After this week, those assigned to the Facebook abstinence group reported significantly higher life satisfaction and more positive emotions than those assigned to the ‘Facebook as usual’ group [5]. However, due to the unblinded design of this study, its results do not represent causal evidence of the effect of Facebook either—an effect, which will be difficult to establish.

If we nevertheless assume that Facebook use indeed has a harmful effect on mental well-being, what is then the mechanism underlying it? This aspect remains unclear, but an intuitively logical explanation—with some empirical support—is that people predominantly display the most positive aspects of their lives on social media [6] and that other people—who tend to take these positively biased projections at face value—therefore get the impression that their own life compares negatively to that of other Facebook users [7]. As indicated by the recent findings by Hanna et al., such upward social comparison is very likely to mediate the negative effect of Facebook use on mental well-being [4].

Is it plausible that a negative effect of Facebook use on mental well-being contributes to development of outright mental disorder? The answer to this question is most likely ‘yes’, as it is well established that low levels of self-reported mental well-being are a rather sensitive marker of mental disorder—especially depression [8]. Furthermore, individuals prone to depression may be extra sensitive to the potentially harmful effects of social media due to so-called negative cognitive bias, which is a prevalent feature in this population [9-11]. In the context of Facebook, the negative cognitive bias could likely entail that individuals vulnerable to depression would feel that their own life compares particularly negative to that of other people on Facebook. In addition to depression, it would seem that Facebook and other picture-driven social media platforms could also have a harmful effect in relation to mental disorders where a negative/distorted self-image is part of the psychopathology, such as eating disorders [4, 12].

If the use of social media such as Facebook does compromise mental health, we may be facing a global epidemic of mental disorders, which probably has its largest impact on the younger generations that use these applications the most [3]. Therefore, the psychiatric field must take this possibility very seriously and conduct further studies on the effect of social media on mental health, and ways to mitigate this effect if it is indeed a harmful one. One way to do this could be to stress again and again—for children and adolescents in particular—that social media is based on highly selected and positively biased projections of reality that should not be taken at face value.

Orbitofrontal gray matter deficits as marker of Internet gaming disorder: converging evidence from a cross-sectional and prospective longitudinal design (2017)

In a unique study subjects non-video gamers played video games fro 6 weeks. These naive players experienced a loss of gray matter in the prefrontal cortex. Lower gray matter in this region was correlated with higher level of gaming addiction. Excerpts:

Internet gaming disorder represents a growing health issue. Core symptoms include unsuccessful attempts to control the addictive patterns of behavior and continued use despite negative consequences indicating a loss of regulatory control. Previous studies revealed brain structural deficits in prefrontal regions subserving regulatory control in individuals with excessive Internet use. However, because of the cross-sectional nature of these studies, it remains unknown whether the observed brain structural deficits preceded the onset of excessive Internet use.

Against this background, the present study combined a cross-sectional and longitudinal design to determine the consequences of excessive online video gaming. Forty-one subjects with a history of excessive Internet gaming and 78 gaming-naive subjects were enrolled in the present study. To determine effects of Internet gaming on brain structure, gaming-naive subjects were randomly assigned to 6 weeks of daily Internet gaming (training group) or a non-gaming condition (training control group).

At study inclusion, excessive Internet gamers demonstrated lower right orbitofrontal gray matter volume compared with Internet gaming-naive subjects. Within the Internet gamers, a lower gray matter volume in this region was associated with higher online video gaming addiction severity. Longitudinal analysis revealed initial evidence that left orbitofrontal gray matter volume decreased during the training period in the training group as well as in the group of excessive gamers. Together, the present findings suggest an important role of the orbitofrontal cortex in the development of Internet addiction with a direct association between excessive engagement in online gaming and structural deficits in this brain region.

Outcome of the Psychological Intervention Program: Internet Use for Youth (2017)

Social anxiety decreased while desire to socialize increased. Perhaps social anxiety isn't a pre-existing condition for internet addicts. Excerpts

The exacerbation of problematic adolescent behaviors has been found to associate significantly with PIU and is expected to worsen with age. Cognitive Behavioural Therapy (CBT)-integrated therapy has been shown to significantly reduce in the presence of psychological symptoms such as depression and social anxiety. The Psychological Intervention Program-Internet Use for Youth (PIP-IU-Y) is a CBT-based program designed for adolescents and comprises of a series of interpersonal skills to improve their face-to-face interaction. It focuses on taking preventative measures against Internet addiction before it develops by addressing the participant’s PIU as a negative coping style and incorporating positive psychological techniques.

A total of 157 participants between the ages of 13 and 18 completed the program which consisted of eight weekly, 90 min sessions in a group format. Treatment outcomes were measured using mean change at the end of the program and 1 month post-treatment. The majority of the participants showed improvement after the eight weekly sessions of PIP-IU-Y and continued symptom maintenance at the 1 month follow-up. An overwhelming majority of participants were able to manage PIU symptoms after the intervention program, reinforcing the efficacy of the PIP-IU-Y. Not only did it addresses the PIU behaviour but also helped in reducing social anxiety and increasing social interaction.

Further research could investigate treatment differences among the various subtypes of PIU (e.g., online gaming and pornography) in order to see if treatment differences exist.

Internet Gaming Disorder Treatment: A Case Study Evaluation of Four Different Types of Adolescent Problematic Gamers (2017)

Drastically reducing time spent gaming resulted in improved scores on instruments assessing all sorts of emotional and psychological issues. An excerpt:

Phase changes were marked using the following criteria: (i) A-B occurred when all measurements for phase A had been obtained; (ii) B-A’ occurred when the intervention was complete; and (iii) phase A’ occurred with data collection three months after treatment ended

The pre-post comparison of the scores on the battery of scales showed a reduction tendency (see Table 2). Clinical scores on the IGD-20 Test and the CERV normalized from t1 to t6, and they remained stable three months after treatment ended (Table 2, t6 to t7). General symptoms as assessed by the YSR-Total and SCL-R-PSDI scales notably improved. Scores related to school (CBCL), social problems (YSR), and family conflict (FES) also improved following treatment (Table 2). To evaluate the effects of treatment on specific comorbid diagnoses, the scales of the MACI test were compared. Scores on these scales also decreased: C1: Depressive Affect (FF)pre = 108, FFpost = 55, Introversion (1)pre = 107, 1post = 70; C2: Peer Insecurity (E)pre = 111, Epost = 53, Anxious Feelings (EE)pre = 76, EEpost = 92; C3: Borderline Tendency (9)pre = 77, 9post = 46, Unruly (6A)pre = 71, 6Apost = 71; C4: FFpre = 66, FFpost = 29, 1pre= 104, 1post = 45. The only exceptions were the EE scale [Anxious Feelings] (for C2) and Scale 9 [Borderline tendency] (for C3), where no decreases occurred. To evaluate the therapeutic alliance and the patients’ degree of satisfaction, theWATOCI instrument was used (Corbella and Botella 2004) (Table 2). Positive scores highlight the four participants’ satisfaction with the treatment.

Internet Addiction Creates Imbalance in the Brain (2017)

Compared with a control group, internet addicts had elevated levels of gamma aminobutyric acid, or GABA, a neurotransmitter that has been linked with other addictions and psychiatric disorders. After 9 weeks of reduced internet use, and cognitive behavioral therapy, GABA levels "normalized".

From the article:

New research has linked Internet addictions with a chemical imbalance in the brain. In the small study, presented today at the annual meeting of the Radiological Society of North America in Chicago, 19 participants with addictions to phones, tablets, and computers exhibited disproportionately high levels of a neurotransmitter that inhibits brain activity. 

The good news: After nine weeks of therapy, the participants’ brain chemicals normalized, and their screen time decreased, says Hyung Suk Seo, a professor of neuroradiology at Korea University in Seoul, who presented the study. 

Seo and his colleagues discovered the brain chemical imbalance using magnetic resonance spectroscopy—an imaging technique that detects changes in certain metabolites in the brain. The tool showed that participants with Internet addictions, compared with a control group, had elevated levels of gamma aminobutyric acid, or GABA, a neurotransmitter that has been linked with other addictions and psychiatric disorders. 

The participants—19 young people in Korea with an average age of 15—had all been diagnosed with Internet and smartphone addictions. A diagnosis of Internet addiction typically means that the person uses the Internet to the point that it interferes with daily life. Participants also had significantly higher scores in depression, anxiety, insomnia, and impulsivity, compared with non-addicted teenagers.

Twelve of the addicts were then given nine weeks of a type of addiction treatment called cognitive behavioral therapy. After the treatment, Seo again measured their GABA levels, and found that they had normalized.

More importantly, the number of hours the kids spent in front of a screen also decreased. “Being able to observe normalization—that’s a very intriguing finding,” says Max Wintermark, a neuroradiologist at Stanford University who was not involved in the study. Finding a way to monitor the effect of an addiction treatment—especially some kind of early indicator—can be difficult, he says. “So to have some kind of biomarker that you extract from an imaging technique that allows you to monitor the effect of your treatment and tell you early on whether it’s succeeding—that’s extremely valuable,” he says. 

Clinical predictors of gaming abstinence in help-seeking adult problematic gamers (2018)

Unique study having treatment seeking gamers try to quit for a week. Many of the gamers reported withdrawal symptoms - which made it harder to abstain. Withdrawal symptoms mean that gaming caused brain changes. An excerpt:

The study aimed to identify variables predictive of short-term commitment to gaming abstinence following initial voluntary contact with an online help service. A total of 186 adult gamers with gaming-related problems were recruited online. Participants completed the DSM-5 Internet gaming disorder (IGD) checklist, Depression Anxiety Stress Scales-21, Internet Gaming Cognition Scale, Gaming Craving Scale, and Gaming Quality of Life Scale. A one-week follow up survey assessed adherence with intended gaming abstinence. Abstainers were less likely to have withdrawal symptoms and less likely to play action shooting games. Participants with mood symptoms (40% of the total) reported significantly more IGD symptoms, stronger maladaptive gaming cognitions (e.g., overvaluing game rewards), more previous occurrences of gaming problems, and poorer quality of life. However, mood symptoms did not predict abstinence from or continuation of gaming. Adults with gaming disorder seeking help to reduce their gaming may benefit initially from strategies that manage withdrawal and psychoeducation about riskier gaming activities.

The links between healthy, problematic, and addicted Internet use regarding comorbidities and self-concept-related characteristics (2018)

Another unique study examining subjects with recently developed ADHD-like symptoms. The authors strongly believe that internet use is causing ADHD like symptoms. An excerpt from the discussion.

ADHD comorbidity and ADHD-like symptoms in Internet addicts

Regarding ADHD diagnoses in this study, the current and lifetime prevalence in the group of Internet addicts (13.8% and 11.5%) was significantly higher compared with problematic Internet users and healthy controls. A meta-analysis estimated the general prevalence of ADHD at about 2.5% (Simon, Czobor, Bálint, Mészáros, & Bitter, 2009). Most of the studies on ADHD and Internet addiction were conducted on adolescents and not on young adults (Seyrek et al., 2017; Tateno et al., 2016). There is only one study reporting an ADHD prevalence of 5.5% in adult “problematic” Internet users (Kim et al., 2016). However, the sample also included addicted users and therefore the findings might be not comparable with those of this study.

To our knowledge, this was the first study to attempt at including the assessment of the impact of recently developed ADHD symptoms in addition to the ADHD diagnosis in Internet addicts. Participants with ADHD as well as those with only recently developed ADHD-like symptoms showed significantly higher lifetime and current Internet use severity compared with those who did not fulfill these conditions. Furthermore, addicted participants with recently developed ADHD symptoms (30% of the addicted group) exhibited increased lifetime Internet use severity compared with those addicted participants without ADHD symptoms. Our results indicate that recently developed ADHD symptoms (without fulfilling the diagnostic criteria for ADHD) are associated with Internet addiction. This may lead to a first indication that the excessive Internet use has an impact on the development of cognitive deficits similar to those found in ADHD. A recent study of Nie, Zhang, Chen, and Li (2016) reported that adolescent Internet addicts with and without ADHD as well as participants with ADHD alone showed comparable deficits in inhibitory control and working memory functions.

This assumption seems to also be supported by certain studies reporting reduced gray matter density in the anterior cingulate cortex in addictive Internet users as well as in ADHD patients (Frodl & Skokauskas, 2012; Moreno-Alcazar et al., 2016; Wang et al., 2015; Yuan et al., 2011). Nevertheless, to confirm our assumptions, further studies assessing the relationship between the onset of excessive Internet use and ADHD in Internet addicts are needed. In addition, longitudinal studies should be applied to clarify causality. If our findings are confirmed by further studies, this will have clinical relevance for the diagnostic process of ADHD. It is conceivable that the clinicians would be required to carry out a detailed assessment of possible addictive Internet usage in patients with suspected ADHD.

Adverse physiological and psychological effects of screen time on children and adolescents: Literature review and case study (2018)

The case study demonstrates that internet use caused ADHD-related behavior which was inaccurately diagnosed as ADHD. Abstract:

A growing body of literature is associating excessive and addictive use of digital media with physical, psychological, social and neurological adverse consequences. Research is focusing more on mobile devices use, and studies suggest that duration, content, after-dark-use, media type and the number of devices are key components determining screen time effects. Physical health effects: excessive screen time is associated with poor sleep and risk factors for cardiovascular diseases such as high blood pressure, obesity, low HDL cholesterol, poor stress regulation (high sympathetic arousal and cortisol dysregulation), and Insulin Resistance. Other physical health consequences include impaired vision and reduced bone density. Psychological effects: internalizing and externalizing behavior is related to poor sleep. Depressive symptoms and suicidal are associated to screen time induced poor sleep, digital device night use, and mobile phone dependency. ADHD-related behavior was linked to sleep problems, overall screen time, and violent and fast-paced content which activates dopamine and the reward pathways. Early and prolonged exposure to violent content is also linked to risk for antisocial behavior and decreased prosocial behavior. Psychoneurological effects: addictive screen time use decreases social coping and involves craving behavior which resembles substance dependence behavior. Brain structural changes related to cognitive control and emotional regulation are associated with digital media addictive behavior. A case study of a treatment of an ADHD diagnosed 9-year-old boy suggests screen time induced ADHD-related behavior could be inaccurately diagnosed as ADHD. Screen time reduction is effective in decreasing ADHD-related behavior.

Components crucial for psychophysiological resilience are none-wandering mind (typical of ADHD-related behavior), good social coping and attachment, and good physical health. Excessive digital media use by children and adolescents appears as a major factor which may hamper the formation of sound psychophysiological resilience.