Studies demonstrating Internet use/porn use as the cause of symptoms & brain 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 that strongly suggest internet use  (porn, gaming, etc.) causes mood alterations or disorders, and addiction-related brain changes.


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

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.

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


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.


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: The only study to have subjects abstain 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)

J Sex Res. 2015 Aug 25:1-12.

Negash S1Sheppard NVLambert NMFincham FD.

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.


Comments: 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."


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.


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 US Navy doctors, 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. While the abstract shifts back and forth between Internet pornography use and masturbation, it's clear that he's mostly referring to porn-induced sexual dysfunctions (erectile dysfunction and anorgasmia). 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 (keep in mind that masturbation does not cause chronic ED, and it is never given as a cause of ED). 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.


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

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.

COMMENTS: 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 & effect, not just correlation.


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

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 CheckList-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 can not find a solid pathological predictor for Internet addiction disorder. Internet addiction disorder may bring some pathological problems to the addicts in some ways.

COMMENTS: 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 higher on the obsessive scale, while they were lower on scores for anxiety depression, and hostility.

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

  • 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.
  • 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.


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

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.

COMMENTS: Internet addiction was associated with depressive states, but NOT with depressive traits. This means that Internet use was the likely cause of depression.Put simply, depression was not a pre-existing condition.


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)

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


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

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.

COMMENTS: 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 from former Internet addicts. Addicts brain differed from controls, and recovery lead to reversal of addiction-related brain changes.


Virtual reality therapy for internet gaming disorder (2014)

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.

COMMENTS; improvements in the cortico-striatal connectivity occured with time.


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

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. 

COMMENTS: 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 proves that poorer cognitive function was not a pre-existing condition, and improved with abstinence.


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

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.

COMMENTS: One of the rare studies that tracked Internet users over time. This study found that Internet use caused depression in adolescents at alarmingly high rates.


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

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.

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


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

he 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[21], 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 craving behavioral intervention on neural substrates of cue-induced craving in Internet gaming disorder (2016)

  • 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)

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)

J Clin Psychol. 2017 Feb 2. doi: 10.1002/jclp.22460.

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

ONCLUSIONS: 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)

Volume 37, Issue 1, 15 February 2017, Pages 43–48


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).


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.


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).


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.