Internet Addiction

This chapter presents the history and evolution of Internet addiction and describes the risk factors identified. As the problem has become more widespread, new studies examine the neuroscientific causes of Internet addiction and ways that the disorder may be treated primarily using behavior therapy, cognitive-behavioral techniques, and residential care. The chapter also provides the theoretical frameworks to understand the etiologic models or causal factors associated with the development of Internet addiction including a brief overview of the neuroscientific studies recently done. Finally, this chapter reviews the current treatment models used in Internet addiction recovery. As an introduction to this book, it is hoped this chapter gives a historical context of the disorder and promotes future areas of research as new studies in the field continue to emerge.

In this contribution, theoretical considerations of the development and maintenance of specific types of Internet addiction are summarized. On the basis of previous research, several predisposing variables, and vulnerability factors have been identified. These comprise psychopathological symptoms, such as depression and social anxiety, but also personality variables, such as impulsivity and self-esteem. Social cognitions, like perceived social support, stress vulnerability, and also genetic vulnerabilities are considered further potential predisposing variables. It is argued that predisposing variables act in concert with moderating and mediating variables in the development and maintenance of an Internet addiction. Dysfunctional coping style and Internet use expectancies are considered important in this context. In the course of reinforcement learning and conditioning processes, cue reactivity and craving is supposed to develop, which may interact with reduced executive functioning and inhibitory control. Future research should more explicitly investigate the interactions of certain variables, beyond addressing bivariate effects on a correlational or group-comparison level. The model suggested should be seen as a model in progress, which hopefully has the potential to inspire both future research and clinical practice.

In recent years, neuroimaging techniques have increasingly been used to study Internet addiction disorder (IAD), with the aim of identifying functional and structural changes in the brain, which may constitute the neurological/psychiatric causes of IAD. This chapter reviews current neuroimaging findings concerning brain structural changes associated with IAD. To aid readers in understanding these findings, the commonly used structural imaging methodologies—primarily, magnetic resonance imaging (MRI)—are also outlined. The literature review clearly demonstrates that IAD is associated with neuroanatomical changes involving prefrontal cortex, thalamus, and other brain regions. At least some of these changes appear to correlate with behavioral assessments of IAD. More importantly, these data suggest that the pattern of IAD-related structural differences in the brain resemble, to some extent, those changes observed in substance addiction.

Internet gaming is now among the most popular recreational activities worldwide. While the Internet enables access to online games 24 h a day, smartphones further enable access from any location.

Pathological use of the Internet is a new and rapidly growing worldwide phenomenon; however, few studies have examined the neurobiological factors underlying this condition. Internet addiction has been considered a behavioral addiction that is accompanied by withdrawal symptoms and tolerance, characteristics that may result from abnormalities in neural substrates involved in impulse control and reward processing. Recent studies on Internet addiction have highlighted symptoms of cognitive and emotional dysfunction that are similar to other types of drug and/or behavioral addiction. In this chapter, we describe the results of neurobiological investigations of the underlying mechanisms of Internet addiction using positron emission tomography (PET). The altered cerebral glucose metabolism and the reduced striatal dopamine D2 receptor availability found in people exhibiting pathological use of the Internet are discussed in terms of the similarities of these characteristics to those observed in substance abusers.

This chapter consists of three parts. First, we suggest the possible therapeutic mechanisms of dopaminergic and serotonergic medications for Internet gaming disorder (IGD) through an overview of the results of pharmacological trials. Second, we review the functional brain changes, especially in terms of cortico-striatal circuitry, in response to pharmacological treatments in individuals with IGD. Finally, we discuss the functional brain changes observed in response to non-pharmacological interventions, including family therapy and abstinence from online gaming. Although the studies discussed in this chapter suggest that a partial recovery of dysfunctional brain activity may be possible, the existence of a causal relationship between brain functional abnormalities and IGD is still open to debate. Functional neuroimaging studies with novel and efficient designs are needed for the development of more effective treatments for IGD as well as for increasing the understanding of the pathophysiology of IGD.

The availability of pornographic material has substantially increased with the development of the Internet. As a result of this, men ask for treatment more often because their pornography consumption intensity is out of control; i.e., they are not able to stop or reduce their problematic behavior although they are faced with negative consequences. There is a long lasting debate whether these kinds of problems should be conceptualized as a behavior addiction. In the last two decades, several studies with neuroscientific approaches, especially functional magnetic resonance imaging (fMRI), were conducted to explore the neural correlates of watching pornography under experimental conditions and the neural correlates of excessive pornography use. Given previous results, excessive pornography consumption can be connected to already known neurobiological mechanisms underlying the development of substance-related addictions. In the introduction, phenomenological, epidemiological, and diagnostic aspects of a syndrome, which is here labeled pornography addiction, will be described knowing that the adequacy of this terminology has to be further validated. In the second section, after aetiological considerations, contemporary neurobiological models will be presented to offer reference points for the question whether excessive pornography consumption can result in an addiction. In the third section of the chapter, neurobiological findings concerning three topics will be summarized: Neural correlates of watching pornography, cue reactivity and appetitive conditioning, and finally neurobiological characteristics of men with pornography addiction. The present contribution will be rounded off with a short conclusion highlighting possible future research questions.

It is now well established that all human traits are influenced both by genes and the environment. This suggests that most relationships, such as the relationship between personality and Internet addiction, may be due in part to genetic influences. To reach a more complete understanding of the risk factors associated with the initiation and maintenance of Internet addiction, the dynamic interplay of genes and environment over the life course must be investigated to allow for the identification of potential developmental changes linked to genetic vulnerabilities and resilience. In this chapter, we highlight behavior genetic research approaches and findings with respect to Internet addiction (In line with the editors of this book, we use the term Internet addiction as an umbrella term encompassing different conceptualizations and understandings of the phenomenon of problematic Internet use.) and related constructs. We will outline how genetically informative data can provide new and promising insights into the understanding of underlying sources of individual differences in Internet addiction. Future research questions will also be discussed.

Mounting evidence suggests that personality plays an important role for a better understanding of Internet addiction. As twin studies have shown that both Internet addiction and personality are influenced by genetics, we highlight molecular genetics approaches to Internet addiction in this chapter too.

The autonomic nervous system can be divided into sympathetic and parasympathetic divisions. The activation of the sympathetic and parasympathetic autonomic nervous systems in Internet addiction is similar to that in drug addiction. The sympathetic division is more strongly reactive, with responses in internal glands and bodily organs and acceleration of heart rate (or blood volume pulse) and respiratory response rate as well as a reduction of temperature, while surfing the Internet. However, contradictory data have also been obtained. Decelerations of skin conductance have also been observed in Internet addiction, showing activity of the parasympathetic division, but not the sympathetic division. Drug addiction produces greater activation of the sympathetic nervous system, but less activation of the parasympathetic system. The autonomic nervous system reciprocally connects to neural circuitry in the brain to modulate both systems, reflecting specific features of Internet addiction. Moreover, Internet addiction induces numerous behavioral and psychopathological symptoms related to pathogenesis, including depression, anxiety, hostility, psychoticism, interpersonal sensitivity, attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, novelty seeking, and social anxiety disorder. Therapeutic interventions for Internet addiction, including pharmacological and non-pharmacological treatments, need to be linked to psychopathological symptoms. The autonomic nervous system, brain circuitry pathogenesis, and specific interventions targeting Internet addiction are discussed in the present review article.

Background: Little attention has been paid to research on Internet Gaming Disorder (IGD) using neuroimaging techniques even though this type of research is of key importance for the formal recognition of IGD as an independent disorder. Aims: The aim of the present study was to conduct a systematic review of some of the methodological and assessment characteristics in neuroimaging studies that have been published from May 2013 to January 2016 and that have assessed IGD whilst also having used a neuroimaging technique to gather neurobiological evidence of this potential disorder. Methods: Systematic electronic searches using strict inclusion and exclusion criteria were conducted on ProQuest (in the following scholarly databases: ProQuest Psychology Journals, PsycARTICLES, PsycINFO, Applied Social Sciences Index and Abstracts, and ERIC) and on MEDLINE to identify potential eligible studies. Results: A total of 853 studies were screened and after a careful systematic selection process, 14 studies were found to meet the inclusion criteria. Based on the findings, it was concluded that research on IGD using neuroimaging techniques is on the rise. Additionally, this systematic review offers ten practical recommendations to authors based on the methodological and assessment shortcomings of extant empirical studies on IGD using neuroimaging techniques. Conclusions: It is envisaged that the results of this study will help improve the overall quality of research on IGD using neuroimaging techniques.

Neuroscientific approaches to the understanding of Internet addiction have broadened our knowledge on the biological basis related to the overuse of the Internet. The present chapter lends a short introduction to this area. Moreover, it integrates and summarizes the most important findings of this research field.

Psychoinformatics refers to the new collaboration between the disciplines computer science and psychology to study psychological phenotypes by means of data mining. This chapter gives an overview of how Psychoinformatics can aid research and therapy in the context of Internet addiction.

The increasing number of Internet users has resulted in an increased population percentage affected by the negative effects of problematic Internet usage. To date, the management of psychopathological Internet use is not supported by extensive empirical research. No standard clinical treatment protocols for pharmacological treatment exist, and as a result, empirical or anecdotal assessments based on case studies are mainly consulted. A relevant problem in performing clinical trials is the evolving nosology, which encompasses ambiguous definitions of Internet addiction and a diversity of diagnostic, prognostic, and therapeutic criteria. The aim of this chapter is to review the current literature, to assess the extent to which specific pharmacological interventions (e.g., using antidepressants, mood stabilizers, opioid receptor antagonists, or antipsychotics) can alleviate the symptomatic burden in patients with “Internet addiction.” We also explore pharmacological interventions that target patterns of comorbidity and underlying psychopathological dimensions (e.g., addiction, impulsivity, obsessive-compulsive spectrum, bipolar spectrum, dissociation, etc.) shared with other behavioral or substance addictions.

This chapter introduces several intervention programs that have been developed and implemented for adolescents and younger Internet addicts. A few individual and group counseling programs currently operating in Korea will be outlined, and residential camps and integrative long-term therapy programs will also be introduced. The author also includes a summary of the characteristics of Internet-addicted youth in Korea.

In this chapter, the Internet usage behaviour of the general population and the prevalence of problematic Internet use will be discussed and a variety of treatment options are introduced. Theoretically and practically, through use of a case study, the brief intervention, “Compass”, is described. The last section considers research on the efficacy of existing approaches to the treatment of problematic Internet use. To contextualize the prevalence of Internet use, the underlying concepts and the therapy, this chapter opens with a brief consideration of television and the debate about TV dependency, which took place during the 1990s. Before taking a closer look at the prevalence of Internet use, the underlying concepts and the therapy, this chapter begins with a brief recourse on television and the debate about TV dependency, which took place during the nineties of the last century. For the triumph of the Internet will possibly go hand in hand with the “death” of another medium: television, in any case, in its “classical” form (Katz and Scannell, The end of television? Its impact on the world (so far), 2009). At least with youngsters, television seems to have become less important compared with the Internet. For instance, among 12–19-year-olds, as far as frequency of media activity went, television came in third place in 2011, after the mobile phone and the Internet. Among boys, 89 % considered personal use of the Internet very important/important, while only 58 % made this statement about television. Among girls, the Internet came after “listening to music” and “mobile phone use”, in third place with 86 %, and television was in sixth place with 54 % (Medienpädagogischer Forschungsverbund Südwest (MPFS), Jugend, Information, (Multi-)Media. Basisstudie zum Medienumgang 12- bis 19-Jähriger in Deutschland, 2012). In 2009, Internet and television were of equal importance to this age group; television may even have had a slight edge (MPFS, Jugend, Information, Multimedia. Basisstudie zum Medienumgang 12- bis 19-Jähriger in Deutschland, 2010). A note on terminology is necessary here. A key problem in looking at the phenomenon of Internet use is the veritable flood of terminology—much of which may also be used differentially; the concept “problematic Internet use (PIG)” will be consistently used in this chapter, except in the reproduction of results from studies that explicitly use a different terminology.

Treatment of Internet addiction within the German healthcare system is performed by two main clinical disciplines, “Psychiatry and Psychotherapy” on the one hand and “Psychosomatic medicine and Psychotherapy” on the other. Acute states of addiction and withdrawal are usually treated in psychiatric hospitals, which can deal with any medical implications that arise and which offer expertise in psychopharmacology. Long-term rehabilitation treatment is traditionally offered by psychosomatic hospitals, which boast expertise in inpatient psychotherapy. However, the majority of Internet addicted patients are treated as outpatients. The chapter presents an overview of the two different psychotherapeutic approaches to the treatment of Internet addiction from a scientific and a clinical angle. As in the case of addiction medicine more generally, cognitive behavioural approaches have shown the greatest efficacy in the initial treatment of Internet addiction. A growing body of evidence supports this approach. However, far less is known about the effectiveness of psychodynamic psychotherapy. It most likely has a place in the long-term treatment and management of Internet Addiction and in the treatment of underlying co-morbid disorders, such as depression or anxiety. We will outline the current state of play in both psychotherapeutic schools, before concluding with a more holistic, integrative view of how an ideal integrated treatment scenario could work.

This chapter provides insights into two innovative treatment approaches for psychiatric disorders that have gained increasing attention in the neurosciences: real-time fMRI-based neurofeedback training and the necuopeptide oxytocin. Progress in neuroimaging technology during the last years has enabled the ultra-fast analysis (near real-time) of brain activity patterns. Combined with neurofeedback approaches, this technology enables subjects to learn the volitional control of regional brain activity. On the background of the neuroimaging literature on Internet addiction, the present chapter discusses potential targets for the application of these training methods, with a focus on the prefrontal-limbic-striatal circuitry. In addition, the intranasal application of the neuropeptide oxytocin as potential innovative treatment approach for psychiatric disorders has received increasing interest during the last years. Initial studies in patient populations revealed promising effects in psychopathological conditions such as autism, depression, and social phobia. Given links between the underlying pathology of these conditions and Internet addiction, the present chapter outlines which subtype of Internet addicted patients might potentially benefit from the intranasal application of the neuropeptide oxytocin.

The Korean Government was the first in the world to develop a national policy to tackle the problem of Internet addiction. For this reason, it has received global attention. To combat the problem of Internet addiction, Korea has established specific laws and systems; a governance system is administrated in government offices, and a “master plan” (revised at 3 year intervals) has been developed. In addition to these measures, many practical spheres of counseling and treatment have also been established. Examples of Korea’s efforts to tackle the problem of Internet addiction include the development of the evaluation scale for Internet addiction, an extensive counseling program, and treatment systems linked to hospital care. This study comprehensively outlines Korea’s national policy on Internet addiction.

In recent years as the prevalence of smartphones has increased, so too has excessive smartphone use become a prominent social issue. “Smartphone addiction” is one form of a more general technological addiction. In this chapter, we review the evolution of substance and behavioural addiction through an examination of the process for the diagnosis of mental illness. We introduce four common factors between smartphone addiction, and other forms of addiction, diagnostic criteria, and a mobile application (App) to identify smartphone addiction.

The present chapter considers early insights on some pressing issues in the investigation of smartphone (over)use. More specifically, we consider whether tendencies toward overuse of the smartphone and Internet are related. And, if so, whether the same personality structure represents a vulnerability factor for both kinds of digital addiction. This chapter also identifies some similarities and differences between Internet and smartphone overuse, beyond the findings from personality psychology. Finally, the chapter provides a short overview of the important relationship between smartphone use, flow experience at work, and productivity issues. This section is followed by a simple behaviorist model, which aims to explain the aetiogenesis of problematic smartphone use. The chapter closes with some easy to implement therapeutic interventions designed to reduce smartphone use in order to live more meaningful lives in the here and now.

Explaining how the human brain operates in the real world remains far from the reach of modern systems and cognitive neuroscience. The brain is measured in highly controlled laboratory settings and most neuroscientific research is laser focused on explaining highly simplistic behaviours designed in the laboratory. The ubiquitous use of smartphones provides a fresh opportunity to radically reverse this trend by providing a quantitative insight into human actions in the real world. Addressing how this digital behaviour maps onto elementary neuronal measures is a powerful starting point towards appreciating the complexity of human actions.