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Background: An association between gaming disorder (GD) and the symptoms of common mental disorders is unraveled yet. In this preregistered study, we quantitatively synthesized reliability, convergent and discriminant validity of GD scales to examine association between GD and other constructs. Methods: Five representative GD instruments (GAS-7, AICA, IGDT-10, Lemmens IGD-9, and IGDS9-SF) were chosen based on recommendations by King et al. (2020) to conduct correlation meta-analyses and reliability generalization. A systematic literature search was conducted through Pubmed, Proquest, Embase, and Google Scholar to identify studies that reported information on either reliability or correlation with related variables. 2,124 studies were full-text assessed as of October 2020, and 184 were quantitatively synthesized. Conventional Hedges two-level meta-analytic method was utilized. Results: The result of reliability generalization reported a mean coefficient alpha of 0.86 (95% CI = 0.85 - 0.87) and a mean test-retest estimate of .86 (95% CI = 0.81 – 0.89). Estimated effect sizes of correlation between GD and the variables were as follows: .33 with depression (k = 45; number of effect sizes), .29 with anxiety (k = 37), .30 with aggression (k = 19), -.22 with quality of life (k = 18), .29 with loneliness (k = 18), .56 with internet addiction (k = 20), and .40 with game playtime (k = 53) respectively. The result of moderator analyses, funnel and forest plots, and publication bias analyses were also presented. Discussion and conclusions: All five GD instruments have good internal consistency and test-retest reliability. Relatively few studies reported the test-retest reliability. The result of correlation meta-analysis revealed that GD scores were only moderately associated with game playtime. Common psychological problems such as depression and anxiety were found to have a slightly smaller association with GD than the gaming behavior. GD scores were strongly correlated with internet addiction. Further studies should adopt a rigorous methodological procedure to unravel the bidirectional relationship between GD and other psychopathologies. Limitations: The current study did not include grey literature. The representativeness of the five tools included in the current study could be questioned. High heterogeneity is another limitation of the study.

In the past decade, research has accumulated suggesting that excessive Internet use can lead to the development of a behavioral addiction. Internet addiction has been considered as a serious threat to mental health and the excessive use of the Internet has been linked to a variety of negative psychosocial consequences. The aim of this review is to identify all empirical studies to date that used neuroimaging techniques to shed light upon the emerging mental health problem of Internet and gaming addiction from a neuroscientific perspective. Neuroimaging studies offer an advantage over traditional survey and behavioral research because with this method, it is possible to distinguish particular brain areas that are involved in the development and maintenance of addiction. A systematic literature search was conducted, identifying 18 studies. These studies provide compelling evidence for the similarities between different types of addictions, notably substance-related addictions and Internet and gaming addiction, on a variety of levels. On the molecular level, Internet addiction is characterized by an overall reward deficiency that entails decreased dopaminergic activity. On the level of neural circuitry, Internet and gaming addiction led to neuroadaptation and structural changes that occur as a consequence of prolonged increased activity in brain areas associated with addiction. On a behavioral level, Internet and gaming addicts appear to be constricted with regards to their cognitive functioning in various domains. The paper shows that understanding the neuronal correlates associated with the development of Internet and gaming addiction will promote future research and will pave the way for the development of addiction treatment approaches.

818 – The neuroscience of internet and computer game addiction - what do we know about what is going on inside our patients brains?

There is emerging evidence that the psychobiological mechanisms underlying behavioral addictions such as internet and videogame addiction resemble those of addiction for substances of abuse. Review of brain imaging, treatment and genetic studies on videogame and internet addiction. Literature search of published articles between 2009 and 2013 in Pubmed using "internet addiction" and "videogame addiction" as the search word. Twenty-nine studies have been selected and evaluated under the criteria of brain imaging, treatment, and genetics. Brain imaging studies of the resting state have shown that long-term internet game playing affected brain regions responsible for reward, impulse control and sensory-motor coordination. Brain activation studies have shown that videogame playing involved changes in reward and loss of control and that gaming pictures have activated regions similarly to those activated by cue-exposure to drugs. Structural studies have shown alterations in the volume of the ventral striatum possible as result of changes in reward. Furthermore, videogame playing was associated with dopamine release similar in magnitude to those of drugs of abuse and that there were faulty inhibitory control and reward mechanisms videogame addicted individuals. Finally, treatment studies using fMRI have shown reduction in craving for videogames and reduced associated brain activity. Videogame playing may be supported by similar neural mechanisms underlying drug abuse. Similar to drug and alcohol abuse, internet addiction results in sub-sensitivity of dopamine reward mechanisms. Given the fact that this research is in its early stage it is premature to conclude that internet addiction is equivalent to substance addictions.

Introduction: Based on international evidence-based research results, the disorder "Gaming Disorder" was logically suggested for the ICD-11 in the chapter "Disorders due to addictive behaviors". Clinical practice shows that patients with Internet-related disorders can be addicted on (online) computer gaming -but also on specific Internet usage behavior such as chatting, social networks, online purchasing behavior or the consumption of pornographic material (Online Sex Addiction). Method: In a multi-centre, randomized controlled clinical trial (Short-term Treatment of Internet and Computer Game Addiction, STICA) the effectiveness of a cognitive behavioral therapy intervention was examined in 143 patients with computer game and Internet addiction. In addition, further analyzes examined how effective this therapy is in individual sub-forms of Internet-related disorders, especially for Online Sex Addiction. Results: The results show that the presented behavioral therapy is comprehensively effective (10-fold increased chance of being symptom-free at the end of the therapy). In a sub-group analysis, it was also shown, which effectiveness values are to be expected for those affected with Online Sex Addiction. Discussion: One can assume that specific group concepts especially for online sex addiction should be developed. The lecture draws learnings from STICA. We designed a specific psychotherapeutic treatment approach addressing Online Sex Addiction. This newly designed approach is abstinence-focused and combines cognitive behavioral therapy (CBT) and mentalization-based therapy (MBT). Recently, we are testing this approach.

Internet addiction and Internet gaming disorders are increasingly prevalent. Whilst there has been much focus on the use of conventional psychological approaches in the treatment of individuals with these addictive disorders, there has also been ongoing research exploring the potential of cognitive bias modification amongst individuals with Internet and gaming addiction. Some studies have documented the presence of cognitive biases and the effectiveness of bias modification for Internet addiction and gaming disorders. However, there have not been any reviews that have synthesized the findings related to cognitive biases for Internet addiction and Internet gaming disorders. It is important for us to undertake a scoping review as an attempt to map out the literature for cognitive biases in Internet addiction and gaming disorders. A scoping review was undertaken, and articles were identified using a search through the following databases: PubMed, MEDLINE, and PsycINFO. Six articles were identified. There were differences in the methods of ascertaining whether an individual has an underlying Internet or gaming addiction, as several different instruments have been used. With regards to the characteristics of the cognitive bias assessment task utilized, the most common task used was that of the Stroop task. Of the six identified studies, five have provided evidence documenting the presence of cognitive biases in these disorders. Only one study has examined cognitive bias modification and provided support for its effectiveness. Whilst several studies have provided preliminary findings documenting the presence of cognitive biases in these disorders, there remains a need for further research evaluating the effectiveness of bias modification, as well as the standardization of the diagnostic tools and the task paradigms used in the assessment.

Adolescents with autism spectrum disorder (ASD) often have various psychiatric comorbidities, particularly depression. In recent years, gaming disorder (GD) and Internet addiction (IA) have been identified as common comorbidities of ASD. We administered three self-administered screening instruments to adolescents with ASD to assess the severity of depression, GD, and IA. The participants were 10-18-year-olds with ASD. They were asked to complete three questionnaires to assess depressive symptoms, GD, and IA: the Patient Health Questionnaire for Adolescents (PHQ-A), Ten-Item Internet Gaming Disorder Test (IGDT-10), and Internet Addiction Test (IAT). The total IGDT-10 score was calculated in two different ways: the original scoring version (IGDT-10-OV) and the modified version (IGDT-10-MV). Of the 74 respondents, 24.3% had moderate or severe depressive symptoms, 8.1% were identified as having possible GD according to the IGDT-10-OV, 39.2% were identified as having possible GD according to the IGDT-10-MV, and 27.0% were positive for IA according to the IAT. Two-group comparisons revealed that depressive symptoms were more strongly associated with IA than with GD. IA was associated with more depressive symptoms than GD. Since adolescents with ASD have difficulties with social communication, they are prone to isolation and feelings of loneliness. Longer screen times due to social isolation may be a risk factor for the development of GD/IA. Adolescents with ASD often exhibit a preference for visual processing but may struggle with verbal communication. Thus, they may find online spaces more comfortable for them to alleviate their feelings of loneliness.

Study background: Inclusion of Internet addiction into the upcoming revision of DSM-V has been discussed recently. However, its nosological features and diagnostic criteria have remained a matter of debate. Core criteria have been suggested for classification, including craving, tolerance and loss of control. Whereas some questionnaire-based diagnostic tools assess internet addiction, of standardized clinical interviews are still missing. Operationalizing internet addiction by such an interview, akin to the structured clinical interview for DSM Disorders would be beneficial identifying internet addiction, also as a co-morbid disorder in patients suffering from any form of mental illness. Methods: In a specialized clinic a short clinical interview (checklist for the Assessment of Internet and Computer game Addiction, AICA-C) including six core criteria of internet addiction was developed. To generate clinical cut-offs, test its psychometric property and clinical validity, 141 patients were assessed with AICA-C along with further clinical questionnaires and expert ratings, like global assessment of functioning. Trained clinician’s rating regarding presence of internet addiction was used as an external criterion to determine the predictive validity of AICA-C. Results: Items of AICA-C display sound psychometric properties. A preliminary cut-off was determined by using therapist’s rating of internet addiction. This cut-off yielded a sensitivity of 85.1% and specificity of 87.5%. Significant correlations to both, self-report data, like Symptom Checklist-90R and expert ratings, like global assessment of functioning were found. Conclusion: AICA-C can be regarded as a useful and economic tool to assess internet addiction in an oral clinical exploration. Due to its economic applicability in combination with good detection rates, its implementation in the daily routine of psychosomatic and psychiatric institutions can be considered as a promising way to diagnose (co-morbid) internet addiction.

This meta-analytic review aimed to examine the pooled prevalence rates of Internet addiction and gaming disorders in Southeast Asia. Several databases including PubMed, MEDLINE, PsycINFO, Web of Science, Embase, and Cochrane Central were searched and a total of 24 studies were included in this study. The selection of studies was conducted in accordance to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Two meta-analyses were conducted to examine data on Internet addiction and gaming disorders separately. A random-effects model was employed to derive the pooled prevalence rate. Mixed-effects meta-regression and subgroup analyses were performed to examine the moderators of the between-study heterogeneity. Publication bias was tested using the Egger’s regression test and funnel plot. Only seven out of the 11 Southeast Asian countries were represented in the literature. All except for two of the included studies were cross-sectional in nature. The findings revealed a pooled prevalence rate of 20.0% (95% confidence interval: 14.5%–27.0%) and 10.1% (95% confidence interval: 7.3%–13.8%) for Internet addiction and gaming disorders respectively. Mean age and study population were significant moderators of the between-study heterogeneity in the prevalence rates of gaming disorders such that samples involving older participants showed higher prevalence rate than those involving younger individuals. Country of study was found to be significant moderator of the between-heterogeneity for both Internet addiction and gaming disorders, however the findings should be interpreted with caution due to the small and unbalanced sample sizes. There was no significant publication bias. Such epidemiology research should be extended to the Southeast Asian countries that have not been studied or are under-studied. Given that the prevalence rates appear to be higher in Southeast Asia than in other world regions, future research should also explore the factors behind these inter-regional differences. Further longitudinal studies should also be conducted to examine the trajectories of such disorders.

IntroductionInternet gaming addiction (IGA) can have a significant impact on the characteristics of individual gamers, and may even be a contributing factor to the development of social anxiety symptoms. This study of adolescent Saudi Arabian Internet gamers examined the influences of Internet gaming time and probable Internet Gaming Disorders (IGDs). It investigated the association between Internet game addiction and social anxiety symptoms among them.ObjectivesThe aim of this study was to investigate the association between internet game addiction and social anxiety symptoms among Saudi adolescents. Since very few researches examined the association between internet game addiction and psychiatric illnesses among Saudi youth, Our study focused on social anxiety symptoms which has not been done so far.MethodsA cross-sectional, survey was conducted from March to June of 2023 among adolescents in the Saudi population. Probable Internet Game Addiction was measured by using the DSM-5 checklist and the Arabic version of the Social Phobia Inventory (SPIN) was used to evaluate social phobia or anxiety.ResultsA total of 764 participants were enrolled in the current study, majority of gaming addiction participants were 15-16 years old. There was a significant association between gender and gaming addiction (p-value ≤ 0.05). 86.6% of Saudis have been significantly associated with gaming addiction. The majority of the participants have moderate social phobia compared to severe social phobia. There was a significant association between social phobia and age (p-value ≤ 0.05). 34.9% of male participants have moderate social phobia and 24.6% of females have moderate social phobia. There was an insignificant association between social phobia and nationality. The participants with gaming addiction showed 37.2% had mild, 60.5% had moderate, 68.1% had severe and 79.5% had very severe social phobia. There was a significant association between Social Phobia and gaming Addiction (p-value≤0.05).ConclusionsThis study examines the association between video game addiction and social anxiety amongadolescents in Saudi Arabia. Despite its limitations of less sample size and small setting, the findings imply a significant correlation between IGA and these psychological concerns, particularly among male adolescents. Excessive video gaming use leads to higher levels of social anxiety. Future research should adopt experimental or longitudinal designs to establish causal relationships and consider the potential reciprocal nature of the association. Mental health educators and practitioners should be mindful of the adverse impacts of excessive video gaming, with a specific focus on male adolescents who might be more susceptible to heightened social anxiety.Disclosure of InterestB. Alsubaie Employee of: General physician in psychiatry department. Declare no conflict of interest, N. Alhujaili Consultant of: Psychiatry. Declare no conflict of Interest, S. Alzahrani Employee of: General physician. Declare no conflict of interest, F. Aljahdali Employee of: Medical Intern. Declare no conflict of interest, W. Alghamdi Consultant of: Associate professor of psychiatry. Declare no conflict of interest, M. Almatrafi Consultant of: Psychiatry. Declare no conflict of Interest, A. Alghamdi Consultant of: Psychiatry. Declare no conflict of interest

Despite gaming disorder now being diagnosable by the International Classification of Diseases (ICD-11) as a new mental disorder due to addictive behaviors, little is known about the concrete reasons for which people seek treatment for their videogame play. As the current literature is mainly based on children and adolescents, there is a strong need for better understanding adult treatment-seekers in particular. This preregistered study responds to the gap in research by qualitatively investigating the reasons for treatment-seeking with 110 participants who had sought help for their videogame play from a Finnish treatment program. We applied template analysis to the open-ended data, which consist of the participants’ personal accounts regarding their problems. Additionally, we report the game titles that the participants had problems with, as well as Internet Gaming Disorder Test (IGDT-10) scores, which were measured from 89 participants. The template analysis suggested five themes, which cover the main reasons for treatment-seeking: social reasons, existential reasons, practical reasons, self-perceived addiction, and wish for support. Many of these themes overlap with the ICD-11 description of gaming disorder, but several issues, such as loss of meaning and financial harms, are not part of the current diagnosis. The average IGDT-10 score among participants was 3.86 (SD = 2.55) and 37 (42%) individuals met the disorder cutoff (5.00). Numerous videogames with different designs were mentioned as sources of problems, of which 26 were mentioned more than once. The study indicates that adults seek treatment for many kinds of games and gaming-related problems, including but not limited to those, which are described part of the ICD-11 gaming disorder diagnoses. We recommend both researchers and practitioners to implement an expanded perspective on gaming behaviors, acknowledging that adults may seek treatment for diverse gaming-related problems, some of which not necessarily relevant to gaming disorder or mental disorders in general.

Background: While several benefits are attributed to the Internet and video games, an important proportion of the population presents symptoms related to possible new technological addictions and there has been little discussion of treatment of problematic technology use. Although demand for knowledge is growing, only a small number of treatments have been described. Objective: To conduct a systematic review of the literature, to establish Cognitive Behavioral Therapy (CBT) as a possible strategy for treating Internet and video game addictions. Method: The review was conducted in the following databases: Science Direct on Line, PubMed, PsycINFO, Cochrane Clinical Trials Library, BVS and SciELO. The keywords used were: Cognitive Behavioral Therapy; therapy; treatment; with association to the terms Internet addiction and video game addiction. Given the scarcity of studies in the field, no restrictions to the minimum period of publication were made, so that articles found until October 2013 were accounted. Results: Out of 72 articles found, 23 described CBT as a psychotherapy for Internet and video game addiction. The manuscripts showed the existence of case studies and protocols with satisfactory efficacy. Discussion: Despite the novelty of technological dependencies, CBT seems to be applicable and allows an effective treatment for this population.

The present study investigated the association between autism and problematic internet use (PIU) and gaming disorder (GD). A systematic literature search was conducted in accordance with PRISMA guidelines. A total of 2286 publications were screened, and 21 were deemed eligible for inclusion in the review. The majority of the studies found positive associations between PIU and subclinical autistic-like traits with weak and moderate effect sizes and between PIU and Autism Spectrum Disorder (ASD) with varying effect sizes. Additionally, individuals with ASD were more likely to exhibit symptoms of GD with moderate and strong effect sizes. Future research would benefit from high-quality studies examining GD and PIU at a clinical level and their relationship with both clinical and subclinical autism.

Aims Although relationships between addiction and personality have previously been explored, no study has ever simultaneously investigated the interrelationships between several behavioral addictions, and related these to the main dimensions of the five-factor model of personality. Methods In this study, 218 university students completed questionnaires assessing seven different behavioral addictions (i.e., Facebook addiction, video game addiction, Internet addiction, exercise addiction, mobile phone addiction, compulsive buying, and study addiction) as well as an instrument assessing the main dimensions of the five-factor model of personality. Results Of the 21 bivariate intercorrelations between the seven behavioral addictions, all were positive (and nine significantly). The results also showed that (i) Neuroticism was positively associated with Internet addiction, exercise addiction, compulsive buying, and study addiction, (ii) Extroversion was positively associated with Facebook addiction, exercise addiction, mobile phone addiction, and compulsive buying, (iii) Openness to experience was negatively associated with Facebook addiction and mobile phone addiction, (iv) Agreeableness was negatively associated with Internet addiction, exercise addiction, mobile phone addiction, and compulsive buying, and (v) Conscientiousness was negatively associated with Facebook addiction, video game addiction, Internet addiction, and compulsive buying and positively associated with exercise addiction and study addiction. Conclusions The positive associations between the seven behavioral addictions suggest one or several underlying pathological factors. Hierarchical multiple regressions showed that personality traits explained between 6% and 17% of the variance in the seven behavioral addictions, suggesting that personality to a varying degree explains scores on measures of addictive behaviors.

PurposeTo explore the associations of severe musculoskeletal injuries (joint and muscles) and surgeries with symptoms of common mental disorders (distress, anxiety/depression, sleeping disturbance, adverse alcohol behaviour , smoking, adverse nutrition behaviour) among male European professional footballers.MethodsCross-sectional analyses were conducted on electronic questionnaires completed by professional footballers recruited from the national players’ unions of Finland, France, Norway, Spain or Sweden. The number of severe (time loss of more than 28 days) musculoskeletal injuries (total, joint, muscle) and surgeries during a professional football career was examined through four questions, while symptoms of common mental disorders were evaluated through validated scales.ResultsA total of 540 professional footballers (mean age of 27 years; 54 % playing in the highest leagues) participated in the study. Sixty-eight per cent of the participants had already incurred one or more severe joint injuries and 60 % one or more severe muscle injuries. Prevalence of symptoms of common mental disorders ranged from 3 % for smoking to 37 % for anxiety/depression and 58 % for adverse nutrition behaviour. The number of severe musculoskeletal injuries during a football career was positively correlated with distress, anxiety and sleeping disturbance, while the number of surgeries was correlated with adverse alcohol behaviour and smoking. Professional footballers who had sustained one or more severe musculoskeletal injuries during their career were two to nearly four times more likely to report symptoms of common mental disorders than professional footballers who had not suffered from severe musculoskeletal injuries.ConclusionIt can be concluded that the number of severe musculoskeletal injuries and surgeries during a career is positively correlated and associated with symptoms of common mental disorders among male European professional footballers. This study emphasises the importance of applying a multidisciplinary approach to the clinical care and support of professional footballers, especially when a player faces lengthy periods without training and competition as a consequence of recurrent severe joint or muscle injuries.Level of evidenceIII.