Smart Phone/Cellphone Dependence/Addiction

Kobayashi K, Hsu M. Common neural code for reward and information value. PNAS. June 25, 2019 116 (26) 13061-13066.


Adaptive information seeking is critical for goal-directed behavior. Growing evidence suggests the importance of intrinsic motives such as curiosity or need for novelty, mediated through dopaminergic valuation systems, in driving information-seeking behavior. However, valuing information for its own sake can be highly suboptimal when agents need to evaluate instrumental benefit of information in a forward-looking manner. Here we show that information-seeking behavior in humans is driven by subjective value that is shaped by both instrumental and noninstrumental motives, and that this subjective value of information (SVOI) shares a common neural code with more basic reward value. Specifically, using a task where subjects could purchase information to reduce uncertainty about outcomes of a monetary lottery, we found information purchase decisions could be captured by a computational model of SVOI incorporating utility of anticipation, a form of noninstrumental motive for information seeking, in addition to instrumental benefits. Neurally, trial-by-trial variation in SVOI was correlated with activity in striatum and ventromedial prefrontal cortex. Furthermore, cross-categorical decoding revealed that, within these regions, SVOI and expected utility of lotteries were represented using a common code. These findings provide support for the common currency hypothesis and shed insight on neurocognitive mechanisms underlying information-seeking behavior.


It is more important than ever to seek information adaptively. While it is optimal to acquire information based solely on its instrumental benefit, humans also often acquire useless information because of psychological motives, such as curiosity and pleasure of anticipation. Here we show that instrumental and noninstrumental motives are multiplexed in subjective value of information (SVOI) signals in human brains. Subjects’ information seeking in an economic decision-making task was captured by a model of SVOI, which reflects not only information’s instrumental benefit but also utility of anticipation it provides. SVOI was represented in traditional value regions, sharing a common code with more basic reward value. This demonstrates that valuation system combines multiple motives to drive information-seeking behavior.

Raising questions about digital addiction

While the research does not directly address overconsumption of digital information, the fact that information engages the brain’s reward system is a necessary condition for the addiction cycle, he says. And it explains why we find those alerts saying we’ve been tagged in a photo so irresistible.

“The way our brains respond to the anticipation of a pleasurable reward is an important reason why people are susceptible to clickbait,” he says. “Just like junk food, this might be a situation where previously adaptive mechanisms get exploited now that we have unprecedented access to novel curiosities.”

O’Donnell S, Epstein LH. Smartphones are more reinforcing than food for students. Addict Behav. 2018 Oct 18;90:124-133. doi: 10.1016/j.addbeh.2018.10.018. 


• College students engage in high frequency smartphone use despite consequences.

• Comparing smartphones to food may establish their relative reinforcing value.
• Students were deprived of food and smartphones before working for both reinforcers.
• Phones were more reinforcing than food, and smartphone reinforcement was related to smartphone use.
• Smartphones are potent reinforcers, which may be why people use smartphones excessively.


College students engage in high-frequency smartphone use, despite potential negative consequences. One way to conceptualize this behavior is to consider it a highly reinforcing activity. Comparing motivation for smartphones to a powerful primary reinforcer, such as food, can establish their relative reinforcing value. This study investigated whether smartphones were more reinforcing than food, as well as the relationships between smartphone reinforcement, texting use, and smartphone motives. Participants were 76 college students (50% female, Mage = 18.9, SD = 0.99) who had no access to food for three hours and to their smartphones for two hours. After this modest deprivation period, participants worked for time to use their smartphones and 100-cal portions of their favorite snack food concurrently, with the work to obtain portions of both commodities increasing. The amount of smartphone use earned during the task was manipulated across groups (20, 30, 60, 120 s) to establish what amount of smartphone use was needed to motivate responding. Additionally, reinforcing efficacy of smartphones and food using a hypothetical purchase task and motivations for smartphone use was collected. Smartphones were more reinforcing than food using either measurement methodology (p’s < 0.001). Smartphone reinforcement predicted number of text messages, controlling for age, sex, and family income. Positive smartphone use motives were associated with reinforcing efficacy of smartphones. These data show that smartphones are potent reinforcers, and are more reinforcing than food given modest food deprivation. These methods provide one important reason why people may use smartphones.


College students share a perception that smartphone ownership is beneficial; however smartphone use has been linked to increased anxiety (Jenaro, Flores, Gómez-Vela, González-Gil, & Caballo, 2007), social dysfunction (Jenaro et al., 2007) insomnia (Jenaro et al., 2007), low self-esteem (Bianchi & Phillips, 2005; Smetaniuk, 2014), emotional instability (Roberts, Pullig, & Manolis, 2015; Smetaniuk, 2014) and depression (Ezoe et al., 2009; Smetaniuk, 2014). Temporarily removing cell phones from high frequency cell phone users increased self-reported anxiety over a 75 min time period in comparison to less frequent users (Cheever et al., 2014). Despite the negative outcomes associated with problematic smartphone use, college students are highly motivated to use their smartphones.

Kates AW, Wu H, Chris LSC. The effects of mobile phone use on academic performance: A meta-analysis. Computers & Education. 127:107-112. Dec 2018.


• Study purpose is to further examine any relationships that may exist between mobile phone use and educational achievement.

• A meta-analysis on the relationship between mobile phone use & academic outcomes over 10 years (2008–2017) was conducted.
• Results indicate the summary effect of mobile phone use on student outcomes is r = −0.16 with 95% CI of −0.20 to −0.13.


Purpose  Although the mobile phone has been conspicuously proliferated in the past decades, little is known about its influence; especially its effect on student learning and academic performance. Although there is a growing interest in mobile devices and their correlates and consequences for children, effects vary across related studies and the magnitude of the overall effect remains unclear. The purpose of this study is to further examine any relationships that may exist between mobile phone use and educational achievement.

Research design  A meta-analysis of research conducted on the relationship between mobile phone use and student educational outcomes over a 10-year period (2008–2017) was conducted. The operational definition of cell phone use to guide the implementation of this study is: any measure of mobile phone use, whether considered normative or problematic, that quantifies the extent to which a person uses a phone, feels an emotional or other dependence on a phone, or categorizes the types of uses and situations in which use occurs. Studies examining use for the express purpose of educational improvement are not included, as the aim of this study is to ascertain the effects of normal smartphone use. The operational definition of academic achievement to guide the implementation of this study is: any measure that quantifies the extent to which a student or group of students is performing or feels he or she is performing to a satisfactory level, including but not limited to letter grades and test scores, knowledge and skill acquisition, and self-reported measures of academic ability or difficulty.

Findings  The overall meta-analysis indicated that the average effect of mobile phone usage on student outcomes was r =  −0.162 with a 95% confident interval of −0.196 to −0.128. The effect sizes of moderator variables (education level, region, study type, and whether the effect size was derived from a Beta coefficient, and mobile phone use construct) were analyzed. The results of this study and their implications for both research and practice are discussed.

The results of this study indicate that, overall, mobile phone use has a small negative effect (r = −0.16) on educational outcomes which is consistent with the previous literature (Lepp et al., 2015; Li et al., 2015). However, the results caution against coming to hasty conclusions based on these findings. The summary effect size is relatively small, even in the educational sphere. Hattie (2012), for example, conducted over 900 educational meta-analyses and found the largest summary effect for a classroom intervention to be a Cohen’s d of 1.44. Taking this into account, it is not surprising that something so ubiquitous and increasingly integral to students’ lives would have some influence on educational outcomes. Additionally, although the publication bias analysis suggests that these results are not greatly biased by a systematic exclusion of studies, it should be noted that the effects observed could be indicative of an association rather than causation. For example, those who are predisposed to overuse mobile devices may simply be less likely to achieve academically in the first place. That the summary effect is derived from studies involving experimental groups as well as cross-sectional studies, however, brings this possibility into question….

Despite the variability between studies, there appears to be a consistent negative, albeit small, effect on educational achievement. This suggests that avoidance of mobile phones in educational settings, or for those who are currently in school, could be beneficial for academic achievement….. 

Kuss DJ, Kanjo E, Crook-Rumsey M, Kibowski F, Wang GY, Sumich A. Problematic mobile phone use and addiction across generations: the roles of psychopathological symptoms and smartphone use. J Technol Behav Sci. 2018;3(3):141-149. doi: 10.1007/s41347-017-0041-3.


Contemporary technological advances have led to a significant increase in using mobile technologies. Recent research has pointed to potential problems as a consequence of mobile overuse, including addiction, financial problems, dangerous use (i.e. whilst driving) and prohibited use (i.e. use in forbidden areas). The aim of this study is to extend previous findings regarding the predictive power of psychopathological symptoms (depression, anxiety and stress), mobile phone use (i.e. calls, SMS, time spent on the phone, as well as the engagement in specific smartphone activities) across Generations X and Y on problematic mobile phone use in a sample of 273 adults. Findings revealed prohibited use and dependence were predicted by calls/day, time on the phone and using social media. Only for dependent mobile phone use (rather than prohibited), stress appeared as significant. Using social media and anxiety significantly predicted belonging to Generation Y, with calls per day predicted belonging to Generation X. This finding suggests Generation Y are more likely to use asynchronous social media-based communication, whereas Generation X engage more in synchronous communication. The findings have implications for prevention and awareness-raising efforts of possibly problematic mobile phone use for educators, parents and individuals, particularly including dependence and prohibited use.

Kim J-H. Psychological issues and problematic use of
smartphone: ADHD’s moderating role in the associations among loneliness, need
for social assurance, need for immediate connection, and problematic use of smartphone.
Computers in Human Behavior. 80:390-398. Mar 2018.

• Examined the mechanism linking loneliness with
problematic use of smartphone.
• ADHD increased levels of loneliness, NSA, NIC, and
problematic use of smartphone.
• FtF interaction decreased the association between NSA
and NIC for those with ADHD.

Going beyond looking at the direct association between
psychological issues (loneliness and ADHD) and problematic use of media
(smartphone), the present study examined the covert mechanism connecting the
two. NSA (need for social assurance) and NIC (need for immediate connection)
were selected as mediating steps between the two. A total of 615 U.S. American
participants were recruited nationally for survey participation. Research
findings suggest that individuals who are lonely would rely on smartphone hoping
to be connected with and get assurance from others, but might end up struggling
with problematic use of smartphone. Those with ADHD showed higher levels of
loneliness, NSA, NIC, and problematic use of smartphone, and also showed
stronger associations linking loneliness, NSA and NIC compared to those without
ADHD. Face-to-face (FtF) interaction decreased the association between NSA and
NIC for those with ADHD.

Carbonell X, Chamarro A, Oberst U, Rodrigo B, Prades M. Problematic
Use of the Internet and Smartphones in University Students: 2006-2017. Intl J
Environ Research Publ Health. 15(3). Article 475. Mar 2018.

It has been more than a decade since a concern about the
addictive use of the Internet and mobile phones was first expressed, and its
possible inclusion into the lists of mental disorders has recently become a
popular topic of scientific discussion. Thus, it seems to be a fitting moment
to investigate the prevalence of this issue over time. The aim of the present
study was to analyze the prevalence of the perception of problematic Internet
and smartphone use in young people over the period 2006-2017. To this end, a
questionnaire on Internet use habits and two questionnaires on the negative
consequences of Internet and smartphone use were administered to a sample of
792 university students. The scores were then compared with the results of
former studies that had used these questionnaires. The perception of
problematic Internet and mobile phone use has increased over the last decade,
social networks are considered responsible for this increase, and females are
perceived to be more affected than males. The current study shows how strong
smartphone and Internet addiction and social media overlap. Participants from
2017 report higher negative consequences of both Internet and mobile phone use
than those from 2006, but long-term observations show a decrease in problematic
use after a sharp increase in 2013. We conclude that the diagnosis of
technological addictions is influenced by both time and social and culture

Zou Z, Wang H, d’Oleire Uquillas F, Wang X, Ding J, Chen H. Definition
of Substance and Non-substance Addiction. Adv Exp Med Biol. 2017;1010:21-41.

Substance addiction (or drug addiction) is a
neuropsychiatric disorder characterized by a recurring desire to continue
taking the drug despite harmful consequences. Non-substance addiction (or
behavioral addiction) covers pathological gambling, food addiction, internet
addiction, and mobile phone addiction. Their definition is similar to drug
addiction but they differ from each other in specific domains. This review aims
to provide a brief overview of past and current definitions of substance and
non-substance addiction, and also touches on the topic of diagnosing drug
addiction and non-drug addiction, ultimately aiming to further the
understanding of the key concepts needed for a foundation to study the
biological and psychological underpinnings of addiction disorders.

T, Xiang YT, Zhang H, Zhang Z, Mei S. Neuroticism and quality of life: Multiple
mediating effects of smartphone addiction and depression. Psychiatry Res. 2017
Dec;258:457-461. doi: 10.1016/j.psychres.2017.08.074.
purposes of this study were to investigate the mediating effect of smartphone
addiction and depression on neuroticism and quality of life. Self-reported
measures of neuroticism, smart-phone addiction, depression, and quality of life
were administered to 722 Chinese university students. Results showed smartphone
addiction and depression were both significantly affected neuroticism and
quality of life. The direct effect of neuroticism on quality of life was
significant, and the chain-mediating effect of smartphone addiction and
depression was also significant. In conclusion, neuroticism, smartphone
addiction, and depression are important variables that worsen quality of life.
HJ, Min JY, Kim HJ, Min KB. Accident risk associated with smartphone addiction:
A study on university students in Korea. J Behav Addict. 2017 Nov 3:1-9. doi:
and aims: The smartphone is one of the most popular devices, with the average
smartphone usage at 162 min/day and the average length of phone usage at 15.79
hr/week. Although significant concerns have been made about the health effects
of smartphone addiction, the relationship between smartphone addiction and
accidents has rarely been studied. We examined the association between
smartphone addiction and accidents among South Korean university students.

A total of 608 college students completed an online survey that included their
experience of accidents (total number; traffic accidents; falls/slips;
bumps/collisions; being trapped in the subway, impalement, cuts, and exit
wounds; and burns or electric shocks), their use of smartphone, the type of
smartphone content they most frequently used, and other variables of interests.
Smartphone addiction was estimated using Smartphone Addiction Proneness Scale,
a standardized measure developed by the National Institution in Korea.

Compared with normal users, participants who were addicted to smartphones were
more likely to have experienced any accidents (OR = 1.90, 95% CI: 1.26-2.86),
falling from height/slipping (OR = 2.08, 95% CI: 1.10-3.91), and
bumps/collisions (OR = 1.83, 95% CI: 1.16-2.87). The proportion of participants
who used their smartphones mainly for entertainment was significantly high in
both the accident (38.76%) and smartphone addiction (36.40%) groups.

and conclusions: We suggest that smartphone addiction was significantly
associated with total accident, falling/slipping, and bumps/collisions. This
finding highlighted the need for increased awareness of the risk of accidents
with smartphone addiction.
Wolniewicz CA, Tiamiyu MF, Weeks JW, Elhai JD. Problematic smartphone use and relations with negative affect, fear of missing out, and fear of negative and positive evaluation. Psychiatry Res. 2017 Sep 25. pii: S0165-1781(17)30901-0. doi: 10.1016/j.psychres.2017.09.058.
For many individuals, excessive smartphone use interferes with everyday life. In the present study, we recruited a non-clinical sample of 296 participants for a cross-sectional survey of problematic smartphone use, social and non-social smartphone use, and psychopathology-related constructs including negative affect, fear of negative and positive evaluation, and fear of missing out (FoMO). Results demonstrated that FoMO was most strongly related to both problematic smartphone use and social smartphone use relative to negative affect and fears of negative and positive evaluation, and these relations held when controlling for age and gender. Furthermore, FoMO (cross-sectionally) mediated relations between both fear of negative and positive evaluation with both problematic and social smartphone use. Theoretical implications are considered with regard to developing problematic smartphone use.

S, Kim KJ, Kim JH. Understanding Nomophobia: Structural Equation Modeling and
Semantic Network Analysis of Smartphone Separation Anxiety. Cyberpsychol Behav
Soc Netw. 2017 Jul;20(7):419-427. doi: 10.1089/cyber.2017.0113.

study explicates nomophobia by developing a research model that identifies
several determinants of smartphone separation anxiety and by conducting
semantic network analyses on smartphone users’ verbal descriptions of the meaning
of their smartphones. Structural equation modeling of the proposed model
indicates that personal memories evoked by smartphones encourage users to
extend their identity onto their devices. When users perceive smartphones as
their extended selves, they are more likely to get attached to the devices,
which, in turn, leads to nomophobia by heightening the phone proximity-seeking
tendency. This finding is also supplemented by the results of the semantic
network analyses revealing that the words related to memory, self, and
proximity-seeking are indeed more frequently used in the high, compared with
low, nomophobia group.
Lee H, Kim JW, Choi TY. Risk Factors for
Smartphone Addiction in Korean Adolescents: Smartphone Use Patterns. J Korean
Med Sci. 2017 Oct;32(10):1674-1679. doi: 10.3346/jkms.2017.32.10.1674.

With widespread use of the smartphone, clinical
evidence for smartphone addiction remains unclear. Against this background, we
analyzed the effect of smartphone use patterns on smartphone addiction in
Korean adolescents. A total of 370 middle school students participated. The
severity of smartphone addiction was measured through clinical interviews and
the Korean Smartphone Addiction Proneness Scale. As a result, 50 (13.5%) were
in the smartphone addiction group and 320 (86.5%) were in the healthy group. To
investigate the effect of smartphone use patterns on smartphone addiction, we performed
self-report questionnaires that assessed the following items: smartphone
functions mostly used, purpose of use, problematic use, and parental attitude
regarding smartphone use. For smartphone functions mostly used, the addiction
group showed significantly higher scores in “Online chat.” For the
purpose of use, the addiction group showed significantly higher “habitual
use,” “pleasure,” “communication,” “games,” “stress relief,” “ubiquitous trait,” and “not to be
left out.” For problematic use, the addiction group showed significantly
higher scores on “preoccupation,” “tolerance,” “lack
of control,” “withdrawal,” “mood modification,” “conflict,” “lies,” “excessive use,” and “loss of interest.” For parental attitude regarding children’s
smartphone use, the addiction group showed significantly higher scores in “parental punishment.” Binary logistic regression analysis indicated
that “female,” “use for learning,” “use for ubiquitous
trait,” “preoccupation,” and “conflict” were
significantly correlated with smartphone addiction. This study demonstrated
that the risk factors for smartphone addiction were being female,
preoccupation, conflict, and use for ubiquitous trait; the protective factor
was use for learning. Future studies will be required to reveal the additional
clinical evidence of the disease entity for smartphone addiction.

Kuss DJ, Griffiths MD. Social Networking Sites
and Addiction: Ten Lessons Learned. Int J Environ Res Public Health. 2017 Mar
17;14(3). pii: E311. doi: 10.3390/ijerph14030311.
Online social networking sites (SNSs) have
gained increasing popularity in the last decade, with individuals engaging in
SNSs to connect with others who share similar interests. The perceived need to
be online may result in compulsive use of SNSs, which in extreme cases may
result in symptoms and consequences traditionally associated with
substance-related addictions. In order to present new insights into online
social networking and addiction, in this paper, 10 lessons learned concerning
online social networking sites and addiction based on the insights derived from
recent empirical research will be presented. These are: (i) social networking and
social media use are not the same; (ii) social networking is eclectic; (iii)
social networking is a way of being; (iv) individuals can become addicted to
using social networking sites; (v) Facebook addiction is only one example of
SNS addiction; (vi) fear of missing out (FOMO) may be part of SNS addiction;
(vii) smartphone addiction may be part of SNS addiction; (viii) nomophobia may
be part of SNS addiction; (ix) there are sociodemographic differences in SNS
addiction; and (x) there are methodological problems with research to date.
These are discussed in turn. Recommendations for research and clinical
applications are provided.

De-Sola Gutiérrez J, Rodríguez de Fonseca F, Rubio G. Cell-Phone
Addiction: A Review. Front Psychiatry. 2016 Oct 24;7:175.


We present a review of the studies that have been published
about addiction to cell phones. We analyze the concept of cell-phone addiction
as well as its prevalence, study methodologies, psychological features, and
associated psychiatric comorbidities. Research in this field has generally
evolved from a global view of the cell phone as a device to its analysis via
applications and contents. The diversity of criteria and methodological
approaches that have been used is notable, as is a certain lack of conceptual
delimitation that has resulted in a broad spread of prevalent data. There is a
consensus about the existence of cell-phone addiction, but the delimitation and
criteria used by various researchers vary. Cell-phone addiction shows a
distinct user profile that differentiates it from Internet addiction. Without
evidence pointing to the influence of cultural level and socioeconomic status,
the pattern of abuse is greatest among young people, primarily females.
Intercultural and geographical differences have not been sufficiently studied.
The problematic use of cell phones has been associated with personality
variables, such as extraversion, neuroticism, self-esteem, impulsivity,
self-identity, and self-image. Similarly, sleep disturbance, anxiety, stress,
and, to a lesser extent, depression, which are also associated with Internet
abuse, have been associated with problematic cell-phone use. In addition, the
present review reveals the coexistence relationship between problematic
cell-phone use and substance use such as tobacco and alcohol.

NL, Del Puente G. A proposal for including nomophobia in the new DSM-V. Psychol
Res Behav Manag. 2014 May 16;7:155-60. doi: 10.2147/PRBM.S41386.
Diagnostic and Statistical Manual of Mental Disorders (DSM) is considered to be
the gold standard manual for assessing the psychiatric diseases and is
currently in its fourth version (DSM-IV), while a fifth (DSM-V) has just been
released in May 2013. The DSM-V Anxiety Work Group has put forward
recommendations to modify the criteria for diagnosing specific phobias. In this
manuscript, we propose to consider the inclusion of nomophobia in the DSM-V,
and we make a comprehensive overview of the existing literature, discussing the
clinical relevance of this pathology, its epidemiological features, the available
psychometric scales, and the proposed treatment. Even though nomophobia has not
been included in the DSM-V, much more attention is paid to the
psychopathological effects of the new media, and the interest in this topic
will increase in the near future, together with the attention and caution not
to hypercodify as pathological normal behaviors.
source paper:

Hussain Z. Smartphone Use, Addiction, Narcissism, and Personality: A Mixed Methods Investigation.International Journal of Cyber Behavior, Psychology and Learning. 5(1):17-32. 2015.


There are increasing numbers of people who are now using smartphones. Consequently, there is a risk of addiction to certain web applications such as social networking sites (SNSs) which are easily accessible via smartphones. There is also the risk of an increase in narcissism amongst users of SNSs. 

The present study set out to investigate the relationship between smartphone use, narcissistic tendencies and personality as predictors of smartphone addiction. The study also aimed to investigate the distinction between addiction specificity and co-occurrence in smartphone addiction via qualitative data and discover why people continue to use smartphones in banned areas. A self-selected sample of 256 smartphone users (Mean age = 29.2, SD = 9.49) completed an online survey. The results revealed that 13.3% of the sample was classified as addicted to smartphones. Higher narcissism scores and neuroticism levels were linked to addiction. Three themes of; social relations, smartphone dependence and self-serving personalities emerged from the qualitative data. Interpretation of qualitative data supports addiction specificity of the smartphone. It is suggested smartphones encourage narcissism, even in non-narcissistic users. In turn, this increased use in banned areas. Future research needs to gather more in-depth qualitative data, addiction scale comparisons and comparison of use with and without SNS access. It is advised that prospective buyers of smartphones be pre-warned of the potential addictive properties of new technology.

Internet Addiction

Sussman CJ, Harper JM, Stahl JL, Weigel P. Internet and Video Game Addictions: Diagnosis, Epidemiology, and Neurobiology. Child Adolesc Psychiatric Clin N Am 27 (2018) 307–326.

Key Points

  • Proposed criteria for diagnosis of Internet gaming disorder and other digital technology addictions are analogous to those for substance use or gambling disorders.
  • Diagnosis of Internet and video game addictions should include both screening tools and clinical interview for “red flags,” such as academic decline, sleep disruption, and changes in real-life activities and relationships.
  • Epidemiologic studies, limited by variation in diagnostic methods, yield prevalence estimates ranging from less than 1.0% to 26.8%.
  • Internet and video game addictions are associated with psychological and social comorbidities, such as depression, attention-deficit/hyperactivity disorder, alcohol use, anxiety,and poor psychosocial support.
  • Neurobiological evidence suggests a dual processing model of digital technology addictions characterized by an imbalance between the reactive reward system and the reflective reward system


In spite of the lack of a consensus on diagnosis, and the resulting variations in epidemiologic, comorbidity, and neurobiological research, these studies provide overwhelming evidence of similarities between IVGA and SUD. Taken as a whole, the research presented here strongly suggests that IVGA is a clinically relevant and valid syndrome. Like other addictions, it is better understood when incorporating a neuro-biological perspective. Our field must successfully address IVGAs to meet the needs of a society that is increasingly enmeshed in digital technology. Research in this area should continue to accelerate, allowing clinicians to better screen for, diagnose, psycho-educate, and provide multimodal treatment for our patients with IVGA. Treatment of IVGAs is explored in David N. Greenfield’s article, “Treatment Considerations in Internet and Video Game Addiction: A Qualitative Discussion,” in this issue.

Significant limitations in the current body of research include the difficulty in determining causality among many epidemiologic correlations, the limited knowledge of brain changes occurring in IVGA, including whether they are reversible, and the absence of animal model studies. These weaknesses will likely continue to encourage challenges to the validity of IVGA from critics. Some argue that digital technology use is so pervasive that the diagnosis may overpathologize behavior that is normative and acceptable in our culture.105 On the other hand, modern society’s excessive engagement with technology risks falsely normalizing addictions to technology, in what may be a culture of “functional tech-oholics.” It seems difficult to walk down a public street without seeing multiple passersby engaged with smartphones, or to partake in a group conversation with no mention of digital media in some form. It seems evident that the human brain cannot evolve fast enough to adapt to the progress of digital technology, and that even the most powerful prefrontal cortex may be unable to resist the allure of instant stimulation in the ocean of digital screens that our world is becoming. Regardless of where we place the diagnostic cutoff for IVGA, our patients suffering the most profound dysfunction from their use of digital technology need better resources to recognize, understand, and treat their condition. If IVGA proves to be more abundant than a collection of a few extreme cases, it will be even more vital for our psychoeducational interventions to reach not only affected individuals, but their families and the communities as well. Ironically, social media and other forms of screen-based education may prove the best platforms for reaching out to those suffering IVGA without the insight, knowledge, and resources to address it.a This fact reminds us that learning more about the benefits of digital technology as well as its risks represents a challenge for modern providers and an opportunity for contemporary researchers.

Cheng YS, Tseng PT, Lin PY, Chen TY, Stubbs B, Carvalho AF, Wu CK, Chen YW, Wu MK. Internet Addiction and Its Relationship With Suicidal Behaviors: A Meta-Analysis of Multinational Observational Studies. J Clin Psychiatry. 2018 Jun 5;79(4). pii: 17r11761.


OBJECTIVE: To perform a systematic review and meta-analysis of observational studies that investigated the putative association between internet addiction and suicidality.

DATA SOURCES: Major electronic databases (PubMed, Embase, ClinicalKey, Cochrane Library, ProQuest, Science Direct, and were searched using the following keywords (internet addiction OR internet gaming disorder OR internet use disorder OR pathological internet use OR compulsive internet use OR problematic internet use) AND (suicide OR depression) to identify observational studies from inception to October 31, 2017.

STUDY SELECTION: We included 23 cross-sectional studies (n = 270,596) and 2 prospective studies (n = 1,180) that investigated the relationship between suicide and internet addiction.

DATA EXTRACTION: We extracted the rates of suicidal ideation, planning, and attempts in individuals with internet addiction and controls.

RESULTS: The individuals with internet addiction had significantly higher rates of suicidal ideation (odds ratio [OR] = 2.952), planning (OR = 3.172), and attempts (OR = 2.811) and higher severity of suicidal ideation (Hedges g = 0.723). When restricted to adjusted ORs for demographic data and depression, the odds of suicidal ideation and attempts were still significantly higher in the individuals with internet addiction (ideation: pooled adjusted OR = 1.490; attempts: pooled adjusted OR = 1.559). In subgroup analysis, there was a significantly higher prevalence rate of suicidal ideation in children (age less than 18 years) than in adults (OR = 3.771 and OR = 1.955, respectively).

CONCLUSIONS: This meta-analysis provides evidence that internet addiction is associated with increased suicidality even after adjusting for potential confounding variables including depression. However, the evidence was derived mostly from cross-sectional studies. Future prospective studies are necessary to confirm these findings.

Fumero A, Marrero RJ, Voltes D, Peñate  W. Personal and social factors involved in internet addiction among adolescents: A meta-analysis. Computers in Human Behavior. 86:387-400. Sep 2018.


• Internet addiction (IA) was associated with psychosocial factors in adolescents.
• The risk factors had a greater effect on IA than protective factors.
• Personal factors showed a greater association with IA than social factors.
• Hostility, depression and anxiety showed the greatest link with IA.


Background and Aims  The growing popularity and frequency of Internet use has resulted in a large number of studies reporting various clinical problems associated with its abuse. The main purpose of this study is to conduct a meta-analysis of the association between Internet addiction (IA) and a number of personal and social psychological factors in adolescents.

Methods  The search included cross-sectional, case-control and cohort studies which analyzed the relationship between IA and at least one of the following personal variables: (i) psychopathology, (ii) personality features and (iii) social difficulties, as well as (iv) self-esteem, (v) social skills and (vi) positive family functioning. These variables were classified as protective and promoting factors of the risk of developing IA.

Results  A total of 28 studies with adequate methodological quality were identified in the primary medical, health and psychological literature databases up to November 2017. Of the 48,090 students included in the analysis, 6548 (13.62%) were identified as excessive Internet users. The results highlight that risk factors had a greater effect on IA than protective factors. Also, personal factors showed a greater link with IA than social factors.

Conclusions  The data provide relevant information for those developing programs for the prevention of IA and the enhancement of protective factors.

Social Networking Site

Hunt MG, Marx R, Lipson C, Young J. No More FOMO: Limiting social media decreases loneliness and depression. Journal of Social and Clinical Psychology. 37(10): 751-768. 2018.

Introduction: Given the breadth of correlational research linking social media use to worse well-being, we undertook an experimental study to investigate the potential causal role that social media plays in this relationship.
Method: After a week of baseline monitoring, 143 undergraduates at the University of Pennsylvania were randomly assigned to either limit Facebook, Instagram and Snapchat use to 10 minutes, per platform, per day, or to use social media as usual for three weeks.
Results: The limited use group showed significant reductions in loneliness and depression over three weeks compared to the control group. Both groups showed significant decreases in anxiety and fear of missing out over baseline, suggesting a benefit of increased self-monitoring.
Discussion: Our findings strongly suggest that limiting social media use to approximately 30 minutes per day may lead to significant improvement in well-being.
Most of the prior research that has been done on social media and well-being has been correlational in nature. A few prospective and experimental studies have been done, but they have only focused on Facebook. Our study is the first ecologically valid, experimental investigation that examines multiple social media platforms and tracks actual usage objectively. The results from our experiment strongly suggest that limiting social media usage does have a direct and positive impact on subjective well- and depression. That is, ours is the first study to establish a clear causal link between decreasing social media use, and improvements in loneliness and depression. It is ironic, but perhaps not surprising, that reducing social media, which promised to help us connect with others, actually helps people feel less lonely and depressed. 

HM. Investigating the differential effects of social networking site addiction
and Internet gaming disorder on psychological health. J Behav Addict. 2017 Nov
13:1-10. doi: 10.1556/2006.6.2017.075.
and aims: Previous studies focused on examining the interrelationships between
social networking site (SNS) addiction and Internet gaming disorder (IGD) in
isolation. Moreover, little is known about the potential simultaneous
differential effects of SNS addiction and IGD on psychological health. This
study investigated the interplay between these two technological addictions and
ascertained how they can uniquely and distinctively contribute to increasing
psychiatric distress when accounting for potential effects stemming from
sociodemographic and technology-related variables.

A sample of 509 adolescents (53.5% males) aged 10-18 years (mean = 13.02,
SD = 1.64) were recruited.

It was found that key demographic variables can play a distinct role in
explaining SNS addiction and IGD. Furthermore, it was found that SNS addiction
and IGD can augment the symptoms of each other, and simultaneously contribute
to deterioration of overall psychological health in a similar fashion, further
highlighting potentially common etiological and clinical course between these
two phenomena. Finally, the detrimental effects of IGD on psychological health
were found to be slightly more pronounced than those produced by SNS addiction,
a finding that warrants additional scientific scrutiny.

and conclusion: The implications of these results are further discussed in
light of the existing evidence and debates regarding the status of
technological addictions as primary and secondary disorders.
Internet Gaming Disorder/Addiction
The Internet Gaming Disorder Scale (IGDS) is a widely used measure of video
game addiction, a pathology affecting a small percentage of all people who play
video games. Emerging adult males are significantly more likely to be video
game addicts. Few researchers have examined how people who qualify as video
game addicts based on the IGDS compared to matched controls based on age,
gender, race, and marital status.
The current study compared IGDS video game addicts to matched non-addicts in
terms of their mental, physical, social-emotional health using self-report,
survey methods.
Addicts had poorer mental health and cognitive functioning including poorer
impulse control and ADHD symptoms compared to controls. Additionally, addicts
displayed increased emotional difficulties including increased depression and
anxiety, felt more socially isolated, and were more likely to display internet
pornography pathological use symptoms. Female video game addicts were at unique
risk for negative outcomes.
The sample for this study was undergraduate college students and self-report
measures were used.
Participants who met the IGDS criteria for video game addiction displayed
poorer emotional, physical, mental, and social health, adding to the growing
evidence that video game addictions are a valid phenomenon.
SH, Cho H, Chun JW, Jeong JE, Kim DJ. Gaming Device Usage Patterns Predict
Internet Gaming Disorder: Comparison across Different Gaming Device Usage
Patterns. Int J Environ Res Public Health. 2017 Dec 5;14(12). pii: E1512. doi:
behaviors have been significantly influenced by smartphones. This study was
designed to explore gaming behaviors and clinical characteristics across
different gaming device usage patterns and the role of the patterns on Internet
gaming disorder (IGD). Responders of an online survey regarding smartphone and
online game usage were classified by different gaming device usage patterns:
(1) individuals who played only computer games; (2) individuals who played
computer games more than smartphone games; (3) individuals who played computer
and smartphone games evenly; (4) individuals who played smartphone games more
than computer games; (5) individuals who played only smartphone games. Data on
demographics, gaming-related behaviors, and scales for Internet and smartphone
addiction, depression, anxiety disorder, and substance use were collected.
Combined users, especially those who played computer and smartphone games
evenly, had higher prevalence of IGD, depression, anxiety disorder, and
substance use disorder. These subjects were more prone to develop IGD than
reference group (computer only gamers) (B = 0.457, odds ratio = 1.579).
Smartphone only gamers had the lowest prevalence of IGD, spent the least time
and money on gaming, and showed lowest scores of Internet and smartphone
addiction. Our findings suggest that gaming device usage patterns may be
associated with the occurrence, course, and prognosis of IGD.
X, Yang Y, Gao P, Qi X, Du G, et al. Compensatory increase of functional
connectivity density in adolescents with internet gaming disorder. Brain
Imaging Behav. 2017 Dec;11(6):1901-1909. doi: 10.1007/s11682-016-9655-x.
studies have demonstrated visual attention bias and working memory deficits in
individuals with internet gaming disorder (IGD). Neuroimaging studies
demonstrated that individuals with IGD presented abnormalities in brain
structures and functions including resting-state functional connectivity (rsFC)
disturbance. However, most previous studies investigated IGD-related rsFC
alterations by using hypothesis-driven methods with priori selection of a
region of interest, which cannot provide a full picture of the rsFC changes in
IGD individuals. In this study, we recruited 27 male IGD adolescents and 35
demographically matched healthy controls (HCs) to investigate abnormal
connective property of each voxel within whole brain of IGD adolescents using
resting-state functional connectivity density (rsFCD) method, and further to
evaluate the relationship between altered rsFCD and behavioral performances of
visual attention and working memory. The results exhibited no significant
intergroup difference in behavioral performance (visual working memory and
attention). The IGD adolescents exhibited higher global/long-range rsFCD in the
bilateral dorsal lateral prefrontal cortex (DLPFC) and the right inferior
temporal cortex (ITC)/fusiform compared with the HCs. Although no significant
correlation survived after Bonferroni correction, higher global/long-range
rsFCD of the bilateral DLPFC was correlated with the Young’s internet addiction
test (IAT) score and/or behavioral performance in IGD adolescents using an
uncorrected threshold of P < 0.05. In conclusion, IGD adolescents
demonstrated increased rsFCD in the brain regions involved in working memory,
spatial orientation and attention processing, which indicated that increased
rsFCD may reflect a compensatory mechanism for maintaining the normal
behavioral performance in IGD adolescents compared with the HCs.
J, Luo L, Qiu L, Kang Y, Liu B, et al. The topological organization of white
matter network in internet gaming disorder individuals. Brain Imaging Behav.
2017 Dec;11(6):1769-1778. doi: 10.1007/s11682-016-9652-0.
matter (WM) integrity abnormalities had been reported in Internet gaming
disorder (IGD). Diffusion tensor imaging (DTI) tractography allows
identification of WM tracts, potentially providing information about the
integrity and organization of relevant underlying WM fiber tracts’
architectures, which has been used to investigate the connectivity of cortical
and subcortical structures in several brain disorders. Unfortunately,
relatively little is known about the thoroughly circuit-level characterization
of topological property changes of WM network with IGD. Sixteen right-hand
adolescents with IGD participated in our study, according to the diagnostic
criteria of IGD in DSM-5. Meanwhile, 16 age and gender-matched healthy controls
were also enrolled. DTI tractography was employed to generate brain WM networks
in IGD individuals and healthy controls. The 90 cortical and subcortical
regions derived from AAL template were chosen as the nodes. The network
parameters (i.e., Network strength, clustering coefficient, shortest path
length, global efficiency, local efficiency, regional efficiency) were calculated
and then correlated with the Internet addiction test (IAT) scores in IGD. IGD
group showed decreased global efficiency, local efficiency and increased
shortest path length. Further analysis revealed the reduced nodal efficiency in
frontal cortex, anterior cingulate cortex and pallidium in IGD. In addition,
the global efficiency of WM network was correlated with the IAT scores in IGD
(r = -0.5927; p = 0.0155). We reported the abnormal topological organization of
WM network in IGD and the association with the severity of IGD, which may
provide new insights into the neural mechanism of IGD from WM network level.
K, Ginley MK, Chang R, Petry NM. Treatments for Internet gaming disorder and
Internet addiction: A systematic review. Psychol Addict Behav. 2017
Dec;31(8):979-994. doi: 10.1037/adb0000315. Epub 2017 Sep 18.
related to excessive use of the Internet and video games have recently captured
the interests of both researchers and clinicians. The goals of this review are
to summarize the literature on treatment effectiveness for these problems and
to determine whether any treatments meet the minimum requirement of an
evidence-based treatment as defined by Chambless et al. (1998). Studies of
treatments for Internet gaming disorder (IGD) and Internet addiction were
examined separately, as past studies have linked IGD to more severe outcomes.
The systematic review identified 26 studies meeting predefined criteria; 13
focused on treatments for IGD and 13 on Internet addiction. The results
highlighted a paucity of well-designed treatment outcome studies and limited
evidence for the effectiveness of any treatment modality. Studies were limited
by methodological flaws, including small sample sizes, lack of control groups,
and little information on treatment adherence, among other problems. In
addition, the field is beset by a lack of consistent definitions of and
established instruments to measure IGD and Internet addiction. The results of
this review highlight the need for additional work in the area of treatment
development and evaluation for IGD and Internet addiction. Attention to
methodological concerns identified within this review should improve subsequent
research related to treating these conditions, and ultimately outcomes of
patients suffering from them.