Kai W. Müller

[Computer game playing: clinical characteristics of dependence and abuse among adolescents].

SummaryOBJECTIVE AND METHODS: The aim of the study was to investigate the prevalence of excessive computer game playing behaviour among adolescents with psychopathological tendencies that resemble the classic symptoms of addiction. To address this question, criteria for excessive computer game playing behaviour were developed on the basis of diagnostic criteria for substance-related disorders according to ICD-10. RESULTS: Excessive computer playing corresponding to addictive behaviour were found in 12.3% of the adolescents (n = 1068; 9.6% showed abusive and 2.7% dependent behaviour). Adolescents with excessive computer and video game playing behaviour also show substantial correlations with other psychosocial and psychopathological abnormalities, such as alterations in the intensity of social conflict, concentration deficits, maladaptive coping behaviour, stress and psychosomatic challenge, and school phobia. CONCLUSIONS: The study provides the first empirical data about excessive computer game playing among adolescents in Austria. It shows that pathological computer game playing can be well described by criteria developed in accordance to substance dependence, and that abusive or dependent computer game playing shows specific connections with psycho-social, psychopathological and motivational factors. Overall, the results demonstrate a clear need for deeper research on this subject and the need for a design of prevention measures.ZusammenfassungANLIEGEN UND METHODE: Ziel der durchgeführten Studie ist es aufzuzeigen, in wie weit exzessives Computerspielverhalten bei Jugendlichen mit psychopathologischen Tendenzen, die den Symptomen einer klassischen Suchterkrankung entsprechen, vorliegt. Dieser Frage wurde unter Verwendung adaptierter Diagnosekriterien, die den substanzbezogenen Störungen aus den ICD 10 entliehen sind, nachgegangen. ERGEBNIS: Die untersuchte Stichprobe (n = 1068) weist einen Anteil von 12,3% Jugendlichen mit als suchtartig (9,6% missbräuchliches und 2,7% abhängiges Spielverhalten) einzustufendem Computerspielverhalten auf. Jugendliche mit suchtartigen Spielverhalten weisen zudem substanzielle Zusammenhänge mit weiteren psychosozialen und psychopathologischen Auffälligkeiten, wie Intensität ausgetragener sozialer Konflikte, Konzentrationsdefizite, maladaptivem Copingverhalten, psychosomatischer Belastung und Schulängstlichkeit auf. SCHLUSSFOLGERUNG: Die Studie gibt ein erstes empirisches Bild über Computerspielsucht bei Jugendlichen in Österreich. Es zeigt sich, dass pathologisches Computerspielverhalten mittels adaptierter Kriterien zur stoffgebundenen Abhängigkeit gut abgebildet werden kann und dass missbräuchliches bzw. abhängiges Spielverhalten spezifische Zusammenhänge aufweist mit psychosozialen, psychopathologischen und motivationalen Faktoren. Insgesamt weisen diese ersten Resultate auf einen eindeutigen vertieften Forschungsbedarf zu diesem Feld und der Notwendigkeit zur Konzeption von Präventionsmaßnahmen hin.

Regular and Problematic Leisure-Time Internet Use in the Community: Results from a German Population-Based Survey

In our study, we attempted to identify systematically the use of Internet applications in the German population in order to derive risk factors for problematic use. In a representative survey of the German population, we queried 1,401 women and 1,111 men between the ages of 14 and 94 years by specific questions and standardized questionnaires on depression, anxiety (HADS), and depersonalization (CDS-2). The majority of the German population (55%) used the Internet in their leisure time. Users were younger and had a higher socioeconomic status (education, employment, income). Leisure-time use included e-mail and information search, as well as shopping. Chatting, online communities, games and sex were domains of young, mostly male adults. Overall, 9.3% reported at least one negative consequence of Internet use, especially neglect of recreational activities and problems with family/partner, work or education, and health. Problematic use was associated with longer average daily online times, avoidance of negative emotions, preference for certain applications (gaming, gambling, online sex) and an increased rate of depersonalization. The extent of Internet use per se is not sufficient as an addiction criterion and other negative consequences; rather, specific adverse consequences need to be identified. If the Internet is used excessively to cope with negative affect states and alternative means of coping (e.g., social support, health-promoting behavior) are diminished, a vicious cycle may ensue with increasing stress and reliance on the reinforcing properties of certain online activities that may finally lead to addictive behavior.

Investigating risk factors for Internet gaming disorder: a comparison of patients with addictive gaming, pathological gamblers and healthy controls regarding the big five personality traits.

Engaging in online games has become increasingly important as a part of leisure activity in adolescents and adults. While the majority of people use these games in a healthy way, epidemiological studies show that some develop excessive use and symptoms that are related to those of substance-related addictions. Despite increasing research concerning the epidemiology of internet gaming disorder (IGD), predisposing factors have been examined to a lesser extent. Knowing about specific risk factors would help clarify the nosological features of IGD and enhance prevention and intervention. This study aimed to evaluate the relationships between personality traits and IGD. A total of 115 patients meeting the criteria for IGD were compared to 167 control subjects displaying either regular or intense use of online games. Additionally, 115 patients meeting diagnostic criteria for pathological gambling were included. IGD was associated with higher neuroticism, decreased conscientiousness and low extraversion. The comparisons to pathological gamblers indicate that low conscientiousness and low extraversion in particular are characteristic of IGD. An integration of personality variables into an etiopathological model describing presumable mechanisms fostering and maintaining addictive online gaming is proposed. This model could be helpful for the theoretical understanding of addictive gaming, public health campaigns and psychoeducation within therapeutic settings.

Prevalence of internet addiction in the general population: results from a German population-based survey

Despite a growing number of publications, there is still no generally agreed-upon definition and assessment procedure for Internet addiction, and there is a lack of representative data on its prevalence in the general population. Based on a reliable and valid scale of Internet addiction, the purpose of this study was to determine the proportion of the general population of Internet addiction with psychometric evidence and to identify associated psychosocial and health consequences. Out of a representative survey of the German population (N=2512) the leisure time Internet users (n=1382) were queried by standardised questionnaires on Internet addiction, depression, anxiety (HADS) and depersonalisation (CDS-2). According to strict criteria of the Assessment of Internet and Computer Game Addiction (AICA-S), 2.1% of the sample was characterised as addicted by meeting criteria of craving, withdrawal symptoms, tolerance, etc. These reported daily Internet use, excessive online times. The majority reported additional adverse psychosocial and health consequences. Risk factors were male gender and social factors (unmarried, unemployment, students, low income). Online gambling, social networks, gaming chats and pornography were preferentially used by Internet addicts. Assessment of Internet addiction requires a multifaceted approach; the AICA-S is an instrument suitable for further epidemiological study.

A hidden type of internet addiction? Intense and addictive use of social networking sites in adolescents

Internet Gaming Disorder has been included as a preliminary diagnosis in DSM-5. The question remains, if there are additional internet activities related to addictive use. Especially, use of social networking sites has been discussed to be related to excessive use, but only few empirical studies are available. We wanted to explore, if use of social networking sites is related to addiction symptoms and psychosocial distress and which variables (demography, personality) predict addictive use. A representative sample of n?=?9173 adolescents (12-19 years) was enrolled. Self-report questionnaires assessed demography, frequency of social networking sites use, internet addiction, personality, and psychosocial distress. Gender-specific associations were found between frequency of use of social networking sites and addiction criteria, especially regarding preoccupation and loss of control. Adolescents using social networking sites intensely were more often classified with internet addiction (4.1% boys, 3.6% girls) and displayed higher psychosocial distress. Frequency of social networking sites use and its addictive use were predicted by similar variables except for extraversion that was only related to frequency of use. Since the intense use of social networking sites can be related to addictive symptoms and is accompanied by psychosocial distress it might be considered as another form of addictive online behavior. Intense use of social networking is correlated with criteria for internet addiction.The prevalence amounted to 4.1% (boys) and 3.6% (girls).Addictive use was related to higher psychosocial distress.Extraversion predicted frequency of SNS-use but not addictive SNS-use.

Effects of a manualized short-term treatment of internet and computer game addiction (STICA): study protocol for a randomized controlled trial

BackgroundIn the last few years, excessive internet use and computer gaming have increased dramatically. Salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse have been defined as diagnostic criteria for internet addiction (IA) and computer addiction (CA) in the scientific community. Despite a growing number of individuals seeking help, there are no specific treatments of established efficacy.Methods/designThis clinical trial aims to determine the effect of the disorder-specific manualized short-term treatment of IA/CA (STICA). The cognitive behavioural treatment combines individual and group interventions with a total duration of 4 months. Patients will be randomly assigned to STICA treatment or to a wait list control group. Reliable and valid measures of IA/CA and co-morbid mental symptoms (for example social anxiety, depression) will be assessed prior to the beginning, in the middle, at the end, and 6 months after completion of treatment.DiscussionA treatment of IA/CA will establish efficacy and is desperately needed. As this is the first trial to determine efficacy of a disorder specific treatment, a wait list control group will be implemented. Pros and cons of the design were discussed.Trial RegistrationClinicalTrials (NCT01434589)

A contribution to the clinical characterization of Internet addiction in a sample of treatment seekers: Validity of assessment, severity of psychopathology and type of co-morbidity

OBJECTIVE Internet addiction becomes a growing health problem worldwide with prevalence rates up to 3%. Still, uncertainties exist regarding its diagnostics and clinical characterization. Especially the lacking clinical evidence regarding self-report measures assessing Internet addiction has been criticized. METHODS This study aimed to characterize 290 German treatment seekers and to determine the diagnostic accuracy of a self-report scale for Internet addiction. Patients filled in self-report measures (SCL-90R, PHQ, AICA-S - Scale for the Assessment of Internet and Computer game Addiction) and underwent diagnostic interviews to assess symptoms of Internet addiction and level of functioning. RESULTS Of the predominantly male treatment seekers 71% met the clinical diagnosis of Internet addiction. These displayed higher levels of psychopathology, especially depressive and dissociative symptoms. Half of the patients met criteria for one further psychiatric disorder according to clinical interviews, especially depressive disorders. Their level of functioning was decreased in all domains. AICA-S showed good psychometric properties and satisfying diagnostic accuracy (sensitivity: 80.5%; specificity: 82.4%). DISCUSSION In this sample, Internet addiction was associated with high levels of psychosocial distress that is mainly related to depressive symptoms. Co-morbid disorders were common among those patients. First analyses on diagnostic accuracy of AICA-S (using the therapists rating on Internet addiction as an independent external criterion) showed promising results.

Treatment Outcomes in Patients with Internet Addiction: A Clinical Pilot Study on the Effects of a Cognitive-Behavioral Therapy Program

Internet addiction is regarded as a growing health concern in many parts of the world with prevalence rates of 1-2% in Europe and up to 7% in some Asian countries. Clinical research has demonstrated that Internet addiction is accompanied with loss of interests, decreased psychosocial functioning, social retreat, and heightened psychosocial distress. Specialized treatment programs are needed to face this problem that has recently been added to the appendix of the DSM-5. While there are numerous studies assessing clinical characteristics of patients with Internet addiction, the knowledge about the effectiveness of treatment programs is limited. Although a recent meta-analysis indicates that those programs show effects, more clinical studies are needed here. To add knowledge, we conducted a pilot study on the effects of a standardized cognitive-behavioral therapy program for IA. 42 male adults meeting criteria for Internet addiction were enrolled. Their IA-status, psychopathological symptoms, and perceived self-efficacy expectancy were assessed before and after the treatment. The results show that 70.3% of the patients finished the therapy regularly. After treatment symptoms of IA had decreased significantly. Psychopathological symptoms were reduced as well as associated psychosocial problems. The results of this pilot study emphasize findings from the only meta-analysis conducted so far.

Digital Stress over the Life Span: The Effects of Communication Load and Internet Multitasking on Perceived Stress and Psychological Health Impairments in a German Probability Sample

The present study investigated the psychological health effects and motivational origins of digital stress based on a representative survey of 1,557 German Internet users between 14 and 85 years of age. Communication load resulting from private e-mails and social media messages as well as Internet multitasking were positively related to perceived stress and had significant indirect effects on burnout, depression, and anxiety. Perceived social pressure and the fear of missing out on information and social interaction were key drivers of communication load and Internet multitasking. Age significantly moderated the health effects of digital stress as well as the motivational drivers of communication load and Internet multitasking. The results, thus, underline the need to address digital stress from a life span perspective.

Addressing the Question of Disorder-Specific Risk Factors of Internet Addiction: A Comparison of Personality Traits in Patients with Addictive Behaviors and Comorbid Internet Addiction

Uncontrolled use of the internet has been reported to affect the lives of some users in a negative way. According to epidemiological studies, about 1% of the general population is showing signs of internet addiction. Since internet addiction is becoming a growing health concern, research on potential risk factors is becoming more important in order to develop strategies for prevention and to adopt therapeutic treatment. Although there are some studies investigating personality traits in internet addiction, most of these studies are based on samples of healthy subjects. In this research project, we compared personality profiles of a sample of patients in different rehabilitation centers. 70 patients with an addiction disorder that additionally met the criteria for internet addiction were compared to 48 patients suffering from alcohol dependence. Besides Big Five personality traits, we also assessed depressive symptoms. It was shown that patients with comorbid internet addiction can be discriminated from other patients by higher neuroticism and lower extraversion as well as lower conscientiousness. After controlling for depressive symptoms, lower conscientiousness especially turned out to be a disorder-specific risk factor. As internet addiction is related to unique patterns of personality traits and can be discriminated from alcohol dependence, treatment approaches are needed that meet the specific requirements of patients with internet addiction.