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Review
. 2014 May 27:8:375.
doi: 10.3389/fnhum.2014.00375. eCollection 2014.

Prefrontal control and internet addiction: a theoretical model and review of neuropsychological and neuroimaging findings

Affiliations
Review

Prefrontal control and internet addiction: a theoretical model and review of neuropsychological and neuroimaging findings

Matthias Brand et al. Front Hum Neurosci. .

Abstract

Most people use the Internet as a functional tool to perform their personal goals in everyday-life such as making airline or hotel reservations. However, some individuals suffer from a loss of control over their Internet use resulting in personal distress, symptoms of psychological dependence, and diverse negative consequences. This phenomenon is often referred to as Internet addiction. Only Internet Gaming Disorder has been included in the appendix of the DSM-5, but it has already been argued that Internet addiction could also comprise problematic use of other applications with cybersex, online relations, shopping, and information search being Internet facets at risk for developing an addictive behavior. Neuropsychological investigations have pointed out that certain prefrontal functions in particular executive control functions are related to symptoms of Internet addiction, which is in line with recent theoretical models on the development and maintenance of the addictive use of the Internet. Control processes are particularly reduced when individuals with Internet addiction are confronted with Internet-related cues representing their first choice use. For example, processing Internet-related cues interferes with working memory performance and decision making. Consistent with this, results from functional neuroimaging and other neuropsychological studies demonstrate that cue-reactivity, craving, and decision making are important concepts for understanding Internet addiction. The findings on reductions in executive control are consistent with other behavioral addictions, such as pathological gambling. They also emphasize the classification of the phenomenon as an addiction, because there are also several similarities with findings in substance dependency. The neuropsychological and neuroimaging results have important clinical impact, as one therapy goal should enhance control over the Internet use by modifying specific cognitions and Internet use expectancies.

Keywords: Internet addiction; craving; cue-reactivity; executive functions; neuroimaging.

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Figures

Figure 1
Figure 1
The proposed model on the development and maintenance of generalized and specific Internet addiction. (A) Demonstrates the proposed way of using the Internet as a tool for dealing with personal needs and goals in everyday-life. In (B), the proposed mechanisms underlying generalized Internet addiction (GIA) are summarized. (C) Illustrates the proposed processes involved in specific Internet addiction (SIA), for example the addictive use of certain Internet applications, such as gaming, cybersex, communication, and so on. We argue that in both conditions, GIA and SIA, reductions in prefrontal control processes are related to the individuals’ loss of control over their Internet use. As outlined in Section “General Comments on Neuropsychological Research in Addiction,” control processes are related to higher-order cognitive functions. We believe that if an individual with GIA faces the situation that he/she is confronted with the possibility to go online (or to use a certain Internet application in an individual with SIA), these cues are so strong that the individual reacts relatively automatically with a wanting reaction. Cognitive control over this reaction is difficult if the expectancies that using the Internet would reduce craving and result in positive and/or negative reinforcement. We will summarize neuropsychological and neuroimaging findings on the link between executive control functions, cue-reactivity, and an addicted use of the Internet in Sections “Neuropsychological Correlates of Internet Addiction” and “Neuroimaging Correlates of Internet Addiction.”
Figure 2
Figure 2
The prefrontal cortex regions and associated brain structures most likely involved in development and maintenance of an addictive use of the Internet. (A) Shows the lateral view of the brain including medial parts such as anterior cingulate gyrus and amygdala, and (B) illustrates the medio-sagittal view of the prefrontal cortex. These cortical and subcortical brain regions are main correlates of substance addiction and other behavioral additions. The dorsolateral prefrontal cortex (dlPFC) plays a crucial role in executive functions, cognitive control, and decision making under explicit conditions. It is connected to several basal ganglia, in particular to the nucleus caudatus and putamen via the so-called fronto-striatal loops. The orbitofrontal cortex (OFC) and the ventromedial prefrontal cortex (vmPFC) are critically linked to reward anticipation, emotion processing, and decision making under ambiguity. These structures are connected with limbic structures (amygdala) and the ventral striatum (nucleus accumbens, Nc. acc.) via the limbic part of frontal–striatal loops. The nucleus accumbens receives direct dopaminergic and indirect (via glutamate and GABA) projections from the ventral tegmental area (VTA) of the midbrain. The dorsomedial prefrontal cortex (dmPFC) and the anterior cingulate cortex (ACC) receive dopaminergic projections from the nucleus accumbens, and they are most likely involved in the so-called wanting component of craving. The anterior cingulate gyrus has also been discussed as being critical for conflict processing.

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