Exploring the associations between reward disturbances, internet addiction and depression

139 Pages·2016·1.94 MB·English

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UNIVERSITY OF SOUTHAMPTON

FACULTY OF SOCIAL, HUMAN AND MATHEMATICAL
SCIENCES
School of Psychology

Exploring the associations between reward disturbances, internet
addiction and depression

By Phillip Bishop

Supervisors: Dr Catherine Brignell, School of Psychology, University
of Southampton and
Dr Matthew Garner, School of Psychology, University of Southampton

Word Count: 19,985
Literature Review: 10,689 (excluding tables)
Empirical Paper: 9,296 (excluding tables)

Submitted as a thesis for the degree of Doctor of Clinical Psychology, May 2016
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UNIVERSITY OF SOUTHAMPTON
ABSTRACT
FACULTY OF SOCIAL AND HUMAN SCIENCES
Psychology
Thesis for the degree of Doctor of Clinical Psychology
EXPLORING THE ASSOCIATIONS BETWEEN REWARD
DISTURBANCES, INTERNET ADDICTION, AND DEPRESSION

A review of the literature on the relationship between Internet Gaming Disorder (IGD) and
depression was conducted; a total of 22 papers met inclusion criteria. The review was structured
by three questions: 1) Is there an association between IGD and depression? 2) What mediators
and moderators may be involved in this relationship? 3) Is there any evidence to suggest causal
pathways? The majority of the reviewed research identified an association between IGD and
depression. Some potential mediators and moderators were identified, including self-esteem and
loneliness, although methodological limitations restricted the inferences that could be drawn
from the findings. The research is still in its infancy and more sophisticated research methods
are required to further understand the nature of the association between IGD and depression.
A quasi-experimental design was used to explore the proposed association between
reward disturbances, internet addiction and depression. Specifically, it was hypothesised that the
internet addict group would experience reduced ‘liking’ of positive stimuli and increased
‘wanting’ of internet stimuli, whilst being less motivated to obtain reward in comparison with
controls. The internet addiction group reported significantly higher depression scores, however
there were no differences in groups’ ‘liking’ of stimuli, yet the internet addiction group reported
greater arousal overall. There were no between group differences for motivation, although
within group correlations revealed that for the internet addiction group there was a dissociation
between ‘liking’ of rewards and motivation to obtain them; there was also a positive correlation
between BDI-II scores and motivation. These findings were not in line with hypotheses, and
may suggest that the internet addiction group experience greater reward sensitivity, and are
therefore drawn to internet use to satiate this heightened reward sensitivity; or that internet
addiction may serve as a form of experiential avoidance, thus potentially maintaining
depression.

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Contents
LIST OF FIGURES .................................................................................................................. 11
DECLARATION OF AUTHORSHIP .................................................................................... 13
ACKNOWLEDGEMENTS ..................................................................................................... 15
CHAPTER 1: LITERATURE REVIEW: EXPLORING THE ASSOCIATION
BETWEEN INTERNET GAMING DISORDER AND DEPRESSION .............................. 17
1.1 INTRODUCTION ......................................................................................................... 17
1.1.1 DEPRESSION ............................................................................................................ 17
1.1.2 INTERNET USE ......................................................................................................... 17
1.1.3 GAMING ................................................................................................................... 18
1.1.4 INTERNET GAMING DISORDER (IGD) ..................................................................... 18
1.1.5 PURPOSE OF THIS REVIEW ....................................................................................... 19
1.1.6 REVIEW QUESTIONS ................................................................................................ 19
1.2 METHOD ...................................................................................................................... 19
1.2.1 ELIGIBILITY CRITERIA ............................................................................................. 19
1.2.1.1 PARTICIPANTS ............................................................................................................. 20
1.2.1.2 TYPES OF MEASURES ................................................................................................... 20
1.2.2 INFORMATION SOURCES .......................................................................................... 20
1.2.3 SEARCH TERMS ....................................................................................................... 21
1.2.4 STUDY SELECTION .................................................................................................. 21
1.3 RESULTS ...................................................................................................................... 21
1.3.1 CROSS-SECTIONAL STUDIES ................................................................................... 44
1.3.1.1 Association between IGD and depression ............................................................... 44
1.3.1.2 Studies that found an Association between IGD and Depression ...................... 44
1.3.1.5 Results of studies that found an association between gaming and depression ....... 45
1.3.1.6 Strengths of studies that found an association ........................................................ 46
1.3.1.7 Limitations of studies that found an association ..................................................... 46
1.3.1.8 Studies that found no Association between Online Gaming and Depression ......... 46
1.3.1.9 Strengths of studies that found no association ........................................................ 47
1.3.1.10 Limitations of studies that found no association ................................................... 47
1.3.1.11 Summary of the association between IGD and depression ................................... 47
1.3.2 OTHER FACTORS THAT MAY MEDIATE OR MODERATE THE ASSOCIATION BETWEEN
DEPRESSION AND PROBLEMATIC VIDEO GAMING .................................................................... 48
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1.3.2.1 Cognitive model of gaming addiction ...................................................................... 48
1.3.2.2 Beliefs about game reward and tangibility .............................................................. 48
1.3.2.3 Maladaptive and inflexible rules about gaming behaviour ..................................... 49
1.3.2.4 Summary of studies relating to maladaptive and inflexible rules about game
behaviour ............................................................................................................................. 51
1.3.2.5 Over-reliance on gaming to meet self-esteem needs ............................................... 51
1.3.2.6 Self-Esteem .............................................................................................................. 51
1.3.2.7 Summary of self-esteem results ................................................................................ 51
1.3.2.8 Critique of studies that explored self-esteem ........................................................... 52
1.3.2.9 Studies that explored violence ................................................................................. 52
1.3.2.10 Critique of studies that explored violence ............................................................. 54
1.3.2.11 Escaping negative mood ........................................................................................ 54
1.3.2.12 Summary of studies that explored escaping a negative mood ............................... 55
1.3.2.13 Gaming as a means of gaining social acceptance ................................................. 56
1.3.2.14 Social anxiety ......................................................................................................... 56
1.3.2.15 Loneliness .............................................................................................................. 56
1.3.2.16 Summary of studies that explored loneliness, social anxiety and self-esteem ....... 57
1.3.2.17 Conclusions that can currently be drawn about factors that may influence the
relationship between IGD and depression .......................................................................... 58
1.3.3 IS THERE ANY EVIDENCE OF A CAUSAL RELATIONSHIP BETWEEN PROBLEMATIC VIDEO
GAMING AND DEPRESSION? ..................................................................................................... 59
1.3.3.1 Studies that did not find a causal association between IGD and depression .......... 59
1.3.3.2 Strengths of studies that did not find a causal association ...................................... 59
1.3.3.3 Limitations of studies that did not find a causal association ................................... 60
1.3.3.4 Studies that found a causal relationship between gaming and depression ............. 61
1.3.3.5 Strengths of studies that found a causal relationship .............................................. 62
1.3.3.6 Limitations of studies that found a causal relationship ........................................... 62
1.3.3.7 Summary of longitudinal studies ............................................................................. 63
1.4 DISCUSSION ....................................................................................................................... 63
1.4.1 CONCEPT OF ADDICTION ................................................................................................ 64
1.4.2 DOES GAMING CAUSE DEPRESSION? ............................................................................... 65
1.4.3 FUTURE RESEARCH ......................................................................................................... 66
1.4.4 CLINICAL IMPLICATIONS ................................................................................................ 66
1.5 CONCLUSION .................................................................................................................... 67
2.1 INTRODUCTION ......................................................................................................... 69
2.1.1 DEPRESSION .................................................................................................................... 69
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2.1.2 INTERNET ADDICTION .................................................................................................... 69
2.1.3 ASSOCIATION BETWEEN INTERNET ADDICTION AND DEPRESSION ................................. 70
2.1.4 ADDICTIONS AND REWARD ............................................................................................ 71
2.1.5 DECREASED REWARD SENSITIVITY (‘LIKING’) ............................................................... 72
2.1.6 WANTING AND INCENTIVE SALIENCE - ENHANCED SENSITIVITY TO CONDITIONED
EXPECTATIONS TO DRUGS AND CUES ...................................................................................... 72
2.1.7 REWARD DYSFUNCTION AND DEPRESSION .................................................................... 73
2.1.8 RESEARCH AIMS ............................................................................................................. 74
2.1.9 RESEARCH QUESTION .................................................................................................... 75
2.2 METHODS .................................................................................................................... 76
2.2.1 DESIGN ........................................................................................................................... 76
2.2.2 PARTICIPANTS ................................................................................................................ 76
2.2.3 MATERIALS .................................................................................................................... 76
2.2.3.1 Beck Depression Inventory-II (BDI-II) ................................................................... 76
2.2.3.2 Compulsive Internet Use Scale (CIUS) ................................................................... 77
2.2.3.4 Snaith-Hamilton Pleasure Scale (SHAPS) .............................................................. 77
2.2.3.5 Responses to Internet-Related and Naturally Positive Stimuli (‘Liking’ and
‘Wanting’) ........................................................................................................................... 78
2.2.3.6 Motivation Task....................................................................................................... 79
2.2.4 PROCEDURE .................................................................................................................... 80
2.2.4.1 Physiological and explicit responses to internet related, positive and neutral stimuli
............................................................................................................................................ 80
2.2.4.2 Motivation Task....................................................................................................... 81
2.2.5 DATA ANALYSIS ............................................................................................................. 81
2.3 RESULTS ...................................................................................................................... 83
2.3.1 PARTICIPANT CHARACTERISTICS ................................................................................... 84
2.3.2 HYPOTHESIS 1 – DEPRESSION ........................................................................................ 84
2.3.3 HYPOTHESIS 2 AND 3 – SELF-REPORT AND PHYSIOLOGICAL MEASURES FOR INTERNET
AND POSITIVE IMAGES ............................................................................................................. 85
2.3.4 SELF-REPORT RESULTS ................................................................................................... 85
2.3.5 PHYSIOLOGICAL RESULTS .............................................................................................. 87
2.3.6 HYPOTHESIS 4 - MOTIVATION TASK RESULTS ................................................................ 91
2.4 DISCUSSION ...................................................................................................................... 92
2.4.1 DISCUSSION SUMMARY .................................................................................................. 92
2.4.2 HYPOTHESIS 1 ................................................................................................................ 92
2.4.3 HYPOTHESES 2 AND 3 ..................................................................................................... 92
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2.4.4 HYPOTHESIS 4 ................................................................................................................. 93
2.5 STRENGTHS AND WEAKNESSES ................................................................................. 95
2.5.1 STUDY’S STRENGTHS ...................................................................................................... 95
2.5.2 STUDY’S LIMITATIONS.................................................................................................... 95
2.6 CLINICAL IMPLICATIONS ............................................................................................ 97
2.7 FUTURE RESEARCH........................................................................................................ 98
2.8 CONCLUSION .................................................................................................................... 99
REFERENCES ........................................................................................................................ 101
APPENDIX A – PROPOSED DSM-V INTERNET GAMING DISORDER CRITERIA 115
APPENDIX B – ETHICAL APPROVAL ............................................................................. 117
APPENDIX C – RECRUITMENT POSTER ....................................................................... 119
APPENDIX D – INFORMATION SHEET ........................................................................... 121
APPENDIX E - CONSENT FORM ....................................................................................... 123
APPENDIX F – DEBRIEFING STATEMENT .................................................................... 125
APPENDIX G - CORRELATIONS BETWEEN PHYSIOLOGICAL MEASURES AND
SELF-REPORT MEASURES ................................................................................................ 127
APPENDIX H – CORRELATIONS BETWEEN DVS ON THE MOTIVATION TASK 129
APPENDIX I – HEART RATE CALCULATIONS............................................................. 131
APPENDIX J – MOTIVATIONAL TASK ........................................................................... 133
APPENDIX K – DEMOGRAPHICS QUESTIONNAIRE .................................................. 135
APPENDIX L – IAPS IMAGES............................................................................................. 137

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