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Behavioral Neuroscience 2007, Vol. 121, No.

3, 614 618

Copyright 2007 by the American Psychological Association 0735-7044/07/$12.00 DOI: 10.1037/0735-7044.121.3.614

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Specific Cue Reactivity on Computer Game-Related Cues in Excessive Gamers


R. Thalemann, K. Wolfling, and S. M. Grusser
Institute for Medical Psychology, Charite Universitatsmedizin Berlin
It has been posited that excessive computer game playing behavior, referred to as computer game addiction, meets criteria that have been internationally established to define drug addiction. Nevertheless, there have been no psychophysiological investigations of the underlying mechanisms available to support the characterization of excessive computer gaming as behavioral addiction. To investigate whether excessive computer gaming parallels learning processes in development and maintenance (which are assumed to underlie drug addiction), the authors obtained a psychophysiological assessment of the (learned) emotional processing of computer game-relevant and -irrelevant cues. For this purpose, electroencephalographic recordings in excessive and casual computer game players were conducted. Significant between-group differences in event-related potentials evoked by computer game related-cues were found at parietal regions and point to an increased emotional processing of these cues in excessive pathological players compared with casual players. These results are in concordance with the suggestion that addiction is characterized and maintained through sensitization of the mesolimbic dopaminergic system along with incentive salience of specific addiction-associated cues. Keywords: cue reactivity, computer game addiction, EEG, late positive complex

In several recent studies, it has been stated that excessive computer game playing meets criteria of addiction, and it has since been repeatedly referred to as computer game addiction (for an overview, see Griffiths & Davies, 2005; Grusser, Thalemann, & Griffiths, in press). In recent research on addiction, the important role of learning processes as underlying mechanisms of addictive behavior is well-described: According to the model of respondent conditioning, neutral cues (e.g., alcoholic beverages) can become associated with addiction and thus receive an incentive salience in the individuals addiction history (OBrien, Childress, McLellan, & Ehrman, 1992; Robinson & Berridge, 2003). Neutral cues can serve as conditioned addiction-associated cues and induce an emotionalmotivational state as a conditioned response; they may also contribute to craving and motivate renewed drug and alcohol intake. In a recent explanatory model of the development and maintenance of addictive behavior, learning processes as well as the underlying neurobiological mechanisms are described: Both drug or alcohol intake and conditioned addiction-associated cues activate dopamine release in core regions of the brain reward system and thus activate strong emotional and motivational responses to drug intake (Everitt, Dickinson, & Robbins, 2001). According to this psychophysiological approach, it is also assumed

R. Thalemann, K. Wolfling, and S. M. Grusser, Interdisciplinary Re search Group on Addiction Berlin, Institute for Medical Psychology, Charite Universitatsmedizin Berlin, Berlin, Germany. Correspondence concerning this article should be addressed to S. M. Grusser, Interdisciplinary Research Group on Addiction Berlin, Institute for Medical Psychology, Charite Universitatsmedizin Berlin, Tucholsky strasse 2, D-10117, Berlin, Germany. E-mail: sabine.gruesser@charite.de 614

that cues associated with an excessive rewarding behavior that meets the criteria of addiction can elicit a strong motivational state that contributes to craving and repeated excessive, or addictive, behavior. For instance, this pattern has been shown in pathological gamblers (Grusser, Plontzke, & Albrecht, 2005) and is supported by Crockford, Goodyear, Edwards, Quickfall, and el-Guebaly (2005), who found that pathological gambling subjects reported a significant increase in mean craving for gambling after being exposed to visual gambling cues during the assessment. In addition, compared with control subjects, in response to visual gambling cues, pathological gamblers in this functional MRI study exhibited significantly greater activity in the right dorsolateral prefrontal cortex, including the inferior and medial frontal gyri; the right parahippocampal gyrus; and left occipital cortex, including the fusiform gyrus. Furthermore, in their functional MRI study, Potenza et al. (2003) reported pronounced between-group differences in neural activities during the initial period of viewing videos of gambling scenarios: Compared with controls, pathological gambling subjects displayed decreased activity in frontal and orbitofrontal cortex, caudate/basal ganglia, and thalamus. To date, the state of knowledge regarding computer game addiction consists generally of case studies or phenomenological descriptions of excessive computer game playing, whereas psychophysiological investigations of the underlying mechanisms of computer gamerelated disorders are missing. Therefore, the aim of the study was to assess psychophysiological reactivity toward computer gameassociated cues in both excessive and occasional computer game players. We used the cue-reactivity paradigm as described by Grusser et al. (2002) and Grusser, Wrase, et al. (2004), in which psychophys

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iological cue reactivity is measured while addicted and nonaddicted subjects are exposed to addiction-relevant and addictionirrelevant cues. This paradigm has repeatedly been used to assess emotionalmotivational reactions in several studies on addiction and emotional processing (e.g., Grusser, Wrase, et al., 2004; Namkoong, Lee, Lee, Lee, & An, 2004) and does not require additional tasks: The late positive complex (LPC) appears as enlarged late positive potential amplitudes differentiating affective and emotion-irrelevant cues (Schupp et al., 2000). Therefore, this paradigm seems to be most appropriate to investigate computer game-related cue reactivity as well. Since the enhancement of visually evoked event-related potentials late positive component is particularly prominent at parietal regions (especially at electrode Pz) when subjects are exposed to visual cues, the following analyses focus mainly on this region. The aim of this study was to assess the underlying learning mechanisms in excessive computer game players compared with casual computer game players. An incentive salience of computer game-associated cues only in excessive computer game playersshould be indicated by a cue-induced, conditioned emotionalmotivational state as it has been described in cuereactivity studies in alcohol- or drug-dependent subjects confronted with alcohol- or drug-specific cues in a cue-reactivity paradigm. (e.g., Franken, Stam, Hendricks, and van den Brink, 2003; Herrmann et al., 2000; Namkoong et al., 2004).

Method
Subjects were selected from a list of registered male users of an online gaming network. Fifteen male excessive computer game players (mean age 28.75 years, SD 6.11) and 15 male nonexcessive, casual computer game players (mean age 25.73 years, SD 8.14) took part in the study. The age differences did not meet the level of statistical significance, t(28) 1.07, p .30. Concerning the quality of their computer playing behavior, excessive computer players (mean hours of daily playing 4.31, SD 2.17) had to meet at least three criteria of addiction (e.g., craving, withdrawal symptoms, increased playing behavior, neglect of alternative pleasures) according to the International Classification of Diseases-10 (World Health Organization, 1993) and as measured by the Questionnaire of Differentiated Assessment of Addiction (Grusser et al., 2007; Grusser, Wolfling, Duffert, Morsen, & Flor, 2004). This questionnaire was also used to assess the pattern of consumption of psychotropic substances. Casual gamers (mean hours of daily playing 0.25, SD 0.46) were familiar with computer games but did not play excessively (fulfilled no diagnostic criterion of addiction). The groups differed significantly with regard to hours of daily playing, t(16.26) 6.66, p .001. In addition, general craving was rated once (using a 0 100-mm visual analogue scale to report the subjective average current desire to play) prior to cue presentation (Grusser, Heinz, & Flor, 2000). All participants were separately exposed to standardized visual computer game-relevant cues and the following categories of computer game-irrelevant cues: alcohol-related (Grusser et al., 2000), as well as neutral, positive, and negative material as defined by the normative ratings provided by the International Affective Picture System (Center for the Study of Emotion and Attention, 1995). To

control the addiction-specific pattern, we included alcohol-related cues as drug cues that are not specific for the computer gaming behavior. Therefore, we assumed that alcohol cues would be perceived as comparable to neutral cues. The specific stimulusinduced craving for computer game playing was measured for each stimulus prior to the electroencephalogram (EEG) measurement: The visual cues (printed on high-quality photo paper) were rated correctly by each participant as computer game-related; neutral, positive, or negative; or alcohol-related. Computer game-related cues consisted of in-game screen captures of popular action and strategy computer games (e.g., Doom3, Counterstrike, Warcraft III). To control possible negative emotional reactions due to the quite violent material (weapons arsenal, threatening opponents etc.), we asked each participant to rate (using a 100-mm visual analogue scale) how typically the game-related cues were perceived with regard to his individual gaming preferences. No significant group differences were found, F(1, 28) 1.30, p .27; the games chosen were rated as typical by excessive players (M 41.09, SD 27.13) and casual players (M 27.71, SD 32.71). Each visual stimulus was controlled for size (resolution of 1,024 768 pixels [36.12 27.09 cm], 72 dpi), luminance, brightness, and color. During EEG measurement, the cues were presented at the center of a 15-in. (38.1-cm) LCD screen for a duration of 3,000 ms, with an interstimulus interval of 2,000 ms, using the Presentation software package (Neurobehavioral Systems, n.d.) installed on a PC with an optimized Windows XP operating system. The LCD screen was placed about 100 cm in front of the subject. Latency between loading the stimulus and its appearance on the screen was measured at less than 10 ms. To minimize carry-over effects from strongly arousing pictures, in each category, we presented five cues 10 times, pseudorandomized in a counterbalanced block design. Cue-induced event-related potentials (ERP) were recorded using the international EEG 10-20 system placement with 19 electrodes. To control muscular artifacts, we recorded horizontal ocular movements and blinks from peripheral electrodes placed at the outer canti of both eyes (HEOG) as well as above and below the right eye (VEOG). All active electrodes were referenced to linked mastoids. Impedance threshold of all electrodes remained below 10 K during recording. EEG, HEOG, and VEOG were amplified using a NEUROSCAN Synamps amplifier in DC mode. All signals were digitized at 1,000 Hz. The amplifiers high-frequency filter was set to a cut-off frequency of 25 Hz. Data were recorded continuously on a Windows-compatible PC using Scan 4.1 software (Metris, 2005). The same software was used to analyze the data offline. For further statistical analysis, SPSS 12 (SPSS, Chicago, IL) was used. EEG epochs were recorded for 1,000 ms, starting 200 ms before stimulus onset (baseline). Trials with larger activity ( 50 V) were excluded. EEG was corrected by EOG artifacts (Hughes & Miller, 1988). Only artifact-free EEG epochs after stimulus onset were accepted for further analysis; these were averaged separately for each electrode, each category, and each subject. No special tasks were required of the subjects during the EEG recording except for careful watching. The study was approved by the Ethics Committee of Charite Universitatsmedizin Berlin and was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all the subjects. For data analyses of group differences regarding craving for computer game playing, analysis of variance (ANOVA) was per-

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formed. ERPs of the LPC (Schupp et al., 2000), expressed as a mean value of amplitudes in a special latency range between 350 and 750 ms after stimulus onset, were analyzed in a 2 3 3 5 repeated measures ANOVA involving the between-subjects factor group (casual players, excessive players) and three withinsubject factors: sagittal (left hemisphere F3, C3, P3; midline Fz, Cz, Pz; right hemisphere F4, C4, P4), coronal (frontal F3, Fz, F4; central C3, Cz, C4; parietal P3, Pz, P4), and stimulus category (game-related cues; alcohol-related cues; and positive, negative, and neutral visual cues). To control possible topographic or hemispheric effects, we scaled each ERP separately for each condition and subject by its corresponding norm vector (see McCarthy & Wood, 1985). In order to obtain normalized data, we followed the method of Picton et al. (2000), who suggested dividing data for each condition by their specific root-mean-square amplitude. Normalized data were further submitted to another 2 3 3 5 repeated measures ANOVA. Topographical differences were accepted if interactions between group/stimulus category and the coronal or sagittal factors proved to be significant. Results of the ANOVA with nonscaled values were reported only if the ANOVA with normalized data became significant. Simple contrasts were used as a priori contrast to determine changes between the stimulus categories within each group. If the sphericity assumption was not met, GreenhouseGeisser corrections were performed. The level of significance (two-tailed) was set at p .05.

Table 1 Mean Values and Standard Deviations of Event-Related Potential Amplitudes in the Late Positive Complex
CP Cue type and electrode Computer game-related cues P3 Pz P4 Alcohol-related cues P3 Pz P4 Negative cues P3 Pz P4 Neutral cues P3 Pz P4 Positive cues P3 Pz P4 M (SD) 2.83 (4.61) 1.32 (4.30) 3.95 (3.57) 2.66 (3.74) 0.68 (3.04) 2.86 (2.48) 6.39 (3.63) 6.48 (4.83) 5.73 (4.28) 1.89 (2.69) 0.69 (2.39) 1.67 (2.35) 5.88 (3.13) 5.75 (2.74) 6.33 (2.30) EP M (SD) 5.61 (5.76) 6.65 (5.99) 7.09 (5.04) 1.40 (2.02) 1.47 (2.82) 1.40 (4.01) 5.36 (3.34) 5.36 (3.60) 5.07 (3.13) 0.12 (3.54) 0.24 (2.95) 0.65 (3.39) 5.83 (4.21) 6.86 (3.29) 6.08 (4.38) p .156 .009 .059 .262 .473 .240 .423 .476 .632 .135 .648 .347 .973 .323 .845

Note. Latency range of late positive complex is 350 750 ms after stimulus onset. CP casual computer game players; EP excessive computer game players. Significance was set at p .05.

Results
No significant group differences were found with regard to smoking, t(28) 1.02, p .319; on average, excessive computer game players reported smoking 5.6 (SD 8.74) cigarettes a day, compared with casual computer game players, who reported smoking 2.8 cigarettes (SD 6.14) daily. A similar result was found regarding daily alcohol intake in grams, t(28) 0.971, p .34, of excessive computer game players (M 3.51, SD 7.72) compared with occasional computer game players (M 10.40, SD 26.55). Compared with casual players (M 28.89, SD 21.47), excessive players (M 73.33, SD 16.76) reported significantly higher amount of general craving for gaming, t(22) 5.66, p .001. Examining the segments of the visual evoked potentials with repeated measures showed no significant main effect in the LPC for the factors stimulus category and group but did indicate a significant interaction between both factors, F(4, 28) 2.58, p .041. Post hoc between-groups analyses of ERPs representing game cue-induced cortical activity revealed that excessive players showed significantly more extended late positivity at electrode Pz, F(1, 28) 7.84, p .009, and trendwise at P4, F(1, 28) 3.86, p .059, whereas no significant group differences were found in the analysis of all other (computer game-irrelevant) categories at the parietal electrodes (see Table 1 and Figure 1). Within the group of casual players, gaming cue-induced amplitudes (LPC) did not differ significantly from those induced by neutral cues at electrodes Pz, F(1, 14) .701, p .416, and P3, F(1, 14) 1.27, p .280, but did differ significantly at P4, F(1, 14) 10.37, p .006, whereas within the group of excessive players, gaming cue-induced amplitudes (LPC) were significantly larger than those induced by neutral cues at Pz, F(1, 14) 11.08, p p .005; P3, F(1, 14) .005. 7.24, p .018; and P4, F(1, 14) 11.33,

Discussion
Taken together, the results of psychophysiological cue reactivity showed that in contrast to casual computer game players, the only significantly stronger cue-induced cortical reactivity (LPC) at parietal electrodes exhibited by excessive computer game players occurred in response to the computer game-related cues. No significant group differences were found concerning all other assessed cue categories. In addition, within the group of excessive computer game players, the computer game-related cues were processed similarly to negative and positive cues as being significantly more arousing than neutral and alcohol-related cues. This was not true for the findings within the group of casual computer game players. These results indicate that in contrast to casual players, the excessive computer game players perceived the computer game cues as significantly more arousing. Therefore, they were processed emotionally in a significantly stronger manner (Schupp et al., 2000). According to Berridge and Robinson (2003), the sight of food, drugs, or other incentives is merely a sensory configuration of shape and color that is not intrinsically motivating. The authors state that it is the attribution of incentive salience to a percept that makes a specific cue a wanted target of motivation (Berridge & Robinson, 2003). They point out that conditioned incentive salience can be attributed to the Pavlovian conditioned cues themselves, making them wanted stimuli. Other authors found that late positivity is modulated by intrinsic motivational relevance (Keil et

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Figure 1. Visual cue-induced event-related potentials (electrodes F3, Fz, F4, C3, Cz, C4, P3, Pz, P4) in casual computer game players (CP, left) and excessive computer game players (EP, right). Green curves indicate computer game-related cues; blue, alcohol-related; black, neutral; yellow, negative; and red, positive.

al., 2002; Schupp et al., 2000). Therefore, the results of the present study provide evidence that, in concordance with findings in substance addicts, excessive computer game playing is maintained through sensitization (of the mesolimbic dopaminergic system) along with incentive salienceas a motivational component of reward (wanting) of specific computer game-related cues. In contrast, computer game cues associated with liking found in casual players did not gain this quality. In conclusion, the significantly stronger enhanced late positivity of computer game-related cues in excessive computer game players leads to the assumption that computer game-associated cues have in fact gained an intrinsic motivational relevance during learning processes for excessive computer game players, but not for casual players. Nevertheless, casual computer game players showed a strong emotional response at P3 and especially at P4 (at which the simple contrast computer game-related vs. neutral within the group turned out to be significant). This leads to the assumption that at least some casual computer game players are highly emotionally involved in computer game playing. For further studies, it may be considered in this context that a limitation of this study is its choice of subjects. However, the significant group differences concerning hours played daily, the reported significantly higher craving/ desires and the other addiction criteriafulfilled only by the pathological gamersshould differentiate sufficiently between pathological and occasional computer game players. Preliminary data support the assumption that excessive (pathological) computer game playing not only meets the criteria of addiction, but also may have common underlying learning mechanisms of development and maintenance. These mechanisms have been described repeatedly in previous cue reactivity studies in alcohol and drug addicts (Franken et al., 2003; Grusser, Wrase, et al., 2004; Herrmann et al., 2000; Namkoong et al., 2004). Nevertheless, this preliminary result needs to be confirmed by further studies. Since excessive computer game playing is going to be an increasing problem behavior in adolescents (Grusser & Thale mann, 2006), further psychophysiological investigations should be conducted in order to characterize this disorder more properly and

to provide knowledge-based measures of intervention and prevention.

References
Berridge, K. C., & Robinson, T. E. (2003). Parsing reward. Trends in Neuroscience, 26, 507513. Center for the Study of Emotion and Attention. (1995). The international affective picture system: Photographic slides. Gainesville: University of Florida Center for Research in Psychophysiology. Crockford, D. N., Goodyear, B., Edwards, J., Quickfall, J., & el-Guebaly, N. (2005). Cue-induced brain activity in pathological gamblers. Biological Psychiatry, 58, 787795. Everitt, B. J., Dickinson, A., & Robbins, T. W. (2001). The neurobiological basis of addictive behaviour. Brain Research: Brain Research Reviews, 36, 129 138. Franken, I. H. A., Stam, C., Hendriks, V. M., & van den Brink, W. (2003). Neuropsychological evidence for abnormal cognitive processing of drug cues in heroin dependence. Psychopharmacology, 170, 205212. Griffiths, M. D., & Davies, M. N. O. (2005). Videogame addiction: Does it exist? In J. Goldstein & J. Raessens (Eds.), Handbook of computer game studies (pp. 359 368). Boston: MIT Press. Grusser, S. M., Heinz, A., & Flor, H. (2000). Standardized stimuli to assess drug craving and drug memory in addicts. Journal of Neural Transmission, 107, 715720. Grusser, S. M., Heinz, A., Raabe, A., Wessa, M., Podschus, J., & Flor, H. (2002). Stimulus-induced craving and startle potentiation in abstinent alcoholics and controls. European Journal of Psychiatry, 17, 188 193. Grusser, S. M., Plontzke, B., & Albrecht, U. (2005). Pathological gam bling. An empirical study of the desire for addictive substances. Nervenarzt, 76, 592596. Grusser, S. M., & Thalemann, R. (2006). Excessive computer gaming in adolescence. In F. Columbus (Ed.), Advances in psychology research (Vol. 45, pp. 133144). New York: Nova Publishers. Grusser, S. M., Thalemann, R., & Griffiths, M. (in press). Excessive computer game playing: Evidence for addiction and aggression? Cyberpsychology & Behavior. Grusser, S. M., Wolfling, K., Albrecht, U., Duffert, S., Morsen, C. P., & Flor, H. (2007). Fragebogen zur Differenzierten Drogenanamnese (FDDA) [Questionnaire of Differentiated Assessment of Addiction (QDDA)], Gottingen, Germany: Hogrefe.

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BRIEF COMMUNICATIONS Neurobehavioral Systems. (n.d.). Presentation [Computer software]. Retrieved from http://www.neurobs.com/presentation OBrien, C. P., Childress, A. R., McLellan, A. T., & Ehrman, T. (1992). A learning model of addiction. In C. P. OBrien & J. Jaffe (Eds.), Addictive states (pp. 157177). New York: Raven Press. Picton, T. W., Bentin, S., Berg, P., Donchin, E., Hillyard, S. A., Johnson, R., Jr., et al. (2000). Guidelines for using human event-related potentials to study cognition: Recording standards and publication criteria. Psychophysiology, 37, 127152. Potenza, M. N., Steinberg, M. A., Skudlarski, P., Fulbright, R. K., Lacadie, C. M., Wilber, M. K., et al. (2003). Gambling urges in pathological gambling: A functional magnetic resonance imaging study. Archives of General Psychiatry, 60, 828 836. Robinson, T. E., & Berridge, K. C. (2003). Addiction. Annual Review of Psychology, 54, 2553. Schupp, H. T., Cuthbert, B. N., Bradley, M. M., Cacioppo, J. T., Ito, T., & Lang, P. J. (2000). Affective picture processing: The late positive potential is modulated by motivational relevance. Psychophysiology, 37, 257261. World Health Organization. (1993). The ICD-10 classification of mental and behavioural disorders: Diagnostic criteria for research. Geneva: Author.

Grusser, S. M., Wolfling, K., Duffert, S., Morsen, C. P., & Flor, H. (2004). Psychometrische Kennwerte und erste Ergebnisse zur Validitat des Fragebogens zur Differenzierten Drogenanamnese (FDDA) [Psychometric properties and initial validation of the Questionnaire on Differentiated Assessment of Addiction]. Psychotherapie Psychosomatik Medizinische Psychologie, 54, 405 412. Grusser, S. M., Wrase, J., Klein, S., Hermann, D., Smolka, M. N., Ruf, M., et al. (2004). Cue-induced activation of the striatum and medial prefrontal cortex is associated with subsequent relapse in abstinent alcoholics. Psychopharmacology, 175, 296 302. Herrmann, M. J., Weijers, H.-G., Wiesbeck, G. A., Aranda, D., Boning, J., & Fallgatter, A. J. (2000). Event-related potentials and cue-reactivity in alcoholism. Alcoholism: Clinical and Experimental Research, 24, 1724 1729. Hughes, J. R., & Miller, J. K. (1988). Eye movements on brain maps. Clinical Electroencephalography, 19, 210 213. Keil, A., Bradley, M. M., Hauk, O., Rockstroh, B., Elbert, T., & Lang, P. J. (2002). Large-scale neural correlates of affective picture processing. Psychophysiology, 39, 641 649. McCarthy, G., & Wood, C. C. (1985). Scalp distributions of event-related potentials: An ambiguity associated with analysis of variance models. Electroencephalography and Clinical Neurophysiology, 62, 203208. Metris. (2005). Scan (Version 4.1) [Computer software]. Leuven, Belgium: Author. Namkoong, K., Lee, E., Lee, C. H., Lee, B. O., & An, S. K. (2004). Increased P3 amplitudes induced by alcohol-related pictures in patients with alcohol dependence. Alcoholism: Clinical and Experimental Research, 28, 13171323.

Received April 28, 2006 Revision received January 24, 2007 Accepted January 25, 2007

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