Behavioral Addictions _ _______________________________________________________________________
competencies that directly impact satisfaction in romance and friendships, emotional functioning, interpersonal communica- tion, and social behavior [48; 49; 51]. Attachment style may also influence motivation for pathologic behavior. In persons with attachment anxiety, attachment needs are activated by relational or environmental stressors. Some persons with insecure early attachments may display attachment avoidance, which is the absence of desire for closeness in important relationships. In the context of Internet- mediated addictions, the high dependency in attachment anxiety leads individuals to seek comfort and connection online [50; 52; 53]. In one study of college students, attachment anxiety (both maternal and paternal) significantly predicted pathologic Internet use, but attachment avoidance did not. Maternal attachment anxiety was a significant predictor of male patho- logic Internet use, while paternal attachment anxiety was most relevant in female pathologic Internet use. It is important to note that this study examined college students in the United States, where parental roles and attachment patterns may differ from those in earlier international studies [50]. Rejection Sensitivity Another interpersonal model is rejection sensitivity, a cog- nitive-affective worry of rejection that impairs well-being and interpersonal function. Persons who doubt acceptance by oth- ers fear and expect rejection, are more hostile and aggressive in relationships, and experience more unstable and dissatisfying relationships that end sooner. They respond to social rejec- tion with hostility, depression, emotional regression, jealousy, and/or over-politeness [36]. Susceptible individuals may turn to Internet-mediated activities first as a way to avoid social interactions; these behaviors may then evolve into addictions. BEHAVIORAL ADDICTION MODELS Most theoretical models address behavioral addictions broadly; a few are specific to Internet-mediated behavioral addictions. Many borrow from substance addiction models to address the motivational, behavioral, and cognitive factors associated with other behavioral addictions. However, a few models specific to behavioral addictions have emerged. Many psychological therapies have been incorporated in behavioral addiction mod- els, because patients with specific behavioral addictions show cognitive, behavioral, and personality dysfunctions successfully treated in other patient populations by the same therapy [54]. The Components Model of Addiction The components model of addiction defines addiction as any behavior with all six core addiction components [17; 55]: • Salience: The behavior dominates activity, focus, think- ing (preoccupation, cognitive distortion), feelings (crav- ing), and behavior (deterioration of socialized behavior). • Mood modification: The subjective experience of euphoria or relief from aversive emotional states rein- forces the behavior.
• Tolerance: Escalation in frequency or stimulus intensity is required to deliver the desired level of mood modifi- cation. • Withdrawal symptoms: Unpleasant emotional effects occur when the behavior is discontinued, interrupted, or decreased, including feeling shaky, restless, moody, depressed, or irritable. • Conflict: Interpersonal friction occurs when the behavior supersedes obligations and responsibilities to others. Conflict can be intrapsychic, from guilt or loss of control. • Relapse: There are repeated failed attempts to quit, cut back, or control the behavior, with previous addictive behavior patterns quickly restored. The Cognitive-Behavioral Model The cognitive-behavioral model addresses the role of motiva- tional drives for reward-seeking and stress-reduction; behav- ioral control (related to executive inhibition); and decision- making (involving weighing the pros and cons of engaging in motivated behaviors) in addictive behaviors. Reward and Motivation Motivational drives linked to reward-seeking importantly contribute to addictive behavior, and diminished executive function/cognitive control over these motivational drives con- tributes to decision-making that leads to persistent engagement in the behaviors. Enhanced reward sensitivity and decreased loss sensitivity may increase urges to gamble (in gambling disorder) or online game (in Internet gaming disorder) [54]. Executive Control and Behavioral Inhibition Executive systems exert cognitive and behavioral control over motivational drives, allowing inhibition of desires and control or moderation of reward-seeking behaviors [56; 57]. Subjects with behavioral addiction show diminished response- inhibition and cognitive-control responses to addiction-specific stimuli, reflecting cognitive bias and altered set-shifting related to compulsive aspects of addictions. This is a reflection of alterations in executive function and neural processes that underlie attention, response inhibition, and behavioral flex- ibility [58; 59]. Decision-Making In deciding between pursuit of immediate reward and delayed consequences, individuals with behavioral addictions show strong tendencies for deciding on immediate reward. Decision- making is the final “check point” before a behavior is enacted [54]. Interaction of Cognitive Domains Increased sensitivity to winning or pleasure can enhance urges to gamble, online game, or engage in sexual activity. Impaired capacity for executive control leads to inadequate control over reward-seeking behaviors, permitting urges and craving
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