Affective and cognitive drivers explain current and future symptoms of problematic usage of the internet

OBJECTIVE: Problematic usage of the internet (PUI) is a steadily growing public health issue that requires better understanding of the underlying psychological mechanisms to optimize prevention and treatment. This study aimed at investigating affective and cognitive processes that may explain symptoms of PUI cross-sectionally and longitudinally. METHODS: A comprehensive face-to-face laboratory assessment with individuals with varying types and degrees of PUI (N = 819) was conducted, including a structured diagnostic interview to measure PUI symptoms, multiple neurocognitive tasks, a cue-reactivity paradigm, and questionnaires, which were administered in the same manner to all participants. This was complemented by a six-month follow-up survey (N = 528). RESULTS: Based on theoretical considerations, the comprehensive model-testing empirically confirmed three interconnected potential pathways to PUI: an affective pathway ("feels better") including positive and negative reinforcement and emotional responses to internet-related stimuli, an impulsivity and behavior automatization pathway ("must do") including both affective and cognitive processes, and a cognitive control pathway potentially preventing PUI, whereby reductions in general and specific control functions contribute to PUI (difficulties in "stop now" operations resulting in "can't stop" feelings). These affective and cognitive mechanisms explain 63.5% of PUI symptoms at baseline, and 42.3% at the six-month follow-up assessment. CONCLUSIONS: Clinicians should systematically assess the main drivers of PUI in their patients and then choose the optimal interventions to specifically target the pathway(s), e.g., by combining classical cognitive-behavioral therapy with specific affective and/or cognitive trainings.