Proximal and distal cues in social network use disorder: the interplay of cue-reactivity, craving, and acute stress

Background: Key mechanisms that contribute to the development and maintenance of behavioral addictions are cue-reactivity and craving, which can arise from reward-related conditioning learning in which stimuli are associated with the rewarding properties of the behavior. Stimuli could be differentiated into proximal cues showing the reward directly (closely linked to executing the behavior) and more distal cues which are less explicit and only indicate hints related to the potential behavior. Acute stress can be an important situational trigger for cue-reactivity and craving. We examine whether craving experiences differ in individuals with social network use disorder (SNUD) and a control group when confronted with distal or proximal cues. Furthermore, the effect of acute stress will be investigated.

Methods: 138 female participants were assigned to the control group (n=64) or the SNUD group (n=74) in a multicenter study (FOR2974) based on a diagnostic interview using the DSM-5 criteria for gaming disorder (applied to SNUD). Subjects were randomly exposed to acute stress using the Trier Social Stress Test (TSST) or a placebo TSST. They performed two cue-reactivity paradigms with distal (e.g., SN-login page) and proximal SN-related stimuli, with craving queries before and after, respectively.

Results: In the placebo TSST condition, the SNUD group reported higher craving and arousal after the distal stimuli than the control group. In the TSST condition, no differences were found between the SNUD group and the control group in terms of cue-reactivity and increase in craving after viewing the distal stimuli. In both groups, there are no differences between cue-reactivity and craving for proximal vs. distal cues, but there is an increased cue-reactivity for proximal cues in the SNUD group compared to the control group.

Conclusions: Without stress induction, individuals with SNUD exhibit higher cue-reactivity and craving than control subjects, which is consistent with previous findings. Acute stress does not affect cue-reactivity to distal stimuli or craving for SN use in SNUD or control subjects. Proximal stimuli elicit greater urge and arousal in SNUD than in control subjects but do not differ from cue-reactivity towards distal stimuli. Future studies should investigate to what extent the results can be transferred to other Internet usage behaviors and how situational stress in everyday life influences affective mechanisms of SNUD and thus impacts decision-making for the use of SN and promotes the emergence of habitualized behavior patterns.