TOPLINE:

A preregistered laboratory study found that individuals with problematic use of the internet (PUI) showed heightened cue reactivity (arousal, urge, and craving) to distal cues compared with those with non-problematic use, with pathologic users showing heightened responses to both relevant and unrelated content.

METHODOLOGY:

• Researchers conducted a preregistered laboratory study including 536 participants (aged 18-65 years; mean age, 26.12 ± 6.79 years) who were divided into three groups on the basis of structured diagnostic interviews: those with pathologic (n = 133), risky (n = 135), and non-problematic (n = 268) internet use.
• Participants were assessed on the basis of specific PUI types: gaming, buying/shopping, pornography use, and social networking; participants who met the diagnostic criteria for multiple types of PUI were excluded.
• A cue-reactivity paradigm used "distal cues," showing devices with starting/log-in screens, and assessed subjective cue reactivity, arousal, and urge across picture, block, and task levels.
• The Craving Assessment Scale for Behavioral Addictions and Substance use Disorders measured multidimensional craving before and after cue exposure, followed by a 14-day assessment of real-world behaviour and temptation (rated 1-10).

TAKEAWAY:

• Individuals with pathologic internet use demonstrated the highest levels of subjective urge across all assessment points, with significant increases seen in relief craving and urgency following cue exposure (P < .001).
• Laboratory measures of cue reactivity showed a strong correlation with real-world behaviours, with arousal, urge, and craving significantly associated with both the mean temptation (correlation coefficient [r] ≥ 0.396) and actual usage time (r ≥ 0.122) during the 14-day follow-up.
• Response patterns were generally consistent across different types of PUI, although buying/shopping and social network use groups showed faster response times than gaming and pornography use groups.
• The pathologic use group exhibited heightened responses to both target and non-target cues, suggesting the generalisation of cue reactivity beyond specific problematic behaviours.

IN PRACTICE:

"Even distal cues — those that individuals cannot easily avoid in everyday life — trigger significant cue-reactivity and craving responses, and these effects are generalisable," the authors wrote.

"The cue-reactivity response is linked not only to the temptation to engage in the behaviour but also to the actual engagement in it in the natural environment. This highlights the critical relevance of these findings, as such cues are pervasive in everyday life. The inability to escape these omnipresent triggers helps to explain why individuals with PUIs struggle to control their behaviour in daily situations," they added.

SOURCE:

This study was led by Stephanie Antons, Centre for Behavioural Addiction Research, University of Duisburg-Essen, Essen, Germany. It was published online on November 20, 2025, in The British Journal of Psychiatry.

LIMITATIONS:

The cross-sectional design prevented conclusions about causality. Complete matching of participants in terms of gender and internet activity was not feasible, potentially affecting generalisability. The focus on adults excluded adolescents, and symptoms of PUI may have developed earlier. Neither emotional states nor time elapsed since last internet use was assessed. Although using different devices for cue presentation offered comparability, varying device accessibility and usage patterns may have activated distinct underlying mechanisms.

DISCLOSURES:

This study was supported by the Deutsche Forschungsgemeinschaft through the Research Unit Assessment of Criteria for Specific Internet use Disorders. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.