Addictive Behaviors 79 (2018) 171–177

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Addictive Behaviors
journal homepage: www.elsevier.com/locate/addictbeh

Trait and state impulsivity in males with tendency towards Internet- T

pornography-use disorder
⁎
Stephanie Antonsa, Matthias Branda,b,
a
Department of General Psychology: Cognition and Center for Behavioral Addiction Research, University of Duisburg-Essen, Duisburg, Germany
b
Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany

H I G H L I G H T S

• Modified stop-signal task with pornographic pictures and informative cues

• Involvement of trait and state impulsivity in Internet-pornography-use disorder
• Results may be indicative of an imbalance between dual systems

A R T I C L E I N F O A B S T R A C T

Keywords: Introduction: Impulsivity has been identified to be involved in the development and maintenance of specific
Cybersex addiction Internet-use disorders (IUD). It can be differentiated between relatively stable trait impulsivity and state im-
Problematic sexual behavior pulsivity which is dependent on environmental and affective factors such as craving. Following the I-PACE
Stop-signal task (Interaction of Person-Affect-Cognition-Execution) model, both trait and state impulsivity may play an inter-
Inhibitory control
active role in IUD. The present study aimed to investigate the relationship between trait and state impulsivity
Craving
Problematic Internet use
and symptom severity of Internet-pornography-use disorder (IPD) as one form of IUD.
Methods: Fifty heterosexual males participated in this study. State impulsivity was measured with reaction times
in a modified stop-signal task. Each participant conducted two blocks of this task which included neutral and
pornographic pictures. Moreover, current subjective craving, trait impulsivity, and symptom severity of IPD
were assessed using several questionnaires.
Results: Results indicate that trait impulsivity was associated with higher symptom severity of IPD. Especially
those males with higher trait impulsivity and state impulsivity in the pornographic condition of the stop-signal
task as well as those with high craving reactions showed severe symptoms of IPD.
Conclusion: The results indicate that both trait and state impulsivity play a crucial role in the development of
IPD. In accordance with dual-process models of addiction, the results may be indicative of an imbalance between
the impulsive and reflective systems which might be triggered by pornographic material. This may result in loss
of control over the Internet-pornography use albeit experiencing negative consequences.

1. Introduction consume of pornography on the Internet (Brand et al., 2016).

While most people use the Internet in a functional and healthy way,
there are some individuals who experience loss of control over their
Internet (e.g. Internet-pornography) use, leading to negative con-
sequences in psychological, social, and work domains (Brand, Young, &
Laier, 2014; Young, 1998). This phenomenon is called Internet-use
disorder (IUD; Brand, Young, Laier, Wölfling, & Potenza, 2016). The
term Internet-pornography-use disorder (IPD) is used for a specific type
of IUD which is characterized by a loss of control with respect to the
Current research indicates etiological similarities between specific
IUDs and substance-use disorders (Brand et al., 2016). A shared vul-
nerability factor is impulsivity (Brand et al., 2014; Verdejo-Garcia,
Lawrence, & Clark, 2008). Impulsivity is a multidimensional construct
which refers to the tendency to act prematurely and without foresight
(Dalley, Everitt, & Robbins, 2011). It can be differentiated between trait
and state impulsivity (Wiers, Ames, Hofmann, Krank, & Stacy, 2010;
Wingrove & Bond, 1997). Trait impulsivity is a stable personality
characteristic which is mostly assessed by self-report questionnaires.

Abbreviations: IPD, Internet-pornography-use disorder; IUD, Internet-use disorder; SSD, Stop-signal-delay; SSRT, Stop-signal reaction time; SST, Stop-signal task
⁎
Corresponding author at: Department of General Psychology: Cognition, University of Duisburg-Essen, Forsthausweg 2, 47057 Duisburg, Germany.
E-mail address: matthias.brand@uni-due.de (M. Brand).

https://doi.org/10.1016/j.addbeh.2017.12.029
Received 17 July 2017; Received in revised form 23 November 2017; Accepted 21 December 2017
Available online 23 December 2017
0306-4603/ © 2017 Published by Elsevier Ltd.
S. Antons, M. Brand
State impulsivity is rather determined by environmental variables and
is generally assessed with psychological tasks which measure inhibitory
control such as the go/no-go or stop-signal task (SST) (Bari & Robbins,
2013).
Brand et al. (2016) developed a model of specific IUDs, called I-
PACE (Interaction of Person-Affect-Cognition-Execution) model. Ac-
cording to this model the development and maintenance of a specific
IUD result from relatively stable predisposing factors, affective and
cognitive responses in a certain situation which can lead to the loss of
control over the Internet use (Brand et al., 2016). In this context, trait
impulsivity has been identified as an important predisposing factor of
IUD (Cao, Su, Liu, & Gao, 2007; Choi, Park, et al., 2014; Lee et al.,
2012) and of Internet-gaming disorder in particular (Choi, Kim, et al.,
2014; Ding et al., 2014; Metcalf & Pammer, 2014; Nuyens et al., 2016).
Affective and cognitive responses may influence state impulsivity
especially in situations in which addiction-related cues are present. Due
to associative learning processes, these cues become more salient and
trigger a craving response, which is the irresistible urge to consume a
substance (Breiner, Stritzke, & Lang, 1999; Wiers et al., 2010). This cue-
reactivity mechanism is, moreover, associated with an imbalance be-
tween the automatic, impulsive system and the controlled, reflective
system (Bechara, 2005; Schiebener & Brand, 2015). Responses on ad-
diction-related cues are assumed to increase the activity of the im-
pulsive system and may cause impulsive action tendencies (Volkow,
Wang, Tomasi, & Baler, 2013; Wiers et al., 2010). A functional re-
flective system could inhibit impulsive action tendencies by inhibitory
control. Accordingly, reduced inhibitory control abilities or higher
impulsive action tendencies might lead to impulsive behavior, sub-
stance use, and relapse.
It has been shown that craving reactions due to cue-reactivity also
exist in IPD (e.g. Laier, Pawlikowski, Pekal, Schulte, & Brand, 2013) and
in other specific IUDs (e.g. Ko et al., 2013; Trotzke, Starcke, Müller, &
Brand, 2015). Studies which investigated state impulsivity in Internet
users and Internet gamers with problematic behavior using inhibitory
control tasks, have obtained mixed results (Choi et al., 2013; Choi,
Park, et al., 2014; Dong, Zhou, & Zhao, 2010, 2011; Irvine et al., 2013;
B. Li et al., 2014; Li et al., 2016; Lim et al., 2016; van Holst et al., 2012).
For instance, some found significantly higher stop and go error rates
during a SST in individuals with a general IUD and Internet-gaming
disorder compared to healthy controls (Choi et al., 2013; Choi, Park,
et al., 2014; Lim et al., 2016). However, with respect to the stop-signal
reaction time (SSRT), a measure for inhibitory control ability, only Li
et al. (2016) reported slower SSRTs for problematic Internet users
compared to healthy controls.
Some studies investigated how state impulsivity is biased by
Internet-related cues in the context of Internet-gaming disorder in
contrast to neutral cues (Liu et al., 2014; van Holst, van Holstein, van
den Brink, Veltman, & Goudriaan, 2012; Yao et al., 2015). Only in the
Internet-gaming-related cue conditions and not in neutral conditions,
individuals with Internet-gaming disorder showed higher deficits in
response inhibition compared to a control group (Liu et al., 2014; van
Holst et al., 2012).
To the best of our knowledge, there is no study which investigated
trait and state impulsivity in individuals with tendency towards IPD.
Studies which investigated impulsivity in hypersexual individuals re-
ported higher trait impulsivity compared to controls (Raymond,
Coleman, & Miner, 2003; Rettenberger, Klein, & Briken, 2016) and,
similarly to specific IUDs, mixed results were found for state impulsivity
(Miner, Raymond, Mueller, Lloyd, & Lim, 2009; Reid, Garos, Carpenter,
& Coleman, 2011). Few studies examined the effects of Internet-por-
nographic-cues on individuals with IPD tendencies. When participants
were confronted with pornographic-cues, symptom severity of IPD was
associated with reduced executive functioning (Schiebener, Laier, &
Brand, 2015), higher approach and avoidance tendencies (Snagowski &
Brand, 2015), and positive emotional implicit associations (Snagowski,
Wegmann, Pekal, Laier, & Brand, 2015). Those action tendencies have
172
Addictive Behaviors 79 (2018) 171–177
also been associated with imbalances concerning dual processing
(Wiers et al., 2010).
The aim of the current study is to explore how trait and state im-
pulsivity are related to IPD. To understand the factors involved in the
development of IPD, it is especially relevant to investigate individuals
with varying degrees in symptom severity of IPD (Abramowitz et al.,
2014). Following prior studies, which investigated trait and state im-
pulsivity in other specific IUDs, we expected symptom severity of IPD in
an analogue sample to be associated with trait and state impulsivity
(increased impulsive action tendencies and reduced inhibitory control
ability). We assume that especially when individuals are confronted
with pornographic material, state impulsivity would be related to IPD
because of craving responses. Based on the I-PACE model, we further
hypothesized that individuals with higher trait impulsivity combined
with increased state impulsivity should suffer from more symptoms of
IPD.
2. Methods
2.1. Participants
Fifty male pornography users (age M = 23.30, SD = 4.08, range:
18–40; pornography use in h/week M = 1.67, SD = 1.28), who stated
to be heterosexual and to prefer pornography which displays hetero-
sexual sex, were examined. Participants were recruited through local
advertisements at the University Duisburg-Essen and online advertise-
ment in the university's internal networks. The advertisement ex-
plicated that the study is about Internet-pornography use and that ex-
plicit pornographic material will be presented during the examination.
Written informed consent was obtained from all participants after a
complete description of the study. Participants could collect credits or
received a monetary incentive of €15 in return of the 1.5 h lasting
study. The study protocol was approved by the local ethics committee.
2.2. Measures
2.2.1. Stop-signal task (SST)
A modified version of the stop-signal task (Chikazoe et al., 2009;
Pawliczek et al., 2013) was used to measure inhibitory control ability
and impulsive action tendency. To differentiate between affective
states, each participant randomly conducted two SST blocks, one with
pornographic and one with neutral pictures. The pornographic pictures
showed scenes of sexual vaginal and oral intercourse between male and
female (Laier, Pawlikowski, & Brand, 2014; Schiebener et al., 2015). In
the study by Laier et al. (2014) those pictures were rated with respect to
subjective sexual arousal (1 = not sexually arousing; 5 = very sexually
arousing), M = 3.31, SD = 0.78. Neutral pictures were taken from the
International Affective Picture System and showed individuals in ev-
eryday life situations (Lang, Bradley, & Cuthbert, 2008). We chose
neutral pictures which were rated in the study by Lang et al. (2008)
with mean ratings (1 = unhappy/calm); 9 = happy/excited for pleasure
(M = 5.41, SD = 0.85) and arousal (M = 4.32, SD = 0.62).
Each trial was initiated by the presentation of a picture (neutral or
pornographic) which was shown until the end of the trial. Cues in form
of frames informed the participant whether this trial would be a certain
or uncertain go-trial. In certain go-trials, a green dashed frame in-
formed the participant that in this trial no stop-signal would appear. In
uncertain go-trials a red dashed frame indicated that it is uncertain
whether a stop-signal would appear and whether participants would
have to inhibit their go-response or not. After the cue presentation, the
go-signal (green solid frame) was presented in each trial after a variable
inter-stimulus interval. Participants had to respond as fast as possible
with their index-finger upon the go-signal. In one third of all uncertain
go-trials, the go-signal was followed by a stop-signal (red solid frame)
after a variable stop-signal-delay (SSD). In case of a stop-signal, parti-
cipants had to inhibit the already initiated go-response (see Fig. 1). The
S. Antons, M. Brand Addictive Behaviors 79 (2018) 171–177

Fig. 1. Schematic overview of the modified stop-signal task.

Pictures were presented without the black rectangles. When the certain go-cue was presented, participants could be sure that no stop-signal would occur. When the uncertain go-cue was
presented the go- signal was followed by a stop-signal in one third of the cases (represented by the dashed arrow). ISI = inter-stimulus interval; SSD = stop-signal-delay.

variable SSD was adjusted by using a staircase-tracking procedure as it
was done by Verbruggen, Logan, and Stevens (2008). Participants were
advised that prompt responses on go-signals were as important as
staying alert for the stop-signal.
The SST enables to measure impulsive action tendencies on go-
signals (certain and uncertain go-RTs) and to calculate the covert time
needed to inhibit a response upon a stop-signal (SSRT), a measure for
inhibitory response ability. The SSRT was computed using the in-
tegration method (Verbruggen, Chambers, & Logan, 2013).
The go-RTs in certain and uncertain go-trials both describe im-
pulsive action tendencies, however, the uncertain go-RT also includes
preparatory processes for the possible stop-process, while the certain
go-RT is a more unbiased measure for general motor speed (Chikazoe
et al., 2009).
Each SST block consisted of 150 trials with 75 uncertain and certain
go-trials, respectively. Subjects were trained before the experiment. The
training trials provided feedback following slow or wrong responses,
whereas during the experimental block no feedback was given. The task
was programmed using the Presentation software package
(Neurobehavioral Systems Inc., Albany, CA, USA).
security.”) with possible ranges from 5 to 20.
2.3. Data analysis
The statistical analyses were computed using SPSS 24.0 for
Windows (IBM SPSS Statistics, released 2016). Pearson's correlations
were used to test for relations between trait and state impulsivity,
craving, and symptom severity of IPD. To analyze interaction effects
between trait and state impulsivity or trait impulsivity and craving as
predictors of symptom severity of IPD, hierarchical moderated regres-
sion analysis (all variables centralized; Cohen, Cohen, West, & Aiken,
2003) were used. Interaction effects are shown with simple slopes
which present the estimated scores based on the regression's coeffi-
cients. Low values for the variables are estimates for subjects with va-
lues one standard deviation below the group's mean, high values are
estimates for subjects with values one standard deviation above the
group's mean.
3. Results

2.2.2. Questionnaires Descriptive statistics of all variables are shown in Table 1.

Before and after each SST block participants were asked to indicate
their current need to watch Internet-pornography, using a scale ranging Table 1
from 0 (=no need to watch Internet pornography) to 100 (= very great Mean Values of s-IATsex Scores, Craving, BIS-15, and Stop-Signal Task Measures.

need to watch Internet pornography) as an indicator for craving. Craving Minimum Maximum M SD
was assessed at three points in time: before the SST as a baseline
measure, after neutral SST, and after pornographic SST. s-IATsex
A German version of the short Internet Addiction Test (Pawlikowski, Sum 12 41 21.32 7.16
Control 6 26 11.20 5.09
Altstötter-Gleich, & Brand, 2013) modified for cybersex was used to Craving 6 20 10.12 3.06
assess symptom severity of IPD (s-IATsex; Laier et al., 2013). The s- Craving
IATsex consists of 12 items paired with a five-point Likert scale ranging Baseline 0 80 20.62 21.13
from 1 (= never) to 5 (= very often) resulting in a total score of 12–60. After neutral SST 0 76 20.88 20.51
After pornographic SST 0 86 35.02 23.72
The s-IATsex can be divided into two subscales control/time management
BIS
(s-IATsex control; e.g., “How often do you find that you stay on In- Sum 20 49 33.88 6.30
ternet-sex sites longer than you intended?”) and craving/social problems Attentional 5 16 10.36 2.57
(s-IATsex craving; e.g. “How often do you feel preoccupied with online Motor 5 20 11.04 3.19
sexual activities when off-line, or fantasize about being on Internet-sex Non-planning 5 18 12.48 3.11
Neutral SST
sites?”) with a possible range of 6–30. The s-IATsex has repeatedly used Certain go-RT 270 434 329 42
in previous studies (e.g. Brand, Snagowski, Laier, & Maderwald, 2016; Uncertain go-RT 283 871 490 128
Laier et al., 2013; Snagowski & Brand, 2015). SSRT 121 497 235 60
To assess trait impulsivity, the short version of the German Barratt False stop trials (%) 33 76 51 9
SSD 67 583 246 130
Impulsiveness Scale (BIS-15; Meule, Vögele, & Kübler, 2011) was used.
Pornographic SST
The questionnaire consists of 15 items paired with a four-point Likert Certain go-RT 275 425 330 40
scale ranging from 1(=rarely/never) to 4 (=almost always/always) to Uncertain go-RT 308 825 474 102
indicate the frequency of several common impulsive or non-impulsive SSRT 111 378 251 50
behaviors/traits. A higher sum score (possible range from 15 to 60) False stop trials (%) 38 83 52 9
SSD 61 547 217 106
indicates higher trait impulsivity. The BIS-15 can be divided into three
subscales: attentional (BIS attentional; e.g. “I am restless at the theater Note. BIS-15 = Barratt Impulsiveness Scale-short version; go-RT = go- reaction time; s-
or lectures.”), motor (BIS motor; e.g. “I do things without thinking.”), IATsex = short Internet Addiction Test modified for cybersex; SSD = stop-signal-delay;
and non-planning impulsivity (BIS non-planning; e.g. “I plan for job SSRT = stop-signal reaction time; SST = stop-signal task.

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S. Antons, M. Brand Addictive Behaviors 79 (2018) 171–177

Table 2
Bivariate correlations between s-IATsex score and variables of craving, trait and state impulsivity.

1 2 3 4 5 6 7 8 9 10

1 s-IATsex sum –
2 BIS-15 sum 0.282⁎ –
3 Craving baseline 0.294⁎ 0.197 –
4 Craving after neutral SST 0.408⁎⁎ 0.117 0.809⁎⁎ –
5 Craving after pornographic SST 0.411⁎⁎ 0.073 0.600⁎⁎ 0.681⁎⁎ –
6 Neutral SST: certain go-RT − 0.145 − 0.139 0.103 0.222 0.030 –
7 Neutral SST: uncertain go-RT − 0.214 0.099 − 0.008 0.013 − 0.137 0.219 –
8 Neutral SST: SSRT 0.009 − 0.101 0.171 0.242 0.159 0.364⁎⁎ − 0.078 –
9 Pornographic SST: certain go-RT − 0.077 − 0.200 0.100 0.172 0.119 0.904⁎⁎ 0.184 0.386⁎⁎ –
10 Pornographic SST: uncertain go-RT − 0.177 0.162 0.036 0.000 − 0.140 0.222 0.890⁎⁎ − 0.192 0.209 –
11 Pornographic SST: SSRT 0.027 − 0.079 0.114 0.054 0.135 0.124 − 0.244 0.353⁎ 0.043 −0.259

Note. BIS-15 = Barratt Impulsiveness Scale-short version; go-RT = go- reaction time; s-IATsex = short Internet Addiction Test modified for cybersex; SSRT = stop-signal reaction time;
SST = stop-signal task.
⁎
p < 0.05.
⁎⁎
p < 0.01.

3.1. Correlational analysis
In Table 2 correlations between the s-IATsex scores and variables of
trait impulsivity (BIS-15), state impulsivity (certain and uncertain go-
RT, SSRT), and craving are presented. The s-IATsex score correlated
significantly with the BIS-15 sum score and craving after the neutral
and pornographic SST. We did not find bivariate correlations between
SST measures and s-IATsex, BIS-15, or craving.
3.2. Moderated regression analyses
A moderated regression analysis for trait impulsivity (BIS-15 as
predictor), uncertain go-RT (moderator), and symptom severity of IPD
(s-IATsex sum) was calculated. In the first step, the BIS-15 sum score
explained 7.9% of the s-IATsex sum score variance, F(1, 48) = 4.14,
p = 0.047. In the second step, the uncertain go-RT in the pornographic
SST did not lead to a significant increase of variance explanation,
ΔR2 = 0.051, ΔF(1, 47) = 2.75, p = 0.104. The interaction of the BIS-
15 sum score and the uncertain go-RT in the pornographic SST sig-
nificantly increased variance explanation, ΔR2 = 0.074, ΔF(1, 46)
= 4.30, p = 0.044. Overall, the regression model was significant and
explained 20.5% variance of s-IATsex sum score, F(3, 46) = 3.94,
p = 0.014.
The interaction effect is illustrated with simple slope analysis, in
Fig. 2A. The dashed line in the figure shows that, in particular
individuals with low uncertain go-RTs in the pornographic SST, com-
bined with high trait impulsivity, significantly showed higher symptom
severity of IPD, t = 2.93, p = 0.006. In contrast, the slope of the solid
line shows that individuals with high uncertain go-RT in the porno-
graphic SST showed low symptom severity of IPD regardless of whether
they scored high or low trait impulsivity. Accordingly, the slope was not
significant, t = 0.39, p = 0.701.
A second moderated regression analysis was calculated to in-
vestigate the relationship between trait impulsivity (BIS-15 sum),
craving after pornographic SST (as moderator), and symptom severity
of IPD (s-IATsex sum). In the first step, the BIS-15 sum score explained
7.9% of the s-IATsex sum score variance, F(1, 48) = 4.14, p = 0.047. In
the second step, craving led to a significant increase in variance ex-
planation, ΔR2 = 0.153, ΔF(1, 47) = 9.37, p = 0.004. In the third step,
the interaction of BIS-15 sum score and craving led to a significant
increase in variance explanation, ΔR2 = 0.082, ΔF(1, 46) = 5.49,
p = 0.024. Overall, the regression model was significant and explained
31.4% variance of s-IATsex sum score, F(3, 46) = 7.03, p = 0.001.
Simple slopes are presented in Fig. 2B. The slope of the solid line shows
that individuals with low craving after the pornographic SST showed
low symptom severity of IPD regardless of whether they scored high or
low trait impulsivity. Accordingly, the slope was not significant,
t = 0.65, p = 0.518. In contrast, the slope of the dashed line shows that
particularly individuals with high craving after the pornographic SST,
combined with high trait impulsivity, had significantly higher symptom

Fig. 2. Simple slopes.

Results of the simple slope analyses of the moderated regressions with s-IATsex as dependent variable, trait impulsivity (BIS-15 Sum) as predictor and (A) uncertain go-RT in the
pornographic SST; (B) craving after the pornographic SST as moderators. Scores represent estimated values above/below one standard deviation from the group's mean, based on the
regression coefficients. BIS-15 sum = sum score of Barratt Impulsiveness Scale-short version; go-RT = go- reaction time; s-IATsex = short Internet Addiction Test modified for cybersex;
SST = stop-signal task. * slope significant with p < 0.05.

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S. Antons, M. Brand
Table 3
Hierarchical Regression Analyses with the s-IATsex Sum Score as Dependent Variable.
β T
Model 1
Main effects BIS-15 sum 0.342 2.56
Uncertain go-RT (pornographic SST) −0.174 − 1.28
Interaction BIS-15 sum × Uncertain go-RT −0.280 − 2.07
(pornographic SST)
Model 2
Main effects BIS-15 sum 0.203 1.63
Craving after pornographic SST 0.393 3.21
Interaction BIS-15 sum × Craving after 0.290 2.34
pornographic SST
Note. BIS-15 = Barratt Impulsiveness Scale-short version; go-RT = go-reaction time; s-
IATsex = short Internet Addiction Test modified for cybersex; SST = stop-signal task.
severity of IPD, t = 3.16, p = 0.003. Further regression values for both
models are summarized in Table 3.
Similar moderated regression analyses were calculated with certain
go-RT and SSRT for the pornographic SST (both as moderators) which
revealed no significant interaction effects, all ΔR2's < 0.037, all ΔFs(1,
46) < 1.95, all ps > 0.169. Moreover, we did not find any significant
interaction effects for SST measures of the SST with neutral pictures as
moderators (ΔR2s < 0.038, all ΔFs(1, 46) < 2.11, all ps > 0.147) as
well as when craving at baseline or after neutral SST were used as
moderators (ΔR2s < 0.041, all ΔFs(1, 46) < 2.59, all ps > 0.114).
4. Discussion
The main results of this study are that trait impulsivity and craving
are associated with symptom severity of IPD and, secondly, that trait
impulsivity interacts with state impulsivity, leading to an accumulating
effect on symptom severity of IPD. In detail, especially males with
higher trait impulsivity and more impulsive action tendencies in un-
certain situations (uncertain go-RT) or higher craving responses showed
severe symptoms of IPD. This effect only existed when participants
were confronted with pornographic material and not in neutral situa-
tions (go-RTs in neutral SST). Moreover, we cannot report any sig-
nificant correlation between inhibitory control ability (SSRT) and
symptom severity of IPD, neither during the pornographic nor during
the neutral SST. The results are in line with studies investigating trait
impulsivity in other specific IUDs and hypersexuality (e.g. Cao et al.,
2007; Choi, Park, et al., 2014; Lee et al., 2012; Rettenberger et al.,
2016). However, Gola et al. (2017) did not find significant differences
in trait impulsivity (measured with the UPPS-P Impulsive Behaviour
Scale) between diagnosed problematic pornography users and healthy
control subjects. This association should be investigated more deeply in
future studies. Furthermore, the results are similar to studies which did
not find any associations between IUD and state impulsivity in a neutral
situation, but reported associations when participants were confronted
with Internet-related cues (Liu et al., 2014; van Holst et al., 2012).
Additionally, the results support assumptions of the I-PACE model of
specific IUD for IPD (Brand et al., 2016). On a neurobiological level, it
is assumed that an imbalance between the impulsive and reflective
system promote state impulsivity (Bechara, 2005; Volkow et al., 2013).
Since inhibitory control ability (SSRT) was not related to IPD, it may
be suggested that the dysfunctional pornography use is rather related to
a dysfunctional reflective system than to a hyperactivity of the im-
pulsive system (increased impulsive action tendency towards porno-
graphic pictures). This contrasts with the results in the field of sub-
stance-use disorders where high evidence for reduced inhibitory control
abilities in clinical groups were found (see meta-analysis by Smith,
Mattick, Jamadar, & Iredale, 2014). Lawrence, Luty, Bogdan, Sahakian,
and Clark (2009) explain this difference between substance-use dis-
orders and behavioral addictions with the missing damaging effects of
Addictive Behaviors 79 (2018) 171–177
drug use on brain structure and function, although this has been de-
bated recently (e.g. Dong, DeVito, Huang, & Du, 2012; Liu et al., 2014).
For example, Liu et al. (2014), who reported a hypoactivation of the
p
dorsolateral prefrontal cortex, a brain region of the reflective system
(Bechara, 2005), during inhibitory control task with gaming-related
0.014 cues in a sample consisting of individuals diagnosed with Internet-
0.206
gaming disorder. In contrast to the assumption by Lawrence et al.
0.044
(2009) these results indicate that individuals diagnosed with a specific
IUD show altered brain functionality. Since our sample only involved
0.110
seven participants with problematic pornography use (cut-off > 30 for
0.002 the s-IATsex as proposed by Laier et al., 2013; Please note that this is
0.024 only an indicator for problematic Internet-pornography use and not a
diagnosis. Individuals might not have been aware of their problematic
usage.), it is conceivable that deficits in inhibitory control and pre-
frontal dysfunctions, as found in the study by Liu et al. (2014), only
emerge in individuals with severe problems due to IPD. Therefore, this
experimental design should be replicated with a clinical sample of in-
dividuals with IPD.
The SST variant used here, included certain and uncertain go-trials
which enabled us to differentiate between effects on general motor
speed and more complex preparatory processes. We only found a sig-
nificant interaction effect concerning the uncertain go-RT and not
concerning the certain go-RT. Accordingly, we suggest that more
complex processes such as preparation to inhibition are more impaired
by the addiction process than general motor processes.
Further, in line with previous studies (Brand et al., 2011; Laier et al.,
2013), we found that higher craving responses predict symptom se-
verity of IPD. In a recent functional magnetic resonance imaging study,
Brand et al. (2016) showed that activity of the ventral striatum corre-
lates with arousal ratings during pornographic picture presentation and
symptom severity of IPD. The ventral striatum is one main structure of
the impulsive system, representing reward anticipation (Robinson &
Berridge, 2000).
Feil et al. (2010) argue that addictive behaviors may result from
imbalances between the direct, indirect, and hyperdirect basal ganglia
pathways which preferentially express different dopamine receptors.
The SST has been used to investigate the functionality of these basal
ganglia pathways (Aron, 2011). The direct pathway is presumed to be
responsible for the processing of go-responses and is modulated by D1-
receptors. The indirect and hyperdirect pathways are considered to
inhibit behavior and are modulated by D2-receptors (Albin, Young, &
Penney, 1989). Thus, our results may indicate that especially the direct
pathway and D1-receptors are involved in IPD, since we only found
effects for the go-RT. Further evidence from neuroimaging studies is
needed to evaluate the involvement of the direct basal ganglia pathway
in IPD.
There are some limitations of the current study. First, a hetero-
sexual, male, and young analogue sample was used in this study. Since
symptoms of IPD are rather dimensional than categorical and have si-
milar etiologies in clinical and analogue samples (Abramowitz et al.,
2014), we assume that our results are relevant for the understanding of
the development and maintenance of IPD. However, the study should
be replicated with female and homosexual participants and also in a
clinical sample. Second, we cannot distinguish whether the effects are
specific to the pornographic pictures. Future studies should include a
third SST condition with highly arousing pictures.
Beside the mentioned limitations, we conclude that our results re-
vealed first evidence for the interactive involvement of both, trait and
state impulsivity in IPD.
Role of funding sources
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
175
S. Antons, M. Brand
Contributors
The contents of the manuscript are solely the responsibility of the
authors. Stephanie Antons wrote the main text of the manuscript and
conducted data acquisition and statistical analysis. Prof. Matthias Brand
provided contentual input to the study design and improved parts of the
manuscript. All authors did proofreading and approved the final version
of the manuscript.
Conflict of interest
There are no conflicts of interest to declare.
Acknowledgements
We thank Katrin Starcke for her support of the current study. The
authors are grateful to Heike Averbeck for her help with data acquisi-
tion and Guillermo Carbonell, Patrick Trotzke, and Elisa Wegmann for
their constructive comments on earlier versions of the manuscript.
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