Inhibitory control and problematic Internet-pornography use - The important balancing role of the insula

Background and aims: Diminished control over a specific behavior is a core characteristic in addictive behaviors such as problematic Internet-pornography (IP) use. First studies suggest that a hyperactivity of the impulsive system is one reason for impulsive behaviors in the context of problematic IP use. The tripartite-process theory of addiction explains neurocognitive mechanisms beyond common dual-process theories in addictive behaviors. However, the role of the reflective and interoceptive system is still unresolved. Methods: The study comprised a stop-signal task (SST) including neutral and pornographic images during fMRI and questionnaires to investigate associations between symptoms of problematic IP use, craving, and neural activity of the impulsive, reflective, and interoceptive system. We examined 28 heterosexual males with varying symptom severity of problematic IP use. Results: Data indicates that individuals with more symptoms of problematic IP use showed better performance in the SST which was linked to decreased insula and inferior frontal gyrus activity during pornographic image processing. An increase in craving was associated with lower activity of the ventral striatum during pornographic image processing. The interoceptive system showed varying effects. Increased insula activity during inhibitory control and decreased activity during pornographic image processing were associated with higher inhibitory control performance. Discussion and Conclusion: Effects of tolerance and motivational aspects may explain the better inhibitory control performance in individuals with higher symptom severity which was associated with differential activity of the interoceptive and reflective system. Diminished control over IP use presumably results from the interaction between the impulsive, reflective, and interoceptive systems.