NUESTRO SISTEMA CULTURAL POSTMODERNO, LOS MAV-MCM Y LA ESCUELA

In order to address the dimensionality of problematic internet use in this thesis emphasis was given to the theories from the field of addictions which have incorporated psychophysical and biopsychological factors. These theories have proposed the means through which different underlying mechanisms interact and account for addictive behaviours. More specifically, the psychophysical view outline the ways in which

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physiological reactions underlie structural and functional alterations in the brain systems which result in behavioural outcomes associated with impaired decision-making processes.

Thus, observable cognitive deficits and the associated physiological measures can be related to impairments in brain systems which supports these functions. The Somatic Marker Hypothesis (SMH) has been employed in the field of addictions in order to account for deficits in decision-making processes which are evident in individuals with substance dependency and pathological gambling (Brevers, Cleeremance, Goudriaan et al., 2012;

Damasio, 1994; Goudriaan et al., 2005, 2006; Murphy et al., 2012; Verdejo-García &

Bechara, 2009). In detail, this theory explains why addicted individuals show patterns of decision-making processes which are characterized by a “myopia for the future”. For example, individuals continue to use a drug or gamble even though they know this will lead to negative outcomes for themselves and others around them. According to the SMH our emotions or emotional-related signals play a significant role in the processes guiding decision-making (Damasio, 1994). Damasio conceptualized emotions as homeostatic changes that occur at different levels in the brain and the body in certain situations, referring to these changes as somatic markers (Damasio, 1994). The SMH states that for every choice we make a somatic marker is generated. Thus, in the future whenever a similar situation is encountered, somatic markers provide an emotional indication for that situation. One of the basic assumptions underpinning this theory is that individuals make decisions by encoding the consequences of alternative actions affectively (Damasio, 1994). Thus, especially in situations where the outcome of a decision is unknown, emotional markers can provide a gut feeling of the outcome of a particular choice. This assumption is based on the evidence which has found that negative outcomes are associated with stronger emotional reactions. This arousal can indicate that the expected outcome is disadvantageous and as such, works to guide decisions away and towards more advantageous outcomes (Bechara et al., 1999).

The SMH was developed after Damasio observed patients with Ventromedial Prefrontal Cortex (VMPFC) lesions, who started making disadvantageous choices regarding future outcomes. They also showed deficits in expressing appropriate emotions and feelings in certain situations. These processes were, however, evident in the absence of other cognitive impairments such as memory, attention, language and logical reasoning. This observation made Damasio conclude that there must be a link between the observed deficits in emotions

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and feelings and those in the decision-making processes of the patients. Under the SMH, the VMPFC is the part of the brain which reactivates the emotional valence of a stimulus (Weller, Levin, & Bechara, 2010) and damage to this causes a deficit in the generation of somatic markers and consequently, deficits in decision-making processes (Bechara, Damasio, & Damasio, 2000). Further, the amygdala is thought to have a pertinent role in the emotional process (Gupta, Koscik, Bechara, & Tranel, 2011) for it is argued that it plays a part in attributing affective value to a stimulus (Bechara & Damasio, 2002; Bechara et al., 2002; Gupta et al., 2011; Verdejo-García & Bechara, 2009; Weller et al., 2010). These two brain structures are of vital importance in the generation of somatic markers, and as a consequence in providing emotional valence especially to choices associated with ambiguous outcomes. The involvement of these brain areas in decision-making processes has been extensively studied through the application of the Iowa Gambling Task (IGT) which is a task that mimics the way people make decisions in an everyday scenario. Research combining neuroimaging techniques and the IGT has identified neural structures that are involved in the decision-making processes similar to the ones that have been implicated in the generation of somatic markers and thus has provided validation for the SMH (Bechara et al., 1999; Bechara & Damasio, 2005; Ernst et al., 2002; Fellows & Farah, 2005; Li, Lu, D’Argembeau, Ng, & Bechara, 2010; Manes et al., 2002; Tanabe et al., 2007; Windmann et al., 2006). In the IGT individuals have to make choices based on unknown outcomes and thus integration of emotions into making live choices is vital for optimal performance in the task. Emotional integration has been assessed with Skin Conductance Responses (SCRs) which associates physiological responses with cognitive and emotional processes (Bechara et al., 1999; Bechara & Damasio, 2002; Bechara et al., 2002; Verdejo-García & Bechara, 2009). Using this task, researchers have revealed deficits in decision-making processes in patients with bilateral lesions in the VMPFC and amygdala (Bechara et al., 1999).

Moreover, these patients not only showed an overall deficit in performance on the IGT but this impairment was coupled with an inability to generate emotional arousal before they made a choice (anticipatory SCRs, for both amygdala and VMPFC patients) and/or when they received a reward or punishment (for only amygdala patients), (Bechara et al., 1999, Clark & Manes, 2004; Gupta et al., 2011). In this way, the assessment of physiological measures during decision-making processes can indicate whether or not impairments in cognitive processes are associated with VMPFC or amygdala functioning.

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Bechara et al. (2001) conducted a study to assess decision-making processes in patients with VMPFC lesions and substance dependent individuals. Results from the IGT showed that substance dependent individuals and VMPFC patients had similar behavioural outcomes (i.e. choosing disadvantageously in the IGT) and SCRs (lower skin activation before choosing from disadvantageous cards). The VMPFC lesion patients' behavioural outcomes were characterized by a tendency for immediate rewards at the expense of negative future consequences (Bechara et al., 2001). Thus, deficits in the generation of somatic markers which are associated with impairment in decision-making processes in substance dependent individuals, could be partially due to a dysfunctional VMPFC. This dysfunction has been suggested as underlying the development of addiction via a mechanism which intensifies the importance of immediate rewards at the expense of long-term outcomes. Similar results have been revealed with studies conducted concerning behavioural addictions (gambling addiction) (Goudriaan et al., 2006). Evidence supporting these claims have come from neuroimaging studies which have shown the deficits in the brain areas of VMPFC and amygdala to be evident in addicted individuals (Verdejo-García & Bechara, 2009).

Considering that similar patterns of decision-making process are prominent in problematic internet users it can be inferred that these deficits are associated with impairments in somatic marker activation. However, there is currently no evidence to justify such an assumption. Thus, in my thesis I assess emotional integration into decision-making processes in problematic internet users and investigate whether deficits in somatic marker activation underlie deficits in decision-making processes.