Academic literature on the topic 'Meta-cognition; Intrusive thoughts; Anxiety'

Mindfulness-Based Stress Reduction (MBSR) is an 8-week meditation program known to improve anxiety, depression, and psychological well-being. Other health-related effects, such as sleep quality, are less well established, as are the psychological processes associated with therapeutic change. This prospective, observational study (n=213) aimed to determine whether perseverative cognition, indicated by rumination and intrusive thoughts, and emotion regulation, measured by avoidance, thought suppression, emotion suppression, and cognitive reappraisal, partly accounted for the hypothesized relationship between changes in mindfulness and two health-related outcomes: sleep quality and stress-related physical symptoms. As expected, increased mindfulness following the MBSR program was directly correlated with decreased sleep disturbance (r=-0.21, p=0.004) and decreased stress-related physical symptoms (r=-0.38, p<0.001). Partial correlations revealed that pre-post changes in rumination, unwanted intrusive thoughts, thought suppression, experiential avoidance, emotion suppression, and cognitive reappraisal each uniquely accounted for up to 32% of the correlation between the change in mindfulness and change in sleep disturbance and up to 30% of the correlation between the change in mindfulness and change in stress-related physical symptoms. Results suggest that the stress-reducing effects of MBSR are due, in part, to improvements in perseverative cognition and emotion regulation, two “transdiagnostic” mental processes that cut across stress-related disorders.

The obsessive–compulsive spectrum refers to disorders drawn from several diagnostic categories that share core features related to obsessive–compulsive disorder (OCD), such as obsessive thoughts, compulsive behaviors and anxiety. Disorders that include these features can be grouped according to the focus of the symptoms, e.g., bodily preoccupation (i.e., eating disorders, ED) or impulse control (i.e., substance use disorders, SUD), and they exhibit intriguing similarities in phenomenology, etiology, pathophysiology, patient characteristics and clinical outcomes. The non-competitive N-methyl-D-aspartate receptor (NMDAr) antagonist ketamine has been indicated to produce remarkable results in patients with treatment-resistant depression, post-traumatic stress disorder and OCD in dozens of small studies accrued over the past decade, and it appears to be promising in the treatment of SUD and ED. However, despite many small studies, solid evidence for the benefits of its use in the treatment of OCD spectrum and addiction is still lacking. Thus, the aim of this perspective article is to examine the potential for ketamine and esketamine in treating OCD, ED and SUD, which all involve recurring and intrusive thoughts and generate associated compulsive behavior. A comprehensive and updated overview of the literature regarding the pharmacological mechanisms of action of both ketamine and esketamine, as well as their therapeutic advantages over current treatments, are provided in this paper. An electronic search was performed, including all papers published up to April 2021, using the following keywords (“ketamine” or “esketamine”) AND (“obsessive” OR “compulsive” OR “OCD” OR “SUD” OR “substance use disorder” OR “addiction” OR “craving” OR “eating” OR “anorexia”) NOT review NOT animal NOT “in vitro”, on the PubMed, Cochrane Library and Web of Science online databases. The review was conducted in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The use and efficacy of ketamine in SUD, ED and OCD is supported by glutamatergic neurotransmission dysregulation, which plays an important role in these conditions. Ketamine’s use is increasing, and preliminary data are optimistic. Further studies are needed in order to better clarify the many unknowns related to the use of both ketamine and esketamine in SUD, ED and OCD, and to understand their long-term effectiveness.

Meta-cognition refers to the notion of thoughts about one’s own thoughts and has been defined as knowledge and cognition about cognitive phenomena (Flavell, 1979). In recent years, meta-cognitive models have provided accounts of the maintenance of anxiety disorders (e.g., Wells, 2000). Meta-cognitive models would argue that the thoughts about the appearance and utility of otherwise normal thoughts generate anxiety. In this article we apply a meta-cognitive approach to understanding obsessions but, rather than thoughts about thoughts, we suggest that the ruminations in obsessive-compulsive disorder (OCD) without overt compulsions result largely from thoughts about thoughts that do not actually occur. Persons with obsessions thinks they might have or might have had the thoughts, and through a meta-cognitive process termed “inferential confusion,” confuse these imagined thoughts with actual thoughts. This account would explain the repetitive, compulsive yet ego-dystonic nature of obsessions. The justification, provided by patients with OCD, for treating imaginary thoughts as actual thoughts appears to be an imaginary narrative, which produces and maintains the obsessional preoccupation, and seems imposed on reality by a distorted inductive reasoning process.

Background: Distressing intrusive images are frequently experienced by sufferers from chronic and acute pain. The images (Index images) are correlated with elevations in anxiety, threat, and a cognition that the imaged event might actually happen. The over-estimation that having a negative cognition about an adverse event will increase the probability of the negative event occurring - the likelihood bias - has been observed in a variety of psychological disorders. Preliminary research indicated this cognitive bias might occur in pain sufferers. Aims: To investigate the occurrence of a cognitive likelihood bias associated with imagery in acute and chronic pain sufferers, and to relate the postulated cognitive bias to psychological characteristics of participants, and four other important cognitive responses to their Index images. Method: Fifty-nine pain sufferers completed a newly developed questionnaire (Image-Event-Fusion-pain: IEF-p) to assess cognitive likelihood bias in pain sufferers. The internal consistency, reliability, factor structure and validity of the scale were evaluated. Psychological measures to assess anxiety, depression, PTSD symptoms, and levels of mental defeat were administered. Results: The IEF-p was found to be psychometrically robust with satisfactory test-retest reliability, good internal consistency, single factor structure and criterion validity. The IEF-p was significantly correlated with four key cognitive appraisals of the Index Images (responsibility, likelihood, premonition, and threat). Three of these correlations were independent of depression. High cognitive bias scores were significantly associated with elevated levels of anxiety symptoms, depression, PTSD symptoms, and mental defeat. Conclusion: Pain Index images were significantly associated with cognitive bias (IEF-p), increased threat levels, and raised estimate of the likelihood of imaged events actually occurring. The results indicate the prevalence of a cognitive bias associated with pain imagery cognitions, comparable to that established with intrusive cognitions in OCD, notably Thought-Action- Fusion.

AbstractObsessive compulsive disorder (OCD) is characterized by intrusive thoughts and repetitive ritualistic behaviors and has been associated with diverse functional brain abnormalities. We sought to synthesize current evidence from functional magnetic resonance imaging (fMRI) studies and examine their alignment to pathogenetic models of OCD. Following systematic review, we identified 54 task-fMRI studies published in the last decade comparing adults with OCD (n = 1186) to healthy adults (n = 1159) using tasks of affective and non-affective cognition. We used voxel-based quantitative meta-analytic methods to combine primary data on anatomical coordinates of case-control differences, separately for affective and non-affective tasks. We found that functional abnormalities in OCD cluster within cortico-striatal thalamic circuits. Within these circuits, the abnormalities identified showed significant dependence on the affective or non-affective nature of the tasks employed as circuit probes. In studies using affective tasks, patients overactivated regions involved in salience, arousal and habitual responding (anterior cingulate cortex, insula, caudate head and putamen) and underactivated regions implicated in cognitive and behavioral control (medial prefrontal cortex, posterior caudate). In studies using non-affective cognitive tasks, patients overactivated regions involved in self-referential processing (precuneus, posterior cingulate cortex) and underactivated subcortical regions that support goal-directed cognition and motor control (pallidum, ventral anterior thalamus, posterior caudate). The overall pattern suggests that OCD-related brain dysfunction involves increased affective and self-referential processing, enhanced habitual responding and blunted cognitive control.

D. P. Hallahan and J. M. Kauffman (2003) define self-control as an ability of an individual to regulate own behavior (application of strategies solving problems) and this is linked with metacognition. Skills of meta-cognition are abilities of self-control, which are mastered while learning; this embraces thoughts about what we know and how we regulate learning. There exists a mutual link between development of self-control and physical abilities: while developing self-control abilities, it is possible to better cultivate school students’ physical abilities, to teach them movements because self-control enables them to better penetrate in general cognitive strategies. On the other hand, developing children’s physical abilities, favorable conditions for improvement of school students’ self-control abilities are established. However, the influence of self-control development at primary school age has not been widely researched and few works on researches in primary learners in the context of their physical education have been published. The goal of the research – to reveal dynamics of change in primary school learners’ physical abilities and links with development of self-control abilities during the period of experiment, applying experimental programme for self-control abilities development during lessons of physical culture. The methods of the research: analysis of literature sources; questionnaire survey; testing; mathematical statistics: research data were analysed applying the coefficient of Cronbach Alfa, Pearson correlation analysis, Student’s t-criterion, MannWhitney U criterion. Statistical data analysis was conducted employing the statistical analysis package SPSS 19. The methodology of the research. The method of questionnaire survey evaluated dynamics of changes in self-control abilities, whereas testing method measured changes in physical abilities. The questionnaire for self-control evaluation (targeted at assessment of physical, emotional and social control) was designed on the basis of the Lithuanian Physical Culture Programme ‘To Grow and to Strengthen’ and the Social Skills Inventory by R. E. Riggio and H. S. Friedman. Dynamics of physical abilities was measured applying the following tests: ‘sit and reach’–for flexibility, ‘standing jump’– for explosive force, ‘10x5 shuttle run’– for agility, 20 m run’ – for velocity, ‘sit up and lie down’ – for trunk force (abdominal muscle endurance), ‘Flamingo balance fitness test’-for balance. These test were selected following the Methodology for Testing of Physical Capacity of Lithuanian Inhabitants and Establishment of their Physical Condition (2007) and the Lithuanian Physical Culture Programme ‘To Grow and to Strengthen’ (2004). All the measurements were obtained twice: before and after the experiment. The organization of the research. The pedagogical experiment was conducted in fourth forms of secondary schools in Klaipėda, Kaunas and Raseiniai in the school year of 2011–2012. The duration of the pedagogical experiment was one school year. The schools were selected following the criteria-based principle of sampling, taking into account teacher’s qualification, number of classes and agreement to participate in the experiment. The research sample initially included 203 learners but in the course of the research their number changed and the final sample consisted of 178 school students, who were divided into experimental (n = 85) and control (n = 93) groups. The results of the research. The research revealed a positive impact of the programme for development of self-control abilities on dynamics of change in physical abilities. Statistically significant differences (p < 0.05) were observed between physical abilities in experimental and control groups: long jump, agility, velocity, abdominal muscle power and endurance results between boys in E and C groups; long jump, velocity, balance, abdominal muscle power and endurance results among girls. The norms of scales for evaluation of self-control abilities were established (Cronbach’s Alpha 0.911 (n = 37)). The self-control abilities were divided into physical (Cronbach’s Alpha 0,866 (n = 19) and psychosocial self-control (Cronbach’s Alpha 0.866 (n = 18). It was established that self-control abilities of 10–11 year old boys and girls differ: in most cases girls show greater skills of psychosocial self-control (p < 0.01). They are able to better follow the rules of the game (p < 0.001), to keep their promises and obligations (p < 0.01), to make themselves behave as if it is pleasant (p < 0.05), to get on well with other people (p < 0.001), to evaluate well-being (p < 0.01), mood (p < 0.05), flexibility (p < 0.05) and dress up appropriately for the weather (p < 0.01). Compared to the girls, boys more frequently are able to control own fears and anxiety (p < 0.01). The least developed abilities of self-control include the ability to evaluate the pulse and to understand own physical activity. School students, who possess greater skills of psychosocial self-control, also show better indicators of certain physical abilities. The established linear correlation links indicate relationship between the following psychosocial self-control and physical abilities: flexibility, explosive force, velocity, endurance and balance. Development of self-control abilities produces an effect on development of physical skills. The analysis of the variables in the scale of psychosocial self-control allows concluding that school learners, who are able to control themselves and do not reveal their soreness (p < 0.01) and are able to adjust to various requirements (p < 0.05), demonstrate better balance skills; children, who are able to notice and evaluate fatigue and frequency of pulse, show better endurance skills. This is very important developing school students’ physical abilities in lessons of physical culture.

Mental Illnesses, particularly anxiety, insomnia, and depression often involve vicious cycles which are self-perpetuating and can trap one into a more chronic state. For example in the case of insomnia, sympathetic overactivity, intrusive thoughts, and emotional instability due to sleep loss can perpetuate further sleep loss the next night and so on. In this article, we put forward a perspective on breaking these vicious cycles based on preeminent theories in global and spatial cognition, that the foundation of the conscious mind is a spatial coordinate system. Based on this we discuss the potential and future of virtual reality therapeutic applications which utilize massive virtual spaces along with biofeedback designed to help break perpetual cycles in depression, anxiety, and insomnia. “Massive spaces” are those which are truly expansive such as when looking to the clear night sky. These virtual realities may take the form of a night sky, fantastical cosmic scenes, or other scenes such as mountain tops. We also hope to inspire research into such a spatial foundation of mind, use of perceived massive spaces for therapy, and the integration of biofeedback into virtual therapies.

Abstract Background Major depressive disorder (MDD) is a prevalent mental disorder characterized by impairments in affect, behaviour and cognition. Previous studies have indicated that the anterior cingulate cortex (ACC) may play an essential role in the pathophysiology of depression. In this study, we systematically identified changes in functional connectivity (FC) for ACC subdivisions that manifest in MDD and further investigated the relationship between these changes and the clinical symptoms of depression. Methods Sub-regional ACC FC was estimated in 41 first-episode medication-naïve MDD patients compared to 43 healthy controls. The relationships between depressive symptom severity and aberrant FC of ACC subdivisions were investigated. In addition, we conducted a meta-analysis to generate the distributions of MDD-related abnormal regions from previously reported results and compared them to FC deficits revealed in this study. Results In MDD patients, the subgenual and perigenual ACC demonstrated decreased FC with the posterior regions of the default network (DN), including the posterior inferior parietal lobule and posterior cingulate cortex. FC of these regions was negatively associated with the Automatic Thoughts Questionnaire scores and largely overlapped with previously reported abnormal regions. In addition, reduced FC between the caudal ACC and precuneus was negatively correlated with the Hamilton Anxiety Scale scores. We also found increased FC between the rostral ACC and dorsal medial prefrontal cortex. Conclusions Our findings confirmed that functional interaction changes in different ACC sub-regions are specific and associated with distinct symptoms of depression. Our findings provide new insights into the role of ACC sub-regions and DN in the pathophysiology of MDD.

IntroductionCan a person’s tastes in art, music, literature, cinema, sport, humour or other fields be changed through online activity? This article explores that question by comparing recent research findings in the areas of neuroplasticity and flow. Neuroplasticity, also known as brain plasticity, is the idea that the human brain can change its structure and function through thought and activity, even into old age (Doidge). The second concept—flow—comes from the field of psychology, and refers to a deeply satisfying state of focused attention that people sometimes experience while engaging in an enjoyable activity such as browsing the Web (Csikszentmihalyi, Flow). Research into the experiences of web users, conducted from these two different perspectives, reveal interesting connections to the acquisition of taste and opportunities for further investigation. Neuroplasticity The term neuroplasticity comes from the words neuron and plastic. Neurons are the nerve cells in our brains and nervous systems. Plastic, in this context, means flexibility or malleability. Neuroplasticity has replaced the formerly-held belief that the brain is a physiologically static organ, hard-wired like a machine (Kolb, Gibb and Robinson). For much of the last century, scientists believed that adult brains, unlike those of children, could not produce new neurons or build new pathways or connections between neurons. According to this view, any brain function that was lost through damage was irretrievable. Today, research into neuroplasticity has proven that this is not the case. In the late 1960s and 1970s pioneering scientists such as Paul Bach-y-Rita demonstrated that brains change their structure with different activities they perform (Kercel). When certain parts fail, other parts can sometimes take over. Subsequent research by many scientists has validated this once-controversial idea, leading to practical benefits such as the restoration of limb function in stroke victims, and improved cognition and perception in people with learning disabilities (Nowak et al.). Merzenich, for example, has demonstrated how a brain’s processing areas, called brain maps, change in response to what people do over the course of their lives. Different brain maps exist for different activities and functions, including sensory perception, motor skills and higher mental activities. Brain maps are governed by competition for mental resources and the principle of “use it or lose it.” If a person stops exercising particular mental skills, such as speaking Spanish or playing piano, then the brain map space for those skills is handed over to skills that they practise instead. Brain maps are also governed by a principle that is summarised by the expression, “neurons that fire together wire together” (Doidge 63). Neurons in brain maps develop stronger connections to each other when they are activated at the same moment in time. Consequently people are able to form new maps by developing new neural connections. Acquiring Tastes Doidge has illustrated the role that neuroplasticity plays in acquiring new tastes by explaining how habitual viewing of online pornography can shape sexual tastes (102). In the mid- to late-1990s, Doidge (a psychiatrist and psychoanalyst) treated several men who had lost interest in their sexual partners as a consequence of their addiction to online pornography. Doidge explains their change of sexual taste in terms of neuroplasticity, noting that “pornography, delivered by high-speed Internet connections, satisfies every one of the prerequisites for neuroplastic change” (102). The sexual excitement of viewing pornography releases a chemical neurotransmitter named dopamine that activates the brain’s pleasure centres. Since “neurons that fire together wire together”, the repeated viewing of pornography effectively wires the pornographic images into the pleasure centres of the brain with the focused attention required for neuroplastic change. In other words, habitual viewers of pornography develop new brain maps based on the photos and videos they see. And since the brain operates on a “use it or lose it” principle, they long to keep those new maps activated. Consequently, pornography has an addictive power. Like all addicts, the men who Doidge treated developed a tolerance to the photos and videos they observed and sought out progressively higher levels of stimulation for satisfaction. Doidge explains the result: The content of what they found exciting changed as the Web sites introduced themes and scripts that altered their brains without their awareness. Because plasticity is competitive, the brain maps for new, exciting images increased at the expense of what had previously attracted them—the reason, I believe, they began to find their girlfriends less of a turn-on. (109) If the habitual viewing of online pornography can change sexual tastes, what other tastes can be changed through online activity? Art? Music? Literature? Cinema? Sport? Humour? One avenue for investigating this question is to consider existing research into the flow experiences of web users. The term flow refers to a deeply satisfying state of focused attention that was first identified by psychologist Mihaly Csikszentmihalyi (Beyond Boredom) in his studies of optimal experiences. According to Csikszentmihalyi, people in flow “are so involved in an activity that nothing else seems to matter; the experience itself is so enjoyable that people will do it even at great cost, for the sheer sake of doing it” (Flow 4). Flow experiences are characterised by some common elements, which include a balance between the challenges of an activity and the skills required to meet those challenges; clear goals and feedback; concentration on the task at hand; a sense of control; a merging of action and awareness; a loss of self-consciousness; a distorted sense of time; and the autotelic experience. The term autotelic refers to an activity that is done, not with the expectation of some future benefit, but simply because the doing itself is the reward. Whenever people reflect on their flow experiences, they mention some, and often all, of these characteristics. Support for Csikszentmihalyi’s characterisation of flow can be found in studies of many diverse activities, such as playing computer games (Chen) and participating in sport (Jackson), to mention just two examples. The activities that people engage in to experience flow vary enormously, but they describe how it feels in almost identical terms. Pace has developed a grounded theory of the flow experiences of web users engaged in content-seeking activities including directed searching and exploratory browsing. The term grounded in this instance refers to the fact that the theory was developed using the Grounded Theory research method, and its explanations are grounded in the study’s data rather than deduced from research literature (Charmaz). A review of that theory reveals many similarities between the flow experiences of web users engaged in content-seeking activities and the experiences of habitual viewers of online pornography described by Doidge. The following sections will consider several of those similarities. Focused Attention Focused attention is essential for long-term neuroplastic change. Goleman notes that “when practice occurs while we are focusing elsewhere, the brain does not rewire the relevant circuitry for that particular routine” (164). In a series of brain mapping experiments with monkeys, Merzenich discovered that “lasting changes occurred only when his monkeys paid close attention” (Doidge 68). When the animals performed tasks without paying close attention, their brain maps changed, but the changes did not last. Focused attention also plays a central role in the flow experiences of web users. The higher-than-average challenges associated with flow activities require a complete focusing of attention on the task at hand, or as Csikszentmihalyi puts it, “a centering of attention on a limited stimulus field” (Beyond Boredom 40). An important by-product of this fact is that flow leaves no room in one’s consciousness for irrelevant thoughts, worries or distractions (Csikszentmihalyi, Flow 58). People who experience flow frequently report that, while it lasts, they are able to forget about the unpleasant aspects of life. Consider the following comment from a 42-year-old male’s recollection of experiencing flow while using the Web: “It’s a total concentration experience. You’re so interested in doing what it is you’re doing that nothing’s interrupting you.” In everyday life, one’s concentration is rarely so intense that all preoccupations disappear from consciousness, but that is precisely what happens in a flow experience. All of the troubling thoughts that normally occupy the mind are temporarily suspended while the pressing demands of the flow activity consume one’s attention. Let’s now consider a second similarity between the flow experiences of web users and the taste-changing experiences of habitual viewers of online pornography. Enjoyment The pleasure experienced by the pornography addicts treated by Doidge played an important role in the alteration of their brain maps and sexual tastes. Since “neurons that fire together wire together”, the repeated viewing of pornographic photos and videos wired those images into the pleasure centres of their brains with the focused attention required for neuroplastic change. Web users in flow also experience enjoyment, but possibly a different kind of enjoyment to the pleasure described by Doidge. Seligman and Csikszentmihalyi make the following distinction between pleasure and enjoyment: Pleasure is the good feeling that comes from satisfying homeostatic needs such as hunger, sex, and bodily comfort. Enjoyment, on the other hand, refers to the good feelings people experience when they break through the limits of homeostasis—when they do something that stretches them beyond what they were—in an athletic event, an artistic performance, a good deed, a stimulating conversation. (12) The enjoyment experienced by people in flow is sometimes described as “the autotelic experience.” According to Csikszentmihalyi, an autotelic experience is “a self-contained activity, one that is done not with the expectation of some future benefit, but simply because the doing itself is the reward” (Flow 67). Because autotelic experiences are so satisfying, they create a strong desire to repeat the activity that produced the experience. Consider the following comment from a web user about the reasons he enjoys online content-seeking activities that have led to flow: It’s like going to somewhere new. You’re always learning something. You’re always finding something. And you don’t know what it is you’re going to find. There’s so much out there that you’ll go there one day and then you’ll come back, and you’ll actually end up on a different path and finding something different. So it’s investigation of the unknown really. This comment, like many web users’ recollections of their flow experiences, points to a relationship between enjoyment and discovery. This connection is also evident in flow experiences that occur during other kinds of activities. For example, Csikszentmihalyi suggests that “the reason we enjoy a particular activity is not because such pleasure has been previously programmed in our nervous system, but because of something discovered as a result of interaction” (The Evolving Self 189). He illustrates this point with the example of a person who is at first indifferent to or bored by a particular activity, such as listening to classical music. When opportunities for action in the context of the activity become clearer, or when the individual’s skills improve, the activity may start to be interesting and finally gratifying. For example, if a person begins to understand the design underlying a symphony he or she might begin to enjoy the act of listening. This example hints at how discovery, enjoyment and other rewards of flow may engender change in a person’s taste. Let’s now consider a third similarity between the two areas of research. Compulsive Behaviour One consequence of flow experiences being so enjoyable is that they create a strong desire to repeat whatever helped to make them happen. If a person experiences flow while browsing online for new music, for example, he or she will probably want to repeat that activity to enjoy the experience again. Consider the following comment from a 28-year-old female web user who recalled experiencing flow intermittently over a period of three days: “I did go to bed—really late. And then as soon as I got up in the morning I was zoom—straight back on there […] I guess it’s a bit like a gambling addiction.” This study informant’s use of the term addiction highlights another similarity between the flow experiences of web users and habitual viewing of online pornography. Flow experiences can, in a very small percentage of cases, encourage compulsive behaviour and possibly addiction. A study by Khang, Kim and Kim found that “experiences of the flow state significantly influenced media addiction” across three media forms: the Internet, mobile phones and video games (2423). Examples of problems associated with excessive Internet use include sleep deprivation, poor eating and exercise habits, conflict with family members, and neglect of academic, interpersonal, financial and, occupational responsibilities (Douglas et al). Some heavy Internet users report feelings of moodiness and anxiety while they are offline, along with an intense desire to log in. Doidge states that “the addictiveness of Internet pornography is not a metaphor” (106), but many researchers are reluctant to apply the term addiction to heavy Internet use. Internet addiction first came to the attention of the research community in the mid-1990s when Young conceptualised it as an impulse-control disorder and proposed a set of diagnostic criteria based on the diagnostic criteria for pathological gambling in the Diagnostic and Statistical Manual of Mental Disorders. However, after more than fifteen years of research on this subject, there is still no agreement on a definition or diagnostic criteria for Internet addiction. Some researchers argue that Internet addiction is not a true addiction and may be no more than a symptom of other existing disorders such as anxiety or depression (Weinstein and Lejoyeux). Regardless of this controversy, the potential for compulsive behaviour is another clear similarity between the flow experiences of web users and the neuroplastic change caused by habitual viewing of online pornography. One more similarity will be considered. Sidetracks In Pace’s study of the flow experiences of web users, informants reported engaging in two general types of content-seeking behaviour: (1) a directed searching mode in which one is motivated to find a particular piece of content such as the answer to a question or a specific music video; and (2) an exploratory browsing mode that is characterised by diffuse motives such as passing time or seeking stimulation. Directed searching and exploratory browsing are not dichotomous forms of navigation behaviour. On the contrary, they are closely interrelated. Web users move back and forth between the two modes, often many times within the same session. Just as web users can change from one navigation mode to another, they can also get sidetracked from one topic to another. For instance, it is reportedly quite common for a web user engaged in a content-seeking activity to decide to pursue a different goal because his or her curiosity is aroused by interesting content or links that are not directly relevant to the task at hand. Consider the following comment from a 21-year-old female web user whose desire to find contact details for a local Tai Chi group disappeared when a link to the Sportsgirl web site attracted her attention: I think I typed in “sports” […] I was actually looking for a place to do Tai Chi and that sort of thing. So I was looking for a sport. And it ended up coming up with the Sportsgirl web site. And I ended up looking at clothes all afternoon. So that was kind of cool. Sidetracks are a common feature of the flow experiences of web users. They are also a prominent feature of the description that Doidge provided of the pornography addicts’ neuroplastic change (109). The content of what the men found exciting changed as the web sites they viewed introduced “themes and scripts” or sidetracks that altered their brain maps. “Without being fully aware of what they were looking for, they scanned hundreds of images and scenarios until they hit upon an image or sexual script that touched some buried theme that really excited them”, Doidge notes (110). Conclusion Can a person’s tastes in art, music, literature, cinema, sport, humour or some other field be changed through online activity, just as sexual tastes can? This article alone cannot conclusively answer that question, but significant similarities between the flow experiences of web users and the neuroplastic change experienced by habitual viewers of online pornography suggest that flow theory could be a fruitful line of investigation. Can the flow experiences of web users lead to changes in taste, just as the neuroplastic change caused by habitual viewing of online pornography can lead to changes in sexual taste? What is the relationship between flow and neuroplastic change? Is the Internet the most appropriate environment for exploring these questions about taste, or do offline flow activities provide insights that have been neglected? These are some of the unanswered questions arising from this discussion that require further investigation. Advances in the field of neuroplasticity have been described as some of “the most extraordinary discoveries of the twentieth century” (Doidge xv). These advances provide an opportunity to revisit related theories and to enhance our understanding of phenomena such as flow and taste. References Charmaz, Kathy. Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis. Thousand Oaks, California: Sage Publications, 2006. Chen, Jenova. “Flow in Games (and Everything Else).” Communications of the ACM 50.4 (2007): 31–34. Csikszentmihalyi, Mihaly. Beyond Boredom and Anxiety: The Experience of Play in Work and Games. San Francisco: Jossey-Bass Publishers, 1975. Csikszentmihalyi, Mihaly. The Evolving Self: A Psychology for the Third Millennium. New York: HarperPerennial, 1993. Csikszentmihalyi, Mihaly. Flow: The Psychology of Optimal Experience. New York: HarperPerennial, 1990. Doidge, Norman. The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science. Melbourne: Scribe Publications, 2010. Douglas, Alecia C., Juline E. Mills, Mamadou Niang, Svetlana Stepchenkova, Sookeun Byun, Celestino Ruffini, Seul Ki Lee, Jihad Loutfi, Jung-Kook Lee, Mikhail Atallah, and Marina Blanton. “Internet Addiction: Meta-Synthesis of Qualitative Research for the Decade 1996-2006.” Computers in Human Behavior 24 (2008): 3027–3044. Goleman, Daniel. Focus: The Hidden Driver of Excellence. New York: HarperCollins, 2013. Jackson, Susan. “Toward a Conceptual Understanding of the Flow Experience in Elite Athletes.” Research Quarterly for Exercise and Sport 67.1 (1996): 76–90. Khang, Hyoungkoo, Jung Kyu Kim, and Yeojin Kim. “Self-Traits and Motivations as Antecedents of Digital Media Flow and Addiction: The Internet, Mobile Phones, and Video Games.” Computers in Human Behavior 29 (2013): 2416–2424. Kercel, Stephen W. “Editorial: The Wide-Ranging Impact of the Work of Paul Bach-y-Rita.” Journal of Integrative Neuroscience 4.4 (2005): 403–406. Kolb, Bryan, Robbin Gibb, and Terry E. Robinson. “Brain Plasticity and Behavior.” Current Directions in Psychological Science 12.1 (2003): 1–5. Merzenich, Michael. Soft-Wired: How the New Science of Brain Plasticity Can Change Your Life. San Francisco: Parnassus Publishing, 2013. Nowak, Dennis A., Kathrin Bösl, Jitka Podubeckà, and James R. Carey. “Noninvasive Brain Stimulation and Motor Recovery After Stroke.” Restorative Neurology and Neuroscience 28 (2010): 531–544. Pace, Steven. “A Grounded Theory of the Flow Experiences of Web Users.” International Journal of Human-Computer Studies 60.3 (2004): 327–363. Seligman, Martin E. P., and Mihaly Csikszentmihalyi. “Positive Psychology: An Introduction.” American Psychologist 55.1 (2000): 5–14. Weinstein, Aviv, and Michel Lejoyeux. “Internet Addiction or Excessive Internet Use.” The American Journal of Drug and Alcohol Abuse 36 (2010): 277–283. Young, Kimberly S. Caught in the Net: How to Recognize the Signs of Internet Addiction—And a Winning Strategy for Recovery. New York: John Wiley & Sons, 1998.