Background:
Cue-reactivity responses in addictive behaviours are triggered by cues associated with the addictive activity itself. Although such cues may depict the rewarding aspects of the behaviour, responses may also generalise to more distal cues that do not directly convey this content.

Aims:
To examine cue reactivity to distal cues (i.e. devices displaying starting or log-in screens of internet applications) in a diagnostically validated sample of individuals with specific problematic usage of the internet (PUIs) and determine whether laboratory-measured cue reactivity predicts real-life behavioural engagement and temptation experiences, in addition to differences across PUI stages and cue types.

Method:
In this preregistered study, data were collected from October 2021 to 31 August 2024 from individuals with non-problematic (n = 268), risky (n = 135) and pathological (n = 133) engagement in specific internet activities (gaming, buying and/or shopping, pornography use and social networking). Participants were aged 18–65 years (mean age 26.12 years, s.d. 6.79), and 44.6% were female. A cue-reactivity paradigm with distal cues showing target and non-target internet activities was used. A within–between participants design was used, with repeated measures analyses of variance. Correlations between laboratory cue-reactivity measures and measures from a 14-day end-of-day assessment in the natural environment are reported.

Results:
Heightened cue reactivity (arousal, urge and/or craving) was observed in individuals with risky and pathological use compared with those with non-problematic use across all levels of the paradigm. Individuals with pathological use showed elevated levels of urge and craving, along with generalised responses to stimuli showing starting and/or log-in screens not related to their specific (addictive) behaviour. These effects were consistent across different types of PUI and were associated with engagement in the behaviour and temptation experiences in naturalistic settings.

Conclusions:
These findings indicate that cue reactivity and craving are central aspects of PUIs. Although different devices may elicit different types of action, our results highlight the challenges of regulating behaviour in environments saturated with unavoidable triggers, such as internet content and devices.