Resting-State Activity of Prefrontal-Striatal Circuits in Internet Gaming Disorder: Changes With Cognitive Behavior Therapy and Predictors of Treatment Response.

Yao Wang,Xiaowei Wu,Mengqiu Cao,Xiaochen Bao,Weina Ding,Yan Zhou,Yasong Du,Xu Han,Yawen Sun,Wenqing Jiang

doi:10.3389/fpsyt.2018.00341

Abstract

Cognitive behavior therapy (CBT) is effective for the treatment of Internet gaming disorder (IGD). However, the mechanisms by which CBT improves IGD-related clinical symptoms remain unknown. This study aimed to discover the therapeutic mechanism of CBT in IGD subjects using resting-state functional magnetic resonance imaging (rsfMRI). Twenty-six IGD subjects and 30 matched healthy controls (HCs) received rsfMRI scan and clinical assessments; 20 IGD subjects completed CBT and then were scanned again. The amplitude of low-frequency (ALFF) values and the functional connectivity (FC) between the IGD group and the HC group were compared at baseline, as well as the ALFF values and FC before and after the CBT in the IGD group. Prior to treatment, the IGD group exhibited significantly increased ALFF values in the bilateral putamen, the right medial orbitofrontal cortex (OFC), the bilateral supplementary motor area (SMA), the left postcentral gyrus, and the left anterior cingulate (ACC) compared with the HC group. The HC group showed significantly increased FC values between the left medial OFC and the putamen compared with the IGD group, the FC values of IGD group were negatively associated with the BIS-11 scores before treatment. After the CBT, the weekly gaming time was significantly shorter, and the CIAS and BIS-II scores were significantly lower. The ALFF values in the IGD subjects significantly decreased in the left superior OFC and the left putamen, and the FC between them significantly increased after the CBT. The degree of the FC changes (ΔFC/Pre−FC) was positively correlated with the scale of the CIAS scores changes (ΔCIAS/Pre−CIAS) in the IGD subjects. CBT could regulate the abnormal low-frequency fluctuations in prefrontal-striatal regions in IGD subjects and could improve IGD-related symptoms. Resting-state alternations in prefrontal-striatal regions may reveal the therapeutic mechanism of CBT in IGD subjects.

Highlights

Internet gaming disorder (IGD), known as problematic Internet use, is the excessive and recurrent use of online Internet games [1]
We found that IGD subjects demonstrated abnormal function of some prefrontal-striatal regions relative to the healthy controls (HCs) subjects and that Cognitive behavior therapy (CBT) could attenuate the functional abnormalities in the orbitofrontal cortex (OFC) and the putamen and increase the interactions between them, in addition to improving the symptoms of IGD
The Barratt Impulsiveness Scale-11 (BIS-11) correlates of the functional connectivity (FC) alternations demonstrated that the impairment in the prefrontal-striatal circuits may have an impact on impulsive behavior of IGD subjects

Summary

Introduction

Internet gaming disorder (IGD), known as problematic Internet use, is the excessive and recurrent use of online Internet games [1]. Neuroimaging studies found that excessive Internet gaming was associated with abnormal resting-state activity in the frontal lobe, the brain region responsible for cognitive process, such as inhibitory control [7]. Previous studies revealed the association between structural and functional abnormalities in the prefrontal cortex (PFC) and impaired inhibitory control in IGD [11,12,13,14,15,16]. Ko et al [10] demonstrated that the impaired function in prefrontal-striatal regions may explain the decrease in the inhibitory capacity in IGD. These imaging studies characterized how both frontal lobe structures and functions are altered in association with impaired inhibitory control in IGD. Impaired dopamine function in the striatum (a decrease in dopamine D2 receptors and reduced dopamine release) and its association with reduced baseline glucose metabolism in the PFC were observed [18, 19]

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