Internet Gaming Disorder Patients Research Articles

Regional brain activity of resting-state fMRI and auditory oddball ERP with multimodal approach in individuals with internet gaming disorder.

Resting-state brain activity may be associated with the ability to perform tasks; however, a multimodal approach involving resting-state functional magnetic resonance imaging (fMRI) and event-related potentials (ERPs) has not been widely used to investigate addictive disorders. We explored resting-state fMRI and auditory oddball ERP values from 26 with internet gaming disorder (IGD) patients and 27 age- and intelligence quotient-matched healthy controls (HCs). To assess the characteristics of resting-state fMRI, we calculated regional homogeneity (ReHo), amplitude of low-frequency fluctuation (ALFF), and fractional amplitude of low-frequency fluctuation (fALFF); we also calculated the P3 component of the ERPs. Compared with HCs, the individuals with IGD exhibited significant decreases in ReHo and fALFF values in the left inferior occipital gyrus, increased ReHo and ALFF values in the right precuneus, increased ALFF in the left superior frontal gyrus, and lower P3 amplitudes in the midline centro-parietal area during the auditory ERP task. Furthermore, the regional activity of resting-state fMRI in the right inferior temporal gyrus and the occipital regions were positively correlated with the P3 amplitudes in IGD patients, whereas ReHo values of the left hippocampus and the right amygdala were negatively correlated with P3. Our results suggest that IGD patients have difficulty interacting effectively with cognitive function and sensory processing, although its interpretations need some cautions. The findings in this study will broaden the overall understanding of the neurobiological mechanisms that underlie IGD pathophysiology.

Reduced loss aversion in value-based decision-making and edge-centric functional connectivity in patients with internet gaming disorder.

Impaired value-based decision-making is a feature of substance and behavioral addictions. Loss aversion is a core of value-based decision-making and its alteration plays an important role in addiction. However, few studies explored it in internet gaming disorder patients (IGD). In this study, IGD patients (PIGD) and healthy controls (Con-PIGD) performed the Iowa gambling task (IGT), under functional magnetic resonance imaging (fMRI). We investigated group differences in loss aversion, brain functional networks of node-centric functional connectivity (nFC) and the overlapping community features of edge-centric functional connectivity (eFC) in IGT. PIGD performed worse with lower average net score in IGT. The computational model results showed that PIGD significantly reduced loss aversion. There was no group difference in nFC. However, there were significant group differences in the overlapping community features of eFC1. Furthermore, in Con-PIGD, loss aversion was positively correlated with the edge community profile similarity of the edge2 between left IFG and right hippocampus at right caudate. This relationship was suppressed by response consistency3 in PIGD. In addition, reduced loss aversion was negatively correlated with the promoted bottom-to-up neuromodulation from the right hippocampus to the left IFG in PIGD. The reduced loss aversion in value-based decision making and their related edge-centric functional connectivity support that the IGD showed the same value-based decision-making deficit as the substance use and other behavioral addictive disorders. These findings may have important significance for understanding the definition and mechanism of IGD in the future.

Effects of Transcranial Electrical Stimulation on Gambling and Gaming: A Systematic Review of Studies on Healthy Controls, Participants with Gambling/Gaming Disorder, and Substance Use Disorder.

Gambling disorder (GD) and internet gaming disorder (IGD) are formally recognized behavioral addictions with a rapidly growing prevalence and limited treatment options. Recently, transcranial electrical stimulation (tES) techniques have emerged as potentially promising interventions for improving treatment outcomes by ameliorating cognitive functions implicated in addictive behaviors. To systematize the current state of evidence and better understand whether and how tES can influence gambling and gaming-related cognitive processes, we conducted a PRISMA-guided systematic review of the literature, focusing on tES effects on gaming and gambling in a diverse range of population samples, including healthy participants, participants with GD and IGD, as well as participants with substance abuse addictions. Following the literature search in three bibliographic databases (PubMed, Web of Science, and Scopus), 40 publications were included in this review, with 26 conducted on healthy participants, 6 focusing on GD and IGD patients, and 8 including participants with other addictions. Most of the studies targeted the dorsolateral prefrontal cortex, using transcranial direct current stimulation (tDCS), and assessed the effects on cognition, using gaming and gambling computerized cognitive tasks measuring risk taking and decision making, e.g., balloon analogue risk task, Iowa gambling task, Cambridge gambling task, etc. The results indicated that tES could change gambling and gaming task performances and positively influence GD and IGD symptoms, with 70% of studies showing neuromodulatory effects. However, the results varied considerably depending on the stimulation parameters, sample characteristics, as well as outcome measures used. We discuss the sources of this variability and provide further directions for the use of tES in the context of GD and IGD treatment.

Resting-state heart rate variability, level of stress and resilience in internet gaming disorder and alcohol use disorder.

Stress and resilience are involved in the pathophysiology of addictive disorders, and heart rate variability (HRV) is an index of an individual's global capability to regulate psychological responses. In this study, we aimed to identify transdiagnostic and disorder-specific markers in people with addictive disorders by analyzing resting-state HRV and associations with the levels of stress and resilience. We compared relevant data between patients with internet gaming disorder (IGD) and/or alcohol use disorder (AUD) and healthy controls (HCs). In all, 163 adults aged 18-35years (53 with IGD, 49 with AUD, 61HCs) participated. The levels of stress and resilience were measured using the Psychosocial Wellbeing Index and the Connor-Davidson Resilience Scale, respectively. The HRV was obtained from each participant during a 5min resting-state. The IGD and AUD patients exhibited increased levels of stress and decreased resilience compared to the HCs. Patients with either addictive disorder exhibited a lower standard deviation of the normal-to-normal beat interval (SDNN) index [SDNNi] compared to HCs even after adjusting for clinical variables such as depression, anxiety, and impulsivity. In multiple comparison tests among the three groups, the AUD group had lower HRV than HCs, but no differences were observed among the groups after adjusting for the clinical variables. The HRV indices were correlated with the levels of stress, resilience, and disease severity. In conclusion, IGD and AUD patients exhibit lower HRV as indicated by the SDNNi compared to HCs, revealing their vulnerability to stress as well as a common transdiagnostic marker of addiction.

Alexithymia and internet gaming disorder in the light of depression: A cross-sectional clinical study

BackgroundSocial and emotional deficits are assumed to be involved in the development and maintenance of internet gaming disorder (IGD). Alexithymia refers to a personality construct, which is characterized by deficits in emotional awareness and processing. The constructs of alexithymia and depression share similarities, and depression is a common comorbidity of IGD patients. The aim of this study was to analyze the relationship between alexithymia and IGD when controlling for depression symptom severity. Moreover, we compared alexithymia traits of IGD patients with those of non-pathological video gamers. MethodsIn a cross-sectional study n = 38 male IGD patients (EG) were recruited at specialized healthcare services in Germany. In addition, n = 39 male non-pathological video gamers (CG) were recruited via social media and bulletin board announcement. Both groups completed questionnaires measuring alexithymia (TAS-20), depression symptom severity (BDI) and IGD severity (s-IAT). ResultsAlexithymia and depression symptom severity both predicted IGD severity. Yet, when including both factors in multiple regression analysis, only alexithymia predicted IGD severity. The prevalence of alexithymia in the EG was 34.2 % (n = 13). None of the non-pathological video gamers scored above the cut-off indicating alexithymia. IGD patients showed higher traits of alexithymia in general and on each subscale, irrespective of whether or not they were currently consuming video games. As previously observed, depression symptom severity was significantly greater in IGD patients compared to healthy video gamers. Yet, group differences in alexithymia traits remained stable, with a ~29 % decrease of effectiveness in the relationship, when controlling for depression symptom severity and sociodemographic factors. ConclusionThe results reveal that alexithymia is associated with and predicts IGD severity independently of depression symptom severity. Moreover, alexithymia is highly prevalent in IGD patients.

Differential resting-state neurophysiological activity associated with game usage patterns and genres in Internet gaming disorder.

We investigated differences in quantitative electroencephalogram (EEG) patterns associated with game usage patterns and genre among patients with Internet gaming disorder (IGD). Data from 140 participants (76 IGD patients and 64 healthy controls) were analysed. The IGD group was divided into subgroups based on game usage patterns (single game [SG] or multiple games [MGs]) and genre (multiplayer online battle arena, first-person shooter [FPS], or massively multiplayer online role-playing game [MMORPG; hereafter, MMG]). A resting-state, eye-closed quantitative EEG was recorded, and the absolute power and coherence of brain waves were analysed. IGD patients who played SGs showed increased beta activity compared with those who played MGs and controls. Increased absolute beta power was significantly associated with higher tendencies towards behavioural inhibition compared with controls. FPS gamers showed increased delta power in the frontal region compared with controls, which was related to the severity of IGD. Furthermore, decreased intrahemispheric coherence in the left frontoparietal region was observed in the MMG and FPS groups compared with controls. This decreased coherence was observed in the theta (MMG and FPS), delta (MMG), and beta (FPS) bands. These features were related to impairment in visuospatial working memory. Unique neurophysiological features related to preoccupation with an SG may be associated with the inhibition of behavioural changes. The present study suggests that the underlying neurophysiological networks in IGD differ according to game usage patterns and genre.

Biochemical Correlates of Video Game Use: From Physiology to Pathology. A Narrative Review

In the last few decades, video game playing progressively became a widespread activity for many people, in childhood as well in adulthood. An increasing amount of literature has focused on pathological and non-pathological correlates of video game playing, with specific attention towards Internet Gaming Disorder (IGD). While many neurobiological studies in this field were based on neuroimaging, highlighting structural and functional brain changes among video game users, only a limited number of studies investigated the presence of biochemical correlates of video gaming. The present work aims to summarize and review the available literature about biochemical changes linked to video game use in IGD patients as well as non-pathological users, and the differences in between. Results may shed light on risks and benefits of video games, providing directions for further research on IGD treatment and, on other hand, on the potential role of video games in therapeutic or preventive protocols for specific conditions.

Requirements of a Group Intervention for Adolescents with Internet Gaming Disorder in a Clinical Setting: A Qualitative Interview Study.

Internet gaming disorder (IGD) has become an important health concern in a significant proportion of adolescents. Intervention studies in this age group are scarce, mostly follow quantitative designs, and rarely consider adolescents’ experiences. This study aimed to evaluate the requirements for a group therapy program for adolescents with IGD. A qualitative interview study was conducted in a German clinic for addictive disorders in childhood and adolescence with nine participants (seven IGD patients (12–18 years, M = 15.86, SD = 1.95) and two psychotherapists). The semi-structured interviews addressed helpful contents, general conditions, and suggestions for alterations for an effective group intervention. Data were analyzed using content structuring qualitative analysis. Patient interview data resulted in 234 codings with eight main categories. Expert interview data yielded 151 codings with six main categories. The following treatment components were described as effective by the participants and experts: psychoeducation, emotion management, behavior analysis and modification, social skills training, parent participation, and relapse prevention. Additionally, adolescents emphasized the importance of group functionality for coherence, feedback and rewards, content presentation, physical activity and fun. The results are a valuable addition to findings from quantitative studies on IGD interventions and an interesting starting point for further representative studies.

Impact of attention‐deficit/hyperactivity disorder comorbidity on longitudinal course in Internet gaming disorder: a 3‐year clinical cohort study

Although attention-deficit/hyperactivity disorder (ADHD) symptoms were identified as a key risk factor for Internet gaming disorder (IGD), the effect of ADHD comorbidity on longitudinal course of IGD in the clinical population remains to be further examined. This study aimed to investigate whether ADHD comorbidity in IGD patients affects the recovery, recurrence rates, and trajectories of IGD symptoms, and examine the relationship between the changes in IGD and ADHD symptoms. The study included 128 IGD patients without any psychiatric comorbidities (pure-IGD group) and 127 IGD patients with comorbid ADHD (ADHD-IGD group) aged 11 to 42years. IGD and ADHD were diagnosed according to DSM-5 criteria at enrollment. Participants were offered 8-week treatment with additional care provided as needed and followed up over a 3-year period. IGD diagnosis was reassessed annually and used as a dichotomous outcome. The severity of IGD and ADHD symptoms was measured using the Young Internet Addiction Scale and the Korean ADHD rating scale, respectively, at baseline and each annual follow-up. The recovery rates of IGD by Year 3 were 60% and 93% in ADHD-IGD and in pure-IGD groups, respectively. The ADHD-IGD group showed lower rates of recovery, higher odds of recurrence within 1year, and higher severity of IGD symptoms over time than the pure-IGD group. Family environment was also associated with the trajectories of IGD symptoms. The changes in ADHD symptoms were significantly associated with the changes in IGD symptoms. This study found that ADHD comorbidity in IGD patients was associated with poor clinical course of IGD and that the changes in ADHD symptoms were associated with the changes in IGD symptoms over time. Our findings suggest that evaluation and treatment of ADHD symptoms and family environment in IGD patients may be important in improving the prognosis of IGD.

Differences in resting-state functional connectivity according to the level of impulsiveness in patients with internet gaming disorder.

Background and aimsImpulsiveness is an important factor in the pathophysiology of Internet gaming disorder (IGD), and regional brain functions can be different depending on the level of impulsiveness. This study aimed to demonstrate that different brain mechanisms are involved depending on the level of impulsiveness among patients with IGD.MethodsResting-state functional MRI data were obtained from 23 IGD patients with high impulsivity, 27 IGD patients with low impulsivity, and 22 healthy controls, and seed-based functional connectivity was compared among the three groups. The seed regions were the ventromedial prefrontal cortex (vmPFC), dorsolateral prefrontal cortex, nucleus accumbens (NAcc), and amygdala.ResultsConnectivity of the vmPFC with the left temporo-parietal junction (TPJ) and NAcc-left insula connectivity were significantly decreased in the patients with high impulsivity, compared with the patients with low impulsivity and healthy controls. On the other hand, amygdala-based connectivity with the left inferior frontal gyrus showed decreases in both patient groups, compared with the healthy controls.ConclusionThese findings may suggest a potential relationship between impulsivity and deficits in reward-related social cognition processes in patients with IGD. In particular, certain interventions targeted at vmPFC-TPJ connectivity, found to be impulsivity-specific brain connectivity, are likely to help with addiction recovery among impulsive patients with IGD.

Neuromodulatory Effect of Transcranial Direct Current Stimulation on Resting-State EEG Activity in Internet Gaming Disorder: A Randomized, Double-Blind, Sham-Controlled Parallel Group Trial.

Transcranial direct current stimulation (tDCS) has been used as an adjunct therapy for psychiatric disorders; however, little is known about the underlying neurophysiological effects of tDCS in Internet gaming disorder (IGD). We investigated the effects of tDCS on cortical activity using resting-state electroencephalography (EEG) in patients with IGD. This randomized, double-blind, sham-controlled parallel group study of tDCS (ClinicalTrials.gov NCT03347643) included 31 IGD patients. Participants received 10 sessions (2 sessions per day for 5 consecutive days) of active repetitive tDCS (2 mA for 20 min per session) or sham stimulation. Anode/cathode electrodes were placed over the left and right dorsolateral prefrontal cortex, respectively. In total, 26 participants (active group n = 14; sham group n = 12) completed the trial. Resting-state EEG spectral activity (absolute power) and functional connectivity (coherence) were used to assess the effects of tDCS on cortical activity before stimulation and 1 month after the intervention. Active stimulation of tDCS suppressed increase of intra-hemispheric beta coherence after 1 month, which was observed in the sham group. The 1-month follow-up assessment revealed that absolute gamma power in the left parietal region was decreased in the active group relative to the sham group. Our findings suggest that repetitive tDCS stabilizes fast-wave activity in IGD.

The imbalance between goal-directed and habitual systems in internet gaming disorder: Results from the disturbed thalamocortical communications

BackgroundConverging evidence has identified the imbalance between goal-directed systems and habitual systems in the addiction process. The thalamocortical loop plays an important role in the habitual/goal-directed system. However, little is known about the role of the thalamus in goal-directed and habitual systems in Internet gaming disorder (IGD) patients. This study investigated whether thalamocortical circuit was disrupted and how they affected goal-directed and habitual behaviors in IGD patients. MethodsThis is a functional magnetic resonance imaging (fMRI) study. Twenty-five IGD patients and 25 matched recreational game users (RGUs) were scanned when they were in a resting state and were performing an instrumental learning task to obtain behavioral data related to habitual/goal-directed behavior. We used the whole-brain seed-based functional connectivity (FC) of the four thalamic nuclei (bilateral) and correlation analyses to examine the thalamocortical loop difference and relationship with habitual/goal-directed performance. ResultsCompared with RGUs, IGD patients demonstrated significantly increased FC between the left midline nucleus (MN) and the right postcentral gyrus (PCG), and between the pulvinar and medial frontal gyrus (MFG). Correlation results showed that within the IGD group, the correct response rates of the participants to inconsistent stimulus-result pairs were positively correlated with the FC between the pulvinar and MFG. Inhibition-control scores were negatively correlated with the FC between the left MN and the PCG. ConclusionsIGD patients showed disrupted thalamocortical communication that could further result in an imbalance between the goal-directed and habitual systems in IGD patients. These findings provide more information about the involvement of the thalamus in the pathophysiology of IGD, and as potential circuit-level biomarkers of IGD patients, these circuit alterations may be useful in treatment development and in monitoring treatment outcomes.

Neurophysiological and Cognitive Correlates of Error Processing Deficits in Internet Gaming Disorder

The ability to detect and correct errors is a critical aspect of human cognition. Neuronal dysfunction in error processing has been reported in addictive disorders. The aim of this study was to investigate neural systems underlying error processing using event-related potentials (ERPs) and current source localization as well as neurocognitive executive function tests in patients with Internet gaming disorder (IGD). A total of 68 individuals (34 patients with IGD and 34 healthy controls [HCs]) were included, and two ERP components, error-related negativity (ERN) and error positivity (Pe), were extracted during a GoNogo task. Patients with IGD exhibited significantly reduced ERN and Pe amplitudes compared with HCs. Standardized low-resolution brain electromagnetic tomography (sLORETA) in between-group comparisons revealed that patients with IGD had decreased source activations of the Pe component in the anterior cingulate cortex (ACC) under the Nogo condition. These ERP changes were associated with deficits in decision-making and response inhibition in IGD patients. The results suggest that IGD may be associated with functional abnormalities in the ACC and alterations in neural activity related to both the early unconscious and the later conscious stages of error processing, as well as deficits in area of decision-making.

Internet Gaming Disorder Clustering Based on Personality Traits in Adolescents, and Its Relation with Comorbid Psychological Symptoms.

In recent years, the evidence regarding Internet Gaming Disorder (IGD) suggests that some personality traits are important risk factors for developing this problem. The heterogeneity involved in problematic online gaming and differences found in the literature regarding the comorbid psychopathology associated with the problem could be explained through different types of gamers. Clustering analysis can allow organization of a collection of personality traits into clusters based on similarity. The objectives of this study were: (1) to obtain an empirical classification of IGD patients according to personality variables and (2) to describe the resultant groups in terms of clinical and sociodemographic variables. The sample included 66 IGD adolescent patients who were consecutive referrals at a mental health center in Barcelona, Spain. A Gaussian mixture model cluster analysis was used in order to classify the subjects based on their personality. Two clusters based on personality traits were detected: type I “higher comorbid symptoms” (n = 24), and type II “lower comorbid symptoms” (n = 42). The type I included higher scores in introversive, inhibited, doleful, unruly, forceful, oppositional, self-demeaning and borderline tendency traits, and lower scores in histrionic, egotistic and conforming traits. The type I obtained higher scores on all the Symptom Check List-90 items-Revised, all the State-Trait Anxiety Index scales, and on the DSM-5 IGD criteria. Differences in personality can be useful in determining clusters with different types of dysfunctionality.

Aberrant structural network of comorbid attention deficit/hyperactivity disorder is associated with addiction severity in internet gaming disorder.

Internet gaming disorder (IGD) is commonly comorbid with attention-deficit/hyperactivity disorder (ADHD). Although the addiction is more severe when comorbid with ADHD, little is known about the neural correlates of the association. This study aimed to identify whether an ADHD-related structural brain network exists in IGD patients with comorbid ADHD (IGDADHD+) by comparing them with those without comorbid ADHD (IGDADHD-) and elucidating how the sub-network is associated with addiction severity. Brain structural networks were constructed based on streamline tractography with diffusion tensor imaging in a cohort of 46 male IGDADHD+ patients, 48 male IGDADHD- patients, and 34 healthy controls (HC). We used network-based statistics (NBS) to identify the sub-network differences between the two IGD groups. Furthermore, the edges in the sub-network that significantly contributed to explaining the Young Internet Addiction Scale (YIAS) score were delineated using partial least square (PLS) regression analyses in IGD patients. The YIAS score was higher in the IGDADHD+ group than in the IGDADHD- group and was correlated with the Korean Dupaul's ADHD scale score (r = 0.42, p <0.01). The NBS detected a sub-network with stronger connectivity in the IGDADHD+ group than in the IGDADHD-group. The PLS regression model showed that the sub-network is associated with the YIAS score in the IGDADHD+ group (q2 = 0.019). Edges connecting the left pre- and postcentral gyri, bilateral superior frontal gyri, medial orbital parts, and left fusiform to the inferior temporal gyrus were most important predictors in the regression model. Our results suggest that an aberrant increase in some structural connections within circuits related to inhibitory function or sensory integration can indicate how comorbid ADHD is associated with addiction severity in IGD.

The Mediating Effects of Affect on Associations between Impulsivity or Resilience and Internet Gaming Disorder.

Internet gaming disorder (IGD) is a new disease proposed by the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5), and has been studied extensively in relation to depression and impulsivity. The relationship between resilience and disease has been found in a variety of addictive disorders, but studies on IGD are lacking. In this study, 71 IGD patients and 78 healthy controls (HCs) were recruited. Impulsivity, resilience, affects, and the degree of internet game addiction were measured using formal tools. The measured values were analyzed by mediation analysis to evaluate the mediating role of affects on resilience and impulsivity related to IGD symptoms. The IGD group showed higher impulsivity, lower resilience, lower positive affect, and higher negative affect than the HC group. The mediation analysis showed that a positive affect was a mediator between impulsivity and the severity of addiction in both groups. Negative affect mediated impulsivity/resilience and the severity of addiction only in the IGD group. Although the results of this study are based on a narrow category of subjects, who are young male adults around 25 years of age, the results suggest that positive affect can be strengthened to prevent the IGD illness, and that illness symptoms may be alleviated by reducing negative affect.

Dysfunctional attentional bias and inhibitory control during anti-saccade task in patients with internet gaming disorder: An eye tracking study

BackgroundAlthough internet gaming disorder (IGD) is considered an addictive disorder, evidence of the neurobiological underpinnings of IGD as an addictive disorder is currently lacking. We investigated whether attentional bias toward game-related stimuli was altered in IGD patients using an eye-tracking method during an anti-saccade task. MethodsTwenty-three IGD patients and 27 healthy control (HC) subjects participated in the anti-saccade task with game-related, neutral, and scrambled images during eye tracking. Participants rated subjective scores of valence, arousal, and craving for each image stimulus after finishing eye tracking. Mixed design analysis of variance was performed to compare the differences between eye movement latency and error rate in the pro-saccade and anti-saccade conditions according to image type across the IGD and HC groups. ResultsIn the anti-saccade task, the IGD group exhibited higher error rates in the case of game-related images than in neutral or scrambled images. However, ratings on valence, arousal, and craving did not vary among image types. The error rates of the HCs did not vary across image types, but higher arousal/craving and lower valence were reported with respect to the game-related images. ConclusionsIncreased error rate during anti-saccade tasks with game-related stimuli in IGD may be due to disabilities in goal-directed behavior or inhibitory control, as observed in other addictive disorders. These findings suggest that attentional bias toward game-related stimuli can be a sensitive biological marker of IGD as an addictive disorder.

Maladaptive neurovisceral interactions in patients with Internet gaming disorder: A study of heart rate variability and functional neural connectivity using the graph theory approach.

Heart rate variability (HRV) can be used to represent the regulatory adaptive system and is a proxy for neurovisceral integration. Consistent with the view that, like other addictions, Internet gaming disorder (IGD) involves disrupted regulatory function, the present study hypothesized that IGD patients would show (a) decreased HRV, (b) ineffective functional neural connectivity, and (c) differential patterns of association between HRV and functional neural connectivity relative to healthy controls (HCs). The present study included 111 young adults (53 IGD patients and 58 age‐ and sex‐matched HCs) who underwent simultaneous recordings with an electrocardiogram and electroencephalogram during a resting state. Heart rate (HR), HRV, and functional neural connectivity were calculated using the graph theory approach. Compared with the HCs, the IGD patients exhibited elevated HR and decreased HRV based on the high frequency (HF), which reflects suppression of parasympathetic and/or vagal tone. The IGD patients also exhibited a heightened theta band characteristic path length (CPL) compared with HCs, indicating decreased efficacy of the functional network. Furthermore, IGD patients exhibited negative correlations between the standard deviation of the normal‐to‐normal interval index (SDNNi) and theta and delta CPL values, which were not observed in HCs. In conclusion, the present findings suggest that IGD patients might have maladaptive brain‐body integration features involving disruptions of the autonomic nervous system and brain function.

Neurophysiological Mechanisms of Resilience as a Protective Factor in Patients with Internet Gaming Disorder: A Resting-State EEG Coherence Study.

Background: Resilience, an important protective factor against Internet gaming disorder (IGD), is the ability to recover from negative emotional experiences and constitutes a flexible adaptation to stress. Despite the importance of resilience in predicting IGD, little is known about the relationships between resilience and the neurophysiological features of IGD patients. Methods: We investigated these relationships using resting-state electroencephalography (EEG) coherence, by comparing IGD patients (n = 35) to healthy controls (n = 36). To identify the resilience-related EEG features, the IGD patients were divided into two groups based on the 50th percentile score on the Connor–Davidson Resilience Scale: IGD with low resilience (n = 16) and IGD with high resilience (n = 19). We analyzed differences in EEG coherence among groups for each fast frequency band. The conditional indirect effects of resilience were examined on the relationships between IGD and resilience-related EEG features through clinical symptoms. Results: IGD patients with low resilience had higher alpha coherence in the right hemisphere. Particularly, resilience moderated the indirect effects of IGD on alpha coherence in the right hemisphere through depressive symptoms and stress level. Conclusion: These neurophysiological findings regarding the mechanisms underlying resilience may help to establish effective preventive measures against IGD.

Subregions of the Anterior Cingulate Cortex Form Distinct Functional Connectivity Patterns in Young Males With Internet Gaming Disorder With Comorbid Depression.

Depression is one of the most common comorbid conditions in Internet Gaming Disorder (IGD). Although there have been many studies on the pathophysiology of IGD, the neurobiological basis underlying the close association between depression and IGD has not been fully clarified. Previous neuroimaging studies have demonstrated functional and structural abnormalities in the anterior cingulate cortex (ACC) in IGD patients. In this study, we explored functional connectivity (FC) abnormalities involving subregions of the ACC in IGD subjects with comorbid depression. We performed a resting state seed-based FC analysis of 21 male young adults with IGD with comorbid depression (IGDdep+ group, 23.6 ± 2.4 years), 22 male young adults without IGD with comorbid depression (IGDdep− group, 24.0 ± 1.6 years), and 20 male age-matched healthy controls (24.0 ± 2.2 years). ACC-seeded FC was evaluated using the CONN-fMRI FC toolbox. The dorsal ACC (dACC), the pregenual ACC (pgACC), and the subgenual ACC (sgACC) were selected as seed regions. Both IGD groups had stronger pgACC FC with the right precuneus, the posterior cingulate cortex, and the left inferior frontal gyrus/insula than the control group. The IGDdep+ group had stronger dACC FC with the left precuneus and the right cerebellar lobule IX than the control and IGDdep- groups. The IGDdep+ group also had weaker pgACC FC with the right dorsomedial prefrontal cortex and the right supplementary motor area and had weaker sgACC FC with the left precuneus, the left lingual gyrus, and the left postcentral gyrus than the other groups. The strength of the connectivity between the sgACC and the left precuneus correlated positively with a higher omission error rate in the continuous performance test in the IGDdep+ group. In addition, the IGDdep– group had stronger sgACC FC with the left dorsolateral prefrontal cortex than the other groups. Our findings suggest that young males with IGD comorbid with depression have FC alterations of the default mode network and diminished FC with the prefrontal cortex. This altered FC pattern may be involved in the close association of IGD and depression.