Positive Health Online

Abstract

NI and COLLEAGUES, (1)Department of Psychology, Yunnan Normal University, Kunming, China. (2)Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China. (3)NuanCun Mindful-Living Mindfulness Center, Hangzhou, China. (4)Center of Mindfulness, School of Psychology, Zhejiang Normal University, Jinhua, China. (5)Department of Psychiatry and the Child Study Center, Yale University School  of Medicine, New Haven, Connecticut. (6)Department of Neuroscience, Yale University, New Haven, Connecticut.(7)Connecticut Council on Problem Gambling, Wethersfield set out to explore the efficacy of MM used to treat adults with IGD and to identify neural mechanisms underlying Mindfulness meditation (MM) and conducted a randomized clinical trial.

Background

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), recently identified internet gaming disorder (IGD) as a condition warranting more research, and few empirically validated treatments exist. Mindfulness meditation (MM) has multiple health benefits; however, its efficacy in treating IGD and potential neural mechanisms underlying MM treatment of the disorder remain largely unknown.

Methodology

Objective: To explore the efficacy of Mindfulness meditation (MM) used to treat adults with internet gaming disorder (IGD) and to identify neural mechanisms underlying Mindfulness meditation (MM). Design, Setting, And Participants: This randomized clinical trial was performed from October 1 to November 30, 2023, at Hangzhou Normal University in Hangzhou, China. Adults (aged ≥18 years) who met at least 6 of the 9 DSM-5-TR proposed criteria for IGD were recruited to receive either MM or progressive muscle relaxation (PMR). Data analysis was performed on December 1, 2023. Intervention: Participants underwent MM training (an 8-session meditation program that focuses on attention and acceptance) and PMR training (an 8-time program for body relaxation) delivered in groups that met 2 times each week for 4 weeks. Main Outcomes And Measures: This per-protocol analysis included only participants who finished the pretest assessment, 8 training sessions, and post-test assessment. The main outcomes were addiction severity (measured with the DSM-5-TR proposed criteria for IGD and with Internet Addiction Test scores), gaming craving (measured with Questionnaire for Gaming Urges scores), and blood oxygen level-dependent signals assessed with cue-craving tasks on fMRI.  Behavioral and brain measurements were compared using analysis of variance. Functional connectivity (FC) among identified brain regions was measured to test connectivity changes associated with MM.

Results

This study included 64 adults with IGD. A total of 32 participants received MM (mean [SD] age, 20.3 [1.9] years; 17 women [53%]) and 32 received PMR (mean [SD] age, 20.2 [1.5] years; 16 women [50%]). The severity of IGD decreased in the MM group (pretest vs post-test: mean [SD], 7.0 [1.1] vs 3.6 [0.8]; P < .001) and in the progressive muscle relaxation (PMR) group (mean [SD], 7.1 [0.9] vs 6.0 [0.9]; P = .04). The MM group had a greater decrease in IGD severity than the PMR group (mean [SD] score change for the MM group vs the PMR group, -3.6 [0.3] vs -1.1 [0.2]; P < .001). Mindfulness meditation was associated with decreased brain activation in the bilateral lentiform nuclei (r = 0.40; 95% CI, 0.19 to 0.60; P = .02), insula (r = 0.35; 95% CI, 0.09 to 0.60; P = .047), and medial frontal gyrus (MFG; r = 0.43; 95% CI, 0.16 to 0.70; P = .01). Increased MFG-lentiform FC and decreased craving (pretest vs post-test: mean [SD], 58.8 [15.7] vs 33.6 [12.0]; t = -8.66; ƞ2 = 0.30; P < .001) was observed after MM, and changes in MFG-lentiform FC mediated the relationship between increased mindfulness and decreased craving (mediate effect, -0.17; 95% CI, -0.32 to -0.08; P = .03).

Conclusion

In this study, Mindfulness meditation (MM) was more effective in decreasing addiction severity and gaming cravings compared with progressive muscle relaxation (PMR). These findings indicate that MM may be an effective treatment for IGD and may exert its effects by altering frontopallidal pathways. Conflict of interest statement: Conflict of Interest Disclosures: Dr Potenza reported receiving consulting fees from Opiant, Baria-Tek, Game Day Data, and the Addiction Policy Forum; has been involved in a patent application with Yale University and Novartis; and has received research support (to Yale University) from Mohegan Sun Casino, Children and Screens, and the Connecticut Council on Problem Gambling outside the submitted work. In addition, Dr Potenza has participated in surveys, mailings, or telephone consultations related to drug addiction, impulse-control disorders, or other health topics; has consulted for and advised gambling and legal entities on issues related to impulse control, internet use, and addictive disorders; has provided clinical care in a problem gambling services program; has performed grant reviews for research-funding agencies; has edited journals and journal sections; has given academic lectures in grand rounds, continuing medical education events, and other clinical or scientific venues; and has generated books or book chapters for publishers of mental health texts. No other disclosures were reported. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2300075869.

References

Ni H(1), Wang H(1)(2), Ma X(1)(2), Li S(1)(2), Liu C(3), Song X(4), Potenza MN(5)(6)(7), Dong GH(1). Efficacy and Neural Mechanisms of Mindfulness Meditation Among Adults With Internet Gaming Disorder: A Randomized Clinical Trial.  JAMA Netw Open.;7(6):e2416684. doi: 10.1001/jamanetworkopen.2024.16684. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820099  Jun 3 2024.