Addiction is characterized by compulsive engagement despite adverse consequences. Psychobehavioral interventions targeting compulsivity in addictions are relatively rare, particularly for behavioral addictions like internet gaming disorder (IGD). Free from confounding drug-on-brain effects, IGD provides a promising model for understanding neuropsychological processes of addictions. IGD is a global concern in the setting of increasing internet use worldwide. Thus, developing interventions and understanding their mechanisms of action are important. Positive emotional association biases (EABs) towards addiction cues based on reward conditioning may underlie addiction-associated compulsivity. Here, we developed an EAB modification (EABM) protocol and examined whether modifying EABs via cognitive training would alter neurocognitive aspects of addiction-associated compulsivity in IGD. We recruited 90 IGD participants who were randomly assigned to receive EABM or sham training in a 1:1 ratio. The EABM intervention involved six consecutive days of exposure to negative emotional terms linked to gaming stimuli and positive terms linked to non-gaming healthy-alternative stimuli. The sham training involved similar stimuli linked to neutral words. Participants underwent event-related fMRI while performing a regulation-of-craving task and received several behavioral assessments pre-training and post-training. Primary efficacy measures were changes in gaming-related positive EABs, and compulsive gaming thoughts and behaviors. Behaviorally, EABM (vs. sham) training decreased gaming-related positive EABs and compulsive gaming thoughts and behaviors. Neurally, EABM training involved decreased activation in the bilateral dorsal striatum (DS) in the regulation-of-craving task, and altered left DS-centric functional connectivity with ventral prefrontal cortical regions, which correlated with decreases in gaming-related EABs or compulsive gaming thoughts and behaviors. EABM training also implicated activation changes in the right medial frontal gyrus and posterior insula. EABM may reduce compulsive gaming thoughts and behaviors via reshaping functional organization of fronto-striatal pathways and insular activity in IGD. The therapeutic potential of EABM should be examined in larger, longer-term studies, as should its application to other addictive disorders.

中文翻译：

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情绪偏差修正削弱了与游戏相关的强迫性并重塑了额纹状体通路

成瘾的特点是不顾后果而强迫性参与。针对成瘾强迫症的心理行为干预相对较少，尤其是对于网络游戏障碍 (IGD) 等行为成瘾而言。IGD 没有混杂的药物对大脑的影响，为理解成瘾的神经心理过程提供了一个有前途的模型。在全球互联网使用不断增加的背景下，IGD 是一个全球性的问题。因此，制定干预措施并了解其作用机制非常重要。基于奖励调节的对成瘾线索的积极情绪联想偏差 (EAB) 可能是与成瘾相关的强迫症的基础。这里，我们开发了 EAB 修改 (EABM) 协议，并检查了通过认知训练修改 EAB 是否会改变 IGD 中成瘾相关强迫性的神经认知方面。我们招募了 90 名 IGD 参与者，他们以 1:1 的比例被随机分配接受 EABM 或假训练。EABM 干预涉及连续六天暴露于与游戏刺激相关的负面情绪术语和与非游戏健康替代刺激相关的积极术语。假训练涉及与中性词相关的类似刺激。参与者在执行渴望调节任务时接受了事件相关的 fMRI，并在训练前和训练后接受了多项行为评估。主要疗效指标是与游戏相关的积极 EAB 以及强迫性游戏思想和行为的变化。在行为上，EABM（与 假）训练减少了与游戏相关的积极 EAB 和强迫性游戏思想和行为。在神经上，EABM 训练涉及在调节渴望任务中减少双侧背侧纹状体 (DS) 的激活，并改变以左侧 DS 为中心的功能连接与腹侧前额叶皮层区域，这与游戏相关 EAB 或强迫游戏的减少相关思想和行为。EABM 训练还涉及右侧内侧额回和后脑岛的激活变化。EABM 可以通过重塑额纹状体通路的功能组织和 IGD 中的岛状活动来减少强迫性游戏思想和行为。EABM 的治疗潜力应该在更大规模、更长期的研究中得到检验，就像它在其他成瘾性疾病中的应用一样。