Han Xu, Wang Yao, Jiang Wenqing, Bao Xiaochen, Sun Yawen, Ding Weina, Cao Mengqiu, Wu Xiaowei, Du Yasong, Zhou Yan
Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Child and Adolescent Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China.
Front Psychiatry. 2018 Aug 3;9:341. doi: 10.3389/fpsyt.2018.00341. eCollection 2018.
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 (Δ) was positively correlated with the scale of the CIAS scores changes (Δ) 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.
认知行为疗法（CBT）对治疗网络游戏障碍（IGD）有效。然而，CBT改善IGD相关临床症状的机制尚不清楚。本研究旨在使用静息态功能磁共振成像（rsfMRI）发现CBT对IGD受试者的治疗机制。26名IGD受试者和30名匹配的健康对照（HC）接受了rsfMRI扫描和临床评估；20名IGD受试者完成了CBT，然后再次进行扫描。比较了IGD组和HC组在基线时的低频振幅（ALFF）值和功能连接（FC），以及IGD组CBT前后的ALFF值和FC。治疗前，与HC组相比，IGD组双侧壳核、右侧内侧眶额皮质（OFC）、双侧辅助运动区（SMA）、左侧中央后回和左侧前扣带回（ACC）的ALFF值显著增加。与IGD组相比，HC组左侧内侧OFC和壳核之间的FC值显著增加，IGD组的FC值与治疗前的BIS-11评分呈负相关。CBT后，每周游戏时间显著缩短，CIAS和BIS-II评分显著降低。IGD受试者左侧眶额皮质上部和左侧壳核的ALFF值显著降低，CBT后它们之间的FC显著增加。FC变化程度（Δ）与IGD受试者CIAS评分变化量表（Δ）呈正相关。CBT可以调节IGD受试者前额叶-纹状体区域异常的低频波动，并可以改善IGD相关症状。前额叶-纹状体区域的静息态改变可能揭示了CBT对IGD受试者的治疗机制。
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