单次经颅直流电刺激对成瘾相关抑制控制和渴求的疗效：一项男性网络游戏障碍患者的随机试验。
Efficacy of single-session transcranial direct current stimulation on addiction-related inhibitory control and craving: a randomized trial in males with Internet gaming disorder.
机构信息
From the State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China (Wu, Xu, Shi, Zhu, Wang, Liu, Zhang); the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA (Potenza, Kober, Yip); the Child Study Center, Yale University School of Medicine, New Haven, CT, USA (Potenza); the Department of Neuroscience, Yale University School of Medicine, Connecticut Mental Health Center, New Haven, Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Council on Problem Gambling, Wethersfield, CT, USA (Potenza); the Connecticut Mental Health Center, New Haven, CT, USA (Potenza); the Faculty of Education, Beijing Normal University, Beijing 100875, China (Zhou); and the Department of Psychology, Yale University School of Medicine, New Haven, CT, USA (Kober).
出版信息
J Psychiatry Neurosci. 2021 Jan 4;46(1):E111-E118. doi: 10.1503/jpn.190137.
BACKGROUND
Transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex (dlPFC) may reduce substance use and other addictive behaviours. However, the cognitive mechanisms that underpin such effects remain unclear. Impaired inhibitory control linked to hypoactivation of the prefrontal cortex may allow craving-related motivations to lead to compulsive addictive behaviours. However, very few studies have examined whether increasing the activation of the dlPFC via anodal tDCS could enhance inhibitory control over addiction-related distractors. The current study aimed to enrich empirical evidence related to this issue.
METHODS
Thirty-three males with Internet gaming disorder underwent active (1.5 mA for 20 minutes) and sham tDCS 1 week apart, in randomized order. We assessed inhibitory control over gaming-related distractors and craving pre- and post-stimulation.
RESULTS
Relative to sham treatment, active tDCS reduced interference from gaming-related (versus non-gaming) distractors and attenuated background craving, but did not affect cue-induced craving.
LIMITATIONS
This study was limited by its relatively small sample size and the fact that it lacked assessments of tDCS effects on addictive behaviour. Future tDCS studies with multiple sessions in larger samples are warranted to examine the effects on addictive behaviours of alterations in addiction-related inhibitory control.
CONCLUSION
These findings demonstrate that stimulation of the dlPFC influences inhibitory control over addiction-related cues and addiction-related motivation. This is the first empirical study to suggest that enhanced inhibitory control may be a cognitive mechanism underlying the effects of tDCS on addictions like Internet gaming disorder. Our finding of attenuated background craving replicated previous tDCS studies. Intriguingly, our finding of distinct tDCS effects on 2 forms of craving suggests that they may have disparate underlying mechanisms or differential sensitivity to tDCS.
CLINICAL TRIALS #: NCT03352973.
背景
经颅直流电刺激（tDCS）对背外侧前额叶皮层（dlPFC）的刺激可能会减少物质使用和其他成瘾行为。然而，支持这些效果的认知机制仍不清楚。与前额叶皮层激活不足相关的抑制控制受损可能会使与渴望相关的动机导致强迫性成瘾行为。然而，很少有研究探讨通过阳极 tDCS 增加 dlPFC 的激活是否可以增强对与成瘾相关的干扰物的抑制控制。本研究旨在丰富与此问题相关的实证证据。
方法
33 名男性互联网游戏障碍患者在相隔一周的时间内，以随机顺序接受主动（1.5 mA 持续 20 分钟）和假 tDCS 治疗。我们在刺激前后评估了对游戏相关干扰物的抑制控制和渴望程度。
结果
与假刺激相比，主动 tDCS 降低了与游戏相关（而非非游戏）干扰物的干扰，并减轻了背景渴望，但并未影响线索诱发的渴望。
局限性
本研究受到样本量较小以及缺乏评估 tDCS 对成瘾行为影响的限制。未来需要进行多次治疗的更大样本量的 tDCS 研究，以检验改变与成瘾相关的抑制控制对成瘾行为的影响。
结论
这些发现表明，dlPFC 的刺激会影响对与成瘾相关的线索和成瘾相关动机的抑制控制。这是第一项表明增强抑制控制可能是 tDCS 对像互联网游戏障碍等成瘾影响的认知机制的实证研究。我们发现背景渴望减轻的结果复制了以前的 tDCS 研究。有趣的是，我们发现 2 种形式的渴望存在不同的 tDCS 效应，这表明它们可能具有不同的潜在机制或对 tDCS 的敏感性不同。
临床试验注册号
NCT03352973。
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