Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jul 26, 2024
Date Accepted: Jan 10, 2025
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Real-time fMRI Neurofeedback in Young Adults with Internet Gaming Disorder Risks: A Randomized Controlled Trial
ABSTRACT
Background:
Internet Gaming Disorder (IGD) has become an increasing mental health problem but efficacious treatments are currently lacking. Across addictive disorders craving represents a key symptom and motivational driver which is neurally mediated by heightened activity within the mesolimbic dopamine system, including the midbrain ventral tegmental area (VTA). Real-time fMRI neurofeedback (rt-fMRI NF) training is a non-invasive neuromodulatory tool that allows modulation of activity within deep brain structures, yet its efficacy in ameliorating symptoms of IGD or any other behavioral addiction has not been examined.
Objective:
This pre-registered, randomized, single-blind study examined the efficacy of a real-time fMRI neurofeedback VTA down-regulation training protocol in enhancing voluntary control over brain hyperreactivity to gaming cues.
Methods:
Twenty young adults at risk for IGD completed two sessions of neurofeedback training in which they learned to down-regulate the feedback signal after exposure to gaming cues. The experimental group (N=10) received VTA neurofeedback, while the control group (N=10) received sham feedback from the middle temporal gyrus, a region not involved in reward processing. The primary outcome measurement was the change in self-reported craving level, while changes in control over VTA activity and inhibitory control-related activity in the dorsolateral prefrontal cortex (DLPFC) during a Go/No-go task served as secondary outcome measurements.
Results:
We found that over the neurofeedback sessions, there was significantly greater improvement in control in VTA activity in the experimental group than in the control group (P = .018) which indicated successful self-regulation learning. Both groups exhibited significant decreases in subjective craving levels (P = .002) with no between-group differences (P = .1) in this effect. VTA neurofeedback compared to sham feedback resulted in greater but statistically insignificant reductions in VTA cue-reactivity (P = .14). VTA cue reactivity decrease was positively correlated with improved control of VTA activity during neurofeedback training (P = .004) for both groups.
Conclusions:
These preliminary findings suggest that VTA neurofeedback training improves craving-related dopaminergic midbrain activity, providing initial evidence of neurofeedback’s potential as an early intervention for IGD and other behavioral addictions. The lack of group differences in behavioral improvement warrants further investigations with larger samples. Clinical Trial: ClinicalTrials.gov NCT06063642
Citation
