Effects of retrieval-extinction training on internet gaming disorder

Abstract

Background and aims: Internet gaming disorder (IGD) leads to serious impairments in cognitive functions, and lacks of effective treatments. Cue-induced craving is a hallmark feature of this disease and is associated with addictive memory elements. Memory retrieval-extinction manipulations could interfere with addictive memories and attenuate addictive syndromes, which might be a promising intervention for IGD. The aims of this study were to explore the effect of a memory retrieval-extinction manipulation on gaming cue-induced craving and reward processing in individuals with IGD.

Methods: A total of 49 individuals (mean age: 20.52 ± 1.58) with IGD underwent a memory retrieval-extinction training (RET) with a 10-min interval (R-10min-E, n = 24) or a RET with a 6-h interval (R-6h-E, n = 25) for two consecutive days. We assessed cue-induced craving pre- and post-RET, and at the 1- and 3-month follow-ups. The neural activities during reward processing were also assessed pre- and post-RET.

Results: Compared with the R-6h-E group, gaming cravings in individuals with IGD were significantly reduced after R-10min-E training at the 3-month follow-up (P < 0.05). Moreover, neural activities in the individuals with IGD were also altered after R-10min-E training, which was corroborated by enhanced reward processing, such as faster responses (P < 0.05) and stronger frontoparietal functional connectivity to monetary reward cues, while the R-6h-E training had no effects.

Discussion and conclusions: The two-day R-10min-E training reduced addicts' craving for Internet games, restored monetary reward processing in IGD individuals, and maintained long-term efficacy.

Keywords: gaming craving; internet gaming disorder; memory retrieval-extinction manipulation; reward processing.

Fig. 1.

CONSORT Flow Diagram. R-10min-E indicates memory retrieval-extinction training with 10-min interval; R-6h-E indicates memory retrieval-extinction training with 6-h interval

Fig. 2.

Experimental design. (A) A timeline of the experiment. On day 1, participants received baseline assessments; on days 2–3, the participants were divided into two groups and trained in the retrieval-6 h-extinction (R-6h-E group) context or retrieval-10 min-extinction (R-10min-E group) context for two days; on day 4, the participants received the same assessment on day 1; on day 34/94, participants' craving levels were tested. (B) MIDT procedure. Structure of the task for a gain trial (Knutson et al., 2003). (C) MST procedure. Structure of the task for a relevant trial (Joormann & Gotlib, 2008)

Fig. 3.

R-E training effects on gaming craving. The effect of R-10min-E and R-6h-E trainings on IGD individuals' gaming craving. Error bars indicate standard errors (SEs). “Pre-RET” was defined as before the R-E intervention. * P < 0.05

Fig. 4.

R-E training effects on behavioral performance and P3 amplitudes during MIDT. (A) Effect of R-E training on reaction times with gain cues between the R-6h-E and R-10min-E groups. Grand-averaged ERP evoked by gain cues from pre-RET and post-RET in the (B) R-10min-E group and (B) R-6h-E group. P3 (Pz) amplitudes were calculated by averaging the amplitudes between 300-600 ms and circled by the green dotted line. * P < 0.05; ns: not significant

Fig. 5.

R-E training effects on functional connectivity during the MIDT. Electrode pairs with significantly changed wPLI values in the ROI with gain cues in the (A) R-10min-E group and (B) R-6h-E group. ROI: 8–13 Hz range, 400–500 ms range. The red lines represent the electrode pairs with significantly enhanced connections (Pre-RET < Post-RET); the green dotted line circles the areas where these electrodes were mainly located

Fig. 6.

R-E training effects on functional connectivity between paired electrodes. Effects of R-E training on electrode pairs' wPLI values with gain cues in pre-RET and post-RET in the R-6h-E group and R-10min-E group. Two-way ANOVA was performed. *P < 0.05; **P < 0.01; ***P < 0.001

Fig. 7.

R-E training effects on functional connectivity correlate with gaming craving. Correlations between the wPLI values with gain cues in the MIDT and craving scores in pre-RET and post-RET in the R-10min-E group. The wPLI values were between the electrode pairs with significantly changed functional connectivity