■精神疾病诊断和统计手册,第五版,文本修订(DSM-5-TR),最近发现网络游戏障碍(IGD)是一种需要更多研究的疾病,很少有经验验证的治疗方法存在。正念冥想(MM)具有多种健康益处;然而,其在治疗IGD方面的疗效以及MM治疗该疾病的潜在神经机制仍在很大程度上未知.
■探讨MM用于治疗成人IGD的疗效,并确定MM的神经机制。
■这项随机临床试验于2023年10月1日至11月30日在杭州杭州师范大学进行,中国。招募符合9项DSM-5-TR提出的IGD标准中至少6项的成年人(年龄≥18岁)接受MM或进行性肌肉松弛(PMR)。数据分析于2023年12月1日进行。
■参与者接受了MM训练(专注于注意力和接受的8次冥想计划)和PMR训练(身体放松的8次计划),分组进行,每周开会2次,共4周。
■此按方案分析仅包括完成预测试评估的参与者,8期培训,和后测评估。主要结果是成瘾严重程度(使用DSM-5-TR提出的IGD标准和互联网成瘾测试评分进行测量),游戏渴望(用游戏催促得分问卷衡量),以及通过功能磁共振成像上的线索渴望任务评估的血氧水平依赖性信号。使用方差分析比较行为和大脑测量结果。测量已识别的大脑区域之间的功能连通性(FC)以测试与MM相关的连通性变化。
■这项研究包括64名IGD成年人。共有32名参与者接受了MM(平均[SD]年龄,20.3[1.9]岁;17名女性[53%])和32名接受PMR(平均[SD]年龄,20.2[1.5]岁;16名妇女[50%])。MM组IGD严重程度降低(前测与后测:平均值[SD],7.0[1.1]vs3.6[0.8];P<.001)和PMR组(平均值[SD],7.1[0.9]对6.0[0.9];P=.04)。与PMR组相比,MM组的IGD严重程度降低更大(MM组与PMR组的平均[SD]评分变化,-3.6[0.3]vs-1.1[0.2];P<.001)。正念冥想与双侧扁形核的大脑激活减少有关(r=0.40;95%CI,0.19至0.60;P=0.02),脑岛(r=0.35;95%CI,0.09至0.60;P=0.047),和内侧额回(MFG;r=0.43;95%CI,0.16~0.70;P=0.01)。MFG-LentiformFC增加,渴求减少(前测与后测:平均值[SD],58.8[15.7]vs33.6[12.0];t=-8.66;2=0.30;P<.001)在MM后观察到,MFG-lentiformFC的变化介导了正念增加和渴望减少之间的关系(中介效应,-0.17;95%CI,-0.32至-0.08;P=0.03)。
■在这项研究中,与PMR相比,MM在降低成瘾严重程度和游戏欲望方面更有效。这些发现表明,MM可能是IGD的有效治疗方法,并可能通过改变额头石途径发挥其作用。
■中国临床试验注册标识符:ChiCTR2300075869。
UNASSIGNED: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), recently identified internet gaming disorder (IGD) as a condition warranting more research, and few empirically validated treatments exist. Mindfulness
meditation (MM) has multiple health benefits; however, its efficacy in treating IGD and potential neural mechanisms underlying MM treatment of the disorder remain largely unknown.
UNASSIGNED: To explore the efficacy of MM used to treat adults with IGD and to identify neural mechanisms underlying MM.
UNASSIGNED: This randomized clinical trial was performed from October 1 to November 30, 2023, at Hangzhou Normal University in Hangzhou,
China. Adults (aged ≥18 years) who met at least 6 of the 9 DSM-5-TR proposed criteria for IGD were recruited to receive either MM or progressive muscle relaxation (PMR). Data analysis was performed on December 1, 2023.
UNASSIGNED: Participants underwent MM training (an 8-session
meditation program that focuses on attention and acceptance) and PMR training (an 8-time program for body relaxation) delivered in groups that met 2 times each week for 4 weeks.
UNASSIGNED: This per-protocol analysis included only participants who finished the pretest assessment, 8 training sessions, and posttest assessment. The main outcomes were addiction severity (measured with the DSM-5-TR proposed criteria for IGD and with Internet Addiction Test scores), gaming craving (measured with Questionnaire for Gaming Urges scores), and blood oxygen level-dependent signals assessed with cue-craving tasks on fMRI. Behavioral and brain measurements were compared using analysis of variance. Functional connectivity (FC) among identified brain regions was measured to test connectivity changes associated with MM.
UNASSIGNED: This study included 64 adults with IGD. A total of 32 participants received MM (mean [SD] age, 20.3 [1.9] years; 17 women [53%]) and 32 received PMR (mean [SD] age, 20.2 [1.5] years; 16 women [50%]). The severity of IGD decreased in the MM group (pretest vs posttest: mean [SD], 7.0 [1.1] vs 3.6 [0.8]; P < .001) and in the PMR group (mean [SD], 7.1 [0.9] vs 6.0 [0.9]; P = .04). The MM group had a greater decrease in IGD severity than the PMR group (mean [SD] score change for the MM group vs the PMR group, -3.6 [0.3] vs -1.1 [0.2]; P < .001). Mindfulness
meditation was associated with decreased brain activation in the bilateral lentiform nuclei (r = 0.40; 95% CI, 0.19 to 0.60; P = .02), insula (r = 0.35; 95% CI, 0.09 to 0.60; P = .047), and medial frontal gyrus (MFG; r = 0.43; 95% CI, 0.16 to 0.70; P = .01). Increased MFG-lentiform FC and decreased craving (pretest vs posttest: mean [SD], 58.8 [15.7] vs 33.6 [12.0]; t = -8.66; ƞ2 = 0.30; P < .001) was observed after MM, and changes in MFG-lentiform FC mediated the relationship between increased mindfulness and decreased craving (mediate effect, -0.17; 95% CI, -0.32 to -0.08; P = .03).
UNASSIGNED: In this study, MM was more effective in decreasing addiction severity and gaming cravings compared with PMR. These findings indicate that MM may be an effective treatment for IGD and may exert its effects by altering frontopallidal pathways.
UNASSIGNED: Chinese Clinical Trial Registry Identifier: ChiCTR2300075869.