Transcranial Direct Current Stimulation for Online Gamers

Summary

We present a protocol and a feasibility study for applying transcranial direct current stimulation (tDCS) and neuroimaging assessment in online gamers.

Abstract

Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that applies a weak electric current to the scalp to modulate neuronal membrane potentials. Compared to other brain stimulation methods, tDCS is relatively safe, simple, and inexpensive to administer.

Since excessive online gaming can negatively affect mental health and daily functioning, developing treatment options for gamers is necessary. Although tDCS over the dorsolateral prefrontal cortex (DLPFC) has demonstrated promising results for various addictions, it has not been tested in gamers. This paper describes a protocol and a feasibility study for applying repeated tDCS over the DLPFC and neuroimaging to examine the underlying neural correlates in gamers.

At baseline, individuals who play online games report average weekly hours spent on games, complete questionnaires on addiction symptoms and self-control, and undergo brain ¹⁸F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET). The tDCS protocol consists of 12 sessions over the DLPFC for 4 weeks (anode F3/cathode F4, 2 mA for 30 min per session). Then, a follow-up is conducted using the same protocol as the baseline. Individuals who do not play online games receive only baseline FDG-PET scans without tDCS. Changes of clinical characteristics and asymmetry of regional cerebral metabolic rate of glucose (rCMRglu) in the DLPFC are examined in gamers. In addition, asymmetry of rCMRglu is compared between gamers and non-gamers at baseline.

In our experiment, 15 gamers received tDCS sessions and completed baseline and follow-up scans. Ten non-gamers underwent FDG-PET scans at the baseline. The tDCS reduced addiction symptoms, time spent on games, and increased self-control. Moreover, abnormal asymmetry of rCMRglu in the DLPFC at baseline was alleviated after tDCS.

The current protocol may be useful for assessing treatment efficacy of tDCS and its underlying brain changes in gamers. Further randomized sham-controlled studies are warranted. Moreover, the protocol can be applied to other neurological and psychiatric disorders.

Introduction

In recent years, increasing attention has been paid to excessive online game use since its associations with negative impact on mental health and daily functioning as well as with internet gaming disorder (IGD) have been reported^1,2,3. Although several treatment strategies including pharmacotherapy and cognitive-behavioral therapy have been evaluated, evidence for their effectiveness is limited⁴.

Previous studies have suggested that IGD may share clinical and neurobiological similarities with other behavioral addictions and ....

Protocol

All experimental procedures presented in this protocol have been approved by the Institutional Review Board and are in accordance with the Declaration of Helsinki.

1. Research Participants

1. Recruit individuals who report that they play online games (the gamer group) and those who report that they do not play online games (the non-gamer group).
   NOTE: Here, we included individuals with two or more IGD symptoms according to the Diagnostic and Statistical Manual of Mental Disorders-5²³ or those who play games at least one hour per day on average in the gamer group. The non-gamer group u....

Results

A total of 15 gamers (Table 1) and 10 non-gamers were recruited. The mean age of the gamer group (21.3 ± 1.4) was significantly lower than that of the non-gamer group (28.8 ± 7.5) (t = -3.81, p < 0.001). There were 8 men in the gamer group and 6 men in the non-gamer group (χ² = 0.11, p = 0.74).

Behavioral results using linear mixed models indicate that the tDCS sessions successfully lowered the IAT score (z = -4.29, p < 0.001), weekly hours sp.......

Discussion

We have presented a tDCS and neuroimaging protocol for online gamers and assessed its feasibility. The results demonstrated that repeated sessions of tDCS over the DLPFC reduced online game addiction symptoms and average time spent on games and increased self-control. An increase in self-control was correlated with a decrease in addiction symptoms. Moreover, the abnormal asymmetry of rCMRglu in the DLPFC where the right side was greater than the left side was improved after the tDCS sessions in the gamer group. These res.......

Materials

Name	Company	Catalog Number	Comments
Discovery STE PET/CT Imaging System	GE Healthcare
MarsBaR region of interest toolbox for SPM	Matthew Brett		Neuroimaging analysis software; http://marsbar.sourceforge.net/
Statistical Parametric Mapping 12	Wellcome Centre for Human Neuroimaging		Neuroimaging analysis software; https://www.fil.ion.ucl.ac.uk/spm/software/spm12/
Transcranial direct current stimulation device	Ybrain	YDS-301N
WFU_PickAtlas	ANSIR Laboratory, Wake Forest University School of Medicine		Neuroimaging analysis software; https://www.nitrc.org/projects/wfu_pickatlas/