fMRI: New Weapon in Battling Online Gaming Addiction

By Lingjun Kong

Online gaming addiction (OGA) has become a growing issue around the globe, but China has seen especially abnormal rates in recent years. Internet cafes are often crammed with adolescents, rapidly pressing buttons on their keyboards while yelling gaming jargon to their teammates as they engage in a virtual world online. Weekdays and weekends become intertwined as some of the young boys sleep in the café. This new lifestyle has become a cultural epidemic, many suffering from physical conditions such as gloomy eyes, skinny physique, and frantic rage, indifferent or extremely dissatisfied with the reality. The China Youth Internet Association reported in 2010 that the incidence of OGA in urban youth was approximately 14%. In 2009, a documentary titled “Who Took Our Children” described 30 incidents caused by OGA, including an infamous account of a 17-year-old boy who poisoned his parents.

Fearful of the consequences of this newly emerged disorder that is seemingly sweeping China’s urban youth, various institutions have begun crafting solutions to treat the addiction. The most common approach comes in the form of intervention clinics with intense training regimes. Even more draconian measures have been used such as electric shock treatments. Research efforts to understand the mechanisms underlying OGA focus on the disorder’s behavioral components, effects on society, and self-reported questionnaires diagnose techniques. However, recently, there have been an increasing number of studies that focus on understanding the neural mechanisms of the disorder. One of the more promising methods of studying OGA is functional magnetic resonance imaging (fMRI). This technique is an extension of MRI technology which can measure brain activity by imaging changes in blood flow and non-invasively produce real-time diagrams of activated brain regions during internet use. Numerous institutions in China are showing interest in dissecting OGA using fMRI.

In 2011, with support from multiple national institutions and agencies, one research group at the Second Xiangya Hospital in Changsha recruited 19 college students with OGA and 19 students without to serve as a control group. Each subject was shown a video of an online game during a 3-Tesla fMRI scan. Visualizing the difference in brain activations showed increased activity in the right superior parietal lobule, right insular lobe, right precuneus, right cingulated gyrus, and right superior temporal gyrus. The abnormal activation of the right brain in this study interestingly contradicts a popular opinion of Byun Gi-Won, a doctor at the Seoul’s Balance Brain Center in Korea, who stated that “heavy users are likely to develop the left side of their brains, leaving the right side untapped or underdeveloped.”

Simultaneously, another group led by Dr. Lei Hao from Wuhan Institute of Physics and Mathematics, used diffusion tensor imaging (DTI) with tract-based spatial statistics (TBSS) analysis to examine the microstructure of white matter among 17 OGA subjects and 16 healthy controls. TBSS showed that adolescents with OGA had significantly lower fractional anisotropy (FA) than controls in major white matter pathways. Such abnormal white matter structure may be connected to emotional processing and addiction related behavioral impairments. The study identified that FA can play a critical role as a qualified biomarker in the assessment of the effectiveness of interventions. Furthermore, the white matter integrity may serve as a potential new treatment target for OGA.

As more information is released regarding OGA, researchers are piecing together the neurological components of the addiction. Another study conducted at Dalian Medical University in Dalian, China, found increased brain activity in the dorsolateral prefrontal cortex, anterior cingulate cortex, and right inferior parietal cortex. Each region has been correlated with cravings. Two other task-related fMRI studies using similar cue-induced activation indicated similar brain images to people with substance addiction. With these series of newfound information, researchers began to explore solutions and analyze current efforts of treatment.

One of the popular beliefs among the general population is the idea that family neglect causes youth to look towards online gaming to fill the void. An interesting study conducted by Han et al. evaluated the effectiveness of a 3-week family therapy intervention on the brain activation response using fMRI. Families were asked to help with homework assignments for an hour a day, four days a week, to increase family cohesion. The result was increased activity of the caudate nucleus in response to images depicting parental affection and decreased correlation with images of online games than before the intervention. Their findings suggested that family cohesion may be an effective treatment method to treat OGA and is an important step in finding alternative methods of intervention than current extreme techniques.

The spread of online gaming addiction in China has been a massive issue for many families. Eager to help the nation’s youth, various forms of treatment sprung up to stem the outbreak. Now, researchers are arming themselves with fMRI technology to combat the disorder at a neurological perspective in real-time.

Lingjun Kong, PMP                                                                                                       Virtual Reality Medical Center                                                                                 San Diego, California                                                                       lkong@vrphobia.com