The effect and neural changes underlying mindfulness meditation training in patients with comorbid internet gaming disorder and depression: A randomized clinical trial

Internet gaming disorder (IGD) has been recognized as a serious mental illness and is often accompanied by depression (IGD-D). An ideal treatment strategy should have effects on both the conditions. Mindfulness meditation (MM) has attracted substantial attention for the treatment of psychiatric diseases; however, its effects on IGD-D and the underlying mechanisms remain unknown. A total of 70 patients with IGD-D were randomly divided into the MM and progressive muscle relaxation (PMR) groups. Of these patients, 61 completed the 1-month study (MM group, n = 34; PMR group, n = 27), including pre- and post-resting-state functional magnetic resonance imaging (fMRI) and 8 training sessions. Regional homogeneity and degree centrality were calculated, and overlapping brain regions were selected as seed points for functional connectivity (FC) analysis. The correlation of FC with behavioral data and neurotransmitters was subsequently evaluated. Compared with the PMR group, the MM group had less severe depression, addiction, and cravings. FC analysis showed that MM increased FC in the executive control, frontal-striatal, and default mode networks. FC was significantly correlated with 5-Hydroxytryptamine 1 A receptor, serotonin transporter, vesicular acetylcholine transporter and dopamine receptors D1 and D2. This study demonstrated that MM was effective in the treatment of IGD-D. MM altered the default mode network, enhanced top-down control, and emotion regulation, and disrupted negative reinforcement mechanisms. These phenomena were supported by the correlation between FC and behavioral as well as biochemical measures, suggesting that MM is a promising therapy for IGD-D.