- Retrieval-aversive conditioning reduced cue-induced activation in left insula and middle frontal gyrus and increased left postcentral gyrus activation.
- R-AC training significantly reduced addiction severity and self-reported gaming craving on the IAT and gaming craving scale.
- Reductions in frontal activation were negatively correlated with decreases in addiction severity across participants.
Commun Med (Lond). 2026 Jul 3. doi: 10.1038/s43856-026-01705-4. Online ahead of print.
ABSTRACT
BACKGROUND: Internet gaming disorder (IGD) is a growing mental health concern worldwide, yet effective interventions remain limited. Inspired by memory reconsolidation theory, conditioning, and previous work on retrieval-extinction procedures in substance addiction, this study developed a retrieval-aversive conditioning (R-AC) training protocol to target addiction-related memories in IGD.
METHODS: The trial was registered with the Chinese Clinical Trial Registry (ChiCTR; registration number: ChiCTR2500095444; https://www.chictr.org.cn/) on January 7, 2025. This was a single-center randomized controlled trial conducted in Hangzhou, China. Sixty-two individuals with IGD were randomly assigned to an R-AC group (n = 30) or a control group (n = 32). The R-AC group underwent five days of training involving memory reactivation via gaming cues followed by aversive conditioning within the reconsolidation window. Participants were blinded to the existence of the other group. The primary outcome was neuroimaging measures derived from task-based fMRI, specifically changes in brain activation associated with cue-induced craving following the intervention. Secondary outcomes included behavioral measures obtained from questionnaire assessments, including scores on the Internet Addiction Test (IAT), DSM-5 proposed criteria for IGD, and the gaming craving scale. Exploratory outcomes comprised correlation analyses examining the relationships between changes in brain activation (BOLD signals) and changes in behavioral measures.
RESULTS: The primary outcome shows decreased activation in the left insula and middle frontal gyrus, and increased activation in the left postcentral gyrus. Secondary outcomes show that R-AC training significantly reduces addiction severity scores and self-reported craving. Exploratory outcomes show that changes in frontal activation are negatively correlated with reductions in addiction severity. No adverse events are reported.
CONCLUSIONS: These findings suggest that R-AC training effectively attenuates gaming craving and modulates neural circuits involved in craving and executive control, offering a promising behavioral intervention for IGD.
PMID:42399630 | DOI:10.1038/s43856-026-01705-4
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