Self-and Other-Cognitive Neural Networks In Pathological Gamers: An FMRI Study

Background: The ability to perceive and understand one’s own and others’ perspectives and emotions is an important aspect of social cognitive processes.Previous studies have shown that people with Internet gaming disorder have self-related cognitive deficits,including reduced self-identity and low self-esteem.At the same time,they also show impairments in other-related cognitive aspects,mainly manifested as defects in Theory of Mind(To M)and reduced empathy,which may be associated with damage to specific brain regions.Previous neuropsychological paradigms used can only able to assess a single neural level(physical or psychological)of self and others cognition,or limited to a single form(cognitive or affective).In addition,most studies evaluate the neural networks of self-cognition and others’ cognition separately,and the evaluation methods are mostly in the form of pictures or questions.In this study,we developed a new multimodal fMRI video task paradigm,which not only can be used to measure the somatic level of cognition,but also incorporates topics related to the psychological level of cognition.This new video paradigm can also simultaneously measure self-perception and others neural networks associated with cognitive processing.Therefore,the purpose of this study was to(1)Establish an innovative fMRI video task and confirmatory assessment of its neural responses during perception and understanding of oneself and others;(2)To explore the differences between pathological gamers(PG)and health controls(HC)in neural responses during the task,further analyze the relationship between neural responses and related psychometrics;(3)Psychophysiological interaction analysis(PPI)was used to explore the functional connectivity of regions of interest(ROIs)with whole-brain voxels during the processing of tasks related to self-and others’,further to elucidate the differences between PG and HC.This study will contribute to the exploration and better understanding of the neural mechanisms of behavioral addiction.Methods: The fMRI task is a novel video paradigm designed in blocks,each block containing one subject in one condition(self,close friends,and strangers)(four subjects in total,which are personal introduction,positive character traits,personal values and expectations,future goals).Screening was performed using the Internet and Computer Gaming Addiction Assessment Questionnaire(AICA-C),recruited from outpatient clinics at the Central Institute of Mental Health in Mannheim,Germany,participates with AICA-C≥7 were classified as pathological internet gamers.During the same period,healthy controls were recruited according to matching principles such as age and education level.During the first interview,we ensured that the subjects met the above inclusion criteria and asked the participants to bring one close male friend of the same age for the first interview.After they completed the interviews and psychometrics,we recorded four separate videos of the participants themselves and their close friends.During the second interview,participants took a drug screening test.They then watched videos of themselves,close friends and strangers during the fMRI.Sociodemographic information was collected for all subjects,which included the Rosenberger Self-Esteem Scale(RSES),the Fragebogen Zum K(?)rperbild(FKB-20),Social Anxiety and Social Competencies(SASKO)questionnaire,Emotional Competencies(EKF)and Empathy Questionnaire(EQ).After the inclusion/exclusion criteria and quality control of the data,73 subjects were finally included,35 PG and 38 HC.(1)Combining fMRI data and the findings of previous meta-analyses to verify the validity of the video paradigm and pioneering its application in patients with gaming disorders;(2)Through whole-brain activation analysis,we explored the brain activation in the two task states of "self vs others" and "others vs self",compared the differences in neural responses between the PG and HC groups,and further analyzed related psychological characteristics and abnormalities Correlation between beta values of activated brain regions;(3)Psychophysiological interaction analysis(PPI)was used to study the functional connectivity between seed ROIs of interest(seed ROI)and whole-brain voxels during self-and others-video task processing,and to explore the differences in brain function connectivity between the two groups.Results:(1)Psychometrics findings indicate that PGs rated their body images as more negative and showed significantly lower scores on self-esteem,recognition of others’ emotions,and regulation of their own emotions compared to HCs.Furthermore,they showed higher scores on the scale‘rejection of the own body image’,on all scales of social anxiety,and social competencies.Although the scores on empathy,the ability to express and recognize one’s own emotions,as well as the evaluation of the vital body image were descriptively lower in PGs,between-group differences did not reach significance.(2)Within-group whole-brain activation analysis revealed that for the condition "self vs others",the activation in the bilateral insula and left IFG was significantly increased in the HC group.In the PG group,bilateral insula,ACC,left IFG,and in the left supplementary motor area and dorsal striatum(right putamen)were significantly activated.For the condition "others vs self",whole-brain activation analysis showed that bilateral AG,precuneus,temporal lobes(MTG and inferior temporal gyrus),medial orbitofrontal cortex(OFC,which was considered to be related to ventromedial Prefrontal Cortex),posterior cingulate gyrus(PCC),and right superior temporal gyrus(STG)were significantly activated in the HC group.In the PG group,significantly activated brain areas were bilateral AG,precuneus,MTG,right STG. (3)Whole-brain activation analysis between groups showed that for the condition "others vs self",compared with the HC group,the PG group showed significantly decreased activation in left MTG,STG,inferior temporal gyrus(ITG),fusiform gyrus,middle occipital gyrus and suboccipital gyrus than the HC group.The peak MNI coordinates of the low activation area were located on posterior MTG,which accounted50.3% of the entire activation cluster.We extracted the Beta values of the significantly activated brain regions for comparison between groups,and we found that the PG group had significantly decreased activation in the MTG,STG,inferior temporal gyrus(ITG),fusiform gyrus,middle occipital gyrus and inferior occipital gyrus.(4)The results of correlation analysis showed that: in the whole group,the activation of the left MTG brain area(others vs self)was significantly negatively correlated with the severity of addiction symptoms(ROI left MTG;#voxel =73;MNI=-66-50 2;P cluster(FWE)=0.030).In addition,we also found activation of left MTG(others vs self)and the recognition of one’s own emotion(ROI left MTG;#voxel =66;MNI=-52-60 14;P cluster(FWE)=0.036),also with the regulation of one’s own emotion(ROI left MTG;#voxel =82;MNI=-52-64 22;P cluster(FWE)=0.026).Further correlation analysis in SPSS,we found that in the whole group,activation of the left MTG(others vs self)was associated with the severity of addiction symptoms in the past 30 days(r=-0.37,p<0.001)and lifetime addiction symptom severity(r=-0.34,p < 0.001)was significantly negatively correlated.In addition,we also found a significant positive correlation between activation of the left MTG(others vs self)and the recognition of one’s own emotion(r=0.25,p<0.05).there was a positive correlation between the left MTG and the regulation of one’s own emotion,but the result was not significant(r=0.21,p>0.05).(5)Psychophysiological interaction analysis(PPI)analysis within the group showed: For the condition "self vs others" In the HC group,the functional connectivity of the left insula,the right insula,the left triangular inferior frontal gyrus,the anterior cingulate gyrus,and the default network MPFC with other brain voxels were increased significantly;In the PG group,the left triangle inferior frontal gyrus and operculum inferior frontal gyrus had increased connectivity with other brain voxels.For the condition "others vs self",In the HC group,left posterior middle temporal gyrus,right posterior middle temporal gyrus,left angular gyrus,right angular gyrus,and right posterior superior temporal gyrus showed increased functional connectivity with other brain voxels.The PG group had significantly increased functional connectivity with other brain regions in the posterior right middle temporal gyrus and precuneus.(6)The brain functional connectivity analysis between groups showed that for the condition "self vs others",in the PG group,there was significantly reduced functional connectivity between the anterior cingulate gyrus and occipital lobe(# voxel =360;MNI=-10-78-08;P cluster(FWE)<0.05)(bilateral lingual gyrus,left occipital pole,left occipital fusiform gyrus),also significantly reduced functional connectivity between anterior cingulate and occipital lobes(# voxel =303;MNI=-14-90+20;P cluster(FWE)< 0.05)(bilateral occipital poles,superior lateral occipital lobes).For the condition "others vs self",it was found that the PG group showed significantly decreased functional connectivity between the right angular gyrus and frontal lobe(# voxel =295;MNI=-12+02 +64;P cluster(FWE)< 0.05)(left superior frontal gyrus,bilateral motor cortex,left precentral gyrus),as well as between MPFC and frontal lobes(# voxel =336;MNI=-26 +04 +08;P cluster(FWE)<0.05)(left insula,putamen,caudate nucleus,precentral gyrus,inferior frontal gyrus,and inferior frontal gyrus of insula operculum).Conclusion: The main conclusions of this study are as follows:1.The innovative video paradigm used in this study successfully activated the brain regions related to self and others cognitive representative,and it can be an effective psychological paradigm for evaluating the neural correlates of self and others.2.Pathological internet game users have defects in the ability to perceive and understand the mental state of others,which may be related to the defects of To M-related processing,mainly manifested in the decreased activation of p MTG.3.The decreased functional connectivity between ACC-visual cortex,right angular gyrus-bilateral motor cortex,and MPFC-dorsal striatal circuit may be the neuropathological basis of pathological internet game using.4.Abnormally activated brain regions and abnormally connected neural circuits may be potential targets for neuromodulation therapy for pathological internet game using.Proper interventions may alter motivations and behaviors of pathological internet gaming use and improve social cognition.