病态计算机成瘾者的改变的奖惩过程

1、病态计算机成瘾者改变的奖惩过程一个在半自然条件下的游戏设计的ERP研究结果摘要 Introduction : Internet Gaming Disorder has been added as a research diagnosis in section III for the DSM-V. Previous findings from neuroscientific research indicate an enhanced motivational attention toward cues related to computer games, similar to findings

2、in substance-related addictions. On the other hand in clinical observational studies tolerance effects are reported by patients with Internet Gaming disorder. In the present study we investigated whether an enhanced motivational attention or tolerance effects are present in patients with Internet Ga

3、ming Disorder. 介绍：网络成瘾障碍已经被列入DSM-5第三部分的一项分析调查诊断分析。先前的神经科学的研究已经指出了（网络成瘾者）对于网络游戏的注意力有提高，这与相关物质成瘾相似。另一方面，临床调查研究了网路成瘾患者忍耐力的影响。 Methods : A clinical sample from the Outpatient Clinic for Behavioral Addictions in Mainz, Germany was recruited, fulfilling the diagnostic criteria for Internet Gaming Disorder

4、. In a semi-natural EEG design participants played a computer game during the recording of event-related potentials to assess reward processing. 方法：在临床门诊病人中筛选出符合网络成瘾障碍标准的一个样本，在半自然的EEG设计中进行网络游戏，并记录该过程的势函数和评估其奖惩过程。 Results : The results indicated an attenuated P300 for patients with Internet Gaming Di

5、sorder in response to rewards in comparison to healthy controls, while the latency of N100 was prolonged and the amplitude of N100 was increased. 结果：结果显示网络成瘾者在对奖励的反应上相对于健康组在P300上较弱，并且N100的潜伏期延长，振幅增加。 Conclusions : Our findings support the hypothesis that tolerance effects are present in patients wit

6、h Internet Gaming Disorder, when actively playing computer games. In addition, the initial orienting toward the gaming reward is suggested to consume more capacity for patients with Internet Gaming Disorder, which has been similarly reported by other studies with other methodological background in d

7、isorders of substance-related addictions. 结论：我们的研究支持“忍耐力的影响在网络成瘾者进行网络游戏的过程中体现出来”这一假设。先前对于游戏奖赏的定向研究认为网络成瘾者消耗了更多的容量，这和其他对于物质成瘾方法论背景研究的成果相似。 Event-related potentials incentive sensitization internet gaming disorder pathological computer gaming psychophysiological responses tolerance 关键词：事件相关势函数；刺激敏感性；网

8、络游戏障碍；病态网络游戏；生理心理学反应；忍耐力。介绍 The excessive use of applications in the internet, predominantly the use of online games, has been under investigation by a growing number of researchers during the past 10 years. Internet Gaming Disorder (IGD) has been added as a research diagnosis in section III for the

9、 recently published DSM-V in the new diagnostic chapter “Substance Use and Addictive Disorders”, while “Gambling Disorder” is proposed to be included in the section as a first behavioral addiction diagnosis.网络成瘾现象在不断上升，网络成瘾障碍已被列入DSM-5的第三部分作为新的诊断章节“物质使用及成瘾障碍”，然而“赌博障碍”也被提议被包含进该章节作为第一大行为成瘾诊断。The motiva

10、tional relevance of addiction-specific cues in the development of addiction has been reported in numerous studies, which focus on how the brain of addicted individuals, regardless of the specific form of dependence, reacts toward those addiction-related cues. This idea is based on the assumption tha

11、t the brain is not able to process all environmental stimuli simultaneously. Behaviorally important information is therefore selectively attended to, which is thought to be guided by stimulus-related effects but also by properties of the observer himself. 特殊成瘾的动机相关性在成瘾的发展中已经在许多研究中被多次报道，它们关注于成瘾个体的大脑是

12、如何不顾特殊形式的成瘾而反应于成瘾相关线索的。这些观点基于一个假说：大脑不能同时处理所有的环境刺激。行为上的重要信息是选择性地处理与刺激相关的影响并且取决于观察者自身的人格。（切）Brosch suggest that different sub processes are acting together to form selective attention. These include networks for endo- and exogenous cues, but also special processes for emotionally salient cues. Selecti

13、ve attention toward these cues is thought to be unconscious, however, influenced by current emotional states (e.g. Fox et al. 2001; Bishop et al. 2004, 2007). The development of unconscious selective attention toward behaviorally relevant cues in addiction is described by the theoretical framework o

14、f incentive sensitization by Robinson and Berridge (2003) as increased “wanting” of the drug/behavior through an alteration of the brain reward system is basic to cue-reactivity paradigms. These paradigms assess how the brain reacts to cues that have become motivationally relevant to the addicted in

15、dividual.Brosch认为不同的处理器同时工作以形成选择注意。这包括网络的内在和外在线索以及突出情绪线索的特别过程。情绪注意指向于取决于当前情绪状态的无意识线索。对于成瘾行为的相关线索的无意识注意被Robinson 和Berridge的刺激敏感化的理论框架描述为，大脑通过相关线索的形态改变了奖赏系统，使得对于药物和行为的“wanting”增加。这些线索形态评估了大脑是如何对成为成瘾个体的动机相关线索作出反应。Thalemann investigated specific cue-reactivity to computer game-related cues in excessive

16、computer gamers by using electroencephalography (EEG). They compared the reactions of excessive (gamers meeting at least three criteria for IGD) and casual computer gamers to computer game-relevant and -irrelevant cues to find out whether emotional processing differed between the groups. The excessi

17、ve computer gamers were found to have an increased response to the computer game-relevant cues in comparison to the casual gamers who responded to the computer game-relevant cues in the same way as to the neutral cues. An enhanced late positive complex (LPC) which seems to be functionally similar to

18、 the P300 component in the ERP was recorded for the excessive computer gamers as a reaction to the computer game-relevant cues. Casual gamers displayed an enhanced LPC only for cues of emotional valence (positive and negative). This pattern is similar to reactions of substance-dependent subjects to

19、substance-relevant cuesand of pathological gamblers to gambling-cuesThalemann 在过度网络游戏者身上用EEG研究了对电脑游戏相关线索的特别线索反应。他们比较了过度计算机游戏者和临时计算机游戏者对计算机游戏相关线索和非相关线索的反应以找出两者情绪加工过程是否有差异。网络游戏成瘾者表现出对电脑游戏相关线索增加的反应，而临时游戏对照组表现出对电脑游戏相关线索与中性线索一样的反应。在功能上相似于P300原件的LPC（后正复合体）被用于记录网络游戏者对电脑游戏相关线索的反应，其表现为增强。而临时对照组在LPC上仅对情绪效价（即正

20、性和负性的线索）表现为增强。这一现象与物质成瘾者对物质相关线索的反应，病态赌博患者对赌博线索的反应相似。（切）Likewise, in an fMRI-study found that cue-exposure of online-game screenshots led to increased activation of bilateral dorsolateral prefrontal cortex (DLPFC) in subjects meeting criteria for Internet Gaming Disorder, reflecting enhanced emotion

21、processing. In adolescents who frequently played video games higher left ventral striatum volume was found with voxel-based morphometry (VBM), which is thought to reflect altered reward processing and represent adaptive neural plasticity. General similarities in the underlying brain processes involv

22、ed in abusewhether substance dependent or behavioralhave been shown.另外，一项fMRI的研究表明，满足多项标准的网络游戏成瘾者对网络游戏截图的线索暴露显示为双侧DLPFC（背外侧前额叶）增强的激活，反应了增强的情绪过程。通过基于体素的MRI形态分析法，在频繁上网的青少年中发现了他们更高的左腹侧纹状体体积，这被认为是反应改变了奖惩过程，表现了神经的适应性。相似性在与滥用有关的潜在的大脑过程，无论是物质滥用或是行为成瘾，都有体现。 In an epidemiological study found that students wh

23、o fulfilled the criteria of Internet Gaming Disorder measured by the AICA-S self-report scale (Scale for the Assessment of Internet and Computer game Addiction) also reported a more pronounced increase in the amount of time spent playing computer games. Tolerance is thought to develop through neurob

24、iological processes of adaptation leading to habituation of the individual reaction toward the addictive substance or a specific behavior.在一项流行病学的研究中也发现IGD使用电脑游戏的时间有显著的增长。忍耐力被认为通过发展神经生物学的过程以适应个体对物质成瘾或特殊行为成瘾的习惯。（切）As opposed to the model of incentive sensitization, the concept of tolerance describes

25、the process that increases the necessity for dependent individuals to seek the drug/behavior in higher doses or increased frequency. The individual becomes habituated to the effects of the drug or behavior itself, not to the cues or the visual/auditory presentation of the drug/behavior as in incenti

26、ve sensitization. Individuals who abuse computer gaming therefore need to play more often or for a longer duration to achieve the same effects as before which also can be explained by an altered reward system in the brain. Neurotransmitter-systems involved in the perception of reward seem to be dist

27、urbed not only in drug-related but also in behavioral addiction, as shown by Hu and colleagues who used single-photo emission computed tomography (SPECT) to investigate whether striatal dopamine transporter (DAT) levels were altered in individuals with IGD and found supporting results.不同于刺激敏感性，忍耐力的概

28、念是指，成瘾个体不得不增加药物的剂量或行为的频率。个体开始习惯于药物或行为本身的影响而不是药物或行为的视听觉的刺激敏感性线索。滥用电脑游戏的个体因此需要保持游戏持续状态以达到像以前一样的影响，这也被解释为大脑奖惩系统的改变。对奖惩知觉的神经传导系统似乎对药物相关和行为成瘾变得混乱，Hu和他的同事用单光子发射计算机断层成像术研究了纹状体多巴胺转运体水平在IGD个体上是否发生了改变，结果支持上述结论。The sample originally consisted of 30 male participants, of whom 15 fulfilled the criteria for IGD,

29、especially pathological computer gaming (PCG), and 15 fulfilled the criteria of casual computer gaming (CG). This classification was made with the self-report questionnaire Scale for the Assessment of Internet and Computer game Addiction (AICA-S, CSV-S). A cutoff score of seven of a possible total s

30、core of 27 is an indicator for addicted computer gaming. Casual computer gaming is classified as a score of 03. Additionally, the participants classified as pathological computer gamers underwent a clinical interview by an expert psychologist in order to establish need for treatment For EEG-measurem

31、ent purposes only right-handed participants of full age with normal or corrected-to-normal vision were included.原始样本由30名男性构成，15名符合IGD标准，尤其符合病态电脑游戏标准；15名临时电脑游戏对照组。分类由AICA-S和CSV-S完成。27分及以上为IGD，3分及以下为对照组。另外，病态网络游戏者的分类来自专业心理学者的临床访问，为了确立治疗关系EEG测量仅针对右利手的符合年龄的视力正常或矫正后正常的参与者。（图表）Its items are closely relate

32、d to clinical criteria of substance-related addictions and thus operationalize IGD in a similar way as the Internet Addiction Test (Young 2007), a wide spread measure for IGD. Reliability and factorial as well as construct validity of AICA-S was well demonstrated (Wo ¨lfling et al. 2011b).由Youn

33、g编制的被广泛应用于IGD的网络成瘾量表用与物质相关成瘾的临床诊断标准相同的方式诊断IGD，AICA-S的题目与其十分接近。AICA-S的可靠性及结构的合理性已经被很好的证实。The SCL-90R is a 90-item, self-reported inventory widely used to measure current distress. Nine separate syndrome scales can be calculated. Various studies have proven the validity of the scales. The reliability

34、(internal consistency) of the nine scales lies between 0.80 and 0.90. The scale for depressiveness is used here, as group differences on depression may have influence on the P300 (Singh et al. 2000).SCL-90R是一个90道题目的自我报告，被广泛地用于测量当前的痛苦，其中有9个独立的综合症量表可以被统计。多项研究已经证实了量表的效度。9个量表在国内的可靠性在0.80-0.90之间。因为抑郁的组间差

35、异可能对P300有影响，所以用于抑郁症的量表在这里被应用。Semi-natural design (2D-Computer Game sequence) The computer game sequence used in this experiment consisted of a specifically programmed virtual environment through which the participants had to maneuver to acquire tokens (small trophy symbols). None of the participants

36、 had seen or played this specific computer game sequence beforeThe 2D Game was designed to be not generally arousing so that the occurrence of reward would stand out and overall arousal would not confound the effects Triggers were sent to Analyzer Soft-ware whenever a token was visible and whenever

37、it was acquired. 半自然设计的2D游戏程序在本实验中这种电脑游戏在特定的虚拟程序环境下进行，参与者需要巧妙地操作以获得奖励。所有参与者之前并未接触过这种特殊的电脑游戏这个2D游戏不是通常的唤醒方式，奖惩将会出现并且所有的唤醒均不会对影响结果。每当奖励物出现并当它被获得时，数据便会呈递给分析软件。The EEG-data were recorded using Brain Vision Recorder software and analyzed using Brain Vision Analyzer 2.0.1 software (Brain Products, 2012) t

38、o identify event-related potentials (ERPs). We applied the Gratton & Coles ocular correction algorithm and filtered the data. The data were then segmented to epochs of 1200 ms (200 ms to 1000 ms) by markers set by the Presentation software (Neurobehavioral Systems) around finding the reward and

39、semi-automatically checked for artifacts. In total only 2.96% of the epochs were rejected and there was no significant difference for the number of rejected epochs between the groups (T=1.540,P=0.136)After visual inspection peak detection was used to detect differences between peaks of the N100, N20

40、0, P200, P300 and the results were exported per electrode and participant to IBM SPSS Statistics Version 20. The time range for the different components were 100 ms to 180 ms for N100, for N200 180300 ms, for P200 150 ms to 250 ms and for P300 200 ms to 600 ms. For the ERP-data separate 29393 repeat

41、ed-measures ANOVAs with group as between subject factor (PCG vs. CG) and sagittal (left, central, right) and coronal (frontal, central, parietal) electrode position as within-subject factors were conducted. EEG数据由Brain Vision Recorder软件记录，由Brain Vision Analyzer 2.0.1软件分析ERP，我们用Gratton & Coles 的眼

42、电校正算法过滤数据。数据在1200ms内分段并被上述软件标记，在此间只有2.96%没有显著差异。波峰检测用于区别N100，N200，P200，P300，每个电极的结果都被输出并用于IBM SPSS Statistics Version 20分析。不同成分的时间范围如下：N100：100-180ms；N200：180-300ms；P200：150-250ms；P300：200-600ms。ERP数据在PCG和CG以及矢状（左中右）和冠状（额顶枕）等电极位置中分离出由实验者内部因素导致的29393个方差分析数据。（不确定）As expected, pathological computer gam

43、ers scored significantly higher on the AICA-S than the control group. They also reported longer hours of playtime during the week and on the weekend and a higher number of negative consequences resulting from playing computer games. In addition, they also reported higher craving and cognitive involv

44、ement with computer games (see Table 2). However, the groups did not differ on ratings for depressiveness, as measured with subscale from the SCL-90R. For EEG-Data only significant group and group-interaction effects are reported.病态网络成瘾者的AICA-S量表得分显著高于对照组。他们每周花了很多时间游戏并且从游戏中得到了许多消极的反应。他们也表现出对电脑游戏较高的渴

45、望和兴趣。然而，从SCL-90R的结果显示，两者组间的抑郁评定等级并无差异。EEG数据显示了显著性和组间差异。The latencies of the components were entered into a MANOVA, revealing significant differences between PCG and CG for the N100 (F1 =5.728, P=0.028) with longer latencies for PCG.把潜伏期的数据进行多因素方差分析，发现了PCG和CG间的显著差异，PCG有更长的潜伏期。The amplitude of the N10

46、0 was qualified by a significant interaction between sagittal electrode position and group (F2 =13.55, P<0.001). Post-hoc analyses showed that PCG had a significantly more negative N100 amplitude in comparison to CG on the left hemisphere (F=7.452, P=0.011) and on midline (F1 =14.54, P=0.001). Fo

47、r N200 peak amplitude sagittal electrode position significantly interacted with group (F1 =10.633, P<0.001), however, there were no significant between-groups effects. A significant interaction between sagittal electrode position and group was found for the P200 (F2 =5.036, P=0.015). Post-hoc ana

48、lyses showed that PCG had a significantly less positive P200 amplitude in comparison to CG on the left hemisphere (F1 =4.950, P=0.035) and on midline (F1 =7.997, P=0.009). For the P300 peak there was a significant interaction between sagittal electrode position and group (F2 =5.576, P=0.01; see Fig.

49、 1). Post-hoc analyses showed that PCG had a significantly less positive P300 amplitude in comparison to CG on the left hemisphere (F1 =7.403, P=0.012) and on midline (F1 =6.738, P=0.016; see Fig. 2 and Table 3). In summary PCG showed longer latencies for the N100 and enhanced N100 and reduced P200

50、and P300 amplitudes especially on the left hemisphere and on central electrode sites. Significant results for N200 amplitude were based on differences within groups.N100的振幅被在矢状面电极位置和两组之间的显著相互作用所限制。方差齐性检验分析发现PCG相对于CG在中线及左半球区域有一个明显的N100负性振幅。而N200在矢状面电极位置的峰值与两组显著相关，但两组之间并无显著影响。在P200发现了在状面电极电位和两组之间的显著相关

51、。方差齐性分析显示PCG相对于CG在中线和左半球有一个显著的“不积极”的P200振幅（Fig.1）。P300的发现与P200相同（Fig.2 & table.3）。总之，PCG的N100有一个长时间的潜伏期，并且延长了N100，降低了特别是在左半球和中心电极区域的P200和P300的振幅。N200振幅的显著性结果基于组间差异。The results indicated significant differences in mean amplitude of the P300 between the groups during the finding of reward. There a

52、re two possible explanations four our findings. First, individuals with IGD might have a general reduced sensitivity to “natural rewards”. This argumentation is especially interesting as previous research in cognitive processing in substance-dependent individuals attributed the attenuated amplitude

53、of the P300 to the effects of the substances on the brains reward circuits. As the blunted reaction toward rewards has been shown and as in IGD there is no substance involved this explanation would definitely support the idea that other processes than the detrimental effects of the drug are involved

54、 in how the reward sensitivity of the brain is changed, namely underlying cognitive and emotional dysfunction in addiction. This explanation is difficult as a previous study on the sensitivity to rewards by Dong found a hypersensitivity to guessing-game rewards in IGD, which is in conflict with the

55、current findings. In addition the group of IGD is special in the sense that in contrary to, for example, guessing games in SUDs the computer game reward actually is was constitutes the rewarding effect of the “drug” computer game. Therefore, a second explanation is possible, namely that our findings

56、 support the idea that the electrophysiological reaction toward rewards is a correlate of opponent-processes leading to tolerance, a well-described brain reward circuit alteration in SUDs. According to Volkow, there is a difference between the sensitivity of reward circuits (lowered in individuals wit