Gaming Addiction are now recognized as an official disorder by the World Health Organization.  Researchers in Korea and China are now at the forefront of using EEG and related treatments to tackle the problem.

In 2009, Kim Sa-rang died of malnutrition. The three-year old’s parents routinely spent 12-hour gaming sessions raising a magical, virtual child in the Prius online world. It was the first legal case in South Korea to take gaming addiction head-on, and Kim Sa-rang’s mother was released on bail in consideration of her addiction. Though this is a particularly heart-wrenching story because of an innocent child’s death, there are a surprising number of cases where people shirk their responsibilities, health, and even lose their lives over video games. Stories of men found dead at their computers in Asian internet cafes abound. They have often been playing for hours with little food, water, or sleep. One gamer was murdered by a competitor after selling an online weapon. These are the extreme cases.

A less extreme and more common case was recounted to Vice reporter Matt Shea in a documentary series about gaming in South Korea: “Apart from sleeping, taking showers, or eating, I live in front of the computer,” a young man admits. The sentiment is not uncommon in a country where internet addiction has become a public health issue. A 2010 survey found that over 12 percent of South Korean youth used the internet addictively, spurring government programs to curb usage and protect young people. A 2015 survey indicated the number had since risen by 14 percent. As technology becomes ever more ubiquitous, programs to protect teenagers are unable to keep up.

Gaming addiction as a recognized disorder

Though Asian countries often house the more extreme and visible cases of internet addiction, the problem exists worldwide. One study estimates that 6 percent of the global population suffers from gaming or internet addiction. Calls to liken this addiction to more traditional addictions, and to treat it with the same grave importance, have faced an uphill battle.

This year, gaming addiction activists’ intent on getting the word out secured a notable win. Gaming disorders have featured in a drafted version of the eleventh edition of the International Classification of Diseases (ICD-11), an official listing of health disorders published by the World Health Organization. More and more, medical professionals are recognizing that our technology can trigger the same physiological buttons as drug addictions. Addiction is, after all, in the brain.

Finding gaming addiction in the EEG

How does one measure gaming addiction, and the broader internet addiction in the brain? Like drug addictions, behavioral addictions disturb and pervert reward pathways in the brain.  Behavioral addictions are also related to impulsivity control.  fMRI studies of internet addiction have shown changes in activation in the prefrontal cortex and in the fronto-striatal pathway. However, the ability of EEG to distinguish an internet addicted brain is less well studied. Researchers at the Department of Psychiatry at the Seoul National University College of Medicine in Korea have been particularly active in this pursuit.  The team has published a number of studies using eyes closed, resting state EEG in gaming and internet addicts versus non-addicts over the past five years. Their findings show differences in the power spectrum and gamma band coherence.

In one study (n=41) the addicted showed lower absolute power in beta activity in seven brain sites observed and higher absolute power in gamma activity in the frontal region (image on left).  They also found that the addicted group showed higher impulsivity scores and impaired inhibitory control and a significant correlation between these behavioral scores and the patterns of absolute beta and gamma power across frontal brain regions.

The results are certainly promising.  However, spectral analysis is limited in its discriminatory ability and new approaches may provide greater specificity of results.

From measurement to treatment

More than simply improving our understanding of how gaming addiction changes the brain, identifying EEG-based neuromarkers of internet addiction may help people to develop and test treatment. Biofeedback therapy is a case in point.  While results are yet poorly reported in the literature, the medical community in Korea is not waiting.  At Gangnam Eulji Hospital in Seoul, Dr. Lee Jae-Won is at the front line of South Korea’s efforts to bring teenagers back to the real world using techniques such as include transcranial magnetic stimulation.

Other techniques in use also include Electroacupuncture, where acupuncture needles are pressed into a patient’s head and then connected to an electric stimulator for brief electric stimulation.  A 2017 study by a Chinese group from Chengdu University showed decreased impulsivity and addiction with Electroacupuncture.

As doctors worldwide begin to take gaming addiction more seriously, it will hopefully be added to the list of mental illnesses worthy of intense treatment and rehabilitation. Innovative applications of EEG technology to measure and track addiction us one tool in this battle for the mental health that is yet to come.