Article Figures & Data
Figures
- FIG 1.
GABA, Glx, and creatine measurements in the anterior cingulate cortex. GABA and single-voxel 1H-MR spectroscopy with TE = 135 ms are obtained from a voxel volume of 26.25 mL (voxel dimensions, 3.5 × 3.0 × 2.5 cm) in the anterior cingulate cortex. The volume fractions of brain parenchyma and gray matter in the MR spectroscopy voxels are obtained from T1 MPRAGE segmentation using the SPM program. Last, GABA/Cr and Glx/Cr are adjusted by multiplying brain parenchymal and gray matter volume fractions for each individual.
- FIG 2.
Acquisition and spectral fitting of MEGA-PRESS MR spectroscopy. A, MR imaging data are acquired with a 3T MR imaging scanner with a 32-channel phased array head coil. The signal-to-noise ratio acquired on each channel is visually checked, and raw data with a low signal-to-noise ratio (red characters) are removed from averaging. B, Selected raw data are averaged in the time domain and baseline-corrected, and the areas under the GABA and Glx peaks at 3.01 and 3.8 ppm (red lines) are measured by fitting to double and single Gaussian functions, respectively.
- FIG 3.
The boxplots of GABA/Cr (A) and Glx to Glx/Cr (B) in healthy controls and Internet and smartphone addicted subjects pre- and posttherapy. The horizontal line is the median, and the upper and lower ends of the boxes are the upper and lower quartiles, respectively. The vertical lines represent data ranges. PostTX indicates postcognitive behavioral therapy.
- FIG 4.
The correlations between neurotransmitters and clinical scales of Internet addiction and psychological tests. A, The gm-GABA/Cr is significantly correlated with the Internet Addiction Test (circle and dashed line) and the Smartphone Addiction Scale (x and dotted line) as well as the sum of both scales (square and solid line). B, The gm-GABA/Cr was significantly correlated with the depression scale (circle and dashed line), total anxiety score (x and dotted line), and state anxiety score (square and solid line). C, The gm-Glx/Cr was correlated with insomnia (circle and dashed line) and sleep quality scores (square and solid line). IAT indicates Internet Addiction Test; SAS, Smartphone Addiction Scale; HRSD, Hamilton Rating Scale for Depression; STAI-S, State-Trait Anxiety Inventory to measure state component of anxiety; PSQI, Pittsburgh Sleep Quality Assessment.
Tables
- Table 1:
Demographics, psychological tests, and pre- and postcognitive behavioral therapy data
Internet Addiction (Mean) Control (Mean) P Value PreTx (Mean) PostTx (Mean) P Value (n = 19) (n = 12) Sex (M/F) 9:10 1.0 8:4 Age (yr) 15.47 ± 3.06 (range, 11–22) 1.0 14.00 ± 1.95 (11–17) IAT 63.32 ± 15.15 27.37 ± 4.83 < .001a 68.42 ± 14.74 52.58 ± 10.24 .001a SAS 45.53 ± 7.40 17.89 ± 8.12 < .001a 45.83 ± 6.42 30.67 ± 6.85 < .001a IAT+SAS 108.84 ± 20.19 45.26 ± 11.72 < .001a 114.25 ± 19.43 83.25 ± 15.52 < .001a HRSD 3.53 ± 5.92 0 ± 0 .018a 2.00 ± 3.69 0.25 ± 0.62 .147 State STAI 46.11 ± 7.75 31.95 ± 9.99 < .001a 46.45 ± 8.55 43.82 ± 10.07 .441 Trait STAI 50.16 ± 7.54 39.05 ± 4.93 < .001a 49.27 ± 7.84 45.36 ± 7.89 .085 Total STAI 95.89 ± 14.56 71 ± 13.58 < .001a 95.06 ± 16.19 89.18 ± 17.55 .253 BIS 57.53 ± 7.63 45.58 ± 11.72 .001a 54.27 ± 6.94 52.45 ± 6.83 .093 ISI 6.89 ± 4.977 3.11 ± 2.558 .006a 5.17 ± 3.74 5.00 ± 4.43 .891 PSQI 5.95 ± 3.24 3.53 ± 1.87 .008a 4.67 ± 2.31 4.83 ± 2.92 .777 IQ 95.18 ± 2.88 98 ± 11.12 .467 Note:—PreTx indicates precognitive behavioral therapy; PostTx, postcognitive behavioral therapy; IAT, Internet Addiction Test; SAS, Smartphone Addiction Scale; HRSD, Hamilton Rating Scale for Depression; STAI, State-Trait Anxiety Inventory; BIS, Barratt Impulsiveness Scale; ISI, Insomnia Severity Index; PSQI, Pittsburgh Sleep Quality Assessment; IQ, intelligence quotient.
↵a P value ≤ .05
bp-GABA/Cr gm-GABA/Cr wm-GABA/Cr bp-GLX/Cr gm-GLX/Cr wm-GLX/Cr IA (mean) 73.85 ± 22.74 49.10 ± 15.27 24.90 ± 8.25 167.74 ± 43.44 106.87 ± 39.90 56.25 ± 13.74 Controls (Mean) 56.03 ± 25.25 36.27 ± 16.02 19.77 ± 9.71 179.55 ± 37.30 117.45 ± 25.86 62.67 ± 13.12 P value .028a .016a .088 .375 .587 .149 Note:—wm-GABA/Cr indicates white matter volume-adjusted GABA-to-creatine ratio; wm-GLX/Cr, white matter volume-adjusted glutamine and glutamate-to-creatine ratio; IA, Internet addiction.
↵a P value ≤ 05.
bp-GABA/Cr gm-GABA/Cr wm-GABA/Cr bp-GLX/Cr gm-GLX/Cr wm-GLX/Cr PreTx (mean) 74.20 ± 23.58 46.77 ± 15.95 24.43 ± 8.32b 177.19 ± 47.81 119.07 ± 34.37 58.12 ± 14.81 PostTx (mean) 52.72 ± 14.52 34.60 ± 9.28 18.11 ± 5.67 215.65 ± 48.31 142.46 ± 34.54 73.19 ± 16.40b P value .034a .026a .071b .096 .131 .06b Note:—PreTx indicates precognitive behavioral therapy; PostTx, postcognitive behavioral therapy.
↵a P ≤ .05 based on paired t test or Wilcoxon signed rank test.
↵b wm-GABA/Cr in precognitive behavioral therapy was not in a Gaussian distribution, and the nonparamatric Wilcoxon signed rank test was applied in statistical analysis.
bp-GABA/Cr gm-GABA/Cr wm-GABA/Cr bp-GLX/Cr gm-GLX/Cr wm-GLX/Cr IAT r 0.345 0.387 0.252 –0.088 –0.029 –0.192 P value .034a .016a .127 .599 .863 .249 SAS r 0.300 0.323 0.250 –0.209 –0.172 –0.240 P value .067 .048a .129 .209 .302 .146 IAT+SAS r 0.336 0.372 0.260 –0.144 –0.093 –0.219 P value .039a .022a .116 .388 .578 .186 HRSD r 0.312 0.326 0.298 –0.201 –0.17 –0.201 P value .057 .046a .069 .227 .308 .227 State STAI r 0.327 0.348 0.274 0.075 0.096 0.028 P value .045a .032a .095 .655 .566 .867 Trait STAI r 0.294 0.305 0.263 –0.197 –0.173 –0.212 P value .073 .062 .111 .235 .300 .202 Total STAI r 0.335 0.350 0.291 –0.071 –0.048 –0.097 P value .040a .031a .077 .674 .770 .564 BIS r 0.132 0.145 0.109 –0.06 –0.042 –0.079 P value .429 .386 .513 .72 .800 .637 ISI r 0.073 0.037 0.139 –0.386 –0.419 –0.255 P value .664 .824 .405 .017a .009a .123 PSQI r 0.235 0.194 0.305 –0.405 –0.439 –0.264 P value .155 .242 .063 .012a .006a .109 Note:—PreTx indicates precognitive behavioral therapy; PostTx, postcognitive behavioral therapy; IAT, Internet Addiction Test; SAS, Smartphone Addiction Scale; HRSD, Hamilton Rating Scale for Depression; STAI, State-Trait Anxiety Inventory; BIS, Barratt Impulsiveness Scale; ISI, Insomnia Severity Index; PSQI, Pittsburgh Sleep Quality Assessment.
↵a P value ≤ .05.
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