Internet Gaming Disorder (IGD) has emerged as a significant mental health challenge. It affects about 1 in 10 adolescents and young adults. This condition traps individuals in a cycle of compulsive gaming despite negative consequences.
Addictive memories are causing cravings and relapse in IGD. While cue exposure therapy has shown promise for substance addictions, its results for gaming disorder are yet not clear.
Scientists have discovered that during slow-wave sleep (SWS), the brain enters a unique state:
- Slow oscillations create “UP-states”—brief windows of heightened memory receptivity
- Sleep spindles help reorganize neural connections
- Targeted sound cues can weaken addictive pathways
This study has a new approach: using timed gaming sounds during SWS to disrupt IGD’s memory roots. Using EEG to detect sleep states and deliver gaming sounds is a unique neurorehabilitation approach.
The implications? A potential therapy that works while patients sleep—bypassing conscious resistance. Why this matters? – Traditional therapies often rely on exhausting willpower battles, but sleep-based interventions could transform IGD treatment into a more natural process.
One of the main inclusion criteria for participants was playing the game “Honor of Kings” more than 21 h per week. They were then divided into two groups: Sleep and Awake. Additionally, these two groups were divided into control and intervention groups.
In total, the study included 84 gamers.
For a better understanding, here’s a chart of participant selection process:
The group labels stand for: SIG – sleep intervention group; SCG – sleep control group; AIG – awake intervention group; ACG – awake control group.The intervention lasted for 3 days, with follow ups after 1, 2, 3 weeks and then after 1 month.
Experimental design for the Sleep and Awake groups – participants with gaming disorder
Day 1 – Participants arrived around 10 PM and got prepped for the experiment. Before going to sleep, they completed a cue reactivity task where they were exposed to gaming sounds and images.
Once the task is over, they would go to sleep. During sleep, SIG listened to gaming sounds. The control group did the same procedure, except they listened to non-game related stimuli.
Day2 – followed the same procedure.
Day3 – in the morning, participants did another round of the cue reactivity task.
Follow-ups: all groups had to complete online questionnaires on game craving and playtime. These follow ups happened 1, 2, 3 weeks and 1 month after the intervention.
Sleeping groups experimental procedure: craving task is the cue reactivity task. After the task on the first night, they did intervention sessions during sleep, for two consecutive nights. Morning of the third day they did another session of the craving task. All groups had follow-ups.Awake groups: Their procedure was the same, except the intervention was during the day, when they were awake. They would listen to either game- or non-game related sounds for 50 mins. The procedure is in the image below:
Awake groups: craving task is the cue reactivity task. After the task, they did intervention sessions during the day, for two consecutive days. Morning of the third day they did another session of the craving task. All groups had follow-ups.EEG and other measurements
The intervention implied playing gaming sounds during sleep. However, the sleeping stage at which the therapy is applied plays a big role. Studies reveal that cue exposure during SWS can treat PTSD, smoking addiction, and fear memories. This suggests that SWS could also help rewire addictive gaming unconsciously in IGD.
During the experiment, EEG data was collected and visualized to detect the SWS stage. Once it’s detected, gaming/non-gaming sounds started to play.
Collecting EEG data was done using the Smarting PRO wireless EEG system.
Authors investigated the P300 component in response to gaming/non-gaming sounds. But also wanted to analyze the time-frequency EEG characteristics. These include slow oscillations (SOs) and sleep spindles.
SOs create a window of heightened brain activity ideal for memory processing. This makes them the perfect target for therapeutic cues.
Meanwhile, spindles (bursts of 12–17 Hz activity) split into two roles: early spindles (linked to reactivating cravings) and late spindles (associated with suppressing them).
They picked these features because together, they reveal the push-and-pull of memory disruption during sleep—and why it works.
Subjective measures: Cravings and playtime served as good therapeutic indicators. Participants rated their cravings using the visual analog scale (VAS) and Questionnaire on Gaming Urge Brief Version (QDG-B).
How effective is the sleep-based intervention based on subjective scores?
Exposure to game-related sounds during SWS reduced cravings and playtime in participants with gaming disorder. These effects lasted for at least one month.
In the awake groups we don’t see these effects. This suggests sleep-specific efficacy:
A vs E and B vs F: craving scores for sleep and awake groups, across time. We can see a significant drop in the SIG compared to SCG. D vs H: we can see the same happening with playtime.P300 amplitude also showed significant changes between the two sleeping groups (C and G in the figure above). While there’s no change comparing awake groups.
Why does sleep seem to work better than wakefulness? – Sleep is an unconscious state, in which we’re more open to changes (per consciousness-dependent inhibition theory). Wakeful exposure can be less effective since we can consciously fight the therapy.
The results also align with prior research on olfactory treatment for smoking addiction during sleep.
EEG responses during SWS triggered by game cues
(A) Time-frequency differences between SIG and SCG, extracted using continuous wavelet transformation. Bottom topographical plots show the distribution of low-frequency, early spindle and late spindle activity. We can see the difference is most prominent in the central area. (B,C,D) Mean power levels for the three before mentioned parameters, for SI and SC groups.The cues caused an increase in low-frequency waves and early sleep spindles. This might be a sign that the brain was subconsciously reactivating game cravings.
At the same time, there was a noticeable drop-in late spindle activity. This is typically tied to memory suppression. It can suggest that the brain wasn’t just retrieving addictive memories – it was also dampening their power.
Additionally, researchers found that late spindle power escalated across intervention blocks. This escalation correlates with better therapeutic outcomes i.e., reduced cravings and playtime.
This study opens a door for treating gaming disorders —and potentially other behavioral addictions. The treatment is applied in a non-invasive way, using the natural sleep rhythms. This approach could change how we treat not just gaming disorder, but other addictions rooted in conditioned memories.
To read about future steps and limitations of the study, please read the original paper, linked here.
Curious if this setup is right for your study?
Our team works with researchers across neuroscience, sports science and clinical applications - we'll help you figure out if mobile EEG fits your study design.
