Acting with awareness is positively correlated with dorsal anterior cingulate cortex glutamate concentration but both are impaired in Internet gaming disorder

Internet gaming disorder (IGD) is increasingly recognized as a public concern for its adverse impacts on cognition and mental health. In IGD, the transition from goal-directed actions to habitual and eventually compulsive behaviors is accompanied by altered neural response within the dorsal anterior cingulate cortex (dACC), a critical region involved in conscious actions. However, the neurochemical profile of the dACC in IGD and its relationship with behavioral awareness remain poorly understood. In this study, ¹H-magnetic resonance spectroscopy was employed to quantify dACC glutamate concentration and examine its association with the capacity for ‘acting with awareness’ among 21 participants with IGD and 19 recreational game users. Results indicated that dACC glutamate levels and behavioral awareness were significantly lower in the IGD group compared to recreational game users. Moreover, a significant positive correlation between awareness and dACC glutamate concentration emerged in the recreational game users’ group, a relationship attenuated in those with IGD. In an independent cohort of 107 participants, the positive association between awareness and dACC glutamate concentration was replicated. These findings suggest that reduced dACC glutamate in IGD may underlie diminished awareness of maladaptive habitual behaviors. Enhancing dACC neural excitability through neuromodulation or mindfulness training could represent a potential intervention to restore behavioral awareness.