Effectiveness of Rajyoga meditation on cognitive functions and quality of life in young adults with internet addiction

INTRODUCTION

There has been a global increase in internet usage within the past two decades, with approximately 5.4 billion (67%) of the world’s population using the internet for various recreational and work-related activities.^[1] However, this ubiquitous presence of the internet has raised concerns regarding the ill effects of its excessive usage and the emerging problem of internet addiction (IA). IA, often referred to as problematic internet use (PIU), is a rapidly increasing behavioural disorder defined as ‘an uncontrollable psychological dependence on the internet, regardless of the type of activities pursued after logging in’.^[2] This heterogeneous problem is marked by an excessive preoccupation with online activities such as internet gaming, social networking, compulsive online shopping, information seeking and even cyber-relationship addiction. This maladaptive pattern of internet overuse leads to negative consequences in various aspects of life, including interpersonal relationships and the overall well-being of an individual.^[3] In addition, clinically significant impairments in physical and mental health, co-occurrence of emotional dysregulations, psychological distress and comorbid disorders such as drug or alcohol abuse, anorexia or bulimia and attention deficit hyperactivity disorder have also been reported with PIU.^[4] Furthermore, the diagnostic criteria currently available for IA parallel the criteria commonly used for diagnosing substance use disorder, incorporating features such as escalating use over time, loss of control, concealing excessive use from others, failed attempts to cut back, psychological distress, cravings and withdrawal symptoms when/if prevented from using the internet.^[5] In 2018, the WHO also recognised IA as an official mental health disorder and behavioural addiction and included it under ‘Disorders Due to Addictive Behaviours’ in the International Classification of Diseases 11^th Revision as internet gaming disorder (IGD).^[6] As per a recent meta-analysis, the global prevalence of IA in the general population is about 14%.^[7]

Cognition pertains to the set of all mental abilities and processes involved in the acquisition, processing, storage and retrieval of information by the brain. It is composed of basic cognitive functions such as alertness, higher cognitive abilities such as attention, executive functioning, perception and memory as well as critical elements such as verbal, language and motor skills.^[8] The effects of internet usage on the cognitive functions of an individual are multifaceted. Evidence from the majority of prior studies done on individuals who play online games has shown beneficial effects on the visuospatial skills, working memory and decision-making skills of an internet gamer.^[9] In contrast, case-control studies examining the cognitive performance of individuals with PIU have found that enhanced use of the internet is significantly associated with deficits in alertness, attentional inhibition, motor inhibition, decision-making and working memory.^[10] Moreover, reductions in executive functioning and inhibitory control contribute to engagement in online behaviours, providing gratification and ultimately leading to the emergence and persistence of PIU.^[11]

Quality of life (QOL) is a multidimensional concept composed of domains related to physical, mental, emotional and social functioning; being influenced by personal characteristics and environmental factors.^[12] An emerging body of multidisciplinary studies that have examined the effects of overuse of the internet has indicated a causal link between IA and impairment of QOL.^[13] An increase in self-isolation, feelings of loneliness, depressive mood, anxiety disorders, suicidal behaviours,^[14] poor academic performance, sleep disorders and a sedentary lifestyle have been demonstrated among problematic internet users.^[15] However, this is not a universal finding, and the positive impact of internet usage on developing interpersonal relationships with family and friends has also been reported.^[16]

Considering that internet usage is fast becoming an indispensable part of modern-day society, calls for solutions to prevent and combat IA, especially in adolescents and young adults, are on the rise. Appropriate IA preventive measures are needed to encourage individuals to have more control over their internet usage and help them to positively modify their internet behaviour by strengthening their capability of self-awareness and self-control.^[17]

Mindfulness meditation is a mind-body type of nonpharmacological behavioural therapy that aims to give a sense of calmness, inner peace, and emotional balance^[18] and can also improve cognitive performance.^[19] This therapy helps individuals improve their self-regulation skills. Prior studies have put forth evidence highlighting the beneficial effects of various mindfulness meditation techniques in non-clinical settings.^[18-21] Recently, the usefulness of this technique has also been explored in clinical settings, including addictive behaviours.^[22] Rajyoga meditation (RYM) is a very simple form of meditation performed without rituals or mantra recitation and can be practised anywhere at any time. In this technique, an emphasis is placed on naturally using the mind to concentrate on the present moment, shifting focus from negative thoughts and empowering the mind by promoting positive thought patterns and feelings.^[23] Hence, RYM, with its emphasis on mental discipline, emotional regulation and stress reduction, may prove to be beneficial in terms of prevention, harm reduction and intervention toward addictive internet behaviour.

Therefore, in the present study, we focused on assessing and comparing the influence of RYM on cognitive status and QOL in young adults with IA. By investigating the effectiveness of this non-pharmacological intervention, we seek to provide valuable insights into the potential beneficial role of meditation in combatting the adverse effects of IA and enhancing cognitive functions and psychosocial health.

MATERIALS AND METHODS

RESULTS

There was no statistical difference in the mean age of control (21.80 ± 2.87 years) and meditation (22.70 ± 5.84 years) group participants: χ² = 13.14, P = 0.52. Gender-wise distribution of participants in the control (M: F = 13:7) and meditation (M: F = 11:9) groups were also not significantly different: χ² = 0.42, P = 0.51. All the participants in both groups were undergraduate medical students of our institute and belonged to the Delhi-NCR region.

Young’s IA test

Analysis of the YIAT data revealed a significant main effect of time (P < 0.001) and group (P < 0.05). These effects were further qualified by a significant interaction between time and group (P < 0.001) [Table 2]. There was a significant difference between the mean YIAT scores of the participants in the two study groups at both T1 and T2 times (P < 0.05 and 0.01), respectively. Within the same group, participants of both study groups showed a significant decrease in their IAT scores at T1 (P < 0.01 and <0.001 for control and meditation, respectively) as well as at T2 (P < 0.001 for both) in comparison to their baseline scores. There was also a significant difference (P < 0.001) between their mean IAT scores at 1 week and those at 8 weeks within both the study groups [Figure 1].

Table 2: ANOVA Summary table for the main effect of time, group and interaction effect on YIAT, WHOQOL-Bref and MOCA scores.

Variable	Time		Group		Time X Group
	F (df)	P	F (df)	P	F (df)	P
YIAT	158.92 (1.34, 51.06)	<0.001***	4.62 (1,38)	<0.05*	34.49 (1.34, 51.06)	<0.001***
Overall QOL	33.83 (1.61, 61.06)	<0.001***	0.62 (1,38)	>0.05	2.03 (1.61, 61.06)	>0.05
General Health	33.93 (1.49, 56.44)	<0.001***	0.63 (1,38)	>0.05	9.15 (1.49, 56.44)	<0.01**
D1	29.52 (1.47, 55.96)	<0.001***	0.56 (1,38)	>0.05	3.73 (1.47, 55.96)	<0.05*
D2	21.06 (1.73, 65.78)	<0.001***	0.01 (1,38)	>0.05	15.06 (1.73, 65.78)	<0.001***
D3	14.99 (1.42, 53.98)	<0.001***	0.28 (1,38)	>0.05	0.98 (1.42, 53.98)	>0.05
D4	13.41 (1.37, 51.95)	<0.001***	1.39 (1,38)	>0.05	9.88 (1.37, 51.95)	<0.01**
Total MOCA	27.33 (2, 76)	<0.001***	2.03 (1,38)	>0.05	15.72 (2,76)	<0.001***
Visuospatial Abilities	14.14 (1.14, 43.47)	<0.001***	1.15 (1,38)	>0.05	3.73 (1.14, 43.47)	>0.05
Executive Function	5.40 (2, 76)	<0.01**	0.82 (1,38)	>0.05	5.40 (2, 76)	<0.01**
Attention	4.03 (1.13, 42.88)	<0.01**	0.08 (1,38)	>0.05	10.39 (1.13, 42.88)	<0.01**
Delayed Recall	4.12 (1.63, 62.09)	<0.05*	0.01 (1,38)	>0.05	2.22 (1.63, 62.09)	>0.05
Language	3.43 (1.43, 54.38)	>0.05	0.56 (1,38)	>0.05	0.79 (1.43, 54.38)	>0.05
Orientation	1.00 (2, 76)	>0.05	1.00 (1,38)	>0.05	1.00 (2, 76)	>0.05

Significantly different (*P<0.05, **P<0.01, ***P<0.001). ANOVA: Analysis of variance, df: Degrees of freedom, YIAT: Young’s internet addiction test, QOL: Quality of life, D1-D4: Four domains of World Health Organization quality of life questionnaire, MOCA: Montreal cognitive assessment questionnaire, WHOQOL: World Health Organization Quality of Life, df: degrees of freedom

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Figure 1:

Young’s 20-Item internet addiction test (IAT) score in participants of both study groups at different time points. n = 20 in each. Data represent Mean ± standard deviation significantly different (*P < 0.05; **P < 0.01) compared to control group Significantly different (^††P < 0.01; ^†††P < 0.001) compared to baseline within group significantly different (^‡‡‡P < 0.001) compared to 1 week within group.

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The Chi-square test revealed that there was no significant difference in the severity of IA between the participants of the two study groups at baseline and 1 week (χ² = 1.03 and 6.23, P = 0.60 and 0.10, respectively). However, a significant difference was observed in the severity of IA between participants of control and meditation groups at 8 weeks of study (χ² = 9.41, P = 0.009) [Figure 2].

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Figure 2:

Internet addiction severity comparison between both groups at different follow-up points. n = 20 in each group. Values are frequency (%). 2a,c,e: Control; 2b,d,f: Meditation; (a and b) Baseline; (c and d) 1 week; (e and f) 8 weeks χ² Chi-square; P-inter-group difference in severity of internet addiction.

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DISCUSSION

The key findings of the present study include a significant decrease in the severity of IA along with significant improvements in the cognitive performance and QOL of young adult internet addicts following 8 weeks of RYM, thereby indicating its usefulness as an effective interventional strategy in counteracting the adverse effects of IA.

Following 8 weeks of RYM intervention, 60% of the participants achieved normal levels of internet usage, whereas the remaining exhibited either mild or moderate levels of IA, as illustrated by the YIAT scores. The unidirectional significant decreases seen in mean YIAT scores following both 1 and 8 weeks of RYM are in concurrence with earlier works that have shown similar decreases in PIU following different interventional modalities and protocols.^[17] Surprisingly, a significant reduction in YIAT scores was also observed in control group participants at both 1 and 8 weeks of the study in comparison to their baseline readings. The recruitment and baseline assessments of the participants in the present study were done during the COVID-19 pandemic in April– June 2021. This period was marked by heightened stress and anxiety, both of which also play a crucial role in the causation of compulsive addictive behaviours, including IA.^[4,5] Lifting of lockdown restrictions and resumption of offline classes/activities could have led to decreased scores of YIAT in controls. The same explanation may arguably be applied to the RYM group as well. However, significantly greater decrements were observed in mean YIAT scores in the RYM group as compared to the controls at both T1 and T2 time points. In addition, the significant interaction effect between time and group seen in the present study further highlights that the changes in IA scores over time differed between the meditation and control groups. This indicates that meditation group participants in the present study did experience additional benefits from the RYM practice itself that are not present in the control group. The additional beneficial effects of RYM on IA could be explained by the notion that when participants cultivate greater mindfulness and self-control, they tend to engage with the internet more purposefully, moving away from their compulsive internet use patterns.^[17] This positive shift, in turn, enabled RYM group participants to cope more judiciously with their uncontrollable cravings and psycho-pathological dependence to engage in excessive online activities, resulting in lesser YIAT scores as compared to the controls.^[27]

Paralleling the YIAT changes, significant improvement in the overall QOL of participants practising RYM within the duration of the intervention was also observed. Here, it is noteworthy that significant improvements in overall general health and physical and psychological health domains were evident even after 1 week of RYM. Our results conform with various other previous studies wherein improvements in mental health, QOL and subjective satisfaction with life were reported in behavioural addiction disorders, including IA, following meditation intervention.^[17,18] In addition to within-subject changes, significant inter-group differences in the WHOQOL-Bref domains following 8 weeks of intervention were also seen in the current study.

Recently, some researchers have reported higher grey matter volume in the right superior frontal gyrus, left inferior orbitofrontal cortex, right insula and bilateral precuneus in RYM practitioners as compared to nonmeditators.^[28] Notably, these brain regions are associated with positive thought processes, self-awareness and behaviour. People who spend much time online tend to have lower perceived QOL due to poor physical health, sleep deprivation, impaired work capacity, lack of concentration and reduced intimacy with family members.^[12,13] RYM, as a form of behavioural intervention, empowers the minds of the practitioners by encouraging the positive flow of thoughts, enhancing self-esteem and imparting greater satisfaction and happiness to them.^[23] Such favourable alterations induced by regular 8 weeks of RYM practice manifested as significant overall improvements seen across various domains of WHOQOL-Bref in these participants.

Our MOCA data illustrated the beneficial effect of RYM on visuospatial abilities, executive function, attention and delayed recall mechanisms. These observations in our study corroborate with earlier works examining the influence of meditation on cognitive status employing different populations and different experimental paradigms.^[19-22] For instance, in a study conducted on adolescents aged 12– 18 years, significantly better performance on digit span and trail-making tests A and B were seen in the experimental group following 10 days of mindfulness meditation compared to the control group indicating improvements in working memory, shifting attention and executive functioning in them.^[20] In another study conducted in young adults, a brief mindfulness exercise of 20 min showed a higher response accuracy and a smaller P3 amplitude at the post-test relative to the pre-test across Flanker conditions, whereas no such changes were observed in the control group, indicating more efficient cognitive processing in interventional group.^[19] In addition, findings of a recent meta-analysis which synthesised data across diverse populations put forth mixed evidence of mindfulness meditation on different cognitive domains; namely, they reported significant improvements in executive function but non-significant effects on attention, working memory and long-term memory. The researchers attributed heterogeneity in attention and executive function used across different studies for their observed results.^[21]

Preliminary neuroimaging studies have suggested that meditation induces structural and functional alterations in certain brain regions that play a major role in a variety of cognitive processes. Specifically, alterations are produced in regions such as the prefrontal cortex, entorhinal cortex, striatum, limbic regions and anterior and posterior cingulate cortex.^[29] Strikingly, these areas have been implicated in attentional control, emotional regulation, response inhibition, memory and self-monitoring of thoughts.^[19,29] Recently, in a randomised control trial, the influence of either an 8-session meditation program that focused on attention and acceptance or an 8-time program for body relaxation was compared in young adults with IGD. Meditation intervention was found to be more effective in decreasing addiction severity and gaming cravings compared with body relaxation. Moreover, meditation was associated with decreased brain activation in the bilateral lentiform nuclei, insula and medial frontal gyrus, indicating that it is an effective treatment for IGD, probably exerting its effects by altering frontopallidal pathways.^[22]

Here, it is worth mentioning that in our study, the cognitive performance of meditation group participants following 8 weeks of RYM was also significantly better than controls. It is plausible that regular practice of RYM for 8 weeks enabled the participants to focus and orient their attention to the present experience and induced neuroplastic changes in the above-mentioned cognitive centres of the brain. This, in turn, enhanced their ability to select perceptual task-relevant information and to inhibit stimuli that were not relevant to fulfilling the task goal. This led to an increase in alertness, broadened attentional vigilance, better cognitive flexibility and improved working memory of RYM group participants in our study. However, we could not ascertain any significant difference in the language and orientation of the participants either within or between subjects at any point in time. These observations were on expected lines as all the participants were comparable in terms of age and gender distribution, educational level as well as their ability to read English letters, words and numerals.

Taken together, these current findings provide new insights into the effects of RYM on IA severity, neurocognitive functions and QOL in young adult internet addicts. However, it would be imprudent to attempt any generalisation of the findings to other populations without further statistical validation. Nevertheless, the inclusion of a control group, coupled with repeated recordings at 3-time points, enabled us to directly compare the influence of RYM on different outcome variables as well as track both the initial alterations (1 week) and sustained effects (8 weeks) of RYM in them with reasonable temporal resolution.

CONCLUSION

Our results indicate that 8 weeks of a RYM-based program was impactful in improving the cognitive performance and overall QOL of young adult internet addicts. The findings further illustrated the beneficial effect of RYM in decreasing the severity of IA in these participants, thereby indicating that it is effective in ameliorating the negative effects of IA and can serve as a useful preventive and curative nonpharmacological interventional modality for promoting cognitive and psycho-social well-being in internet addicts.