Effects of transcranial direct current stimulation of the right dorsolateral prefrontal cortex on craving and negative emotion regulation in individuals at risk for problematic pornography use: A double-blind, placebo-controlled study

Background and aims: Sexual craving and the alleviation of negative emotions are fundamental driving forces underlying problematic pornography use (PPU). In healthy individuals, these processes can be effectively attenuated through cognitive strategies mediated by the prefrontal cortex. However, PPU is associated with impaired cognitive control functions. This study aimed to investigate whether transcranial direct current stimulation (tDCS) targeting the right dorsolateral prefrontal cortex (dlPFC) could enhance the regulation of craving and negative emotions in individuals at risk for PPU. Methods: A randomized, within-subject, placebo-controlled design was used, in which 45 male individuals at risk for PPU (mean age = 20.18 years, SD = 1.03) received both active (2.5 mA for 20 min) and sham tDCS to the right DLPFC, with sessions separated by one week. During tDCS, participants at risk for PPU performed the regulation of craving (ROC) task, comparing cue-induced craving with instructed regulation, and the emotion regulation (ER) task, contrasting negative affect with instructed regulation. Subjective ratings of craving and negative emotions were collected for each trial. Results: Our results demonstrated that individuals at risk for PPU effectively regulated their craving and negative affect when guided to use cognitive strategies. Furthermore, anodal tDCS of the right dlPFC during the craving regulation condition significantly reduced craving ratings compared to sham stimulation. However, no facilitative effect of right dlPFC anodal tDCS on ER was observed. Discussion and conclusions: These findings highlight the potential of tDCS as a novel therapeutic intervention for individuals with PPU, offering the first experimental evidence to support its effectiveness in reducing craving.