Neurophysiological and therapeutic efficacy of somatic psychotherapies in addiction: primary behavioral focus with exploratory cross-addiction analyses

Behavioral addictions exhibit convergent dysregulation of meso-striatal reward, cortico-limbic stress, and executive-control circuits. Top-down interventions such as CBT demonstrate moderate, often transient effects, leaving autonomic dysregulation insufficiently targeted. Somatic and body-oriented psychotherapies (SBPs) may remediate these deficits via bottom-up interoceptive and autonomic mechanisms, but quantitative synthesis is lacking. Nine randomized controlled trials (RCTs) (total N = 573) of yoga, mindfulness, or somatic interventions for gambling, gaming, or compulsive sexual behavior were systematically reviewed. Hedges' g was pooled using random-effects meta-analysis (DerSimonian-Laird, Hartung-Knapp intervals). Risk-of-bias was evaluated with RoB-2; sensitivity analyses included leave-one-out models. Pooled effect size indicated a large benefit (g = -2.62, 95% CI [-4.73, -0.51], p = .015), with heterogeneity substantial (I2 = 95.6%). Directionality persisted under sensitivity analyses. No serious adverse events were reported. This review delivers the first quantitative synthesis of SBPs in behavioral addictions, delineating robust short-term symptom reduction alongside preliminary mechanistic signals implicating interoceptive-autonomic and fronto-striatal circuits. A novel phased, biomarker-guided treatment framework is proposed, situating SBPs as adjunctive modulators within integrative addiction care. Future trials should prioritize mechanistic endpoints, longer follow-up, and dismantling designs to isolate active components.