title: Modulation of Craving Related Brain Responses Using Real-Time fMRI in Patients with Alcohol Use Disorder.
abstract: METHODS
  One prominent symptom in addiction disorders is the strong desire to consume a particular substance or to display a certain behaviour (craving). Especially the strong association between craving and the probability of relapse emphasises the importance of craving in the therapeutic process. Neuroimaging studies have shown that craving is associated with increased responses, predominantly in fronto-striatal areas.
  
  
  OBJECTIVE
  The aim of the present study is the modification of craving-related neuronal responses in patients with alcohol addiction using fMRI real-time neurofeedback. For that purpose, patients with alcohol use disorder and healthy controls participated once in neurofeedback training; during the sessions neuronal activity within an individualized cortical region of interest (ROI) (anterior cingulate cortex, insula, dorsolateral prefrontal cortex) was evaluated. In addition, variations regarding the connectivity between brain regions were assessed in the resting state.
  
  
  CONCLUSIONS
  The results showed a significant reduction of neuronal activity in patients at the end of the training compared to the beginning, especially in the anterior cingulate cortex, the insula, the inferior temporal gyrus and the medial frontal gyrus. Furthermore, the results show that patients were able to regulate their neuronal activities in the ROI, whereas healthy subjects achieved no significant reduction. However, there was a wide variability regarding the effects of the training within the group of patients. After the neurofeedback-sessions, individual craving was slightly reduced compared to baseline. The results demonstrate that it seems feasible for patients with alcohol dependency to reduce their neuronal activity using rtfMRI neurofeedback. In addition, there is some evidence that craving can be influenced with the help of this technique.
  
  
  CONCLUSIONS
  In future, real-time fMRI might be a complementary neurophysiological-based strategy for the psychotherapy of patients with psychiatric or psychosomatic diseases. For that purpose, the stability of this effect and the generalizability needs to be assessed.
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Karch
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany; Institute for Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Keeser
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Hümmer
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Marco
authors.initials: M
authors.lastname: Paolini
authors.affiliation: Department of Neurology, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Valerie
authors.initials: V
authors.lastname: Kirsch
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Temmuz
authors.initials: T
authors.lastname: Karali
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Kupka
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Boris-Stephan
authors.initials: BS
authors.lastname: Rauchmann
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Chrobok
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Janusch
authors.initials: J
authors.lastname: Blautzik
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Gabi
authors.initials: G
authors.lastname: Koller
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Ertl-Wagner
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Pogarell
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D002540:Cerebral Cortex / Q000503:physiopathology*; D003199:Computer Systems; D063132:Connectome; D066249:Craving / Q000502:physiology*; D003463:Cues; D005260:Female; D059907:Functional Neuroimaging; D006179:Gyrus Cinguli / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D058765:Neurofeedback / Q000379:methods*; D017397:Prefrontal Cortex / Q000503:physiopathology*; D055815:Young Adult