Individualized real-time fMRI neurofeedback to attenuate craving in nicotine-dependent smokers.
BACKGROUND
Cue-induced craving plays an important role in relapse, and the neural correlates of cue-induced craving have been elucidated using fMRI. This study examined the utility of real-time fMRI (rtfMRI) neurofeedback to strengthen self-regulation of craving-related neural activation and cue-reactivity in cigarette smokers.


METHODS
Nicotine-dependent smokers were randomized to rtfMRI neurofeedback or to a no-feedback control group. Participants completed 3 neuroimaging visits. Within each visit, an initial run during which smoking-related cues were used to provoke craving, an individualized craving-related region of interest (ROI) in the prefrontal cortex or anterior cingulate cortex was identified. In the rtfMRI group, activity from the ROI was fed back via a visual display during 3 subsequent runs while participants were instructed to reduce craving during cue exposure. The control group had an identical experience with no feedback provided.


RESULTS
Forty-four nicotine-dependent smokers were recruited to participate in our study; data from the 33 participants who completed a 1-week follow-up visit were included in the analysis. Subjective craving ratings and cue-induced brain activation were lower in the rtfMRI group than in the control group.


CONCLUSIONS
As participants were not seeking treatment, clinical outcomes are lacking.


CONCLUSIONS
Nicotine-dependent smokers receiving rtfMRI feedback from an individualized ROI attenuated smoking cue-elicited neural activation and craving, relative to a control group. Further studies are needed in treatment-seeking smokers to determine if this intervention can translate into a clinically meaningful treatment modality.
From the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (Hartwell, Hanlon, Li, Borckardt, Canterberry, Priscriandaro, Maria, LeMatty, George, Brady); and the Ralph H. Johnson VA Medical Center, Charleston, SC (Hartwell, George, Brady).
Karen J
KJ
Hartwell
From the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (Hartwell, Hanlon, Li, Borckardt, Canterberry, Priscriandaro, Maria, LeMatty, George, Brady); and the Ralph H. Johnson VA Medical Center, Charleston, SC (Hartwell, George, Brady).
Colleen A
CA
Hanlon
From the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (Hartwell, Hanlon, Li, Borckardt, Canterberry, Priscriandaro, Maria, LeMatty, George, Brady); and the Ralph H. Johnson VA Medical Center, Charleston, SC (Hartwell, George, Brady).
Xingbao
X
Li
From the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (Hartwell, Hanlon, Li, Borckardt, Canterberry, Priscriandaro, Maria, LeMatty, George, Brady); and the Ralph H. Johnson VA Medical Center, Charleston, SC (Hartwell, George, Brady).
Jeffrey J
JJ
Borckardt
From the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (Hartwell, Hanlon, Li, Borckardt, Canterberry, Priscriandaro, Maria, LeMatty, George, Brady); and the Ralph H. Johnson VA Medical Center, Charleston, SC (Hartwell, George, Brady).
Melanie
M
Canterberry
From the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (Hartwell, Hanlon, Li, Borckardt, Canterberry, Priscriandaro, Maria, LeMatty, George, Brady); and the Ralph H. Johnson VA Medical Center, Charleston, SC (Hartwell, George, Brady).
James J
JJ
Prisciandaro
From the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (Hartwell, Hanlon, Li, Borckardt, Canterberry, Priscriandaro, Maria, LeMatty, George, Brady); and the Ralph H. Johnson VA Medical Center, Charleston, SC (Hartwell, George, Brady).
Megan M Moran
MM
Moran-Santa Maria
From the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (Hartwell, Hanlon, Li, Borckardt, Canterberry, Priscriandaro, Maria, LeMatty, George, Brady); and the Ralph H. Johnson VA Medical Center, Charleston, SC (Hartwell, George, Brady).
Todd
T
LeMatty
From the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (Hartwell, Hanlon, Li, Borckardt, Canterberry, Priscriandaro, Maria, LeMatty, George, Brady); and the Ralph H. Johnson VA Medical Center, Charleston, SC (Hartwell, George, Brady).
Mark S
MS
George
From the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (Hartwell, Hanlon, Li, Borckardt, Canterberry, Priscriandaro, Maria, LeMatty, George, Brady); and the Ralph H. Johnson VA Medical Center, Charleston, SC (Hartwell, George, Brady).
Kathleen T
KT
Brady
D000328:Adult; D000359:Aftercare; D001921:Brain / Q000503:physiopathology*; D066249:Craving / Q000502:physiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D058765:Neurofeedback / Q000379:methods*; D057285:Precision Medicine / Q000379:methods; D012907:Smoking / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D014029:Tobacco Use Disorder / Q000503:physiopathology / Q000628:therapy*