Individualized real-time fMRI neurofeedback to attenuate craving in nicotine-dependent smokers

Individualized real-time fMRI neurofeedback to attenuate craving in nicotine-dependent smokers


J Psychiatry Neurosci 2016;41(1):48-55

Karen J. Hartwell, MD; Colleen A. Hanlon, PhD; Xingbao Li, MD; Jeffrey J. Borckardt PhD; Melanie Canterberry PhD; James J. Prisciandaro, PhD; Megan M. Moran-Santa Maria PhD; Todd LeMatty, BA; Mark S. George, MD; Kathleen T. Brady, PhD, MD


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.

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

Conclusion: 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.

Submitted July 21, 2014; Revised Dec. 2, 2014; Revised Mar. 20, 2015; Accepted June 22, 2015; Early-released Oct. 20, 2015

Affiliations: 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).

Acknowledgements: The study was supported by grant 5R21DA026085 and 5R33DA026085 from the National Institute of Drug Abuse (co-primary investigators: K. Brady and M. George). The National Institute of Drug Abuse had no role in the study design nor conduct of the study, including data collection, data analysis, interpretation of the results, manuscript preparation, review, and approval or the decision to submit the manuscript for publication. The authors thank Danielle Paquette for her assistance with the laboratory cue-reactivity sessions outside of the scanner and everyone who shared their expertise and assisted in the development of the real-time fMRI neurofeedback paradigm.

Competing interests: None declared.

Contributors: All authors designed the study. K. Hartwell, X. Li and T. LeMatty acquired the data, which C. Hanlon, X. Li, J. Borckardt, M. Canterberry, J. Prisciandaro, M. Moran-Santa Maria, M. George and K. Brady analyzed. K. Hartwell, X. Li, J. Borckardt, M. Canterberry, J. Prisciandaro and T. LeMatty wrote the article, which all authors reviewed and approved for publication.

DOI: 10.1503/jpn.140200

Correspondence to: K.J. Hartwell, 125 Doughty St, Suite 190, Charleston, SC 29403;