Leena Subramanian1, Leon Skottnik2, W Miles Cox3, Michael Lührs4,5, Rachel McNamara6, Kerry Hood6, Gareth Watson6, Joseph R Whittaker7, Angharad N Williams8, Raman Sakhuja9, Niklas Ihssen10, Rainer Goebel4,5, Rebecca Playle6, David E J Linden1,11. 1. MRC Centre for Neuropsychiatric Genetics and Genomics and Cardiff University Brain Research Imaging Centre, Schools of Medicine and Psychology, Cardiff University, Cardiff, United Kingdom. 2. School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands, l.skottnik@maastrichtuniversity.nl. 3. School of Psychology, Bangor University, Bangor, United Kingdom. 4. Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands. 5. Brain Innovation B.V., Maastricht, The Netherlands. 6. Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, United Kingdom. 7. School of Physics and Astronomy, Cardiff University, Cardiff, United Kingdom. 8. Adaptive Memory Research Group, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany. 9. Addiction Services, Cwm Taf Morgannwg University Health Board, Mountain Ash, United Kingdom. 10. Department of Psychology, Durham University, Durham, United Kingdom. 11. School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Abstract
INTRODUCTION: Alcohol dependence is one of the most common substance use disorders, and novel treatment options are urgently needed. Neurofeedback training (NFT) based on real-time functional magnetic resonance imaging (rtf-MRI) has emerged as an attractive candidate for add-on treatments in psychiatry, but its use in alcohol dependence has not been formally investigated in a clinical trial. We investigated the use of rtfMRI-based NFT to prevent relapse in alcohol dependence. METHODS: Fifty-two alcohol-dependent patients from the UK who had completed a detoxification program were randomly assigned to a treatment group (receiving rtfMRI NFT in addition to standard care) or the control group (receiving standard care only). At baseline, alcohol consumption was assessed as the primary outcome measure and a variety of psychological, behavioral, and neural parameters as secondary outcome measures to determine feasibility and secondary training effects. Participants in the treatment group underwent 6 NFT sessions over 4 months and were trained to downregulate their brain activation in the salience network in the presence of alcohol stimuli and to upregulate frontal activation in response to pictures related to positive goals. Four, 8, and 12 months after baseline assessment, both groups were followed up with a battery of clinical and psychometric tests. RESULTS: Primary outcome measures showed very low relapse rates for both groups. Analysis of neural secondary outcome measures indicated that the majority of patients modulated the salience system in the desired directions, by decreasing activity in response to alcohol stimuli and increasing activation in response to positive goals. The intervention had a good safety and acceptability profile. CONCLUSION: We demonstrated that rtfMRI-neurofeedback targeting hyperactivity of the salience network in response to alcohol cues is feasible in currently abstinent patients with alcohol dependence.
INTRODUCTION: Alcohol dependence is one of the most common substance use disorders, and novel treatment options are urgently needed. Neurofeedback training (NFT) based on real-time functional magnetic resonance imaging (rtf-MRI) has emerged as an attractive candidate for add-on treatments in psychiatry, but its use in alcohol dependence has not been formally investigated in a clinical trial. We investigated the use of rtfMRI-based NFT to prevent relapse in alcohol dependence. METHODS: Fifty-two alcohol-dependent patients from the UK who had completed a detoxification program were randomly assigned to a treatment group (receiving rtfMRI NFT in addition to standard care) or the control group (receiving standard care only). At baseline, alcohol consumption was assessed as the primary outcome measure and a variety of psychological, behavioral, and neural parameters as secondary outcome measures to determine feasibility and secondary training effects. Participants in the treatment group underwent 6 NFT sessions over 4 months and were trained to downregulate their brain activation in the salience network in the presence of alcohol stimuli and to upregulate frontal activation in response to pictures related to positive goals. Four, 8, and 12 months after baseline assessment, both groups were followed up with a battery of clinical and psychometric tests. RESULTS: Primary outcome measures showed very low relapse rates for both groups. Analysis of neural secondary outcome measures indicated that the majority of patients modulated the salience system in the desired directions, by decreasing activity in response to alcohol stimuli and increasing activation in response to positive goals. The intervention had a good safety and acceptability profile. CONCLUSION: We demonstrated that rtfMRI-neurofeedback targeting hyperactivity of the salience network in response to alcohol cues is feasible in currently abstinent patients with alcohol dependence.
Authors: Corinde E Wiers; Christine Stelzel; Thomas E Gladwin; Soyoung Q Park; Steffen Pawelczack; Christiane K Gawron; Heiner Stuke; Andreas Heinz; Reinout W Wiers; Mike Rinck; Johannes Lindenmeyer; Henrik Walter; Felix Bermpohl Journal: Am J Psychiatry Date: 2014-12-19 Impact factor: 18.112
Authors: Kymberly D Young; Vadim Zotev; Raquel Phillips; Masaya Misaki; Han Yuan; Wayne C Drevets; Jerzy Bodurka Journal: PLoS One Date: 2014-02-11 Impact factor: 3.240
Authors: Moses O Sokunbi; David E J Linden; Isabelle Habes; Stephen Johnston; Niklas Ihssen Journal: Front Behav Neurosci Date: 2014-11-25 Impact factor: 3.558