LiteratureOne 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.Aim and MethodsThe 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.Results and DiscussionThe 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.Future ProspectsIn 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.

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Several previous studies have shown that real-time neurofeedback can be used to willfully regulate neuronal activity in specific brain-regions. The aim of the study was to find out whether patients with alcohol dependency would be able to learn how to regulate their neuronal activity in dependency-associated areas. In addition, neurofeedback-related variations to craving for alcohol are assessed.11 patients with alcohol dependency and 14 healthy participants were investigated. Neutral and alcohol-associated pictures were presented during functional MRI measurements. Alcohol-associated BOLD-responses in the frontal cortex (anterior cingulate cortex, dorsolateral prefrontal cortex, insula) were used as a region of interest (ROI). During the neurofeedback sessions, participants were instructed to down regulate their neuronal activity in the specific ROI during the presentation of alcohol-associated pictures.The results show that the patients were able to regulate their neuronal activities in areas related to dependency (p=0,048). After the neurofeedback-sessions, the individual craving (valued on the basis of the obsessive compulsive drinking scale) was slightly reduced in comparison to before the sessions (p=0,068).It seems feasible for patients with alcohol dependency to down-regulate their neuronal activity using rtfMRI. In addition, there is some evidence that craving can be influenced by this technique. However, so far, there were great differences within the group of patients.

One of the most prominent symptoms in addiction disorders is the strong desire to consume a particular substance or to show 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 frontal and striatal brain regions.The aim of the present project was the modification of craving-related neuronal responses in patients with alcohol addiction using neurofeedback (real-time fMRI). Neurofeedback provides the opportunity to influence neuronal responses with the aid of learning processes (operant conditioning) and to cause behavioural changes. Neurofeedback using fMRI is an innovative approach which has been possible only for the last few years, providing a very specific feedback signal. The results indicated decreased brain responses after real-time fMRI sessions in alcoholrelevant brain areas. In addition, the craving was slightly reduced.In future, real-time fMRI will enable a neurophysiologically based therapy for several psychiatric, psychosomatic and neurologic diseases (including depression, anxiety disorders and chronic pain).

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