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Murphy E, Poudel G, Ganesan S, Suo C, Manning V, Beyer E, Clemente A, Moffat BA, Zalesky A, Lorenzetti V. Real-time fMRI-based neurofeedback to restore brain function in substance use disorders: A systematic review of the literature. Neurosci Biobehav Rev 2024; 165:105865. [PMID: 39197715 DOI: 10.1016/j.neubiorev.2024.105865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 08/16/2024] [Accepted: 08/25/2024] [Indexed: 09/01/2024]
Abstract
INTRODUCTION Real-time functional magnetic resonance based-neurofeedback (fMRI-neurofeedback) is a neuromodulation tool where individuals self-modulate brain function based on real-time feedback of their brain activity. fMRI-neurofeedback has been used to target brain dysfunction in substance use disorders (SUDs) and to reduce craving, but a systematic synthesis of up-to-date literature is lacking. METHOD Following PRISMA guidelines, we conducted a systematic review of all the literature that examined the effects of fMRI-neurofeedback on individuals with regular psychoactive substance use (PROSPERO pre-registration = CRD42023401137). RESULTS The literature included 16 studies comprising 446 participants with SUDs involving alcohol, tobacco, and cocaine. There is consistent between-condition (e.g., fMRI-neurofeedback versus control), less consistent pre-to-post fMRI-neurofeedback, and little intervention-by-time effects on brain function in prefrontal-striatal regions and craving. CONCLUSION The evidence for changes in brain function/craving was early and inconsistent. More rigorous experiments including repeated measure designs with placebo control conditions, are required to confirm the efficacy of fMRI-neurofeedback in reducing brain alterations and craving in SUDs.
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Affiliation(s)
- Ethan Murphy
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioral and Health Sciences, Faculty of Health, Australian Catholic University, Australia
| | - Govinda Poudel
- Mary MacKillop Institute for Health Research, Australian Catholic University, Australia
| | - Saampras Ganesan
- Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Australia; Department of Biomedical Engineering, The University of Melbourne, Australia; Contemplative Studies Centre, Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Chao Suo
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioral and Health Sciences, Faculty of Health, Australian Catholic University, Australia; BrainPark, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Clayton, Australia; Turning Point, Eastern Health, Melbourne, Victoria, Australia
| | - Emillie Beyer
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioral and Health Sciences, Faculty of Health, Australian Catholic University, Australia
| | - Adam Clemente
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioral and Health Sciences, Faculty of Health, Australian Catholic University, Australia
| | - Bradford A Moffat
- Melbourne Brain Centre Imaging Unit, Department of Radiology, The University of Melbourne, Australia
| | - Andrew Zalesky
- Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Australia; Department of Biomedical Engineering, The University of Melbourne, Australia
| | - Valentina Lorenzetti
- Neuroscience of Addiction and Mental Health Program, Healthy Brain and Mind Research Centre, School of Behavioral and Health Sciences, Faculty of Health, Australian Catholic University, Australia.
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Farré-Colomés À, Tan H, Gerhardt S, Gerchen MF, Kirsch M, Hoffmann S, Kirsch P, Kiefer F, Vollstädt-Klein S. Cue-exposure treatment influences resting-state functional connectivity-a randomized controlled fMRI study in alcohol use disorder. Psychopharmacology (Berl) 2024; 241:513-524. [PMID: 38261011 PMCID: PMC10884177 DOI: 10.1007/s00213-024-06531-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024]
Abstract
RATIONALE Cue-exposure therapy (CET) consists of exposing patients to the cause of their affliction in a controlled environment and after psychological preparation. Ever since it was conceived, it has been suggested as a treatment for different types of behavioural impairments, from anxiety disorders to substance abuse. In the field of addictive behaviour, many different findings have been shown regarding the effectiveness of this therapy. OBJECTIVES This study aims to examine the underlying neurobiological mechanisms of the effects of CET in patients with alcohol use disorder using resting-state functional magnetic resonance imaging (rs-fMRI). METHODS In a randomized, controlled study, we examined patients after inpatient detoxification as well as healthy controls. Patients underwent nine sessions of CET spaced over 3 weeks. Rs-fMRI was conducted before treatment and 3 weeks after treatment onset in patients, healthy controls received only one rs-fMRI measurement. The final participant sample with complete data included 35 patients in the CET group, 17 patients in the treatment-as-usual group, and 43 HCs. RESULTS Our results show differences in the Salience Network when comparing the CET group to the treatment-as-usual group (TAU). Functional connectivity between the anterior cingulate Cortex (ACC) and the insula was increased after CET, whereas it was decreased from ACC to the putamen and globus pallidus. Further, increased connectivity with the precuneus was found in the dorsal attention network after cue exposure treatment. CONCLUSIONS These findings suggest that cue exposure therapy changes the resting-state brain connectivity with additional effects to the standard psychotherapy treatment. Hence, our study results suggest why including CET in standard therapies might improve the preparation of patients in front of daily situations.
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Affiliation(s)
- Àlvar Farré-Colomés
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty of Mannheim, Heidelberg University, 68159, Mannheim, Germany
| | - Haoye Tan
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty of Mannheim, Heidelberg University, 68159, Mannheim, Germany
| | - Sarah Gerhardt
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty of Mannheim, Heidelberg University, 68159, Mannheim, Germany
| | - Martin Fungisai Gerchen
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty of Mannheim, Heidelberg University, 68159, Mannheim, Germany
- Bernstein Center for Computational Neuroscience Heidelberg/Mannheim, 68159, Mannheim, Germany
- Department of Psychology, Heidelberg University, 69117, Heidelberg, Germany
| | - Martina Kirsch
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty of Mannheim, Heidelberg University, 68159, Mannheim, Germany
| | - Sabine Hoffmann
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty of Mannheim, Heidelberg University, 68159, Mannheim, Germany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty of Mannheim, Heidelberg University, 68159, Mannheim, Germany
- Bernstein Center for Computational Neuroscience Heidelberg/Mannheim, 68159, Mannheim, Germany
- Department of Psychology, Heidelberg University, 69117, Heidelberg, Germany
| | - Falk Kiefer
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty of Mannheim, Heidelberg University, 68159, Mannheim, Germany
- Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty of Mannheim, Heidelberg University, 68159, Mannheim, Germany
- Feuerlein Center on Translational Addiction Medicine, Heidelberg University, 69117, Heidelberg, Germany
| | - Sabine Vollstädt-Klein
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty of Mannheim, Heidelberg University, 68159, Mannheim, Germany.
- Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty of Mannheim, Heidelberg University, 68159, Mannheim, Germany.
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Hou L, Meng Y, Gao J, Li M, Zhou R. Women with more severe premenstrual syndrome have an enhanced anticipatory reward processing: a magnetoencephalography study. Arch Womens Ment Health 2023; 26:803-817. [PMID: 37730923 DOI: 10.1007/s00737-023-01368-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
Laboratory studies reveal that young women with premenstrual syndrome (PMS) often exhibit decreased reward processing during the late luteal phase. However, studies based on the self-reports find opposite results (e.g., higher craving for high-sweet-fat food). These differences may lie in the difference between the stimulus used and measuring the different aspects of the reward. The present study was designed to expand previous work by using a classic monetary reward paradigm, simultaneously examining the motivational (i.e., reward anticipation, "wanting") and emotional (i.e., reward outcome, "liking") components of reward processing in women with high premenstrual symptoms (High PMS). College female students in their early twenties with High PMS (n = 20) and low premenstrual symptoms (Low PMS, n = 20) completed a monetary incentive delay task during their late luteal phase when the premenstrual symptoms typically peak. Brain activities in the reward anticipation phase and outcome phase were recorded using the magnetoencephalographic (MEG) imaging technique. No group differences were found in various behavioral measurements. For the MEG results, in the anticipation phase, when High PMS participants were presented with cues that predicted the upcoming monetary gains, they showed higher event-related magnetic fields (ERFs) than when they were presented with neutral non-reward cues. This pattern was reversed in Low PMS participants, as they showed lower reward cue-elicited ERFs than non-reward cue-elicited ones (cluster mass = 2560, cluster size = 891, p = .03, corrected for multiple comparisons), mainly in the right medial orbitofrontal and lateral orbitofrontal cortex (cluster mass = 375, cluster size = 140, p = .03, corrected for multiple comparisons). More importantly, women with High PMS had an overall significantly higher level of ERFs than women with Low PMS (cluster mass = 8039, cluster size = 2937, p = .0009, corrected for multiple comparisons) in the bilateral precentral gyrus, right postcentral gyrus, and left superior temporal gyrus (right: cluster mass = 410, cluster size = 128, p = .03; left: cluster mass = 352, cluster size = 98, p = .05; corrected for multiple comparisons). In the outcome phase, women with High PMS showed significantly lower theta power than the Low PMS ones for the expected non-reward feedback in the bilateral temporal-parietal regions (cluster mass = 47620, cluster size = 18308, p = .01, corrected for multiple comparisons). These findings reveal that the severity of PMS might alter reward anticipation. Specifically, women with High PMS displayed increased brain activities to reward-predicting cues and increased action preparation after the cues appear.
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Affiliation(s)
- Lulu Hou
- Department of Psychology, Nanjing University, Nanjing, 210023, China
- Department of Psychology, Shanghai Normal University, Shanghai, 200234, China
| | - Yao Meng
- Department of Psychology, Nanjing University, Nanjing, 210023, China
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Jiahong Gao
- Beijing City Key Lab for Medical Physics and Engineering, Institution of Heavy Ion Physics, School of Physics, Peking University, Beijing, 100871, China
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100871, China
- McGovern Institute for Brain Research, Peking University, Beijing, 100871, China
| | - Ming Li
- Department of Psychology, Nanjing University, Nanjing, 210023, China
| | - Renlai Zhou
- Department of Psychology, Nanjing University, Nanjing, 210023, China.
- Department of Radiology, the Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China.
- State Key Laboratory of Media Convergence Production Technology and Systems, Beijing, 100803, China.
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Fede SJ, Kisner MA, Dean SF, Kerich M, Roopchansingh V, Diazgranados N, Momenan R. Selecting an optimal real-time fMRI neurofeedback method for alcohol craving control training. Psychophysiology 2023; 60:e14367. [PMID: 37326428 DOI: 10.1111/psyp.14367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/24/2023] [Accepted: 04/11/2023] [Indexed: 06/17/2023]
Abstract
Real-time fMRI neurofeedback (rt-fMRI-NF) is a technique in which information about an individual's neural state is given back to them, typically to enable and reinforce neuromodulation. Its clinical potential has been demonstrated in several applications, but lack of evidence on optimal parameters limits clinical utility of the technique. This study aimed to identify optimal parameters for rt-fMRI-NF-aided craving regulation training in alcohol use disorder (AUD). Adults with AUD (n = 30) participated in a single-session study of four runs of rt-fMRI-NF where they downregulated "craving-related" brain activity. They received one of three types of neurofeedback: multi-region of interest (ROI), support vector machine with continuous feedback (cSVM), and support vector machine with intermittent feedback (iSVM). Performance was assessed on the success rate, change in neural downregulation, and change in self-reported craving for alcohol. Participants had more successful trials in run 4 versus 1, as well as improved downregulation of the insula, anterior cingulate, and dorsolateral prefrontal cortex (dlPFC). Greater downregulation of the latter two regions predicted greater reduction in craving. iSVM performed significantly worse than the other two methods. Downregulation of the striatum and dlPFC, enabled by ROI but not cSVM neurofeedback, was correlated with a greater reduction in craving. rt-fMRI-NF training for downregulation of alcohol craving in individuals with AUD shows potential for clinical use, though this pilot study should be followed with a larger randomized-control trial before clinical meaningfulness can be established. Preliminary results suggest an advantage of multi-ROI over SVM and intermittent feedback approaches.
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Affiliation(s)
- Samantha J Fede
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - Mallory A Kisner
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
| | - Sarah F Dean
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
| | - Mike Kerich
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
| | - Vinai Roopchansingh
- National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Nancy Diazgranados
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
| | - Reza Momenan
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
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Singer N, Poker G, Dunsky-Moran N, Nemni S, Reznik Balter S, Doron M, Baker T, Dagher A, Zatorre RJ, Hendler T. Development and validation of an fMRI-informed EEG model of reward-related ventral striatum activation. Neuroimage 2023; 276:120183. [PMID: 37225112 PMCID: PMC10300238 DOI: 10.1016/j.neuroimage.2023.120183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 04/06/2023] [Accepted: 05/22/2023] [Indexed: 05/26/2023] Open
Abstract
Reward processing is essential for our mental-health and well-being. In the current study, we developed and validated a scalable, fMRI-informed EEG model for monitoring reward processing related to activation in the ventral-striatum (VS), a significant node in the brain's reward system. To develop this EEG-based model of VS-related activation, we collected simultaneous EEG/fMRI data from 17 healthy individuals while listening to individually-tailored pleasurable music - a highly rewarding stimulus known to engage the VS. Using these cross-modal data, we constructed a generic regression model for predicting the concurrently acquired Blood-Oxygen-Level-Dependent (BOLD) signal from the VS using spectro-temporal features from the EEG signal (termed hereby VS-related-Electrical Finger Print; VS-EFP). The performance of the extracted model was examined using a series of tests that were applied on the original dataset and, importantly, an external validation dataset collected from a different group of 14 healthy individuals who underwent the same EEG/FMRI procedure. Our results showed that the VS-EFP model, as measured by simultaneous EEG, predicted BOLD activation in the VS and additional functionally relevant regions to a greater extent than an EFP model derived from a different anatomical region. The developed VS-EFP was also modulated by musical pleasure and predictive of the VS-BOLD during a monetary reward task, further indicating its functional relevance. These findings provide compelling evidence for the feasibility of using EEG alone to model neural activation related to the VS, paving the way for future use of this scalable neural probing approach in neural monitoring and self-guided neuromodulation.
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Affiliation(s)
- Neomi Singer
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montréal, QC H3A 2B4, Canada; Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, 6 Weizman St. Tel Aviv, 64239, Israel; Sagol school of Neuroscience, Tel-Aviv University, PO Box 39040, Tel Aviv 6997801, Israel
| | - Gilad Poker
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, 6 Weizman St. Tel Aviv, 64239, Israel
| | - Netta Dunsky-Moran
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, 6 Weizman St. Tel Aviv, 64239, Israel; Sagol school of Neuroscience, Tel-Aviv University, PO Box 39040, Tel Aviv 6997801, Israel
| | - Shlomi Nemni
- Sagol school of Neuroscience, Tel-Aviv University, PO Box 39040, Tel Aviv 6997801, Israel; School of Psychological Sciences, Tel-Aviv University, PO Box 39040, Tel Aviv 6997801, Israel
| | - Shira Reznik Balter
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, 6 Weizman St. Tel Aviv, 64239, Israel
| | - Maayan Doron
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montréal, QC H3A 2B4, Canada; Sackler School of Medicine, Tel-Aviv University, PO Box 39040, Tel Aviv 6997801, Israel
| | - Travis Baker
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montréal, QC H3A 2B4, Canada; Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, NJ, USA
| | - Alain Dagher
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montréal, QC H3A 2B4, Canada
| | - Robert J Zatorre
- Montreal Neurological Institute, McGill University, 3801 Rue University, Montréal, QC H3A 2B4, Canada; International Laboratory for Brain, Music, and Sound Research (BRAMS), Canada
| | - Talma Hendler
- Sagol Brain Institute, Tel-Aviv Sourasky Medical Center, 6 Weizman St. Tel Aviv, 64239, Israel; Sagol school of Neuroscience, Tel-Aviv University, PO Box 39040, Tel Aviv 6997801, Israel; School of Psychological Sciences, Tel-Aviv University, PO Box 39040, Tel Aviv 6997801, Israel; Sackler School of Medicine, Tel-Aviv University, PO Box 39040, Tel Aviv 6997801, Israel.
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Testing the efficacy of real-time fMRI neurofeedback for training people who smoke daily to upregulate neural responses to nondrug rewards. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2023; 23:440-456. [PMID: 36788202 DOI: 10.3758/s13415-023-01070-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/16/2023]
Abstract
Although the use of nondrug rewards (e.g., money) to facilitate smoking cessation is widespread, recent research has found that such rewards may be least effective when people who smoke cigarettes are tempted to do so. Specifically, among people who smoke, the neural response to nondrug rewards appears blunted when access to cigarettes is anticipated, and this blunting is linked to a decrease in willingness to refrain from smoking to earn a monetary incentive. Accordingly, methods to enhance the value of nondrug rewards may be theoretically and clinically important. The current proof-of-concept study tested if real-time fMRI neurofeedback training augments the ability to upregulate responses in reward-related brain areas relative to a no-feedback control condition in people who smoke. Adults (n = 44, age range = 20-44) who reported smoking >5 cigarettes per day completed the study. Those in the intervention group (n = 22, 5 females) were trained to upregulate brain responses using feedback of ongoing striatal activity (i.e., a dynamic "thermometer" that reflected ongoing changes of fMRI signal intensity in the striatum) in a single neurofeedback session with three training runs. The control group (n = 22, 5 females) underwent a nearly identical procedure but received no neurofeedback. Those who received neurofeedback training demonstrated significantly greater increases in striatal BOLD activation while attempting to think about something rewarding compared to controls, but this effect was present only during the first training run. Future neurofeedback research with those who smoke should explore how to make neurofeedback training more effective for the self-regulation of reward-related brain activities.
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Rosenthal A, Ebrahimi C, Wedemeyer F, Romanczuk-Seiferth N, Beck A. The Treatment of Substance Use Disorders: Recent Developments and New Perspectives. Neuropsychobiology 2022; 81:451-472. [PMID: 35724634 DOI: 10.1159/000525268] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 04/28/2022] [Indexed: 11/19/2022]
Abstract
Substance-related disorders are complex psychiatric disorders that are characterized by continued consumption in spite of harmful consequences. Addiction affects various brain networks critically involved in learning, reward, and motivation, as well as inhibitory control. Currently applied therapeutic approaches aim at modification of behavior that ultimately leads to decrease of consumption or abstinence in individuals with substance use disorders. However, traditional treatment methods might benefit from recent neurobiological and cognitive neuroscientific research findings. Novel cognitive-behavioral approaches in the treatment of addictive behavior aim at enhancement of strategies to cope with stressful conditions as well as craving-inducing cues and target erroneous learning mechanisms, including cognitive bias modification, reconsolidation-based interventions, mindfulness-based interventions, virtual-reality-based cue exposure therapy as well as pharmacological augmentation strategies. This review discusses therapeutic strategies that target dysregulated neurocognitive processes associated with the development and maintenance of disordered substance use and may hold promise as effective treatments for substance-related disorders.
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Affiliation(s)
- Annika Rosenthal
- Department of Psychiatry and Neurosciences
- CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Claudia Ebrahimi
- Department of Psychiatry and Neurosciences
- CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friederike Wedemeyer
- Department of Psychiatry and Neurosciences
- CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nina Romanczuk-Seiferth
- Department of Psychiatry and Neurosciences
- CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anne Beck
- Department of Psychiatry and Neurosciences
- CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Health and Medical University, Campus Potsdam, Faculty of Health, Potsdam, Germany
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Dave F, Tripathi R. The efficacy of neurofeedback for alcohol use disorders - a systematic review. World J Biol Psychiatry 2022:1-12. [PMID: 36416049 DOI: 10.1080/15622975.2022.2151043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Alcoholism is a serious social, economic and public health problem. Alcoholism can affect the gastrointestinal, neurological, cardiovascular and respiratory systems, and it can be fatal, costing the healthcare system huge amounts of money. Despite the availability of cognitive-behavioural and psychosocial therapies, alcoholism has a high recurrence rate and a dismal prognosis, with a wide inter-individual variation. As a result, better or adjuvant therapies that improve or facilitate alcoholism therapy are required. We conducted a systematic review to look into the published studies that reported the effectiveness of non-pharmacological neurofeedback (NF) interventions in patients with alcohol use disorders (AUDs). METHODS PubMed, Google Scholar, The Cochrane Library, Science Direct and Clinicaltrial.gov were searched until 4 April 2022. Original articles of any design reporting on the use of NF approaches in the treatment of AUDs were included. Information related to study design, participants, control group, neuromodulation therapy, number of sessions and key findings of the study were extracted. The Joanna Briggs Institute's (JBI) Critical Appraisal Checklist for Studies was used to assess the quality of studies. RESULTS A total of 20 research articles (including 618 participants) were retrieved and included for qualitative analysis. The sample size ranged from 1 (case report) to 80, with years of publication ranging from 1977 to 2022. Nine of the 20 articles included in the study were conducted in the United States, followed by Germany, the United Kingdom, India, the Netherlands and South Korea. Out of the 20 studies included, 8 (40%) had a moderate risk of bias, while the other, i.e. 60% had a low risk of bias. The effectiveness of various neurological treatments in the treatment of AUDs was established in these 20 studies. There have been 11 studies on EEG NF training, three studies on real-time FMRI NF, two studies each on transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS), and one study each on deep brain stimulation (DBS) and theta burst stimulation (TBS). These alternative neurological therapies have been demonstrated to lower alcohol cravings and consumption temporarily, reduce anxiety and depression scores, reduce relapse rates and increase control of brain activity. CONCLUSIONS The use of various neuromodulation approaches to the treatment of AUD shows promise. However, more research with larger sample size is required.
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Affiliation(s)
- Forum Dave
- School of Behavioural Science, National Forensic Sciences University, Ganhinagar, India
| | - Ravikesh Tripathi
- School of Behavioural Science, National Forensic Sciences University, Ganhinagar, India
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Orth L, Meeh J, Gur RC, Neuner I, Sarkheil P. Frontostriatal circuitry as a target for fMRI-based neurofeedback interventions: A systematic review. Front Hum Neurosci 2022; 16:933718. [PMID: 36092647 PMCID: PMC9449529 DOI: 10.3389/fnhum.2022.933718] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/08/2022] [Indexed: 11/19/2022] Open
Abstract
Dysregulated frontostriatal circuitries are viewed as a common target for the treatment of aberrant behaviors in various psychiatric and neurological disorders. Accordingly, experimental neurofeedback paradigms have been applied to modify the frontostriatal circuitry. The human frontostriatal circuitry is topographically and functionally organized into the "limbic," the "associative," and the "motor" subsystems underlying a variety of affective, cognitive, and motor functions. We conducted a systematic review of the literature regarding functional magnetic resonance imaging-based neurofeedback studies that targeted brain activations within the frontostriatal circuitry. Seventy-nine published studies were included in our survey. We assessed the efficacy of these studies in terms of imaging findings of neurofeedback intervention as well as behavioral and clinical outcomes. Furthermore, we evaluated whether the neurofeedback targets of the studies could be assigned to the identifiable frontostriatal subsystems. The majority of studies that targeted frontostriatal circuitry functions focused on the anterior cingulate cortex, the dorsolateral prefrontal cortex, and the supplementary motor area. Only a few studies (n = 14) targeted the connectivity of the frontostriatal regions. However, post-hoc analyses of connectivity changes were reported in more cases (n = 32). Neurofeedback has been frequently used to modify brain activations within the frontostriatal circuitry. Given the regulatory mechanisms within the closed loop of the frontostriatal circuitry, the connectivity-based neurofeedback paradigms should be primarily considered for modifications of this system. The anatomical and functional organization of the frontostriatal system needs to be considered in decisions pertaining to the neurofeedback targets.
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Affiliation(s)
- Linda Orth
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Johanna Meeh
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Ruben C. Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Irene Neuner
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
- Institute of Neuroscience and Medicine 4, Forschungszentrum Jülich, Jülich, Germany
| | - Pegah Sarkheil
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
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Karch S, Krause D, Lehnert K, Konrad J, Haller D, Rauchmann BS, Maywald M, Engelbregt H, Adorjan K, Koller G, Reidler P, Karali T, Tschentscher N, Ertl-Wagner B, Pogarell O, Paolini M, Keeser D. Functional and clinical outcomes of FMRI-based neurofeedback training in patients with alcohol dependence: a pilot study. Eur Arch Psychiatry Clin Neurosci 2022; 272:557-569. [PMID: 34622344 PMCID: PMC9095551 DOI: 10.1007/s00406-021-01336-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 09/22/2021] [Indexed: 01/20/2023]
Abstract
Identifying treatment options for patients with alcohol dependence is challenging. This study investigates the application of real-time functional MRI (rtfMRI) neurofeedback (NF) to foster resistance towards craving-related neural activation in alcohol dependence. We report a double-blind, placebo-controlled rtfMRI study with three NF sessions using alcohol-associated cues as an add-on therapy to the standard treatment. Fifty-two patients (45 male; 7 female) diagnosed with alcohol dependence were recruited in Munich, Germany. RtfMRI data were acquired in three sessions and clinical abstinence was evaluated 3 months after the last NF session. Before the NF training, BOLD responses and clinical data did not differ between groups, apart from anger and impulsiveness. During NF training, BOLD responses of the active group were decreased in medial frontal areas/caudate nucleus, and increased, e.g. in the cuneus/precuneus and occipital cortex. Within the active group, the down-regulation of neuronal responses was more pronounced in patients who remained abstinent for at least 3 months after the intervention compared to patients with a relapse. As BOLD responses were comparable between groups before the NF training, functional variations during NF cannot be attributed to preexisting distinctions. We could not demonstrate that rtfMRI as an add-on treatment in patients with alcohol dependence leads to clinically superior abstinence for the active NF group after 3 months. However, the study provides evidence for a targeted modulation of addiction-associated brain responses in alcohol dependence using rtfMRI.
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Affiliation(s)
- Susanne Karch
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
| | - Daniela Krause
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany.
| | - Kevin Lehnert
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
| | - Julia Konrad
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
| | - Dinah Haller
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
| | - Boris-Stephan Rauchmann
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
- Department of Radiology, University Hospital LMU, Munich, Germany
| | - Maximilian Maywald
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
| | - Hessel Engelbregt
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
- Hersencentrum Mental Health Institute, Amsterdam, The Netherlands
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU, Munich, Germany
| | - Gabriele Koller
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
| | - Paul Reidler
- Department of Radiology, University Hospital LMU, Munich, Germany
| | - Temmuz Karali
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
- Department of Radiology, University Hospital LMU, Munich, Germany
| | - Nadja Tschentscher
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
| | - Birgit Ertl-Wagner
- Department of Radiology, University Hospital LMU, Munich, Germany
- Division of Neuroradiology, Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
| | - Marco Paolini
- Department of Radiology, University Hospital LMU, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Nußbaumstr. 7, 80336, Munich, Germany
- Department of Radiology, University Hospital LMU, Munich, Germany
- Munich Center for Neurosciences (MCN), LMU, Munich, Germany
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11
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Weiss F, Zhang J, Aslan A, Kirsch P, Gerchen MF. Feasibility of training the dorsolateral prefrontal-striatal network by real-time fMRI neurofeedback. Sci Rep 2022; 12:1669. [PMID: 35102203 PMCID: PMC8803939 DOI: 10.1038/s41598-022-05675-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/17/2022] [Indexed: 12/17/2022] Open
Abstract
Real-time fMRI neurofeedback (rt-fMRI NF) is a promising non-invasive technique that enables volitional control of usually covert brain processes. While most rt-fMRI NF studies so far have demonstrated the ability of the method to evoke changes in brain activity and improve symptoms of mental disorders, a recently evolving field is network-based functional connectivity (FC) rt-fMRI NF. However, FC rt-fMRI NF has methodological challenges such as respirational artefacts that could potentially bias the training if not controlled. In this randomized, double-blind, yoke-controlled, pre-registered FC rt-fMRI NF study with healthy participants (N = 40) studied over three training days, we tested the feasibility of an FC rt-fMRI NF approach with online global signal regression (GSR) to control for physiological artefacts for up-regulation of connectivity in the dorsolateral prefrontal-striatal network. While our pre-registered null hypothesis significance tests failed to reach criterion, we estimated the FC training effect at a medium effect size at the end of the third training day after rigorous control of physiological artefacts in the offline data. This hints at the potential of FC rt-fMRI NF for the development of innovative transdiagnostic circuit-specific interventional approaches for mental disorders and the effect should now be confirmed in a well-powered study.
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Affiliation(s)
- Franziska Weiss
- Department of Clinical Psychology, Central Institute of Mental Health (ZI), Heidelberg University/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany
| | - Jingying Zhang
- Department of Clinical Psychology, Central Institute of Mental Health (ZI), Heidelberg University/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany
| | - Acelya Aslan
- Department of Addiction Behavior and Addiction Medicine, Central Institute of Mental Health, Heidelberg University/Medical Faculty Mannheim, Mannheim, Germany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health (ZI), Heidelberg University/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany.,Bernstein Center for Computational Neuroscience Heidelberg/Mannheim, Mannheim, Germany.,Department of Psychology, Heidelberg University, Heidelberg, Germany
| | - Martin Fungisai Gerchen
- Department of Clinical Psychology, Central Institute of Mental Health (ZI), Heidelberg University/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany. .,Bernstein Center for Computational Neuroscience Heidelberg/Mannheim, Mannheim, Germany. .,Department of Psychology, Heidelberg University, Heidelberg, Germany.
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12
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Nicholson AA, Rabellino D, Densmore M, Frewen PA, Steryl D, Scharnowski F, Théberge J, Neufeld RWJ, Schmahl C, Jetly R, Lanius RA. Differential mechanisms of posterior cingulate cortex downregulation and symptom decreases in posttraumatic stress disorder and healthy individuals using real-time fMRI neurofeedback. Brain Behav 2022; 12:e2441. [PMID: 34921746 PMCID: PMC8785646 DOI: 10.1002/brb3.2441] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/25/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Intrinsic connectivity networks, including the default mode network (DMN), are frequently disrupted in individuals with posttraumatic stress disorder (PTSD). The posterior cingulate cortex (PCC) is the main hub of the posterior DMN, where the therapeutic regulation of this region with real-time fMRI neurofeedback (NFB) has yet to be explored. METHODS We investigated PCC downregulation while processing trauma/stressful words over 3 NFB training runs and a transfer run without NFB (total n = 29, PTSD n = 14, healthy controls n = 15). We also examined the predictive accuracy of machine learning models in classifying PTSD versus healthy controls during NFB training. RESULTS Both the PTSD and healthy control groups demonstrated reduced reliving symptoms in response to trauma/stressful stimuli, where the PTSD group additionally showed reduced symptoms of distress. We found that both groups were able to downregulate the PCC with similar success over NFB training and in the transfer run, although downregulation was associated with unique within-group decreases in activation within the bilateral dmPFC, bilateral postcentral gyrus, right amygdala/hippocampus, cingulate cortex, and bilateral temporal pole/gyri. By contrast, downregulation was associated with increased activation in the right dlPFC among healthy controls as compared to PTSD. During PCC downregulation, right dlPFC activation was negatively correlated to PTSD symptom severity scores and difficulties in emotion regulation. Finally, machine learning algorithms were able to classify PTSD versus healthy participants based on brain activation during NFB training with 80% accuracy. CONCLUSIONS This is the first study to investigate PCC downregulation with real-time fMRI NFB in both PTSD and healthy controls. Our results reveal acute decreases in symptoms over training and provide converging evidence for EEG-NFB targeting brain networks linked to the PCC.
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Affiliation(s)
- Andrew A Nicholson
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Daniela Rabellino
- Department of Neuroscience, Western University, London, Ontario, Canada.,Imaging, Lawson Health Research Institute, London, Ontario, Canada
| | - Maria Densmore
- Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada
| | - Paul A Frewen
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychology, Western University, London, Ontario, Canada
| | - David Steryl
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Frank Scharnowski
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Jean Théberge
- Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Diagnostic Imaging, St. Joseph's Healthcare, London, Ontario, Canada
| | - Richard W J Neufeld
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychology, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Psychology, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Heidelberg, Germany
| | - Rakesh Jetly
- Canadian Forces, Health Services, Ottawa, Ontario, Canada
| | - Ruth A Lanius
- Department of Neuroscience, Western University, London, Ontario, Canada.,Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada
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13
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Rawls E, Wolkowicz NR, Ham LS, Lamm C. Negative urgency as a risk factor for hazardous alcohol use: Dual influences of cognitive control and reinforcement processing. Neuropsychologia 2021; 161:108009. [PMID: 34454939 PMCID: PMC8488007 DOI: 10.1016/j.neuropsychologia.2021.108009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 01/16/2023]
Abstract
Negative Urgency (NU) is a prominent risk factor for hazardous alcohol use. While research has helped elucidate how NU relates to neurobiological functioning with respect to alcohol use, no known work has contextualized such functioning within existing neurobiological theories in addiction. Therefore, we elucidated mechanisms contributing to the NU-hazardous alcohol use relationship by combining NU theories with neurobiological dual models of addiction, which posit addiction is related to cognitive control and reinforcement processing. Fifty-five undergraduates self-reported NU and hazardous alcohol use. We recorded EEG while participants performed a reinforced flanker task. We measured cognitive control using N2 activation time-locked to the incongruent flanker stimulus, and we measured reinforcement processing using the feedback-related negativity (FRN) time-locked to better-than-expected negative reinforcement feedback. We modeled hazardous drinking using hierarchical regression, with NU, N2, and FRN plus their interactions as predictors. The regression model significantly predicted hazardous alcohol use, and the three-way interaction (NU × N2 × FRN) significantly improved model fit. In the context of inefficient processing (i.e., larger N2s and FRNs), NU demonstrated a strong relationship with hazardous alcohol use. In the context of efficient processing (i.e., smaller N2s and FRNs), NU was unrelated to hazardous alcohol use. Control analyses ruled out the potential impact of other impulsivity subscales, individual differences in dimensional negative affect or anxiety, and use of substances other than alcohol, and post hoc specificity analyses showed that this effect was driven primarily by heavy drinking, rather than frequency of drinking. This analysis provides preliminary evidence that brain mechanisms of cognitive control and reinforcement processing influence the relationship between NU and hazardous alcohol use, and confirms a specific influence of negative reinforcement processing. Future clinical research could leverage these neurobiological moderators for substance misuse treatment.
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Affiliation(s)
- Eric Rawls
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, USA.
| | | | - Lindsay S Ham
- Department of Psychological Science, University of Arkansas, USA
| | - Connie Lamm
- Department of Psychological Science, University of Arkansas, USA
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14
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Deep Network Pharmacology: Targeting Glutamate Systems as Integrative Treatments for Jump-Starting Neural Networks and Recovery Trajectories. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2021; 6. [PMID: 34549091 PMCID: PMC8452258 DOI: 10.20900/jpbs.20210008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Significant advances in pharmacological treatments for mental illness and addiction will require abandoning old monoaminergic theories of psychiatric disorders and traditionally narrow approaches to how we conduct treatment research. Reframing our efforts with a view on integrative treatments that target core neural network function and plasticity may provide new approaches for lifting patients out of chronic psychiatric symptom sets and addiction. For example, we discuss new treatments that target brain glutamate systems at key transition points within longitudinal courses of care that integrate several treatment modalities. A reconsideration of what our novel and already available medications are intended to achieve and how and when we deliver them for patients with complex illness trajectories could be the key to unlocking new advances in general and addiction psychiatry.
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15
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Neuropsychosocial markers of binge drinking in young adults. Mol Psychiatry 2021; 26:4931-4943. [PMID: 32398720 PMCID: PMC7658012 DOI: 10.1038/s41380-020-0771-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/22/2020] [Accepted: 04/29/2020] [Indexed: 01/26/2023]
Abstract
Binge drinking is associated with disease and death, and developing tools to identify risky drinkers could mitigate its damage. Brain processes underlie risky drinking, so we examined whether neural and psychosocial markers could identify binge drinkers. Reward is the most widely studied neural process in addiction, but processes such as emotion, social cognition, and self-regulation are also involved. Here we examined whether neural processes apart from reward contribute to predicting risky drinking behaviors. From the Human Connectome Project, we identified 177 young adults who binged weekly and 309 nonbingers. We divided the sample into a training and a testing set and used machine-learning algorithms to classify participants based on psychosocial, neural, or both (neuropsychosocial) data. We also developed separate models for each of the seven fMRI tasks used in the study. An ensemble model developed in the training dataset was then applied to the testing dataset. Model performance was assessed by the area under the receiver operating characteristic curve (AUC) and differences between models were assessed using DeLong's test. The three models performed better than chance in the test sample with the neuropsychosocial (AUC = 0.86) and psychosocial (AUC = 0.84) performing better than the neural model (AUC = 0.64). Two fMRI-based models predicted binge drinking status better than chance, corresponding to the social and language tasks. Models developed with psychosocial and neural variables could contribute as diagnostic tools to help classify risky drinkers. Since social and language fMRI tasks performed best among the neural discriminators (including those from gambling and emotion tasks), it suggests the involvement of a broader range of brain processes than those traditionally associated with binge drinking in young adults.
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16
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Guerrero Moreno J, Biazoli CE, Baptista AF, Trambaiolli LR. Closed-loop neurostimulation for affective symptoms and disorders: An overview. Biol Psychol 2021; 161:108081. [PMID: 33757806 DOI: 10.1016/j.biopsycho.2021.108081] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 12/28/2022]
Abstract
Affective and anxiety disorders are the most prevalent and incident psychiatric disorders worldwide. Therapeutic approaches to these disorders using non-invasive brain stimulation (NIBS) and analogous techniques have been extensively investigated. In this paper, we discuss the combination of NIBS and neurofeedback in closed-loop setups and its application for affective symptoms and disorders. For this, we first provide a rationale for this combination by presenting some of the main original findings of NIBS, with a primary focus on transcranial magnetic stimulation (TMS), and neurofeedback, including protocols based on electroencephalography (EEG) and functional magnetic resonance imaging (fMRI). Then, we provide a scope review of studies combining real-time neurofeedback with NIBS protocols in the so-called closed-loop brain state-dependent neuromodulation (BSDS). Finally, we discuss the concomitant use of TMS and real-time functional near-infrared spectroscopy (fNIRS) as a possible solution to the current limitations of BSDS-based protocols for affective and anxiety disorders.
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Affiliation(s)
- Javier Guerrero Moreno
- Center of Mathematics, Computation and Cognition, Universidade Federal do ABC, Santo André, Brazil
| | - Claudinei Eduardo Biazoli
- Center of Mathematics, Computation and Cognition, Universidade Federal do ABC, Santo André, Brazil; Department of Psychology, School of Biological and Chemical Sciences, Queen Mary University of London, UK
| | - Abrahão Fontes Baptista
- Center of Mathematics, Computation and Cognition, Universidade Federal do ABC, Santo André, Brazil; Laboratory of Medical Investigations 54 (LIM-54), Universidade de São Paulo, São Paulo, Brazil; NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil; Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
| | - Lucas Remoaldo Trambaiolli
- McLean Hospital, Harvard Medical School, Boston, USA; School of Medicine and Dentistry, University of Rochester, Rochester, USA.
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17
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Zhao Z, Yao S, Zweerings J, Zhou X, Zhou F, Kendrick KM, Chen H, Mathiak K, Becker B. Putamen volume predicts real-time fMRI neurofeedback learning success across paradigms and neurofeedback target regions. Hum Brain Mapp 2021; 42:1879-1887. [PMID: 33400306 PMCID: PMC7978128 DOI: 10.1002/hbm.25336] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 12/11/2022] Open
Abstract
Real-time fMRI guided neurofeedback training has gained increasing interest as a noninvasive brain regulation technique with the potential to modulate functional brain alterations in therapeutic contexts. Individual variations in learning success and treatment response have been observed, yet the neural substrates underlying the learning of self-regulation remain unclear. Against this background, we explored potential brain structural predictors for learning success with pooled data from three real-time fMRI data sets. Our analysis revealed that gray matter volume of the right putamen could predict neurofeedback learning success across the three data sets (n = 66 in total). Importantly, the original studies employed different neurofeedback paradigms during which different brain regions were trained pointing to a general association with learning success independent of specific aspects of the experimental design. Given the role of the putamen in associative learning this finding may reflect an important role of instrumental learning processes and brain structural variations in associated brain regions for successful acquisition of fMRI neurofeedback-guided self-regulation.
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Affiliation(s)
- Zhiying Zhao
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA.,The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Shuxia Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Jana Zweerings
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
| | - Xinqi Zhou
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Feng Zhou
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Keith M Kendrick
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Huafu Chen
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
| | - Benjamin Becker
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
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18
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Subramanian L, Skottnik L, Cox WM, Lührs M, McNamara R, Hood K, Watson G, Whittaker JR, Williams AN, Sakhuja R, Ihssen N, Goebel R, Playle R, Linden DE. Neurofeedback Training versus Treatment-as-Usual for Alcohol Dependence: Results of an Early-Phase Randomized Controlled Trial and Neuroimaging Correlates. Eur Addict Res 2021; 27:381-394. [PMID: 33677449 PMCID: PMC8491491 DOI: 10.1159/000513448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/20/2020] [Indexed: 11/19/2022]
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.
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Affiliation(s)
- Leena Subramanian
- MRC Centre for Neuropsychiatric Genetics and Genomics and Cardiff University Brain Research Imaging Centre, Schools of Medicine and Psychology, Cardiff University, Cardiff, United Kingdom
| | - Leon Skottnik
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands,*Leon Skottnik, School for Mental Health and Neuroscience, Maastricht University, Vijverdalseweg 1, NL–62226 Maastricht (The Netherlands),
| | - W. Miles Cox
- School of Psychology, Bangor University, Bangor, United Kingdom
| | - Michael Lührs
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands,Brain Innovation B.V., Maastricht, The Netherlands
| | - Rachel McNamara
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Kerry Hood
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Gareth Watson
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Joseph R. Whittaker
- School of Physics and Astronomy, Cardiff University, Cardiff, United Kingdom
| | - Angharad N. Williams
- Adaptive Memory Research Group, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Raman Sakhuja
- Addiction Services, Cwm Taf Morgannwg University Health Board, Mountain Ash, United Kingdom
| | - Niklas Ihssen
- Department of Psychology, Durham University, Durham, United Kingdom
| | - Rainer Goebel
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands,Brain Innovation B.V., Maastricht, The Netherlands
| | - Rebecca Playle
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - David E.J. Linden
- MRC Centre for Neuropsychiatric Genetics and Genomics and Cardiff University Brain Research Imaging Centre, Schools of Medicine and Psychology, Cardiff University, Cardiff, United Kingdom,School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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19
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Spanagel R. Cannabinoids and the endocannabinoid system in reward processing and addiction: from mechanisms to interventions
. DIALOGUES IN CLINICAL NEUROSCIENCE 2020; 22:241-250. [PMID: 33162767 PMCID: PMC7605022 DOI: 10.31887/dcns.2020.22.3/rspanagel] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The last decades have seen a major gain in understanding the action of
cannabinoids and the endocannabinoid system in reward processing and the development of
addictive behavior. Cannabis-derived psychoactive compounds such as
Δ9-tetrahydrocannabinol and synthetic cannabinoids directly interact with the reward
system and thereby have addictive properties. Cannabinoids induce their reinforcing
properties by an increase in tonic dopamine levels through a cannabinoid type 1 (CB1)
receptor–dependent mechanism within the ventral tegmental area. Cues that are
conditioned to cannabis smoking can induce drug-seeking responses (ie, craving) by
eliciting phasic dopamine events. A dopamine-independent mechanism involved in
drug-seeking responses involves an endocannabinoid/glutamate interaction within the
corticostriatal part of the reward system. In conclusion, pharmacological blockade of
endocannabinoid signaling should lead to a reduction in drug craving and subsequently
should reduce relapse behavior in addicted individuals. Indeed, there is increasing
preclinical evidence that targeting the endocannabinoid system reduces craving and
relapse, and allosteric modulators at CB1 receptors and fatty acid amide hydrolase
inhibitors are in clinical development for cannabis use disorder. Cannabidiol, which
mainly acts on CB1 and CB2 receptors, is currently being tested in patients with alcohol
use disorder and opioid use disorder.
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Affiliation(s)
- Rainer Spanagel
- Institute of Psychopharmacology, Central Institute of Mental Health, Faculty of Medicine Mannheim, University of Heidelberg, Germany
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20
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Abstract
Abstract
Purpose of Review
Alcohol use disorder (AUD) is a burdening chronic condition that is characterized by high relapse rates despite severe negative consequences. There has been a recent emergence of interest in (neuro)therapeutic intervention strategies that largely involve the detrimental change in mechanisms linked to addiction disorders. Most prominently, the latter include habitual decision-making, cue-induced behavioral tendencies, as well as the amplifying effects of stressful events on drinking behavior. This article discusses these learning mechanisms and modification thereof as possible targets of (neuro)therapeutic interventions for AUD.
Recent Findings
Psychological therapies that target dysregulated neurocognitive processes underlying addictive behavior may hold promise as effective treatments for AUD.
Summary
Despite the progression in psychological and neuroscience research in the field of AUD, many behavioral interventions fail to systematically integrate and apply such findings into treatment development. Future research should focus on the targeted modification of the aforementioned processes.
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Martz ME, Hart T, Heitzeg MM, Peltier SJ. Neuromodulation of brain activation associated with addiction: A review of real-time fMRI neurofeedback studies. Neuroimage Clin 2020; 27:102350. [PMID: 32736324 PMCID: PMC7394772 DOI: 10.1016/j.nicl.2020.102350] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/07/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023]
Abstract
Real-time functional magnetic resonance imaging neurofeedback (rtfMRI-nf) has emerged in recent years as an imaging modality used to examine volitional control over targeted brain activity. rtfMRI-nf has also been applied clinically as a way to train individuals to self-regulate areas of the brain, or circuitry, involved in various disorders. One such application of rtfMRI-nf has been in the domain of addictive behaviors, including substance use. Given the pervasiveness of substance use and the challenges of existing treatments to sustain abstinence, rtfMRI-nf has been identified as a promising treatment tool. rtfMRI-nf has also been used in basic science research in order to test the ability to modulate brain function involved in addiction. This review focuses first on providing an overview of recent rtfMRI-nf studies in substance-using populations, specifically nicotine, alcohol, and cocaine users, aimed at reducing craving-related brain activation. Next, rtfMRI-nf studies targeting reward responsivity and emotion regulation in healthy samples are reviewed in order to examine the extent to which areas of the brain involved in addiction can be self-regulated using neurofeedback. We propose that future rtfMRI-nf studies could be strengthened by improvements to study design, sample selection, and more robust strategies in the development and assessment of rtfMRI-nf as a clinical treatment. Recommendations for ways to accomplish these improvements are provided. rtfMRI-nf holds much promise as an imaging modality that can directly target key brain regions involved in addiction, however additional studies are needed in order to establish rtfMRI-nf as an effective, and practical, treatment for addiction.
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Affiliation(s)
- Meghan E Martz
- Addiction Center, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Tabatha Hart
- Addiction Center, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Mary M Heitzeg
- Addiction Center, Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Scott J Peltier
- Functional MRI Laboratory, USA; Department of Biomedical Engineering, Bonisteel Interdisciplinary Research Building, 2360 Bonisteel Blvd, Ann Arbor, MI 48109, USA
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22
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Weiss F, Aslan A, Zhang J, Gerchen MF, Kiefer F, Kirsch P. Using mind control to modify cue-reactivity in AUD: the impact of mindfulness-based relapse prevention on real-time fMRI neurofeedback to modify cue-reactivity in alcohol use disorder: a randomized controlled trial. BMC Psychiatry 2020; 20:309. [PMID: 32546139 PMCID: PMC7298966 DOI: 10.1186/s12888-020-02717-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/04/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Alcohol Use Disorder is a severe mental disorder affecting the individuals concerned, their family and friends and society as a whole. Despite its high prevalence, novel treatment options remain rather limited. Two innovative interventions used for treating severe disorders are the use of real-time functional magnetic resonance imaging neurofeedback that targets brain regions related to the disorder, and mindfulness-based treatments. In the context of the TRR SFB 265 C04 "Mindfulness-based relapse prevention as an addition to rtfMRI NFB intervention for patients with Alcohol Use Disorder (MiND)" study, both interventions will be combined to a state-of-the art intervention that will use mindfulness-based relapse prevention to improve the efficacy of a real-time neurofeedback intervention targeting the ventral striatum, which is a brain region centrally involved in cue-reactivity to alcohol-related stimuli. METHODS/DESIGN After inclusion, N = 88 patients will be randomly assigned to one of four groups. Two of those groups will receive mindfulness-based relapse prevention. All groups will receive two fMRI sessions and three real-time neurofeedback sessions in a double-blind manner and will regulate either the ventral striatum or the auditory cortex as a control region. Two groups will additionally receive five sessions of mindfulness-based relapse prevention prior to the neurofeedback intervention. After the last fMRI session, the participants will be followed-up monthly for a period of 3 months for an assessment of the relapse rate and clinical effects of the intervention. DISCUSSION The results of this study will give further insights into the efficacy of real-time functional magnetic resonance imaging neurofeedback interventions for the treatment of Alcohol Use Disorder. Additionally, the study will provide further insight on neurobiological changes in the brain caused by the neurofeedback intervention as well as by the mindfulness-based relapse prevention. The outcome might be useful to develop new treatment approaches targeting mechanisms of Alcohol Use Disorder with the goal to reduce relapse rates after discharge from the hospital. TRIAL REGISTRATION This trial is pre-registered at clinicaltrials.gov (trial identifier: NCT04366505; WHO Universal Trial Number (UTN): U1111-1250-2964). Registered 30 March 2020, published 29 April 2020.
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Affiliation(s)
- Franziska Weiss
- Department of Clinical Psychology, Central Institute of Mental Health (ZI), Heidelberg University/Medical Faculty Mannheim, 68159, Mannheim, Germany.
| | - Acelya Aslan
- grid.7700.00000 0001 2190 4373Department of Addiction Behavior and Addiction Medicine, Central Institute of Mental Health, Heidelberg University/Medical Faculty Mannheim, Mannheim, Germany
| | - Jingying Zhang
- grid.7700.00000 0001 2190 4373Department of Clinical Psychology, Central Institute of Mental Health (ZI), Heidelberg University/Medical Faculty Mannheim, 68159 Mannheim, Germany
| | - Martin Fungisai Gerchen
- grid.7700.00000 0001 2190 4373Department of Clinical Psychology, Central Institute of Mental Health (ZI), Heidelberg University/Medical Faculty Mannheim, 68159 Mannheim, Germany ,grid.7700.00000 0001 2190 4373Department of Psychology, Heidelberg University, Heidelberg, Germany ,grid.455092.fBernstein Center for Computational Neuroscience Heidelberg/Mannheim, Mannheim, Germany
| | - Falk Kiefer
- grid.7700.00000 0001 2190 4373Department of Addiction Behavior and Addiction Medicine, Central Institute of Mental Health, Heidelberg University/Medical Faculty Mannheim, Mannheim, Germany
| | - Peter Kirsch
- grid.7700.00000 0001 2190 4373Department of Clinical Psychology, Central Institute of Mental Health (ZI), Heidelberg University/Medical Faculty Mannheim, 68159 Mannheim, Germany ,grid.7700.00000 0001 2190 4373Department of Psychology, Heidelberg University, Heidelberg, Germany ,grid.455092.fBernstein Center for Computational Neuroscience Heidelberg/Mannheim, Mannheim, Germany
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Weiss F, Zamoscik V, Schmidt SN, Halli P, Kirsch P, Gerchen MF. Just a very expensive breathing training? Risk of respiratory artefacts in functional connectivity-based real-time fMRI neurofeedback. Neuroimage 2020; 210:116580. [DOI: 10.1016/j.neuroimage.2020.116580] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/15/2020] [Accepted: 01/20/2020] [Indexed: 10/25/2022] Open
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Heinz A, Kiefer F, Smolka MN, Endrass T, Beste C, Beck A, Liu S, Genauck A, Romund L, Banaschewski T, Bermpohl F, Deserno L, Dolan RJ, Durstewitz D, Ebner‐Priemer U, Flor H, Hansson AC, Heim C, Hermann D, Kiebel S, Kirsch P, Kirschbaum C, Koppe G, Marxen M, Meyer‐Lindenberg A, Nagel WE, Noori HR, Pilhatsch M, Priller J, Rietschel M, Romanczuk‐Seiferth N, Schlagenhauf F, Sommer WH, Stallkamp J, Ströhle A, Stock A, Winterer G, Winter C, Walter H, Witt S, Vollstädt‐Klein S, Rapp MA, Tost H, Spanagel R. Addiction Research Consortium: Losing and regaining control over drug intake (ReCoDe)-From trajectories to mechanisms and interventions. Addict Biol 2020; 25:e12866. [PMID: 31859437 DOI: 10.1111/adb.12866] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/24/2019] [Accepted: 12/04/2019] [Indexed: 12/11/2022]
Abstract
One of the major risk factors for global death and disability is alcohol, tobacco, and illicit drug use. While there is increasing knowledge with respect to individual factors promoting the initiation and maintenance of substance use disorders (SUDs), disease trajectories involved in losing and regaining control over drug intake (ReCoDe) are still not well described. Our newly formed German Collaborative Research Centre (CRC) on ReCoDe has an interdisciplinary approach funded by the German Research Foundation (DFG) with a 12-year perspective. The main goals of our research consortium are (i) to identify triggers and modifying factors that longitudinally modulate the trajectories of losing and regaining control over drug consumption in real life, (ii) to study underlying behavioral, cognitive, and neurobiological mechanisms, and (iii) to implicate mechanism-based interventions. These goals will be achieved by: (i) using mobile health (m-health) tools to longitudinally monitor the effects of triggers (drug cues, stressors, and priming doses) and modify factors (eg, age, gender, physical activity, and cognitive control) on drug consumption patterns in real-life conditions and in animal models of addiction; (ii) the identification and computational modeling of key mechanisms mediating the effects of such triggers and modifying factors on goal-directed, habitual, and compulsive aspects of behavior from human studies and animal models; and (iii) developing and testing interventions that specifically target the underlying mechanisms for regaining control over drug intake.
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Affiliation(s)
- Andreas Heinz
- Department of Psychiatry and PsychotherapyCharité‐Universitätsmedizin Berlin (Campus Charité Mitte) Berlin Germany
| | - Falk Kiefer
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty MannheimUniversity of Heidelberg, Mannheim Germany
| | - Michael N. Smolka
- Department of Psychiatry and Neuroimaging CentreTechnische Universität Dresden Dresden Germany
| | - Tanja Endrass
- Institute for Clinical Psychology and PsychotherapyTechnische Universität Dresden Dresden Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent PsychiatryTechnische Universität Dresden Dresden Germany
| | - Anne Beck
- Department of Psychiatry and PsychotherapyCharité‐Universitätsmedizin Berlin (Campus Charité Mitte) Berlin Germany
| | - Shuyan Liu
- Department of Psychiatry and PsychotherapyCharité‐Universitätsmedizin Berlin (Campus Charité Mitte) Berlin Germany
| | - Alexander Genauck
- Department of Psychiatry and PsychotherapyCharité‐Universitätsmedizin Berlin (Campus Charité Mitte) Berlin Germany
| | - Lydia Romund
- Department of Psychiatry and PsychotherapyCharité‐Universitätsmedizin Berlin (Campus Charité Mitte) Berlin Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty MannheimHeidelberg University Mannheim Germany
| | - Felix Bermpohl
- Department of Psychiatry and PsychotherapyCharité‐Universitätsmedizin Berlin (Campus Charité Mitte) Berlin Germany
| | - Lorenz Deserno
- Department of Psychiatry and Neuroimaging CentreTechnische Universität Dresden Dresden Germany
- Max Planck Centre for Computational Psychiatry and Ageing Research & Wellcome Centre for Human NeuroimagingUniversity College London London UK
| | - Raymond J. Dolan
- Max Planck Centre for Computational Psychiatry and Ageing Research & Wellcome Centre for Human NeuroimagingUniversity College London London UK
| | - Daniel Durstewitz
- Department of Theoretical Neuroscience, Central Institute of Mental Health, Medical Faculty MannheimUniversity of Heidelberg Mannheim Germany
| | - Ulrich Ebner‐Priemer
- Department of Sports and Sports ScienceKarlsruhe Institute of Technology (KIT) Karlsruhe Germany
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty MannheimHeidelberg University Mannheim Germany
- Department of Psychology, School of Social SciencesUniversity of Mannheim Mannheim Germany
| | - Anita C. Hansson
- Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty MannheimHeidelberg University Mannheim Germany
| | - Christine Heim
- Institute of Medical PsychologyCharité – Universitätsmedizin Berlin Berlin Germany
- Department of Biobehavioral HealthPennsylvania State University University Park Pennsylvania
| | - Derik Hermann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty MannheimUniversity of Heidelberg, Mannheim Germany
- Feuerlein Center on Translational Addiction Medicine (FCTS)University of Heidelberg Heidelberg Germany
| | - Stefan Kiebel
- Department of Psychiatry and Neuroimaging CentreTechnische Universität Dresden Dresden Germany
- Department of Psychology and Neuroimaging CenterTechnische Universität Dresden Dresden Germany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty MannheimHeidelberg University Mannheim Germany
| | - Clemens Kirschbaum
- Department of Psychology, Biological PsychologyTechnische Universität Dresden Dresden Germany
| | - Georgia Koppe
- Department of Theoretical Neuroscience, Central Institute of Mental Health, Medical Faculty MannheimUniversity of Heidelberg Mannheim Germany
| | - Michael Marxen
- Department of Psychiatry and Neuroimaging CentreTechnische Universität Dresden Dresden Germany
| | - Andreas Meyer‐Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty MannheimUniversity of Heidelberg Mannheim Germany
| | - Wolfgang E. Nagel
- Center for Information Services and High Performance ComputingTechnische Universität Dresden Dresden Germany
| | - Hamid R. Noori
- Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty MannheimHeidelberg University Mannheim Germany
- Max Planck Institute for Biological Cybernetics Tübingen Germany
| | - Maximilian Pilhatsch
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Faculty of MedicineTechnische Universität Dresden Dresden Germany
| | - Josef Priller
- Department of Neuropsychiatry and Laboratory of Molecular PsychiatryCharité‐Universitätsmedizin Berlin Berlin Germany
- UK Dementia Research InstituteUniversity of Edinburgh Edinburgh UK
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty MannheimHeidelberg University Mannheim Germany
| | - Nina Romanczuk‐Seiferth
- Department of Psychiatry and PsychotherapyCharité‐Universitätsmedizin Berlin (Campus Charité Mitte) Berlin Germany
| | - Florian Schlagenhauf
- Department of Psychiatry and PsychotherapyCharité‐Universitätsmedizin Berlin (Campus Charité Mitte) Berlin Germany
| | - Wolfgang H. Sommer
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty MannheimUniversity of Heidelberg, Mannheim Germany
- Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty MannheimHeidelberg University Mannheim Germany
| | - Jan Stallkamp
- Project Group for Automation in Medicine and BiotechnologyFraunhofer IPA Mannheim Germany
| | - Andreas Ströhle
- Department of Psychiatry and PsychotherapyCharité‐Universitätsmedizin Berlin (Campus Charité Mitte) Berlin Germany
| | - Ann‐Kathrin Stock
- Cognitive Neurophysiology, Department of Child and Adolescent PsychiatryTechnische Universität Dresden Dresden Germany
| | - Georg Winterer
- Experimental and Clinical Research Center (ECRC), Department of Anesthesiology and Intensive Care MedicineCharité‐Universitätsmedizin Berlin Berlin Germany
| | - Christine Winter
- Department of Psychiatry and PsychotherapyCharité‐Universitätsmedizin Berlin (Campus Charité Mitte) Berlin Germany
| | - Henrik Walter
- Department of Psychiatry and PsychotherapyCharité‐Universitätsmedizin Berlin (Campus Charité Mitte) Berlin Germany
| | - Stephanie Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty MannheimHeidelberg University Mannheim Germany
| | - Sabine Vollstädt‐Klein
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty MannheimUniversity of Heidelberg, Mannheim Germany
| | - Michael A. Rapp
- Social and Preventive MedicineUniversität Potsdam Potsdam Germany
| | - Heike Tost
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty MannheimUniversity of Heidelberg Mannheim Germany
| | - Rainer Spanagel
- Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty MannheimHeidelberg University Mannheim Germany
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Fede SJ, Dean SF, Manuweera T, Momenan R. A Guide to Literature Informed Decisions in the Design of Real Time fMRI Neurofeedback Studies: A Systematic Review. Front Hum Neurosci 2020; 14:60. [PMID: 32161529 PMCID: PMC7052377 DOI: 10.3389/fnhum.2020.00060] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/07/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Although biofeedback using electrophysiology has been explored extensively, the approach of using neurofeedback corresponding to hemodynamic response is a relatively young field. Real time functional magnetic resonance imaging-based neurofeedback (rt-fMRI-NF) uses sensory feedback to operantly reinforce patterns of neural response. It can be used, for example, to alter visual perception, increase brain connectivity, and reduce depression symptoms. Within recent years, interest in rt-fMRI-NF in both research and clinical contexts has expanded considerably. As such, building a consensus regarding best practices is of great value. Objective: This systematic review is designed to describe and evaluate the variations in methodology used in previous rt-fMRI-NF studies to provide recommendations for rt-fMRI-NF study designs that are mostly likely to elicit reproducible and consistent effects of neurofeedback. Methods: We conducted a database search for fMRI neurofeedback papers published prior to September 26th, 2019. Of 558 studies identified, 146 met criteria for inclusion. The following information was collected from each study: sample size and type, task used, neurofeedback calculation, regulation procedure, feedback, whether feedback was explicitly related to changing brain activity, feedback timing, control group for active neurofeedback, how many runs and sessions of neurofeedback, if a follow-up was conducted, and the results of neurofeedback training. Results: rt-fMRI-NF is typically upregulation practice based on hemodynamic response from a specific region of the brain presented using a continually updating thermometer display. Most rt-fMRI-NF studies are conducted in healthy samples and half evaluate its effect on immediate changes in behavior or affect. The most popular control group method is to provide sham signal from another region; however, many studies do not compare use a comparison group. Conclusions: We make several suggestions for designs of future rt-fMRI-NF studies. Researchers should use feedback calculation methods that consider neural response across regions (i.e., SVM or connectivity), which should be conveyed as intermittent, auditory feedback. Participants should be given explicit instructions and should be assessed on individual differences. Future rt-fMRI-NF studies should use clinical samples; effectiveness of rt-fMRI-NF should be evaluated on clinical/behavioral outcomes at follow-up time points in comparison to both a sham and no feedback control group.
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Affiliation(s)
| | | | | | - Reza Momenan
- Clinical NeuroImaging Research Core, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
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Oberlin BG, Shen YI, Kareken DA. Alcohol Use Disorder Interventions Targeting Brain Sites for Both Conditioned Reward and Delayed Gratification. Neurotherapeutics 2020; 17:70-86. [PMID: 31863407 PMCID: PMC7007465 DOI: 10.1007/s13311-019-00817-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Alcohol use disorder is a destructive compulsion characterized by chronic relapse and poor recovery outcomes. Heightened reactivity to alcohol-associated stimuli and compromised executive function are hallmarks of alcohol use disorder. Interventions targeting these two interacting domains are thought to ameliorate these altered states, but the mutual brain sites of action are yet unknown. Although interventions on alcohol cue reactivity affect reward area responses, how treatments alter brain responses when subjects exert executive effort to delay gratification is not as well-characterized. Focusing on interventions that could be developed into effective clinical treatments, we review and identify brain sites of action for these two categories of potential therapies. Using activation likelihood estimation (ALE) meta-analysis, we find that interventions on alcohol cue reactivity localize to ventral prefrontal cortex, dorsal anterior cingulate, and temporal, striatal, and thalamic regions. Interventions for increasing delayed reward preference elicit changes mostly in midline default mode network regions, including posterior cingulate, precuneus, and ventromedial prefrontal cortex-in addition to temporal and parietal regions. Anatomical co-localization of effects appears in the ventromedial prefrontal cortex, whereas effects specific to delay-of-gratification appear in the posterior cingulate and precuneus. Thus, the current available literature suggests that interventions in the domains of cue reactivity and delay discounting alter brain activity along midline default mode regions, specifically in the ventromedial prefrontal cortex for both domains, and the posterior cingulate/precuneus for delay-of-gratification. We believe that these findings could facilitate targeting and development of new interventions, and ultimately treatments of this challenging disorder.
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Affiliation(s)
- Brandon G Oberlin
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, USA.
- Department of Neurology, Indiana University School of Medicine, Indianapolis,, USA.
- Addiction Neuroscience Program, Department of Psychology, Indiana University Purdue University at Indianapolis, School of Science, Indianapolis, USA.
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, USA.
| | - Yitong I Shen
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, USA
- Department of Neurology, Indiana University School of Medicine, Indianapolis,, USA
| | - David A Kareken
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, USA
- Department of Neurology, Indiana University School of Medicine, Indianapolis,, USA
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, USA
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Abstract
Brain-computer interfaces (BCIs) based on functional magnetic resonance imaging (fMRI) provide an important complement to other noninvasive BCIs. While fMRI has several disadvantages (being nonportable, methodologically challenging, costly, and noisy), it is the only method providing high spatial resolution whole-brain coverage of brain activation. These properties allow relating mental activities to specific brain regions and networks providing a transparent scheme for BCI users to encode information and for real-time fMRI BCI systems to decode the intents of the user. Various mental activities have been used successfully in fMRI BCIs so far that can be classified into the four categories: (a) higher-order cognitive tasks (e.g., mental calculation), (b) covert language-related tasks (e.g., mental speech and mental singing), (c) imagery tasks (motor, visual, auditory, tactile, and emotion imagery), and (d) selective attention tasks (visual, auditory, and tactile attention). While the ultimate spatial and temporal resolution of fMRI BCIs is limited by the physiologic properties of the hemodynamic response, technical and analytical advances will likely lead to substantially improved fMRI BCIs in the future using, for example, decoding of imagined letter shapes at 7T as the basis for more "natural" communication BCIs.
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Affiliation(s)
- Bettina Sorger
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands; Maastricht Brain Imaging Center (M-BIC), Maastricht, The Netherlands
| | - Rainer Goebel
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands; Maastricht Brain Imaging Center (M-BIC), Maastricht, The Netherlands.
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The effects of nalmefene on emotion processing in alcohol use disorder - A randomized, controlled fMRI study. Eur Neuropsychopharmacol 2019; 29:1442-1452. [PMID: 31740271 DOI: 10.1016/j.euroneuro.2019.10.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/13/2019] [Accepted: 10/29/2019] [Indexed: 11/24/2022]
Abstract
Nalmefene is a µ- and δ-opioid receptor antagonist and a partial κ-opioid receptor agonist. The drug is suggested to reduce the craving for, and the consumption of alcohol effectively, also alleviating anxiety and anhedonia. The present fMRI study is the first to investigate the processing of emotions as a possible mechanism of action of nalmefene in humans. Fifteen non-treatment-seeking participants suffering from alcohol use disorder (AUD) (24-66 years; 5 females) finished this randomized, placebo controlled, double blind study. Following a cross over design, participants received either a single dose nalmefene or a placebo, with an interval of one week between sessions. Using fMRI, we investigated neural reactivity during the presentation of emotional faces picture sets. Additionally, we performed a visual dot-probe task to detect nalmefene's effects on attentional bias. We detected an increase in the response to emotional faces in the supramarginal gyrus, the angular gyrus as well as the putamen in the nalmefene vs. placebo condition. However, contradictory to our initial hypotheses, amygdala activation was not altered significantly in the placebo condition - a limitation, which might be associated with a lack of activation in the placebo condition maybe due to the small sample size. Attentional bias analyses revealed an interaction effect by trend, which was driven by a significant effect in a sub-analysis showing increased attentional shift towards happy compared to fearful facial expressions under nalmefene. Nalmefene increased brain activation in areas responsible for empathy, social cognition and behavior, which might help alleviating the reinforcing properties of alcohol.
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29
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Gerchen MF, Rentsch A, Kirsch M, Kiefer F, Kirsch P. Shifts in the functional topography of frontal cortex-striatum connectivity in alcohol use disorder. Addict Biol 2019; 24:1245-1253. [PMID: 30468293 DOI: 10.1111/adb.12692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/09/2018] [Accepted: 10/09/2018] [Indexed: 11/27/2022]
Abstract
Frontostriatal circuits are centrally involved in the selection of behavioral programs and play a prominent role in alcohol use disorder (AUD) as well as other mental disorders. However, how frontal regions change their striatal connectivity to implement adaptive cognitive control is still not fully understood. Here, we developed an approach for functional magnetic resonance imaging (fMRI) connectivity analysis in which we change the focus from connectivity to individual voxels towards spatial information about the location of strongest functional connectivity. In resting state data of n = 66 participants with AUD and n = 40 healthy controls (HC) we used the approach to estimate frontostriatal connectivity gradients consistent with nonhuman primate tract-tracing studies, characterized for each frontal voxel the striatal peak connectivity location on this gradient (PeaCoG), and tested for group differences and associations with clinical variables. We identified a cluster in the right orbitofrontal cortex (rOFC) with a peak connectivity shift towards ventral striatal regions in AUD. Reduced variability of rOFC striatal peak connectivity in the AUD group suggests a "clamping" to the ventral striatum as the underlying effect. Within the AUD group striatal peak connectivity in the superior frontal gyrus was associated with self-efficacy to abstain from alcohol, in the medial frontal and dorsolateral prefrontal cortex with alcohol dependency, and in the right inferior frontal gyrus with the urge to consume alcohol. Our results demonstrate that the functional topography of frontostriatal circuits exhibits interindividual variability, which provides insight into frontostriatal network adaptations in AUD and potentially other mental disorders.
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Affiliation(s)
- Martin Fungisai Gerchen
- Department of Clinical PsychologyCentral Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim Mannheim Germany
- Bernstein Center for Computational Neuroscience Heidelberg/Mannheim Mannheim Germany
| | - Alena Rentsch
- Department of Clinical PsychologyCentral Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim Mannheim Germany
| | - Martina Kirsch
- Department of Addiction Behavior and Addiction Medicine, Central Institute of Mental HealthUniversity of Heidelberg/Medical Faculty Mannheim Mannheim Germany
| | - Falk Kiefer
- Department of Addiction Behavior and Addiction Medicine, Central Institute of Mental HealthUniversity of Heidelberg/Medical Faculty Mannheim Mannheim Germany
| | - Peter Kirsch
- Department of Clinical PsychologyCentral Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim Mannheim Germany
- Bernstein Center for Computational Neuroscience Heidelberg/Mannheim Mannheim Germany
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30
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Current progress in real-time functional magnetic resonance-based neurofeedback: Methodological challenges and achievements. Neuroimage 2019; 202:116107. [DOI: 10.1016/j.neuroimage.2019.116107] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/26/2019] [Accepted: 08/16/2019] [Indexed: 12/21/2022] Open
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Skottnik L, Linden DEJ. Mental Imagery and Brain Regulation-New Links Between Psychotherapy and Neuroscience. Front Psychiatry 2019; 10:779. [PMID: 31736799 PMCID: PMC6831624 DOI: 10.3389/fpsyt.2019.00779] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 09/30/2019] [Indexed: 01/23/2023] Open
Abstract
Mental imagery is a promising tool and mechanism of psychological interventions, particularly for mood and anxiety disorders. In parallel developments, neuromodulation techniques have shown promise as add-on therapies in psychiatry, particularly non-invasive brain stimulation for depression. However, these techniques have not yet been combined in a systematic manner. One novel technology that may be able to achieve this is neurofeedback, which entails the self-regulation of activation in specific brain areas or networks (or the self-modulation of distributed activation patterns) by the patients themselves, through real-time feedback of brain activation (for example, from functional magnetic resonance imaging). One of the key mechanisms by which patients learn such self-regulation is mental imagery. Here, we will first review the main mental imagery approaches in psychotherapy and the implicated brain networks. We will then discuss how these networks can be targeted with neuromodulation (neurofeedback or non-invasive or invasive brain stimulation). We will review the clinical evidence for neurofeedback and discuss possible ways of enhancing it through systematic combination with psychological interventions, with a focus on depression, anxiety disorders, and addiction. The overarching aim of this perspective paper will be to open a debate on new ways of developing neuropsychotherapies.
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Affiliation(s)
| | - David E. J. Linden
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Eckstein M, Zietlow AL, Gerchen MF, Schmitgen MM, Ashcroft-Jones S, Kirsch P, Ditzen B. The NeMo real-time fMRI neurofeedback study: protocol of a randomised controlled clinical intervention trial in the neural foundations of mother-infant bonding. BMJ Open 2019; 9:e027747. [PMID: 31315861 PMCID: PMC6661567 DOI: 10.1136/bmjopen-2018-027747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/22/2019] [Accepted: 05/22/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Most mothers feel an immediate, strong emotional bond with their newborn. On a neurobiological level, this is accompanied with the activation of the brain reward systems, including the striatum. However, approximately 10% of all mothers report difficulties to bond emotionally with their infant and display impaired reward responses to the interaction with their infant which might have long-term negative effects for the child's development. As previous studies suggest that activation of the striatal reward system can be regulated through functional MRI (fMRI)-based neurofeedback (NFB), we have designed and investigate fMRI-NFB training to treat maternal bonding difficulties. METHODS AND ANALYSIS In the planned trial, mothers will be presented pictures of their infant and real-time fMRI (rtfMRI), peripheral measures, neural, endocrine, psychophysiological and behavioural measures will be assessed. Mothers with bonding difficulties (n=68) will be randomised to one of two double-blind intervention groups at 4-6 months postpartum. They will participate in three repeated NFB training sessions with rtfMRI-NFB training to increase activation of (a) the ventral striatum or (b) the anterior cingulate. Interview data and real-time mother-infant interaction behaviour pre-intervention, post-intervention and at follow-up will serve as clinical outcome measures. ETHICS AND DISSEMINATION Study procedures are in line with the recommendations of the World Medical Association (revised Declaration of Helsinki) and were approved by the Ethics Committee of the Medical Faculty, s-450/2017, Heidelberg University. All participants will provide written informed consent after receiving a detailed oral and written explanation of all procedures and can withdraw their consent at any time without negative consequence. Results will be internationally published and disseminated, to further the discussion on non-pharmacological treatment options in complex mental disorders. TRIAL REGISTRATION NUMBER DRKS00014570; Pre-results.
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Affiliation(s)
- Monika Eckstein
- Institute of Medical Psychology in the Center for Psychosocial Medicine, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - Anna-Lena Zietlow
- Institute of Medical Psychology in the Center for Psychosocial Medicine, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - Martin Fungisai Gerchen
- Department of Clinical Psychology, Central Institute for Mental Health, Mannheim, Germany
- Bernstein Center for Computational Neuroscience, Mannheim, Germany
| | | | - Sarah Ashcroft-Jones
- Institute of Medical Psychology in the Center for Psychosocial Medicine, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute for Mental Health, Mannheim, Germany
- Bernstein Center for Computational Neuroscience, Mannheim, Germany
| | - Beate Ditzen
- Institute of Medical Psychology in the Center for Psychosocial Medicine, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
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Neurofeedback mithilfe funktioneller Magnetresonanztomographie in Echtzeit. PSYCHOTHERAPEUT 2019. [DOI: 10.1007/s00278-019-0352-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lubianiker N, Goldway N, Fruchtman-Steinbok T, Paret C, Keynan JN, Singer N, Cohen A, Kadosh KC, Linden DEJ, Hendler T. Process-based framework for precise neuromodulation. Nat Hum Behav 2019; 3:436-445. [DOI: 10.1038/s41562-019-0573-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/05/2019] [Indexed: 12/20/2022]
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Karch S, Paolini M, Gschwendtner S, Jeanty H, Reckenfelderbäumer A, Yaseen O, Maywald M, Fuchs C, Rauchmann BS, Chrobok A, Rabenstein A, Ertl-Wagner B, Pogarell O, Keeser D, Rüther T. Real-Time fMRI Neurofeedback in Patients With Tobacco Use Disorder During Smoking Cessation: Functional Differences and Implications of the First Training Session in Regard to Future Abstinence or Relapse. Front Hum Neurosci 2019; 13:65. [PMID: 30886575 PMCID: PMC6409331 DOI: 10.3389/fnhum.2019.00065] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/08/2019] [Indexed: 02/04/2023] Open
Abstract
One of the most prominent symptoms in addiction disorders is the strong desire to consume a particular substance or to show a certain behavior (craving). The strong association between craving and the probability of relapse emphasizes the importance of craving in the therapeutic process. Former studies have demonstrated that neuromodulation using real-time fMRI (rtfMRI) neurofeedback (NF) can be used as a treatment modality in patients with tobacco use disorder. The aim of the present project was to determine whether it is possible to predict the outcome of NF training plus group psychotherapy at the beginning of the treatment. For that purpose, neuronal responses during the first rtfMRI NF session of patients who remained abstinent for at least 3 months were compared to those of patients with relapse. All patients were included in a certified smoke-free course and took part in three NF sessions. During the rtfMRI NF sessions tobacco-associated and neutral pictures were presented. Subjects were instructed to reduce their neuronal responses during the presentation of smoking cues in an individualized region of interest for craving [anterior cingulate cortex (ACC), insula or dorsolateral prefrontal cortex]. Patients were stratified to different groups [abstinence (N = 10) vs. relapse (N = 12)] according to their individual smoking status 3 months after the rtfMRI NF training. A direct comparison of BOLD responses during the first NF-session of patients who had remained abstinent over 3 months after the NF training and patients who had relapsed after 3 months showed that patients of the relapse group demonstrated enhanced BOLD responses, especially in the ACC, the supplementary motor area as well as dorsolateral prefrontal areas, compared to abstinent patients. These results suggest that there is a probability of estimating a successful withdrawal in patients with tobacco use disorder by analyzing the first rtfMRI NF session: a pronounced reduction of frontal responses during NF training in patients might be the functional correlate of better therapeutic success. The results of the first NF sessions could be useful as predictor whether a patient will be able to achieve success after the behavioral group therapy and NF training in quitting smoking or not.
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Affiliation(s)
- Susanne Karch
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Marco Paolini
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Sarah Gschwendtner
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Hannah Jeanty
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Arne Reckenfelderbäumer
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Omar Yaseen
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Maximilian Maywald
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Christina Fuchs
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Boris-Stephan Rauchmann
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.,Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Agnieszka Chrobok
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Andrea Rabenstein
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Birgit Ertl-Wagner
- Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.,Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Tobias Rüther
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
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Verdejo-Garcia A, Lorenzetti V, Manning V, Piercy H, Bruno R, Hester R, Pennington D, Tolomeo S, Arunogiri S, Bates ME, Bowden-Jones H, Campanella S, Daughters SB, Kouimtsidis C, Lubman DI, Meyerhoff DJ, Ralph A, Rezapour T, Tavakoli H, Zare-Bidoky M, Zilverstand A, Steele D, Moeller SJ, Paulus M, Baldacchino A, Ekhtiari H. A Roadmap for Integrating Neuroscience Into Addiction Treatment: A Consensus of the Neuroscience Interest Group of the International Society of Addiction Medicine. Front Psychiatry 2019; 10:877. [PMID: 31920740 PMCID: PMC6935942 DOI: 10.3389/fpsyt.2019.00877] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 11/06/2019] [Indexed: 01/01/2023] Open
Abstract
Although there is general consensus that altered brain structure and function underpins addictive disorders, clinicians working in addiction treatment rarely incorporate neuroscience-informed approaches into their practice. We recently launched the Neuroscience Interest Group within the International Society of Addiction Medicine (ISAM-NIG) to promote initiatives to bridge this gap. This article summarizes the ISAM-NIG key priorities and strategies to achieve implementation of addiction neuroscience knowledge and tools for the assessment and treatment of substance use disorders. We cover two assessment areas: cognitive assessment and neuroimaging, and two interventional areas: cognitive training/remediation and neuromodulation, where we identify key challenges and proposed solutions. We reason that incorporating cognitive assessment into clinical settings requires the identification of constructs that predict meaningful clinical outcomes. Other requirements are the development of measures that are easily-administered, reliable, and ecologically-valid. Translation of neuroimaging techniques requires the development of diagnostic and prognostic biomarkers and testing the cost-effectiveness of these biomarkers in individualized prediction algorithms for relapse prevention and treatment selection. Integration of cognitive assessments with neuroimaging can provide multilevel targets including neural, cognitive, and behavioral outcomes for neuroscience-informed interventions. Application of neuroscience-informed interventions including cognitive training/remediation and neuromodulation requires clear pathways to design treatments based on multilevel targets, additional evidence from randomized trials and subsequent clinical implementation, including evaluation of cost-effectiveness. We propose to address these challenges by promoting international collaboration between researchers and clinicians, developing harmonized protocols and data management systems, and prioritizing multi-site research that focuses on improving clinical outcomes.
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Affiliation(s)
- Antonio Verdejo-Garcia
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Valentina Lorenzetti
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Canberra, ACT, Australia
| | - Victoria Manning
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Hugh Piercy
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Raimondo Bruno
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Rob Hester
- School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - David Pennington
- San Francisco Veterans Affairs Health Care System (SFVAHCS), San Francisco, CA, United States.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Serenella Tolomeo
- School of Medicine, University of St Andrews, Medical and Biological Science Building, North Haugh, St Andrews, United Kingdom.,Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Shalini Arunogiri
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Marsha E Bates
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, United States
| | | | - Salvatore Campanella
- Laboratoire de Psychologie Médicale et d'Addictologie, ULB Neuroscience Institute (UNI), CHU Brugmann-Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Stacey B Daughters
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Christos Kouimtsidis
- Department of Psychiatry, Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, United Kingdom
| | - Dan I Lubman
- Eastern Health Clinical School Turning Point, Eastern Health, Richmond, VIC, Australia
| | - Dieter J Meyerhoff
- DVA Medical Center and Department of Radiology and Biomedical Imaging, University of California San Francisco, School of Medicine, San Francisco, CA, United States
| | - Annaketurah Ralph
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Tara Rezapour
- Department of Cognitive Psychology, Institute for Cognitive Sciences Studies, Tehran, Iran
| | - Hosna Tavakoli
- Department of Cognitive Psychology, Institute for Cognitive Sciences Studies, Tehran, Iran.,Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehran Zare-Bidoky
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran.,School of Medicine, Shahid-Sadoughi University of Medical Sciences, Yazd, Iran
| | - Anna Zilverstand
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - Douglas Steele
- Medical School, University of Dundee, Ninewells Hospital, Scotland, United Kingdom
| | - Scott J Moeller
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Martin Paulus
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, OK, United States
| | - Alex Baldacchino
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, OK, United States
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Efficacy of Invasive and Non-Invasive Brain Modulation Interventions for Addiction. Neuropsychol Rev 2018; 29:116-138. [PMID: 30536145 PMCID: PMC6499746 DOI: 10.1007/s11065-018-9393-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 11/08/2018] [Indexed: 12/14/2022]
Abstract
It is important to find new treatments for addiction due to high relapse rates despite current interventions and due to expansion of the field with non-substance related addictive behaviors. Neuromodulation may provide a new type of treatment for addiction since it can directly target abnormalities in neurocircuits. We review literature on five neuromodulation techniques investigated for efficacy in substance related and behavioral addictions: transcranial direct current stimulation (tDCS), (repetitive) transcranial magnetic stimulation (rTMS), EEG, fMRI neurofeedback and deep brain stimulation (DBS) and additionally report on effects of these interventions on addiction-related cognitive processes. While rTMS and tDCS, mostly applied at the dorsolateral prefrontal cortex, show reductions in immediate craving for various addictive substances, placebo-responses are high and long-term outcomes are understudied. The lack in well-designed EEG-neurofeedback studies despite decades of investigation impedes conclusions about its efficacy. Studies investigating fMRI neurofeedback are new and show initial promising effects on craving, but future trials are needed to investigate long-term and behavioral effects. Case studies report prolonged abstinence of opioids or alcohol with ventral striatal DBS but difficulties with patient inclusion may hinder larger, controlled trials. DBS in neuropsychiatric patients modulates brain circuits involved in reward processing, extinction and negative-reinforcement that are also relevant for addiction. To establish the potential of neuromodulation for addiction, more randomized controlled trials are needed that also investigate treatment duration required for long-term abstinence and potential synergy with other addiction interventions. Finally, future advancement may be expected from tailoring neuromodulation techniques to specific patient (neurocognitive) profiles.
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Feasibility of NIRS-based neurofeedback training in social anxiety disorder: behavioral and neural correlates. J Neural Transm (Vienna) 2018; 126:1175-1185. [DOI: 10.1007/s00702-018-1954-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/04/2018] [Indexed: 11/27/2022]
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Dickerson KC. Upregulating brain activity using non-drug reward imagery and real-time fMRI neurofeedback-A new treatment approach for addiction? EBioMedicine 2018; 38:21-22. [PMID: 30448154 PMCID: PMC6306366 DOI: 10.1016/j.ebiom.2018.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/13/2018] [Indexed: 12/15/2022] Open
Affiliation(s)
- Kathryn C Dickerson
- Department of Psychiatry and Behavioral Sciences, Center of Cognitive Neuroscience, Duke University, Box 90999, Durham, NC 27708, United States.
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Kirschner M, Sladky R, Haugg A, Stämpfli P, Jehli E, Hodel M, Engeli E, Hösli S, Baumgartner MR, Sulzer J, Huys QJM, Seifritz E, Quednow BB, Scharnowski F, Herdener M. Self-regulation of the dopaminergic reward circuit in cocaine users with mental imagery and neurofeedback. EBioMedicine 2018; 37:489-498. [PMID: 30377073 PMCID: PMC6286189 DOI: 10.1016/j.ebiom.2018.10.052] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/21/2018] [Accepted: 10/22/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Enhanced drug-related reward sensitivity accompanied by impaired sensitivity to non-drug related rewards in the mesolimbic dopamine system are thought to underlie the broad motivational deficits and dysfunctional decision-making frequently observed in cocaine use disorder (CUD). Effective approaches to modify this imbalance and reinstate non-drug reward responsiveness are urgently needed. Here, we examined whether cocaine users (CU) can use mental imagery of non-drug rewards to self-regulate the ventral tegmental area and substantia nigra (VTA/SN). We expected that obsessive and compulsive thoughts about cocaine consumption would hamper the ability to self-regulate the VTA/SN activity and tested if real-time fMRI (rtfMRI) neurofeedback (NFB) can improve self-regulation of the VTA/SN. METHODS Twenty-two CU and 28 healthy controls (HC) were asked to voluntarily up-regulate VTA/SN activity with non-drug reward imagery alone, or combined with rtfMRI NFB. RESULTS On a group level, HC and CU were able to activate the dopaminergic midbrain and other reward regions with reward imagery. In CU, the individual ability to self-regulate the VTA/SN was reduced in those with more severe obsessive-compulsive drug use. NFB enhanced the effect of reward imagery but did not result in transfer effects at the end of the session. CONCLUSION CU can voluntary activate their reward system with non-drug reward imagery and improve this ability with rtfMRI NFB. Combining mental imagery and rtFMRI NFB has great potential for modifying the maladapted reward sensitivity and reinstating non-drug reward responsiveness. This motivates further work to examine the use of rtfMRI NFB in the treatment of CUD.
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Affiliation(s)
- Matthias Kirschner
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland.
| | - Ronald Sladky
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Amelie Haugg
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology, Switzerland
| | - Philipp Stämpfli
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Elisabeth Jehli
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Martina Hodel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Etna Engeli
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Sarah Hösli
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Markus R Baumgartner
- Center for Forensic Hair Analysis, Institute of Forensic Medicine, University of Zurich, Switzerland
| | - James Sulzer
- Department of Mechanical Engineering, University of Texas at Austin, TX, USA
| | - Quentin J M Huys
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Translational Neuromodeling Unit, Institute of Biomedical Engineering, University of Zurich and ETH, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Boris B Quednow
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Switzerland
| | - Frank Scharnowski
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Switzerland; Department of Basic Psychological Research and Research Methods, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Marcus Herdener
- Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
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Hong KS, Zafar A. Existence of Initial Dip for BCI: An Illusion or Reality. Front Neurorobot 2018; 12:69. [PMID: 30416440 PMCID: PMC6212489 DOI: 10.3389/fnbot.2018.00069] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 10/03/2018] [Indexed: 01/21/2023] Open
Abstract
A tight coupling between the neuronal activity and the cerebral blood flow (CBF) is the motivation of many hemodynamic response (HR)-based neuroimaging modalities. The increase in neuronal activity causes the increase in CBF that is indirectly measured by HR modalities. Upon functional stimulation, the HR is mainly categorized in three durations: (i) initial dip, (ii) conventional HR (i.e., positive increase in HR caused by an increase in the CBF), and (iii) undershoot. The initial dip is a change in oxygenation prior to any subsequent increase in CBF and spatially more specific to the site of neuronal activity. Despite additional evidence from various HR modalities on the presence of initial dip in human and animal species (i.e., cat, rat, and monkey); the existence/occurrence of an initial dip in HR is still under debate. This article reviews the existence and elusive nature of the initial dip duration of HR in intrinsic signal optical imaging (ISOI), functional magnetic resonance imaging (fMRI), and functional near-infrared spectroscopy (fNIRS). The advent of initial dip and its elusiveness factors in ISOI and fMRI studies are briefly discussed. Furthermore, the detection of initial dip and its role in brain-computer interface using fNIRS is examined in detail. The best possible application for the initial dip utilization and its future implications using fNIRS are provided.
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Affiliation(s)
- Keum-Shik Hong
- School of Mechanical Engineering, Pusan National University, Busan, South Korea.,Department of Cogno-Mechatronics Engineering, Pusan National University, Busan, South Korea
| | - Amad Zafar
- School of Mechanical Engineering, Pusan National University, Busan, South Korea
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Thibault RT, MacPherson A, Lifshitz M, Roth RR, Raz A. Neurofeedback with fMRI: A critical systematic review. Neuroimage 2018; 172:786-807. [DOI: 10.1016/j.neuroimage.2017.12.071] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 12/18/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022] Open
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Current practices in clinical neurofeedback with functional MRI-Analysis of a survey using the TIDieR checklist. Eur Psychiatry 2018; 50:28-33. [PMID: 29395621 DOI: 10.1016/j.eurpsy.2017.10.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A core principle of creating a scientific evidence base is that results can be replicated in independent experiments and in health intervention research. The TIDieR (Template for Intervention Description and Replication) checklist has been developed to aid in summarising key items needed when reporting clinical trials and other well designed evaluations of complex interventions in order that findings can be replicated or built on reliably. Neurofeedback (NF) using functional MRI (fMRI) is a multicomponent intervention that should be considered a complex intervention. The TIDieR checklist (with minor modification to increase applicability in this context) was distributed to NF researchers as a survey of current practice in the design and conduct of clinical studies. The aim was to document practice and convergence between research groups, highlighting areas for discussion and providing a basis for recommendations for harmonisation and standardisation. METHODS The TIDieR checklist was interpreted and expanded (21 questions) to make it applicable to neurofeedback research studies. Using the web-based Bristol Online Survey (BOS) tool, the revised checklist was disseminated to researchers in the BRAINTRAIN European research collaborative network (supported by the European Commission) and others in the fMRI-neurofeedback community. RESULTS There were 16 responses to the survey. Responses were reported under eight main headings which covered the six domains of the TIDieR checklist: What, Why, When, How, Where and Who. CONCLUSIONS This piece of work provides encouraging insight into the ability to be able to map neuroimaging interventions to a structured framework for reporting purposes. Regardless of the considerable variability of design components, all studies could be described in standard terms of diagnostic groups, dose/duration, targeted areas/signals, and psychological strategies and learning models. Recommendations are made which include providing detailed rationale of intervention design in study protocols.
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Gerchen MF, Kirsch M, Bahs N, Halli P, Gerhardt S, Schäfer A, Sommer WH, Kiefer F, Kirsch P. The SyBil-AA real-time fMRI neurofeedback study: protocol of a single-blind randomized controlled trial in alcohol use disorder. BMC Psychiatry 2018; 18:12. [PMID: 29343230 PMCID: PMC5773029 DOI: 10.1186/s12888-018-1604-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/11/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Alcohol Use Disorder is a highly prevalent mental disorder which puts a severe burden on individuals, families, and society. The treatment of Alcohol Use Disorder is challenging and novel and innovative treatment approaches are needed to expand treatment options. A promising neuroscience-based intervention method that allows targeting cortical as well as subcortical brain processes is real-time functional magnetic resonance imaging neurofeedback. However, the efficacy of this technique as an add-on treatment of Alcohol Use Disorder in a clinical setting is hitherto unclear and will be assessed in the Systems Biology of Alcohol Addiction (SyBil-AA) neurofeedback study. METHODS N = 100 patients with Alcohol Use Disorder will be randomized to 5 parallel groups in a single-blind fashion and receive real-time functional magnetic resonance imaging neurofeedback while they are presented pictures of alcoholic beverages. The groups will either downregulate the ventral striatum, upregulate the right inferior frontal gyrus, negatively modulate the connectivity between these regions, upregulate, or downregulate the auditory cortex as a control region. After receiving 3 sessions of neurofeedback training within a maximum of 2 weeks, participants will be followed up monthly for a period of 3 months and relapse rates will be assessed as the primary outcome measure. DISCUSSION The results of this study will provide insights into the efficacy of real-time functional magnetic resonance imaging neurofeedback training in the treatment of Alcohol Use Disorder as well as in the involved brain systems. This might help to identify predictors of successful neurofeedback treatment which could potentially be useful in developing personalized treatment approaches. TRIAL REGISTRATION The study was retrospectively registered in the German Clinical Trials Register (trial identifier: DRKS00010253 ; WHO Universal Trial Number (UTN): U1111-1181-4218) on May 10th, 2016.
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Affiliation(s)
- Martin Fungisai Gerchen
- Department of Clinical Psychology, Central Institute of Mental Health (ZI), University of Heidelberg/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany. .,Bernstein Center for Computational Neuroscience Heidelberg/Mannheim, Mannheim, Germany.
| | - Martina Kirsch
- 0000 0001 2190 4373grid.7700.0Department of Addiction Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany
| | - Nathalie Bahs
- 0000 0001 2190 4373grid.7700.0Department of Addiction Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany
| | - Patrick Halli
- 0000 0004 0477 2235grid.413757.3Department of Clinical Psychology, Central Institute of Mental Health (ZI), University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
| | - Sarah Gerhardt
- 0000 0001 2190 4373grid.7700.0Department of Addiction Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany
| | - Axel Schäfer
- 0000 0001 2190 4373grid.7700.0Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany
| | - Wolfgang H. Sommer
- 0000 0001 2190 4373grid.7700.0Department of Addiction Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany ,0000 0001 2190 4373grid.7700.0Department of Psychopharmacology, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany
| | - Falk Kiefer
- 0000 0001 2190 4373grid.7700.0Department of Addiction Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, Mannheim, Germany
| | - Peter Kirsch
- 0000 0004 0477 2235grid.413757.3Department of Clinical Psychology, Central Institute of Mental Health (ZI), University of Heidelberg/Medical Faculty Mannheim, J5, 68159 Mannheim, Germany ,grid.455092.fBernstein Center for Computational Neuroscience Heidelberg/Mannheim, Mannheim, Germany
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Liu L, Yao YW, Li CSR, Zhang JT, Xia CC, Lan J, Ma SS, Zhou N, Fang XY. The Comorbidity Between Internet Gaming Disorder and Depression: Interrelationship and Neural Mechanisms. Front Psychiatry 2018; 9:154. [PMID: 29740358 PMCID: PMC5924965 DOI: 10.3389/fpsyt.2018.00154] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/04/2018] [Indexed: 12/14/2022] Open
Abstract
Internet gaming disorder (IGD) is characterized by cognitive and emotional deficits. Previous studies have reported the co-occurrence of IGD and depression. However, extant brain imaging research has largely focused on cognitive deficits in IGD. Few studies have addressed the comorbidity between IGD and depression symptoms and underlying neural mechanisms. Here, we systematically investigated this issue by combining a longitudinal survey study, a cross-sectional resting-state functional connectivity (rsFC) study and an intervention study. Autoregressive cross-lagged modeling on a longitudinal dataset of college students showed that IGD severity and depression are reciprocally predictive. At the neural level, individuals with IGD exhibited enhanced rsFC between the left amygdala and right dorsolateral prefrontal cortex (DLPFC), inferior frontal and precentral gyrus, compared with control participants, and the amygdala-frontoparietal connectivity at the baseline negatively predicted reduction in depression symptoms following a psychotherapy intervention. Further, following the intervention, individuals with IGD showed decreased connectivity between the left amygdala and left middle frontal and precentral gyrus, as compared with the non-intervention group. These findings together suggest that IGD may be closely associated with depression; aberrant rsFC between emotion and executive control networks may underlie depression and represent a therapeutic target in individuals with IGD. Registry name: The behavioral and brain mechanism of IGD; URL: https://www.clinicaltrials.gov/ct2/show/NCT02550405; Registration number: NCT02550405.
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Affiliation(s)
- Lu Liu
- Faculty of Psychology, Institute of Developmental Psychology, Beijing Normal University, Beijing, China.,State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Yuan-Wei Yao
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States.,Beijing Huilongguan Hospital, Beijing, China
| | - Jin-Tao Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Cui-Cui Xia
- Students Counseling Center, Beijing Normal University, Beijing, China
| | - Jing Lan
- Faculty of Psychology, Institute of Developmental Psychology, Beijing Normal University, Beijing, China
| | - Shan-Shan Ma
- Faculty of Psychology, Institute of Developmental Psychology, Beijing Normal University, Beijing, China
| | - Nan Zhou
- Faculty of Psychology, Institute of Developmental Psychology, Beijing Normal University, Beijing, China
| | - Xiao-Yi Fang
- Faculty of Psychology, Institute of Developmental Psychology, Beijing Normal University, Beijing, China
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Ferreri F, Bourla A, Mouchabac S, Karila L. e-Addictology: An Overview of New Technologies for Assessing and Intervening in Addictive Behaviors. Front Psychiatry 2018; 9:51. [PMID: 29545756 PMCID: PMC5837980 DOI: 10.3389/fpsyt.2018.00051] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/06/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND New technologies can profoundly change the way we understand psychiatric pathologies and addictive disorders. New concepts are emerging with the development of more accurate means of collecting live data, computerized questionnaires, and the use of passive data. Digital phenotyping, a paradigmatic example, refers to the use of computerized measurement tools to capture the characteristics of different psychiatric disorders. Similarly, machine learning-a form of artificial intelligence-can improve the classification of patients based on patterns that clinicians have not always considered in the past. Remote or automated interventions (web-based or smartphone-based apps), as well as virtual reality and neurofeedback, are already available or under development. OBJECTIVE These recent changes have the potential to disrupt practices, as well as practitioners' beliefs, ethics and representations, and may even call into question their professional culture. However, the impact of new technologies on health professionals' practice in addictive disorder care has yet to be determined. In the present paper, we therefore present an overview of new technology in the field of addiction medicine. METHOD Using the keywords [e-health], [m-health], [computer], [mobile], [smartphone], [wearable], [digital], [machine learning], [ecological momentary assessment], [biofeedback] and [virtual reality], we searched the PubMed database for the most representative articles in the field of assessment and interventions in substance use disorders. RESULTS We screened 595 abstracts and analyzed 92 articles, dividing them into seven categories: e-health program and web-based interventions, machine learning, computerized adaptive testing, wearable devices and digital phenotyping, ecological momentary assessment, biofeedback, and virtual reality. CONCLUSION This overview shows that new technologies can improve assessment and interventions in the field of addictive disorders. The precise role of connected devices, artificial intelligence and remote monitoring remains to be defined. If they are to be used effectively, these tools must be explained and adapted to the different profiles of physicians and patients. The involvement of patients, caregivers and other health professionals is essential to their design and assessment.
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Affiliation(s)
- Florian Ferreri
- Sorbonne Université, UPMC, Department of Adult Psychiatry and Medical Psychology, APHP, Saint-Antoine Hospital, Paris, France
| | - Alexis Bourla
- Sorbonne Université, UPMC, Department of Adult Psychiatry and Medical Psychology, APHP, Saint-Antoine Hospital, Paris, France
| | - Stephane Mouchabac
- Sorbonne Université, UPMC, Department of Adult Psychiatry and Medical Psychology, APHP, Saint-Antoine Hospital, Paris, France
| | - Laurent Karila
- Université Paris Sud - INSERM U1000, Addiction Research and Treatment Center, APHP, Paul Brousse Hospital, Villejuif, France
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Schulte T, Jung YC, Sullivan EV, Pfefferbaum A, Serventi M, Müller-Oehring EM. The neural correlates of priming emotion and reward systems for conflict processing in alcoholics. Brain Imaging Behav 2017; 11:1751-1768. [PMID: 27815773 PMCID: PMC5418124 DOI: 10.1007/s11682-016-9651-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Emotional dysregulation in alcoholism (ALC) may result from disturbed inhibitory mechanisms. We therefore tested emotion and alcohol cue reactivity and inhibitory processes using negative priming. To test the neural correlates of cue reactivity and negative priming, 26 ALC and 26 age-matched controls underwent functional MRI performing a Stroop color match-to-sample task. In cue reactivity trials, task-irrelevant emotion and alcohol-related pictures were interspersed between color samples and color words. In negative priming trials, pictures primed the semantic content of an alcohol or emotion Stroop word. Behaviorally, both groups showed response facilitation to picture cue trials and response inhibition to primed trials. For cue reactivity to emotion and alcohol pictures, ALC showed midbrain-limbic activation. By contrast, controls activated frontoparietal executive control regions. Greater midbrain-hippocampal activation in ALC correlated with higher amounts of lifetime alcohol consumption and higher anxiety. With negative priming, ALC exhibited frontal cortical but not midbrain-hippocampal activation, similar to the pattern observed in controls. Higher frontal activation to alcohol-priming correlated with less craving and to emotion-priming with fewer depressive symptoms. The findings suggest that neurofunctional systems in ALC can be primed to deal with upcoming emotion- and alcohol-related conflict and can overcome the prepotent midbrain-limbic cue reactivity response.
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Affiliation(s)
- T Schulte
- Neuroscience Program, Biosciences Division, SRI International, Menlo Park, CA, 94025-3493, USA.
- Pacific Graduate School of Psychology, Palo Alto University, Palo Alto, CA, USA.
| | - Y-C Jung
- Deptartment of Psychiatry & Beh. Sci, Stanford University, Stanford, CA, USA
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, South Korea
| | - E V Sullivan
- Deptartment of Psychiatry & Beh. Sci, Stanford University, Stanford, CA, USA
| | - A Pfefferbaum
- Neuroscience Program, Biosciences Division, SRI International, Menlo Park, CA, 94025-3493, USA
- Deptartment of Psychiatry & Beh. Sci, Stanford University, Stanford, CA, USA
| | - M Serventi
- Neuroscience Program, Biosciences Division, SRI International, Menlo Park, CA, 94025-3493, USA
- Deptartment of Psychiatry & Beh. Sci, Stanford University, Stanford, CA, USA
| | - E M Müller-Oehring
- Neuroscience Program, Biosciences Division, SRI International, Menlo Park, CA, 94025-3493, USA
- Deptartment of Psychiatry & Beh. Sci, Stanford University, Stanford, CA, USA
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Cservenka A, Brumback T. The Burden of Binge and Heavy Drinking on the Brain: Effects on Adolescent and Young Adult Neural Structure and Function. Front Psychol 2017; 8:1111. [PMID: 28713313 PMCID: PMC5491846 DOI: 10.3389/fpsyg.2017.01111] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/15/2017] [Indexed: 12/18/2022] Open
Abstract
Introduction: Adolescence and young adulthood are periods of continued biological and psychosocial maturation. Thus, there may be deleterious effects of consuming large quantities of alcohol on neural development and associated cognition during this time. The purpose of this mini review is to highlight neuroimaging research that has specifically examined the effects of binge and heavy drinking on adolescent and young adult brain structure and function. Methods: We review cross-sectional and longitudinal studies of young binge and heavy drinkers that have examined brain structure (e.g., gray and white matter volume, cortical thickness, white matter microstructure) and investigated brain response using functional magnetic resonance imaging (fMRI). Results: Binge and heavy-drinking adolescents and young adults have systematically thinner and lower volume in prefrontal cortex and cerebellar regions, and attenuated white matter development. They also show elevated brain activity in fronto-parietal regions during working memory, verbal learning, and inhibitory control tasks. In response to alcohol cues, relative to controls or light-drinking individuals, binge and heavy drinkers show increased neural response mainly in mesocorticolimbic regions, including the striatum, anterior cingulate cortex (ACC), hippocampus, and amygdala. Mixed findings are present in risky decision-making tasks, which could be due to large variation in task design and analysis. Conclusions: These findings suggest altered neural structure and activity in binge and heavy-drinking youth may be related to the neurotoxic effects of consuming alcohol in large quantities during a highly plastic neurodevelopmental period, which could result in neural reorganization, and increased risk for developing an alcohol use disorder (AUD).
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Affiliation(s)
- Anita Cservenka
- School of Psychological Science, Oregon State UniversityCorvallis, OR, United States
| | - Ty Brumback
- Mental Health Service, VA San Diego Healthcare SystemSan Diego, CA, United States.,Department of Psychiatry, University of California, San DiegoSan Diego, CA, United States
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Neurofeedback in Substance Use and Overeating: Current Applications and Future Directions. CURRENT ADDICTION REPORTS 2017. [DOI: 10.1007/s40429-017-0137-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Becker A, Kirsch M, Gerchen MF, Kiefer F, Kirsch P. Striatal activation and frontostriatal connectivity during non-drug reward anticipation in alcohol dependence. Addict Biol 2017; 22:833-843. [PMID: 28398011 DOI: 10.1111/adb.12352] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/16/2015] [Accepted: 11/25/2015] [Indexed: 11/29/2022]
Abstract
According to prevailing neurobiological theories of addiction, altered function in neural reward circuitry is a central mechanism of alcohol dependence. Growing evidence postulates that the ventral striatum (VS), as well as areas of the prefrontal cortex, contribute to the increased incentive salience of alcohol-associated cues, diminished motivation to pursue non-drug rewards and weakened strength of inhibitory cognitive control, which are central to addiction. The present study aims to investigate the neural response and functional connectivity underlying monetary, non-drug reward processing in alcohol dependence. We utilized a reward paradigm to investigate the anticipation of monetary reward in 32 alcohol-dependent inpatients and 35 healthy controls. Functional magnetic resonance imaging was used to measure task-related brain activation and connectivity. Alcohol-dependent patients showed increased activation of the VS during anticipation of monetary gain compared with healthy controls. Generalized psychophysiological interaction analyses revealed decreased functional connectivity between the VS and the dorsolateral prefrontal cortex in alcohol dependent patients relative to controls. Increased activation of the VS and reduced frontostriatal connectivity were associated with increased craving. These findings provide evidence that alcohol dependence is rather associated with disrupted integration of striatal and prefrontal processes than with a global reward anticipation deficit.
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Affiliation(s)
- Alena Becker
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
| | - Martina Kirsch
- Department of Addiction Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
| | - Martin Fungisai Gerchen
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
| | - Falk Kiefer
- Department of Addiction Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
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