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

J Psychiatry Neurosci. 2016 Jan;41(1):48-55. doi: 10.1503/jpn.140200.


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

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

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

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

Conclusion: Nicotine-dependent smokers receiving rtfMRI feedback from an individualized ROI attenuated smoking cue-elicited neural activation and craving, relative to a control group. Further studies are needed in treatment-seeking smokers to determine if this intervention can translate into a clinically meaningful treatment modality.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aftercare
  • Brain / physiopathology*
  • Craving* / physiology
  • Female
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Male
  • Neurofeedback / methods*
  • Precision Medicine / methods
  • Smoking / physiopathology
  • Smoking / therapy*
  • Time Factors
  • Tobacco Use Disorder / physiopathology
  • Tobacco Use Disorder / therapy*