Upregulating brain activity using non-drug reward imagery and real-time fMRI neurofeedback-A new treatment approach for addiction?
Upregulating brain activity using non-drug reward imagery and real-time fMRI neurofeedback-A new treatment approach for addiction?
复制标题
使用非药物奖励图像和实时功能磁共振成像神经反馈上调大脑活动——成瘾的新治疗方法？
DOI：
10.1016/j.ebiom.2018.11.021
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发表时间：
2018
期刊：
影响因子：
11.1
通讯作者：
Dickerson,KathrynC
中科院分区：
文献类型：
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作者：
Dickerson,KathrynC
包括可卡因使用障碍（CUD）在内的物质使用障碍（SUD）的成功治疗仍然是世界范围内的一个持续问题。对CUD患者的常见治疗包括行为干预，如应急管理或认知行为治疗以及药物治疗。然而，目前还没有FDA批准的治疗CUD的药物。此外，据估计，40-60%的SUD患者有汇款。因此，需要新的方法来改善SUD（包括CUD）患者的临床结局。神经反馈是一种相对较新的技术，允许参与者实时查看和学习自己的大脑活动。最常见的神经反馈形式包括脑电图（EEG）和功能性磁共振成像（fMRI）。神经反馈的优势在于它是一种安全、非侵入性的调节人类大脑激活的方法。因此，它已被广泛用于解决一系列基础科学和临床问题[1]。在发表在EBioMedicine上的一篇文章中，Kirschner及其同事描述了fMRI神经反馈的一种新用途：询问可卡因使用者和非使用者是否可以上调涉及成瘾和奖励处理的区域-多巴胺能中脑-使用非药物、奖励意象[2]。在物质使用者中的先前工作已经采用了神经反馈，但主要是从试图下调与渴望有关的大脑区域的角度来处理这个问题（例如，见[3-6]）。一种成瘾理论表明，当一个人对药物成瘾时，对药物（例如可卡因）和药物相关线索（例如烟斗）的奖励反应会增加，而对非药物（例如最喜欢的食物、意大利面）的奖励反应会增加。carbonara）和非药物线索（例如，走过你最喜欢的意大利餐厅）减少[7]。这种神经奖励反应的重塑使得人们越来越难以摆脱与毒品有关的活动。Kirschner和他的同事们没有要求个体减少与奖励相关的激活和/或对药物线索的渴望，而是采取了一种新的方法，要求个体上调大脑激活，以非药物，奖励图像。可卡因使用者和非使用者（健康成年人）都被招募参加实验。所有参与者都被要求产生非药物的，有意义的图像（例如，和朋友一起去看电影），同时试图增加多巴胺能中脑的大脑激活。的
Successful treatments for substance use disorders (SUD), including cocaine use disorder (CUD) remain a persistent problem worldwide. Common treatments for individuals with CUD include behavioral interventions such as contingency management or cognitive behavioral therapy as well as treatment with pharmacotherapy. However, at this time there are no FDA-approved drugs for the treatment of CUD. Furthermore, it is estimated that 40–60% of individuals with SUD remit. Novel approaches are therefore needed to improve clinical outcomes for individuals with SUD, including CUD. Neurofeedback is a relatively new technique allowing participants to view and learn from their own brain activity in real-time. The most common forms of neurofeedback include electroencephalography (EEG) and functional magnetic resonance imaging (fMRI). Neurofeedback has the advantage of being a safe, non-invasive method of modulating brain activation in humans. As such, it has been widely used to address a range of basic science and clinical questions [1]. In an article published in this issue of EBioMedicine, Kirschner and colleagues describe a novel use of fMRI neurofeedback: asking if cocaine users and non-users can upregulate a region involved in addiction and reward processing-the dopaminergic midbrain-using non-drug, reward imagery [2].Prior work in substance users has employed neurofeedback, but has primarily approached the problem from the point of view of trying to downregulate brain regions involved in craving (for examples, see [3–6]). One theory of addiction suggests that as a person becomes addicted to a drug, reward responses to the drug (eg, cocaine) and drug-related cues (eg, pipe) increase while reward responses to nondrug (eg, favorite food, pasta carbonara) and non-drug cues (eg, walking past your favorite Italian restaurant) diminish [7]. This reshaping of neural reward responsivity makes it increasingly difficult to disengage from drug-related activity. Rather than asking individuals to decrease reward-related activation and/or craving to drug cues, Kirschner and colleagues took the novel approach of asking individuals to upregulate brain activation to non-drug, rewarding imagery. Both cocaine users and non-users (healthy adults) were recruited to participate in the experiment. All participants were asked to generate non-drug, rewarding imagery (for example, going to the movies with a friend) while trying in increase brain activation in the dopaminergic midbrain. The