The Impact of Real-time fMRI Feedback on Response to Nicotine Cues

描述(申请人提供)：尼古丁依赖是当今世界主要的可预防的死亡原因。线索诱导的渴望很可能在复发中起着重要作用。通过功能磁共振成像已经阐明了吸烟线索诱导的渴求和消退的神经关联。最近的进展使得利用实时功能磁共振成像(RtfMRI)反馈来改变行为、认知和局部大脑活动成为可能。这项应用的目的是开发成像参数、脑机接口和标准化程序，使用具有视觉反馈的rtfMRI来帮助尼古丁依赖者在看到吸烟线索时减少渴望。这项研究的探索性需要分阶段进行。第一阶段将侧重于技术和研究范式的发展。为了进入第二阶段，必须有令人信服的证据表明，相当大比例的尼古丁依赖者可以基于rtfMRI视觉反馈操纵与吸烟线索诱导的渴望相关的关键大脑区域的大脑活动。如果这一点成立，将在第二阶段探索受控比较和效果持续时间。该项目将为临床试验奠定基础，调查一种非常创新的方法来治疗尼古丁依赖和其他物质使用障碍。这项研究将提供有关最佳技术、耐用性和影响到扫描仪外部情况的“可转移性”的关键信息。这项研究的结果可用于设计一项临床试验，以调查rtfMRI神经调节训练在戒烟中的应用。 公共卫生相关性：改善尼古丁依赖的治疗将提供实质性的公共健康益处，因为尼古丁依赖是当今世界主要的可预防的死亡原因。此外，如果个人能够学会调节大脑中控制冲动和渴望状态的关键区域的活动，这可能适用于对公共卫生具有重大意义的广泛疾病状态(即其他物质使用障碍，肥胖)。

DESCRIPTION (provided by applicant): Nicotine dependence is the leading preventable cause of mortality in the world today. Cue-induced craving is likely to play an important role in relapse. The neural correlates of smoking cue-induced craving and extinction have been elucidated using fMRI. Recent advances make it possible to utilize real-time fMRI (rtfMRI) feedback to modify behavior, cognitions and regional brain activity. The purpose of this application is to develop the imaging parameters, brain-computer interface and standardized procedures for using rtfMRI with visual feedback to help nicotine-dependent individuals decrease craving when presented with smoking cues. The exploratory nature of this study requires a phased approach. Phase 1 will focus on the development of the technology and study paradigm. In order to proceed to Phase 2, there must be convincing evidence that a substantial proportion of nicotine-dependent individuals can manipulate brain activity in critical brain regions associated with smoking cue-induced craving based on rtfMRI visual feedback. If this is established, a controlled comparison and duration of effect will be explored in Phase 2. This project will set the stage for clinical trials investigating a very innovative approach to the treatment of nicotine dependence and other substance use disorders. The study will provide critical information about optimal techniques, durability and "transferability" of the effects to situations outside of the scanner. The findings of this study can be used to inform the design of a clinical trial to investigate the use of rtfMRI neuromodulation training in smoking cessation. PUBLIC HEALTH RELEVANCE: Improving treatment for nicotine dependence will provide substantial public health benefit as nicotine dependence is the leading preventable cause of mortality in the world today. Moreover, if individuals can learn to modulate activity in critical brain regions that control urges and craving states, this could have applicability in a broad range of disease states with major public health significance (i.e. other substance use disorders, obesity).