Neurofeedback training versus treatment as usual for alcohol dependence: results of an early phase randomized controlled trial and neuroimaging correlates

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 (rtfMRI) 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: 52 alcohol dependent patients from the United Kingdom who had completed a detoxification programme 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 six NFT sessions over 4 months and were trained to down-regulate their brain activation in the salience network in the presence of alcohol stimuli and to up-regulate frontal activation in response to pictures related to positive goals. Four, eight 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.