Testing the efficacy of real-time fMRI neurofeedback for training people who smoke daily to upregulate neural responses to nondrug rewards

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 female) were trained to upregulate brain responses using feedback of ongoing brain activity (i.e., a dynamic “thermometer” that reflected ongoing changes in reward-related fMRI signal intensity) in a single neurofeedback session with three training runs. The control group (n = 22, 5 female) underwent a nearly identical procedure but received no neurofeedback. Those who received neurofeedback training demonstrated significantly greater increases in striatal BOLD activation compared to controls, but this effect was present only during the first training run. The potential implications of these findings for smoking cessation strategies, as well as directions for neurofeedback research in this population, are discussed.