De-activation Of Activity Patterns Related To Smoking Cue Reactivity Prevents Smoking Behavior

Objective:Approximately three-fourths of patients with nicotine dependence relapse and return to cigarette-smoking behavior during follow-up periods using the Gold Standard Programme for smoking cessation interventions.Typically,smoking cue reactivity plays a crucial role in smoking behavior.In the current study,we test a novel closed-loop smoking cue reactivity pattern EEG-based neurofeedback protocol.The therapeutic efficacy of this novel neurofeedback training was evaluated by assessing smokers' behavior and neurophysiology in both the short and long-term.Method:In a double-blind,placebo-controlled,randomized clinical trial,nicotine-dependent participants(N =60)were assigned to receive two visits of neurofeedback training either from their own brain(N=30,real-feedback group)or from the brain activity pattern of a matched participant in the real-feedback group(N=30,yoked-feedback group).Cigarette craving and craving-related P300 were assessed at pre-neurofeedback(pre-NF)training and at post-neurofeedback(post-NF)training.The number of cigarettes smoked per day was assessed at baseline,1 week,1 month,and 4 months following the final neurofeedback visit.The EEG activity patterns of smoking cue reactivity were assessed at pre-NF and at the 4-month follow-up visit.Results:In the real-feedback group,participants successfully de-activated EEG activity patterns of smoking cue reactivity.The real-feedback group showed significant decrease in cigarette craving and craving-related P300 amplitudes compared with the yoked-feedback group.The decreased P300 amplitude partially mediated the effect of average de-activated neurofeedback performance on decreased cigarette craving.The rates of cigarettes smoked per day in 1-week,1-month and 4-month follow-up decreased 30.6%,38.2%and 27.4%relative to baseline,respectively.In the real-feedback group,the decoding accuracy in smoking and neutral cue reactivity at the 4-month follow-up visit calculated by the pre-NF classifier significantly decreased relative to the yoked-feedback group.The neurofeedback effects on cigarette craving change and the number of cigarettes smoked per day at the 4-month follow-up visit were further predicted by classification accuracy in smoking and neutral cue reactivity at pre-NF and de-activated performance at the beginning of the neurofeedback training,respectively.Conclusions:Our novel neurofeedback training produced significant short-term and long-term effects on cigarette craving and smoking behavior,suggesting this neurofeedback protocol is a promising nonpharmacological method for reducing drug craving and behavior,potentially being a low-cost and high-portability brain-based tool for treating addiction.