Enhancing Self-Control of Cigarette Craving with Real-Time fMRI

利用实时功能磁共振成像增强对香烟渴望的自我控制

• 批准号: 8191696
• 负责人: A EDEN EVINS
• 金额: $ 27.74万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-15 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8191696
• 关键词: Abstinence; Adult; Attention deficit hyperactivity disorder; Auditory area; Brain; Brain region; Cessation of life; Chronic; Cigarette; Clinical; Cognitive; Collaborations; Corpus striatum structure; Cues; Development; Disease; Emotional; Face; Failure; Feedback; Functional Magnetic Resonance Imaging; Galvanic Skin Response; General Hospitals; Goals; Image; Imaging Techniques; Individual; Inferior; Informal Social Control; Institutes; Learning; Magnetism; Massachusetts; Measures; Medial; Mediating; Medicine; Mental Depression; Methods; Morbidity - disease rate; Motivation; Neurobiology; Nicotine; Nicotine Dependence; Nucleus Accumbens; Outcome Measure; Participant; Patient Self-Report; Pattern; Prefrontal Cortex; Premature Mortality; Prevention therapy; Process; Randomized; Regulation; Relapse; Reporting; Research Project Grants; Rewards; Self-control as a personality trait; Smoke; Smoker; Smoking; Smoking Behavior; Source; Structure; System; Techniques; Technology; Testing; Time; Tobacco; Training; Ventral Striatum; Visit; Visual; Work; addiction; base; cigarette smoking; clinically relevant; craving; cue reactivity; design; disorder later incidence prevention; effective therapy; emotion regulation; flexibility; follow-up; frontal lobe; improved; innovation; mind control; mortality; neurobiological mechanism; neurofeedback; neuroregulation; nicotine replacement; novel; novel strategies; primary outcome; response; secondary outcome; smoking cessation; smoking relapse; tool

DESCRIPTION (provided by applicant): Smoking-related illness causes over 440,000 deaths in the U.S. and over 5 million deaths worldwide annually, and this figure is increasing. Although effective existing therapies double to triple cessation rates, relapse rates remain high. Up to 90 percent of people who quit smoking relapse within the first year, even with the best treatment available. Thus, we face a critical need to develop a better understanding of the neurobiological underpinnings of addictive processes, and of relapse in particular, in order to develop targeted relapse prevention therapies that help people to maintain abstinence. Most relapse occurs following smoking cue exposure. We recently demonstrated that functional magnetic resonance imaging (fMRI) measures of heightened cue-reactivity prior to a smoking cessation attempt identified smokers who would relapse on nicotine replacement therapy (NRT); greater brain reactivity to smoking-related cues was associated with relapse and was not ameliorated by NRT. Tools now exist to evaluate individual patterns of abnormal cortical and subcortical brain reactivity to smoking cues in relapse prone smokers and to train people to modulate this abnormal smoking-related cue-associated brain reactivity with the aim of ameliorating disease-associated craving and compulsive urges. This resubmitted Exploratory / Developmental Research project will test such a tool, real-time fMRI used with emotion regulation strategies, as a novel approach to understanding and potentially modulating the neurobiology of addiction and of relapse in particular. This study is made possible by an ongoing collaboration between Drs. Evins and Stoeckel, at the Massachusetts General Hospital (MGH) Center for Addiction Medicine, who have a track record of study of novel treatments for nicotine dependence, and Drs. Gabrieli, Whitfield-Gabrieli and Graybiel, a highly innovative and productive team of cognitive neuroscientists at the Massachusetts Institute of Technology (MIT), who have pioneered this novel imaging technique. The proposed work has the potential to produce improved understanding of brain mechanisms underlying relapse and potentially, a novel therapy that could reduce the enormous morbidity and mortality caused by chronic, relapsing addiction to smoked tobacco, and also offers the potential for improved understanding and treatment of related disorders such as OCD that involve compulsive urges and failure of inhibitory control. PUBLIC HEALTH RELEVANCE: Addiction to smoked tobacco remains the largest preventable cause of morbidity and premature mortality in the developed world. This study will test neuromodulation with real-time fMRI to determine whether people can gain voluntary control of brain activity associated with craving and whether such control is associated with reduced craving and reduced smoking. If our aims are achieved, we will further our understanding of the neurobiological mechanisms of relapse to nicotine dependence, and we will discover what may become an entirely novel therapy that may improve cessation rates and reduce relapse rates. This technique may also have applications to other addictions, depression, OCD, and ADHD.

描述（由申请人提供）：吸烟相关疾病每年在美国导致超过 440,000 人死亡，在全球范围内导致超过 500 万人死亡，而且这个数字还在增加。尽管有效的现有疗法使戒烟率提高了一倍至三倍，但复发率仍然很高。即使采用最好的治疗方法，高达 90% 的戒烟者在第一年内就会复发。因此，我们迫切需要更好地了解成瘾过程，特别是复发的神经生物学基础，以便开发有针对性的复发预防疗法，帮助人们保持戒瘾。大多数复发是在接触吸烟线索后发生的。我们最近证明，在尝试戒烟之前，功能性磁共振成像（fMRI）测量提示反应性增强，可以识别出尼古丁替代疗法（NRT）复吸的吸烟者；大脑对吸烟相关线索的反应性增强与复吸有关，并且 NRT 并不能改善这种情况。现在已有工具可以评估易复发吸烟者皮质和皮质下大脑对吸烟线索的异常反应的个体模式，并训练人们调节这种与吸烟相关的异常线索相关的大脑反应，以改善与疾病相关的渴望和强迫冲动。这个重新提交的探索性/发展研究项目将测试这样一种工具，即与情绪调节策略一起使用的实时功能磁共振成像，作为理解和潜在调节成瘾、特别是复发的神经生物学的新方法。这项研究是通过博士之间的持续合作而得以实现的。马萨诸塞州总医院 (MGH) 成瘾医学中心的埃文斯 (Evins) 和斯托克尔 (Stoeckel) 拥有尼古丁依赖新疗法的研究记录。 Gabrieli、Whitfield-Gabrieli 和 Graybiel 是麻省理工学院 (MIT) 的一个由认知神经科学家组成的高度创新和高效的团队，他们开创了这种新颖的成像技术。拟议的工作有可能提高对复发背后的大脑机制的理解，并有可能开发出一种新的疗法，可以减少慢性、复发性吸烟成瘾引起的巨大发病率和死亡率，并且还可以提高对吸烟成瘾的理解和治疗。相关疾病，例如涉及强迫冲动和抑制控制失败的强迫症。 公共卫生相关性：吸烟成瘾仍然是发达国家发病和过早死亡的最大可预防原因。这项研究将通过实时功能磁共振成像测试神经调节，以确定人们是否能够自愿控制与渴望相关的大脑活动，以及这种控制是否与减少渴望和减少吸烟有关。如果我们的目标实现，我们将进一步了解尼古丁依赖复发的神经生物学机制，并且我们将发现一种全新的疗法，可以提高戒烟率并降低复发率。这项技术也可能适用于其他成瘾、抑郁症、强迫症和多动症。