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David Eagleman Showcases fMRI Neurofeedback For Addiction

Publication date: 21 February 2016

I've been watching David Eagleman's outstanding TV series which is currently airing on BBC4 ("The Brain With David Eagleman"). Episode 4 - How do I decide? - I think is the best yet. Eagleman has a talent for making neuroscience relevant to everyone, and more particularly he suggests that psychological therapies can be more effective by being informed by neuroscience. The showcases an application of neurofeedback using fMRI brain scanning, for addiction.

The neuroscience of addiction is reasonably well understood, and explained in simple terms in the film. Release of the neurotransmitter dopamine in the brain is associated with the experience of anticipated reward - the feeling that something good is coming - and therefore with motivation. Most addictive substances (e.g. cocaine) stimulate the brain's dopamine pathways.

Actually the neurofeedback study doesn't directly relate to dopamine. You would guess that the dopamine pathways are being affected but the study doesn't rely on assessing dopamine. Rather, it's based on detecting two states in the brain, one associated with cravings for drugs, the other with resisting and controlling those impulses.

The study uses fMRI which is a type of brain imaging (it stands for functional magnetic resonance imaging). The key thing to note is that it doesn't just take a picture of brain like a sort of x-ray, but detects activity in specific brain regions. By activity I mean neural firing that consumes energy.

In the programme we meet Karen, who is a recovering crack cocaine addict. The first part of the study involves taking a sort of baseline measurement of Karen's brain - that is detecting the activity (and hence which brain networks are participating) in each of the two states: (i) craving, and (ii) resisting, controlling.

From the brain images we see, it looks very much as though the key brain region for resisting and controlling is the Prefronal Cortex (PFC), which is not really surprising given the PFC's fame as the centre for executive function. This means the ability to maintain steady focus, to resist distracting impulses and keep on track till you achieve your goals.

The second part of the study involves training. This is what neurofeedback is - it means using information measured from the brain activity, to guide yourself towards a desired state. In this case, Karen wants to reinforce her "willpower" - her ability to resist and let go of cravings for drugs. Remember the brain imaging is only providing feedback. There's no sinister manipulation of brain states by experimenters. What happens is, Karen views images e.g. of drug-taking which would ordinarily stimulate craving. Karen is shown a gauge of her current brain state - the indicator tilts either towards craving or resisting. Karen's job is to learn to nudge it towards resisting.

With practice, this is what she does. She's literally shaping her brain to be better aligned with who she'd like to be. But this is not essentially different from any learning situation such as learning to play piano. It still takes effort and commitment from Karen - the only difference is the feedback requires the brain scanner.

What I like about the study as a neurofeedback experiment is that it makes the training contingent on actual arousal of craving by using emotionally potent images. This makes it much more relevant to the real-life challenges of addiction. Eagleman describes it as a "biological" approach but it's not just that - it's a kind of psychological re-conditioning - or simply learning if you like - that's enhanced by measurement of biology. Karen still has to learn - she still has to want to learn.

You'd expect Karen to be empowered to better handle situations where she'd be tempted to turn to drugs. Certainly, in the film Karen appears to be enthusiastic for the method - not that she sees is as a cure for addiction, but as a way of strengthening her life choices.

Now, an fMRI scanner is a pretty expensive piece of kit - it's not likely you'll be able to afford one for home use. But neurofeedback can work (in principle) with any measure of brain activity. Most neurofeedback is done using EEG which is relatively speaking very cheap technology. Several consumer devices for EEG neurofeedback are on the market.

Does that mean there's a cheaper way to achieve the same benefits for addicts? Potentially, yes. Given that in this study, the fMRI scanner appears to be using PFC activation as the measure of resistance, then an obvious idea would be to try the same method using HEG neurofeedback, which uses a much cheaper sensor to measure changes in PFC activation.

Another possible biofeedback parameter is heart rate variability (HRV). HRV aims to induce what's known as heart rate coherence, which seems to go with activation of the PFC.

As far as I know the equivalent studies using these other biofeedback modalities haven't been done - but it would be interesting to see them.

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