Extending Real-Time fMRI Neurofeedback Training into Real-World Contexts

About This Grant

PROJECT SUMMARY Alcohol misuse in young adulthood is a significant public health concern, contributing to numerous adverse consequences and societal costs. Self-regulatory deficits strongly contribute to alcohol misuse in young adults, reflecting a maturational imbalance between heightened reward responsivity and underdeveloped cognitive control. Real-time fMRI neurofeedback (rtfMRI-nf)—an imaging approach that trains individuals to gain volitional control over targeted brain activity—is a powerful tool for more directly measuring self-regulatory brain function than is possible with traditional fMRI. Our prior work has shown that young adults can learn how to increase and decrease reward-related activity in the nucleus accumbens (NAcc) using rtfMRI-nf. Critical gaps remain in understanding how to sustain gains in reward-related self-regulation beyond the lab in real- world settings. This information is essential to maximize the scalability and clinical potential of rtfMRI-nf. In preliminary work, we have demonstrated the feasibility and acceptability of supplementing rtfMRI-nf with a phone app-based ecological momentary intervention (EMI) to extend in-scanner training in real-world contexts. The proposed R01 randomized controlled trial builds upon and extends this work in 240 18- to 30-year-olds (50% female; currently use alcohol). Participants will be randomized to one of three groups in a 1:1:1 ratio: Neurofeedback EMI (NF+EMI): Neurofeedback + EMI (experimental group); Neurofeedback Control (NF Control): Neurofeedback only, no EMI; or EMI Control: EMI only, no neurofeedback. All groups will complete a baseline scan, a 2-week twice-daily ecological momentary assessment (EMA) to report drinking and emotional/physiological states, and a follow-up scan. In addition to the EMA, NF+EMI and EMI Control groups will complete an EMI regimen to practice cognitive strategies used during in-scanner reward-related self- regulation. At both scans, the NF+EMI and NF Control groups will be instructed to up- and down-regulate NAcc activity through rtfMRI-nf; the EMI Control group will receive the same NAcc modulation instructions but without neurofeedback. Post follow-up scan, self-reported self-regulation, alcohol and other substance use, and mental health symptoms will be assessed monthly for 3 months. Specific Aims are: Aim 1) Examine the impact of EMI on improvements in NAcc modulation; Aim 2) Investigate state and context effects of EMI practice on NAcc modulation; and Aim 3) Test associations between neurofeedback training and EMI practice on out-of-scanner self-regulation. This proposed secondary intervention study, which integrates multimodal real-time technology, is both novel and highly innovative. Integrating EMI with rtfMRI-nf offers a powerful approach to extend the impact of neuroimaging-based self-regulation training into daily life, making it more scalable and fostering real-world skill transfer. Strengthening reward-related self-regulation is an important, modifiable treatment target with important downstream implications to reduce risk behaviors, including alcohol misuse, in young adults.