Sunday, November 24, 2024
11/24/2024
PROJECT SUMMARY (See instructions): Initial evidence suggests that interventions that target neurocircuitry, such as real-time fMRI neurofeedback (rt-fMRI-NF) and repetitive transcranial magnetic stimulation (TMS), have promise for AUD treatment; however, there remains a critical need to leverage rt-fMRI-NF and rTMS neuromodulation techniques towards a sustained decrease in problem drinking and related antisocial / aggressive behaviors. Therefore, the overall objective for this R00 project is to identify a neuroscientific intervention that works to decrease alcohol drinking and antisocial behavior in individuals with AUD. The central hypothesis is that a rt-fMRI-NF training/ TMS intervention will result in sustained reduction of alcohol drinking and negative social behaviors. Preliminary data from the K99 portion of the study have shown that learned control of neural response during rt-fMRI-NF training corresponds to less feelings of craving after the session, supporting transfer effects of the intervention . Moreover, preliminary evidence suggests that alcohol attention bias may contribute to the link between alcohol use and antisocial behaviors. Thus, the R00 portion has the following two specific aims: 1) Develop a TMS protocol that contributes to a reduction in alcohol craving and alcohol attention bias; and 2) Evaluate the comparative efficacy of rt-fMRI-NF, TMS, and treatment as usual in reducing drinking and alcohol-related negative social behaviors. The first study will be a crossover TMS study in which studies will receive rTMS to the right frontal eye field (FEF), an area involved in attention switching. All subjects will receive inhibitory and excitatory TMS in separate sessions and will complete MRI scans pre- and post- TMS. We expect to demonstrate a) impairing attention switching in healthy controls (n = 20) leads to neural patterns consistent with attention bias in AUD; and b) improving attention switching through TMS attenuates attention bias in individuals with AUD (n = 20). The second study will follow a RCT design. At each of four weekly treatment session, individuals seeking treatment for AUD (n = 90) will receive an intervention consisting of active/sham rt-fMRI-N F/TMS or a treatment as usual "check in". Subjects will then be followed monthly for a year to assess alcohol use, craving, and related negative behaviors. Subjects will also return for 6 and 12 month MRI follow-ups to assess longitudinal neural changes. We hypothesize that multiple training sessions of a combined rt-fMRI-NF training/rTMS craving reduction protocol in addition to
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