BCI-Based Neurofeedback Training for Quitting Smoking

Neurofeedback is a psychophysiological protocol in which online feedback of brain activation is provided to the participant for self-regulation. As a progenitor of brain–computer interfaces (BCIs), neurofeedback has provided a novel way to improve brain function and investigate neuroplasticity. Previous EEG-based neurofeedback protocols have been employed in drug addiction treatment for more than four decades. However, the efficacy of these traditional EEG neurofeedback approaches in the treatment of addiction remains dubious. Here we developed a novel cognition-guided neurofeedback protocol and evaluated its therapeutic efficacy on nicotine addiction. We trained a personalized multivariate pattern analysis (MVPA) classifier to identify an EEG activity pattern associated with drug cue reactivity using the specific cognitive task (drug cue reactivity task) before neurofeedback, and subsequently trained participants to de-activate this pattern during neurofeedback (hereby termed ‘cognition-guided neurofeedback’). In a double-blind, placebo-controlled, randomized clinical trial, 60 nicotine-dependent participants were assigned to receive two neurofeedback training sessions (about 1 h/session) either from their own brain (\(N = 30\), real-feedback group) or from the brain activity pattern of a matched participant (\(N = 30\), yoked-feedback group). 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 rates of cigarettes smoked per day at 1-week, 1-month and 4-month follow-up decreased 30.6, 38.2, and 27.4% relative to baseline in the real-feedback group, compared to decreases of 14.0, 13.7, and 5.9% in the yoked-feedback group. The neurofeedback effects on craving change and smoking amount at the 4-month follow-up were further predicted by neural markers at pre-neurofeedback. This novel neurofeedback training approach produced significant short-term and long-term effects on cigarette craving and smoking behavior, suggesting the neurofeedback protocol described herein is a promising brain-based tool for treating addiction.