Cigarette craving modulation is more feasible than resistance modulation for heavy cigarette smokers: empirical evidence from functional MRI data

Dong Youl Kim, Marion Tegethoff, Gunther Meinlschmidt, Seung Schik Yoo, Jong Hwan Lee

Research output: Contribution to journalArticlepeer-review


Background Modulation of cigarette craving and neuronal activations from nicotine-dependent cigarette smokers using real-time functional MRI (rtfMRI)-based neurofeedback (rtfMRI-NF) has been previously reported. Objectives The aim of this study was to evaluate the efficacy of rtfMRI-NF training in reducing cigarette cravings using fMRI data acquired before and after training. Methods Treatment-seeking male heavy cigarette smokers (N=14) were enrolled and randomly assigned to two conditions related to rtfMRI-NF training aiming at resisting the urge to smoke. In one condition, subjects underwent conventional rtfMRI-NF training using neuronal activity as the neurofeedback signal (activity-based) within regions-of-interest (ROIs) implicated in cigarette craving. In another condition, subjects underwent rtfMRI-NF training with additional functional connectivity information included in the neurofeedback signal (functional connectivity-added). Before and after rtfMRI-NF training at each of two visits, participants underwent two fMRI runs with cigarette smoking stimuli and were asked to crave or resist the urge to smoke without neurofeedback. Cigarette craving-related or resistance-related regions were identified using a general linear model followed by paired t-tests and were evaluated using regression analysis on the basis of neuronal activation and subjective craving scores (CRSs). Results Visual areas were mainly implicated in craving, whereas the superior frontal areas were associated with resistance. The degree of (a) CRS reduction and (b) the correlation between neuronal activation and CRSs were statistically significant (P<0.05) in the functional connectivity-added neurofeedback group for craving-related ROIs. Conclusion Our study demonstrated the feasibility of altering cigarette craving in craving-related ROIs but not in resistance-related ROIs via rtfMRI-NF training.

Original languageEnglish
Pages (from-to)762-770
Number of pages9
Issue number9
Publication statusPublished - 2021 Jun 9

Bibliographical note

Funding Information:
This work was supported by the National Research Foundation (NRF) grant, MSIP of Korea (NRF-2015R1A2A2A03004462, NRF-2016M3C7A1914450 and NRF-2017R1E1A1A01077288), and in part by the National Research Council of Science & Technology (NST) grant by the Korea government (MSIT) [No. CAP-18-01-KIST]. These sponsors were not involved in the study design, data collection, analysis or interpretation of data, manuscript preparation, or the decision to submit for publication.

Publisher Copyright:
Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.


  • cigarette craving
  • cigarette resistance
  • functional MRI
  • neurofeedback
  • real-time fMRI neurofeedback

ASJC Scopus subject areas

  • Neuroscience(all)


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