CNSPulse

BRAIN-TO-BRAIN MOVIE NEUROFEEDBACK REDUCES CRAVING IN OPIOID USE DISORDER

Natalie McClain — Greg Kronberg1, Nelly Alia-Klein1, Rita Z. Goldstein1 1Icahn School of Medicine at Mount Sinai Natalie McClain, Icahn School of Medicine at Mount Sinai

2026 ASCP Annual Meeting

Background

Despite the escalating overdose crisis, effective brain-based treatments for opioid use disorder (OUD) remain scarce. In a recent fMRI study in inpatients with OUD, we reported malleability with treatment in shared brain dynamics across a network of brain regions during a drug-themed movie, suggesting that helping individuals learn these patterns could facilitate recovery. Real-time fMRI neurofeedback (NF) offers a promising method to directly modulate brain dynamics. However, traditional NF paradigms typically target single brain regions and rely exclusively on an individual’s own neural signals, limiting impact on complex recovery behavior in addiction. Here, for the first time, we develop brain-to-brain NF using a multivariate target signal derived from patients with OUD further along in recovery to facilitate recovery in individuals earlier in treatment. To increase ecological validity and better approximate real-world experiences in OUD, the stimulus was a dynamic, narrative-based, and context-rich movie.

Methods

The NF target signal was derived from an existing dataset of individuals with OUD [(iOUD), n=37] who underwent fMRI while viewing the first 17 minutes of Trainspotting twice, earlier in inpatient treatment and again three months later. We identified a linear transform of ROI-level BOLD signals, such that the resulting 1-dimensional time series reliably classified early vs. late treatment movie viewings (mean accuracy: 77.5%, p < 0.001). The average late treatment signal in this transformed space was then used as the NF target signal. We then implemented a novel real-time movie NF task in a new cohort of early-abstinent iOUD (n=10; 44 ± 11 years old), where the movie was paused after select scenes to display NF scores that reflected the alignment of these participants’ own brain activity with the target signal. A yoked control group of iOUD (n=10; 41 ± 7 years old) received sham feedback that was identical to their matched counterpart in the active NF group. NF training involved 8 runs of the task across 4 consecutive days. We evaluated its efficacy by comparing changes in NF performance, self-reported cue-induced craving, and standard affective ratings between groups over the course of NF training.

Results

NF performance increased in the active NF group (one-sample t=2.6, p=0.015) but not the sham (one-sample t=0.5, p=0.30; two-sample t=1.4, p=.093) during the first four runs. The active group also showed a significantly greater reduction in cue-induced craving after four runs (t=2.77, p=0.01). Linear mixed-effects models controlling for baseline pre-NF craving revealed that, across the first four runs, the active NF group demonstrated a significantly more negative relationship between NF performance and craving compared to sham (interaction β=0.2, p=0.019). Finally, the active NF group exhibited a greater increase in positive affect compared to the sham group (t=2.2, p=0.043).

Conclusion

This study provides the first evidence that a novel brain-to-brain NF paradigm during the processing of a naturalistic context can effectively reduce cue-induced craving in OUD. Unlike sham, active NF enabled participants to increasingly align their neural activity with the recovery-related target signal. Crucially, improvement in NF performance (observed after only 4 runs) was clinically meaningful, tracking with reductions in cue-induced craving and improved positive affect. These results suggest that guiding early-abstinent iOUD towards the neural signatures of those later in recovery may offer scaffolding for the nascent recovery process early in treatment, on route to developing a potent, ecologically valid treatment intervention for opioid addiction.

Learning Objective 1: Be able to describe how multivariate neural signals from patients further along in recovery can be leveraged as neurofeedback targets to reduce craving in early-abstinent individuals with opioid use disorder.

Learning Objective 2: Be able to assess the clinical potential of brain-to-brain neurofeedback for improving craving and positive affect in opioid use disorder treatment.

References

Kronberg G, Ceceli AO, Huang Y, et al. Shared orbitofrontal dynamics to a drug-themed movie track craving and recovery in heroin addiction. Brain. 2025;148(5):1778-1788. doi:10.1093/brain/awae369 Mennen AC, Nastase SA, Yeshurun Y, et al. Real-time neurofeedback to alter interpretations of a naturalistic narrative. Neuroimage Rep. 2022;2(3):100111. doi:10.1016/j.ynirp.2022.100111 ASCP TASK FORCE ON DEPRESCRIBING STIMULANTS FOR ADHD IN ADULTS David Goodman*1 1Johns Hopkins School of Medicine David Goodman, Johns Hopkins School of Medicine

The American Society of Clinical Psychopharmacology (ASCP) convened a task force on the deprescribing of psychotropic medications, including stimulant medications for adult ADHD, which entailed a focused literature review and 2-round Delphi survey querying 47 international psychopharmacology experts on factors related to deprescribing. The publication of these findings will represent the first worldwide published expert consensus recommendations for deprescribing stimulant medications in treated ADHD adults. With the survey as a basis, the panel generated expert consensus recommendations for the deprescription of stimulant medications for adults treated for ADHD for specific clinical presentations. This workshop will review the specific 11 Delphi statements and the voting outcomes. Eighty-two percent (9 of 11) reached consensus as defined by > 75% agreement (defined by “strong” or “moderately strong” endorsements). Consensus was not reached on (1) eliminating one of two co-administered stimulant medications from different classes (i.e., methylphenidate versus amphetamine-type), and (2) whether regular use of cannabis is sufficient reason to deprescribe stimulant medications in adult ADHD patients. We’ll review the clinical implication for the care of adults with ADHD.

Learning Objective 1: Understand the ASCP Task Force recommendations for deprescribing stimulant medication for adults with ADHD.

Learning Objective 2: Understand the clinical considerations and implications of deprescribing stimulants for adults with ADHD.

References

Faraone SV., Banaschewski T, Coghill D, et al. “The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder,” Neurosci. Biobehav. Rev., vol. 128, pp. 789–818, Sep. 2021, doi: 10.1016/j.neubiorev.2021.01.022. Lohr WD, Wanta JW, Baker M, Grudnikoff E, Morgan W, Chhabra D, Lee T. Intentional Discontinuation of Psychostimulants Used to Treat ADHD in Youth: A Review and Analysis. Front Psychiatry. 2021 Apr 20;12:642798. doi: 10.3389/fpsyt.2021.642798. PMID: