Using Neurofeedback to Understand the Relationship Between Stress and Alcohol Consumption

NCT ID: NCT06247306

Last Updated: 2025-01-23

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

102 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-03-01

Study Completion Date

2027-07-01

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

In this research project, the aim is to discover the role specific brain networks play in the relationship between stress reactions and the desire for alcohol and alcohol consumption. To investigate this question, various brain imaging methods as well as cognitive tasks are combined. Various questionnaires are sampled and brain scans are conducted.

Individuals interested in participating in the study have to fulfill certain criteria...

* no serious medical or mental health diagnosis
* problematic alcohol drinking habits
* interested in improving drinking habits

...and undergo various non-invasive procedures
* filling out several questionnaires concerning personality and habits
* undergoing a mental performance task while being in a brain scanner (MRI)
* attempting to regulate their own brain activity while lying in the MRI scanner
* filling out an electronic diary for 6 weeks - concerning daily mood, stress, and alcohol habits

Participants will be randomly allocated to either one of 2 experimental groups. Both groups undergo the same tasks, receive the same instructions and only differ regarding some aspects of the brain self-regulation task .

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

While it is well known and long acknowledged in scientific research that stress and alcohol consumption are closely linked, the actual relationship is complex, and the underlying mechanisms are only partially understood. To investigate the effects of acute stress under controlled conditions, experimental procedures, stress tests, and related paradigms are often employed. Studies on alcohol addiction generally indicate an increase in acute cravings following the experimental induction of stress. Neurologically, acute stress induction is associated with activation changes in widespread networks. In particular, research employing stress tests found increased activations in striatum, thalamus and limbic areas and deactivations in anterior cingulate cortex (ACC) as well as ventromedial prefrontal cortex (vmPFC), areas often associated with emotion regulation during stress induction. Given their role in emotion regulation, deactivations in these areas could reflect a reduction in emotional control during acute stress. Deactivation of these areas during experimentally induced stress has also been linked to problematic alcohol consumption and increased alcohol cravings.

This study aims to elucidate how neurocognitive processes during stress influence alcohol cravings and consumption. To this end, participants with problematic alcohol consumption will be recruited. After having filled out various questionnaires pertaining to their biographical data, alcohol consumption and personality traits, participants will be experimentally stressed during a brain scan using functional Magnetic Resonance Imaging (fMRI). To reliably induce psychosocial stress, the ScanSTRESS test, a paradigm explicitly conceptualized for usage during MRI scanning, will be employed. Once the stress test is completed, participants will attempt to regulate their own neurological stress response through upregulation of the ACC using information about their current stress-induced brain activity (neurofeedback). Additionally, saliva samples will be regularly taken during the experiment to biologically observe the stress response through cortisol measurements. This will be followed by a 6-week follow-up phase, during which participants will be specifically asked about their alcohol cravings, alcohol consumption, and daily stress experiences.

By employing real-time fMRI neurofeedback, this study creates experimental conditions in which participants can self-regulate the neural stress response of the targeted brain network. Nonspecific effects of the neurofeedback paradigm are controlled using a sham condition (Yoke-control group). Participants are randomly assigned to either the control group or the real neurofeedback group (experimental group). This approach allows for the investigation of the neural self-regulation abilities of emotional control networks and their role in the connection between stress, alcohol cravings, and drinking behavior in real life.

In summary, this study aims to examine the relationship between the self-regulation abilities of neural stress responses and real-life drinking behavior.

Investigators hypothesize that 1) the stress experiment significantly increases acute self-reported stress in participants, 2) specifically stress-induced patterns of neural activity, namely increased striatal and thalamic activity as well as decreased ACC activity, predict alcohol cravings and consumption, 3) the experimental neurofeedback group exhibits higher ACC activity during brain self-regulation than the control group, 4) the experimental group shows lower alcohol craving/consumption during the follow-up phase.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Alcohol Abuse Craving Psychosocial Stressor Neural Stress Response

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Firstly,.all participants are assigned to either the experimental or the sham-control (Yoke-control) group through a fully automated, double-blind procedure. All participants undergo one neurofeedback (NFB) session with two runs à 9:30 mins. The NFB runs have a block structure with alternating periods/ blocks of self-regulation and rest. Participants of both groups receive the instruction to decrease their stress-response (thus, upregulating their ACC activity), through whichever strategy helps them to achieve this goal. The experimental group receives real-time fMRI feedback of their respective ACC activity. The sham-control group or Yoke-control group receives a previously acquired recording of the neurofeedback signal from a different participant instead of their own real-time ACC activity.
Primary Study Purpose

BASIC_SCIENCE

Blinding Strategy

DOUBLE

Participants Investigators
Next to the investigator and participants, research assistants as well as medical technical radiology assistants (MTRAs) will be blinded to the conditions. Only after the 6-week long ecological momentary assessment is completed are participants as well as investigators, MTRAs and research assistants debriefed concerning the participants group assignment (experimental or Yoke-control group).

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

real-time fMRI neurofeedback (of the ACC)

Participants are instructed to reduce their stress-response by attempts to upregulate the ACC activity contigent on real-time feedback.

Group Type EXPERIMENTAL

ScanSTRESS fMRI-paradigm (Streit et al., 2014)

Intervention Type BEHAVIORAL

The task is conducted within the MRI scanner and consists of two runs each lasting 11:20 mins., employs a block design and has two different conditions (performance, relaxation), as well as two different task within each condition. Participants undergo the following 2 tasks during the performance condition under time pressure: 1) serial subtraction, 2) a figure matching task. During the performance condition, all participants receive feedback (work faster, mistake, too slow) and are reprimanded concerning their performance. Two investigators in white coats observe the participants with critical facial expression, which is projected to participants through live-video feed during the tasks. The relaxation condition includes easy versions of arithmetic and figure matching task without time constrains or any type feedback on their performance. Performance and relaxation phases are appear in alternating order.

real-time fMRI neurofeedback

Intervention Type BEHAVIORAL

Two real-time fMRI neurofeedback sessions of 9:30 minutes each are conducted. During these sessions, the participants are instructed to regulate a feedback signal from the ACC. Participants are assigned to either the experimental or Yoke-control group through an automated double-blind procedure. In the neurofeedback sessions, participants in the experimental group receive a feedback signal indicating their current ACC activation. Participants in the control group receive the recorded feedback signal from another participant. The neurofeedback sessions follow a block structure with alternating feedback and rest periods.

Before, between, and after the two sections of the fMRI examination, subjective stress levels and alcohol craving are assessed, and saliva samples are collected for cortisol level determination.

Yoke-control group

Participants receive previously recorded feedback signal from other participants\' ACC activity instead of their own live ACC activity.

Group Type SHAM_COMPARATOR

ScanSTRESS fMRI-paradigm (Streit et al., 2014)

Intervention Type BEHAVIORAL

The task is conducted within the MRI scanner and consists of two runs each lasting 11:20 mins., employs a block design and has two different conditions (performance, relaxation), as well as two different task within each condition. Participants undergo the following 2 tasks during the performance condition under time pressure: 1) serial subtraction, 2) a figure matching task. During the performance condition, all participants receive feedback (work faster, mistake, too slow) and are reprimanded concerning their performance. Two investigators in white coats observe the participants with critical facial expression, which is projected to participants through live-video feed during the tasks. The relaxation condition includes easy versions of arithmetic and figure matching task without time constrains or any type feedback on their performance. Performance and relaxation phases are appear in alternating order.

real-time fMRI neurofeedback

Intervention Type BEHAVIORAL

Two real-time fMRI neurofeedback sessions of 9:30 minutes each are conducted. During these sessions, the participants are instructed to regulate a feedback signal from the ACC. Participants are assigned to either the experimental or Yoke-control group through an automated double-blind procedure. In the neurofeedback sessions, participants in the experimental group receive a feedback signal indicating their current ACC activation. Participants in the control group receive the recorded feedback signal from another participant. The neurofeedback sessions follow a block structure with alternating feedback and rest periods.

Before, between, and after the two sections of the fMRI examination, subjective stress levels and alcohol craving are assessed, and saliva samples are collected for cortisol level determination.

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

ScanSTRESS fMRI-paradigm (Streit et al., 2014)

The task is conducted within the MRI scanner and consists of two runs each lasting 11:20 mins., employs a block design and has two different conditions (performance, relaxation), as well as two different task within each condition. Participants undergo the following 2 tasks during the performance condition under time pressure: 1) serial subtraction, 2) a figure matching task. During the performance condition, all participants receive feedback (work faster, mistake, too slow) and are reprimanded concerning their performance. Two investigators in white coats observe the participants with critical facial expression, which is projected to participants through live-video feed during the tasks. The relaxation condition includes easy versions of arithmetic and figure matching task without time constrains or any type feedback on their performance. Performance and relaxation phases are appear in alternating order.

Intervention Type BEHAVIORAL

real-time fMRI neurofeedback

Two real-time fMRI neurofeedback sessions of 9:30 minutes each are conducted. During these sessions, the participants are instructed to regulate a feedback signal from the ACC. Participants are assigned to either the experimental or Yoke-control group through an automated double-blind procedure. In the neurofeedback sessions, participants in the experimental group receive a feedback signal indicating their current ACC activation. Participants in the control group receive the recorded feedback signal from another participant. The neurofeedback sessions follow a block structure with alternating feedback and rest periods.

Before, between, and after the two sections of the fMRI examination, subjective stress levels and alcohol craving are assessed, and saliva samples are collected for cortisol level determination.

Intervention Type BEHAVIORAL

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* Age 18-65 years
* Presence of 2 to a maximum of 5 criteria for alcohol use disorder according to DSM-5
* no clinical necessity for detoxification treatment
* participants may have a moderate cannabis use disorder and tobacco use disorder
* Capacity for consent and ability to use self-assessment scales
* Sufficient knowledge of German
* Willingness to use a mobile phone with Android operating system

Exclusion Criteria

* Lifetime diagnosis of bipolar or psychotic disorder or a substance use disorder according to Diagnostical and Statistical Manual of Mental Disorders - 5 (DSM-5) that is not alcohol, cannabis, or tobacco use disorder
* Current substance use other than cannabis and tobacco
* Current diagnosis of one of the following conditions according to DSM-5: (hypo)manic episode, major depression, generalized anxiety disorder, post-traumatic stress disorder, borderline personality disorder, or obsessive-compulsive disorder
* History of severe head trauma or other severe central neurological disorders (dementia, Parkinson\'s disease, multiple sclerosis)
* Pregnancy or lactation
* Use of medications known to interact with the central nervous system within the last 10 days; testing at least four half-lives after the last dose
* Exercising the prerogative of the \"Right not to know\" in the context of incidental findings during an examination or investigation
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

Central Institute of Mental Health, Mannheim

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Responsibility Role SPONSOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Martin F Gerchen, PhD

Role: PRINCIPAL_INVESTIGATOR

Central Institute of Mental Health

Peter Kirsch, Prof., PhD

Role: PRINCIPAL_INVESTIGATOR

Central Institute of Mental Health

Falk Kiefer, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Central Institute of Mental Health

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

Central Institute of Mental Health - Department of Clinical Psychology

Mannheim, Baden-Wurttemberg, Germany

Site Status RECRUITING

Countries

Review the countries where the study has at least one active or historical site.

Germany

Central Contacts

Reach out to these primary contacts for questions about participation or study logistics.

Nina J Kempf, M. Sc.

Role: CONTACT

+ 49/621-1703 ext. 6529

Lea Wazulin, M. Sc.

Role: CONTACT

+49-621/1703 ext. 6529

Facility Contacts

Find local site contact details for specific facilities participating in the trial.

Martin F Gerchen, PhD

Role: primary

+49-621/1703 ext. 6163

References

Explore related publications, articles, or registry entries linked to this study.

Wolkowicz NR, Peltier MR, Wemm S, MacLean RR. Subjective stress and alcohol use among young adult and adult drinkers: Systematic review of studies using Intensive Longitudinal Designs. Drug Alcohol Depend Rep. 2022 Mar 11;3:100039. doi: 10.1016/j.dadr.2022.100039. eCollection 2022 Jun.

Reference Type BACKGROUND
PMID: 36845979 (View on PubMed)

Vollstadt-Klein S, Hermann D, Rabinstein J, Wichert S, Klein O, Ende G, Mann K. Increased activation of the ACC during a spatial working memory task in alcohol-dependence versus heavy social drinking. Alcohol Clin Exp Res. 2010 May;34(5):771-6. doi: 10.1111/j.1530-0277.2010.01149.x. Epub 2010 Mar 1.

Reference Type BACKGROUND
PMID: 20201927 (View on PubMed)

Vollstadt-Klein S, Lemenager T, Jorde A, Kiefer F, Nakovics H. Development and validation of the craving automated scale for alcohol. Alcohol Clin Exp Res. 2015 Feb;39(2):333-42. doi: 10.1111/acer.12636.

Reference Type BACKGROUND
PMID: 25684052 (View on PubMed)

Streit F, Haddad L, Paul T, Frank J, Schafer A, Nikitopoulos J, Akdeniz C, Lederbogen F, Treutlein J, Witt S, Meyer-Lindenberg A, Rietschel M, Kirsch P, Wust S. A functional variant in the neuropeptide S receptor 1 gene moderates the influence of urban upbringing on stress processing in the amygdala. Stress. 2014 Jul;17(4):352-61. doi: 10.3109/10253890.2014.921903. Epub 2014 Jun 16.

Reference Type BACKGROUND
PMID: 24800784 (View on PubMed)

Sinha R, Li CS. Imaging stress- and cue-induced drug and alcohol craving: association with relapse and clinical implications. Drug Alcohol Rev. 2007 Jan;26(1):25-31. doi: 10.1080/09595230601036960.

Reference Type BACKGROUND
PMID: 17364833 (View on PubMed)

Sinha R, Fox HC, Hong KA, Bergquist K, Bhagwagar Z, Siedlarz KM. Enhanced negative emotion and alcohol craving, and altered physiological responses following stress and cue exposure in alcohol dependent individuals. Neuropsychopharmacology. 2009 Apr;34(5):1198-208. doi: 10.1038/npp.2008.78. Epub 2008 Jun 18.

Reference Type BACKGROUND
PMID: 18563062 (View on PubMed)

Seo D, Lacadie CM, Tuit K, Hong KI, Constable RT, Sinha R. Disrupted ventromedial prefrontal function, alcohol craving, and subsequent relapse risk. JAMA Psychiatry. 2013 Jul;70(7):727-39. doi: 10.1001/jamapsychiatry.2013.762.

Reference Type BACKGROUND
PMID: 23636842 (View on PubMed)

Seo D, Lacadie CM, Sinha R. Neural Correlates and Connectivity Underlying Stress-Related Impulse Control Difficulties in Alcoholism. Alcohol Clin Exp Res. 2016 Sep;40(9):1884-94. doi: 10.1111/acer.13166. Epub 2016 Aug 8.

Reference Type BACKGROUND
PMID: 27501356 (View on PubMed)

Koob GF, Le Moal M. Drug abuse: hedonic homeostatic dysregulation. Science. 1997 Oct 3;278(5335):52-8. doi: 10.1126/science.278.5335.52.

Reference Type BACKGROUND
PMID: 9311926 (View on PubMed)

Kirschbaum C, Pirke KM, Hellhammer DH. The 'Trier Social Stress Test'--a tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology. 1993;28(1-2):76-81. doi: 10.1159/000119004.

Reference Type BACKGROUND
PMID: 8255414 (View on PubMed)

Cox WM, Klinger E. A motivational model of alcohol use. J Abnorm Psychol. 1988 May;97(2):168-80. doi: 10.1037//0021-843x.97.2.168. No abstract available.

Reference Type BACKGROUND
PMID: 3290306 (View on PubMed)

Clay JM, Parker MO. The role of stress-reactivity, stress-recovery and risky decision-making in psychosocial stress-induced alcohol consumption in social drinkers. Psychopharmacology (Berl). 2018 Nov;235(11):3243-3257. doi: 10.1007/s00213-018-5027-0. Epub 2018 Sep 12.

Reference Type BACKGROUND
PMID: 30209533 (View on PubMed)

Clay JM, Adams C, Archer P, English M, Hyde A, Stafford LD, Parker MO. Psychosocial stress increases craving for alcohol in social drinkers: Effects of risk-taking. Drug Alcohol Depend. 2018 Apr 1;185:192-197. doi: 10.1016/j.drugalcdep.2017.12.021. Epub 2018 Feb 15.

Reference Type BACKGROUND
PMID: 29462766 (View on PubMed)

Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998 Sep 14;158(16):1789-95. doi: 10.1001/archinte.158.16.1789.

Reference Type BACKGROUND
PMID: 9738608 (View on PubMed)

Blaine SK, Seo D, Sinha R. Peripheral and prefrontal stress system markers and risk of relapse in alcoholism. Addict Biol. 2017 Mar;22(2):468-478. doi: 10.1111/adb.12320. Epub 2015 Nov 5.

Reference Type BACKGROUND
PMID: 26537217 (View on PubMed)

Amlung M, MacKillop J. Understanding the effects of stress and alcohol cues on motivation for alcohol via behavioral economics. Alcohol Clin Exp Res. 2014 Jun;38(6):1780-9. doi: 10.1111/acer.12423. Epub 2014 May 30.

Reference Type BACKGROUND
PMID: 24890323 (View on PubMed)

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

TRR265-C04

Identifier Type: OTHER

Identifier Source: secondary_id

U1111-1302-2402

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.

Neural Bases of Motivation
NCT07251816 RECRUITING NA
Reliability of the Human Brain Connectome
NCT02193425 COMPLETED EARLY_PHASE1