Improved Response Inhibition Through Cognition-Guided EEG Neurofeedback in Men With Methamphetamine Use Disorder

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OBJECTIVE: Impaired response inhibition is the core cognitive deficit in methamphetamine use disorder (MUD), and methamphetamine cue reactivity is a major factor that reduces inhibition efficiency. The authors sought to use cognition-guided neurofeedback to deactivate methamphetamine cue-related brain reactivity patterns in men with MUD to improve their response inhibition. METHODS: A cognition-guided, closed-loop EEG-based neurofeedback protocol was employed. Methamphetamine cue-related brain activity patterns were identified offline using multivariate pattern analysis of EEG data from all channels during a methamphetamine cue reactivity task. In the real-time feedback phase, participants were trained to deactivate their methamphetamine cue-related patterns, which were presented as feedback. The study included two samples, totaling 99 men with MUD. In sample 1, 66 men received 10 neurofeedback sessions based either on their own brain activity patterns (real neurofeedback group 1, N=33) or on randomly matched participants' patterns (yoke neurofeedback group, N=33). Sample 2, which was used to validate findings in sample 1, included a real feedback group (real neurofeedback group 2; N=17) and a standard rehabilitation group (N=16) that received only standard rehabilitation without additional intervention. Response inhibition was assessed using a go/no-go task based on methamphetamine-related cues before and after the intervention. RESULTS: Compared to the yoke feedback group, real neurofeedback group 1 successfully deactivated methamphetamine cue-related brain reactivity patterns, resulting in significantly enhanced response inhibition (d-prime, Cohen's f=0.31). Neurofeedback performance in real neurofeedback group 1 was significantly correlated with improved response inhibition. Additionally, response inhibition improvements could be predicted by initial neurofeedback performance and baseline characteristics. Sample 2 replicated these findings, showing that response inhibition in real neurofeedback group 2 was improved and predictable. Notably, these intervention effects in real neurofeedback group 2 were better than those in the standard rehabilitation group. CONCLUSIONS: These findings underscore the efficacy of cognition-guided neurofeedback for treating MUD, thereby suggesting its potential applicability in other addiction interventions.

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