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Neurofeedback training for alcohol dependence versus treatment as usual: study protocol for a randomized controlled trial

Cox, W.M.; Subramanian, L.; Linden, D.E.J.; Luehrs, M.; McNamara, R.; Playle, R.; Hood, K.; Watson, G.; Whittaker, J.R.; Sakhuja, R.; Ihssen, N.

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W.M. Cox

L. Subramanian

D.E.J. Linden

M. Luehrs

R. McNamara

R. Playle

K. Hood

G. Watson

J.R. Whittaker

R. Sakhuja


Background Real-time functional magnetic resonance imaging (rtfMRI) is used for neurofeedback training (NFT). Preliminary results suggest that it can help patients to control their symptoms. This study uses rtfMRI NFT for relapse prevention in alcohol dependence. Methods/design Participants are alcohol-dependent patients who have completed a detoxification programme within the past 6 months and have remained abstinent. Potential participants are screened for eligibility, and those who are eligible are randomly assigned to the treatment group (receiving rtfMRI NFT in addition to treatment as usual) or the control group (receiving only treatment as usual). Participants in both groups are administered baseline assessments to measure their alcohol consumption and severity of dependence and a variety of psychological and behavioural characteristics that are hypothesised to predict success with rtfMRI NFT. During the following 4 months, experimental participants are given six NFT sessions, and before and after each session various alcohol-related measures are taken. Participants in the control group are given the same measures to coincide with their timing in the experimental group. Eight and 12 months after the baseline assessment, both groups are followed up with a battery of measures. The primary research questions are whether NFT can be used to teach participants to down-regulate their brain activation in the presence of alcohol stimuli or to up-regulate their brain activation in response to pictures related to healthy goal pursuits, and, if so, whether this translates into reductions in alcohol consumption. The primary outcome measures will be those derived from the functional brain imaging data. We are interested in improvements (i.e., reductions) in participants’ alcohol consumption from pretreatment levels, as indicated by three continuous variables, not simply whether or not the person has remained abstinent. The indices of interest are percentage of days abstinent, drinks per drinking day, and percentage of days of heavy drinking. General linear models will be used to compare the NFT group and the control group on these measures. Discussion Relapse in alcohol dependence is a recurring problem, and the present evaluation of the role of rtfMRI in its treatment holds promise for identifying a way to prevent relapse. Trial registration Identifier: NCT02486900, registered on 26 June 2015.


Cox, W., Subramanian, L., Linden, D., Luehrs, M., McNamara, R., Playle, R., …Ihssen, N. (2016). Neurofeedback training for alcohol dependence versus treatment as usual: study protocol for a randomized controlled trial. Trials, 17(1), Article 480.

Journal Article Type Article
Acceptance Date Sep 15, 2016
Online Publication Date Oct 3, 2016
Publication Date Oct 3, 2016
Deposit Date Oct 6, 2016
Publicly Available Date Oct 6, 2016
Journal Trials
Publisher BioMed Central
Peer Reviewed Peer Reviewed
Volume 17
Issue 1
Article Number 480


Published Journal Article (622 Kb)

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This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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