# A Combined Neurofeedback-TMS Intervention for Alcohol Use Disorder

> **NIH NIH R00** · AUBURN UNIVERSITY AT AUBURN · 2024 · $248,999

## Abstract

PROJECT SUMMARY (See instructions): 
Initial evidence suggests that interventions that target neurocircuitry, such as real-time fMRI
neurofeedback (rt-fMRI-NF) and repetitive transcranial magnetic stimulation (TMS), have promise for AUD
treatment; however, there remains a critical need to leverage rt-fMRI-NF and rTMS neuromodulation
techniques towards a sustained decrease in problem drinking and related antisocial / aggressive
behaviors. Therefore, the overall objective for this R00 project is to identify a neuroscientific intervention
that works to decrease alcohol drinking and antisocial behavior in individuals with AUD. The central
hypothesis is that a rt-fMRI-NF training/ TMS intervention will result in sustained reduction of alcohol
drinking and negative social behaviors. Preliminary data from the K99 portion of the study have shown
that learned control of neural response during rt-fMRI-NF training corresponds to less feelings of craving
after the session, supporting transfer effects of the intervention . Moreover, preliminary evidence suggests
that alcohol attention bias may contribute to the link between alcohol use and antisocial behaviors. Thus,
the R00 portion has the following two specific aims: 1) Develop a TMS protocol that contributes to a
reduction in alcohol craving and alcohol attention bias; and 2) Evaluate the comparative efficacy of
rt-fMRI-NF, TMS, and treatment as usual in reducing drinking and alcohol-related negative social
behaviors. The first study will be a crossover TMS study in which studies will receive rTMS to the right
frontal eye field (FEF), an area involved in attention switching. All subjects will receive inhibitory and
excitatory TMS in separate sessions and will complete MRI scans pre- and post- TMS. We expect to
demonstrate a) impairing attention switching in healthy controls (n = 20) leads to neural patterns
consistent with attention bias in AUD; and b) improving attention switching through TMS attenuates
attention bias in individuals with AUD (n = 20). The second study will follow a RCT design. At each of four
weekly treatment session, individuals seeking treatment for AUD (n = 90) will receive an intervention
consisting of active/sham rt-fMRI-N F/TMS or a treatment as usual "check in". Subjects will then be
followed monthly for a year to assess alcohol use, craving, and related negative behaviors. Subjects will
also return for 6 and 12 month MRI follow-ups to assess longitudinal neural changes. We hypothesize that
multiple training sessions of a combined rt-fMRI-NF training/rTMS craving reduction protocol in addition to

## Key facts

- **NIH application ID:** 10764827
- **Project number:** 5R00AA027830-04
- **Recipient organization:** AUBURN UNIVERSITY AT AUBURN
- **Principal Investigator:** Samantha Jean Fede
- **Activity code:** R00 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $248,999
- **Award type:** 5
- **Project period:** 2020-05-01 → 2027-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10764827

## Citation

> US National Institutes of Health, RePORTER application 10764827, A Combined Neurofeedback-TMS Intervention for Alcohol Use Disorder (5R00AA027830-04). Retrieved via AI Analytics 2026-06-11 from https://api.ai-analytics.org/grant/nih/10764827. Licensed CC0.

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