The top‐down regulation from the prefrontal cortex to insula via hypnotic aversion suggestions reduces smoking craving

Abstract

Hypnosis has been shown to have treatment effects on nicotine addiction. However, the neural basis of these effects is poorly understood. This preliminary study investigated the neural mechanisms of hypnosis‐based treatment on cigarette smoking, specifically, whether the hypnosis involves a top‐down or bottom‐up mechanism. Two groups of 45 smokers underwent a smoking aversion suggestion and viewed smoking‐related pictures and neutral pictures. One group underwent functional magnetic resonance imaging scanning twice (control and hypnotic states), whereas the other group underwent two electroencephalograph sessions. Our study found that self‐reported smoking craving decreased in both groups following hypnosis. Smoking cue‐elicited activations in the right dorsal lateral prefrontal cortex (rDLPFC) and left insula (lI) and the functional connectivity between the rDLPFC and lI were increased in the hypnotic state compared with the control state. The delta band source waveforms indicated the activation from 390 to 862 ms at the rDLPFC and from 490 to 900 ms at the lI was significantly different between the smoking and neutral conditions in the hypnotic state, suggesting the activation in the rDLPFC preceded that in the lI. These results suggest that the decreased smoking craving via hypnotic aversion suggestions may arise from the top‐down regulation of the rDLPFC to the lI. Our findings provide novel neurobiological evidence for understanding the therapeutic effects of hypnosis on nicotine addiction, and the prefrontal–insula circuit may serve as an imaging biomarker to monitor the treatment efficacy noninvasively.

Inhibitory neuromodulation of the putamen to the prefrontal cortex in Internet gaming disorder: How addiction impairs executive control

“…The results showed that the reward, executive control, and interoceptive awareness systems are highly coupled in RGUs when exposed to reward stimuli, while the association does not work in individuals with IGD, which reveals that positive correlations among the tripartite activities may be the major foundation for maintaining relative balances among the systems. This is complementary with previous research results showing that functional connectivity between the striatum and the prefrontal cortex (Becker et al, 2017;Forbes, Rodriguez, Musselman, & Narendran, 2014), as well as between the insula and prefrontal cortex (Dong, Liu, et al, 2019a;Li et al, 2019), are reduced in addicted individuals, reflecting enhanced internal craving and reward sensitivity as well as weak executive control. In addition, given that these couplings among systems are only observed in healthy groups, we infer that it may be an important marker for predicting the risk of addiction and even play a causal role in the transition to IGD.…”

“…Another study on IGD demonstrated that the coupling between decreased DLPFC activity and increased insula activity might underlie continuous addictive behaviors (Dong, Liu, Zheng, Du, & Potenza, 2019a). Additionally, increased connectivity between the insula and the DLPFC was observed in individuals addicted to nicotine after treatment (Li et al, 2019). These findings suggests that dysregulation of the neural response in addicted individuals might be related to this relative imbalance among the tripartite systems.…”

Repeated stimulation of the dorsolateral-prefrontal cortex improves executive dysfunctions and craving in drug addiction: A randomized, double-blind, parallel-group study

“…Functional imaging studies have shown that high ratings of craving positively correlate with insular activity, suggesting that craving is reflected by neural activity of the endogenous reward system [66,67]. As an indirect effect of DLPFC stimulation, modulation of insular activity could be one explanation for the observed reduction in craving, which could be accomplished by prefrontal-directed top-down modulation and cognitive down-regulation of craving [66,68,69]. Previous studies in drug addiction show that indeed cognitive inhibition and suppression of drug-related cues are associated with reduced metabolism in the insula [70] and subcortical structures, such as the ventral striatum [68].…”

Abnormal resting‐state effective connectivity in reward network among long‐term male smokers

“…Previous research has reported that individuals with Internet gaming disorder (IGD) showed lower RSFC between medial orbitofrontal cortex and VTA compared with healthy controls 15 . Li's study suggested that decreased smoking craving via hypnotic treatment may arise from the top‐down regulation of the prefrontal to insula 16 . Combined, tobacco addiction is thought to be linked to the reward system and the top‐down circuit plays a vital role in the reward system including PFC, ventral striatum, insula, and midbrain 17 .…”