The craving stops before you feel it: neural correlates of chocolate craving during cue exposure with response prevention.

Cue reactivity and craving can be influenced by cue exposure with response prevention (CERP). This study investigated the neural correlates of CERP using functional magnetic resonance imaging, while participants smelled chocolate (17 participants) or a control object (17 participants). CERP was interrupted by 7 scanning sequences measuring the brain response to neutral and chocolate pictures. Chocolate craving was hypothesized to be mirrored by activation in brain reward regions. As expected, control group craving remained similar throughout the session. A short exposure (30 min) increased chocolate craving in the experimental group, which was mirrored by significant group differences in activation in brain reward regions. Unexpectedly, a long exposure (60 min) did not lead to craving extinction in the experimental group, although craving started to decrease at this point. On a neural level, however, activation in regions of interest in the experimental group seemed to have extinguished after the long exposure, as activation levels returned to or fell below control group levels. These results indicate that brain reward activation during CERP is linked to craving, at least for a short exposure. Regarding a longer exposure, the decline in brain reward activation in the experimental group may be a precursor of a decrease in craving.