Peer-guided movie neurofeedback to facilitate recovery in opioid use disorder.

Real-time fMRI neurofeedback can modify clinically relevant brain states, but transferring brain dynamics between peers has not been tested, particularly in addiction, where social learning is central to recovery. Here we introduce peer-guided movie neurofeedback (PG-MovieNF), which trains participants to align their brain activity with treatment-related dynamics derived from peers further along in recovery viewing the same movie. Using longitudinal fMRI data from individuals with opioid use disorder watching Trainspotting before and after 8 weeks of adjunctive treatment, we derived a multivariate treatment-predictive signal in dorsolateral and dorsomedial prefrontal cortex. An independent cohort then received real PG-MovieNF or yoked sham feedback during the same film. Real feedback increased alignment with the peer-derived target signal, reduced craving and improved affective ratings. Target alignment was coupled to shared orbitofrontal cortex dynamics during real feedback and predicted craving reduction. Together, these findings establish proof of concept for PG-MovieNF to enhance addiction recovery.