Penn team to explore use of brain training to help people change behaviors that increase cancer risk

PHILADELPHIA-- Most people know that smoking, a bad diet, and physical inactivity can lead to catastrophic personal health consequences, including cancer. Yet millions continue to smoke, eat poorly, and fail to get enough exercise. A new project led by researchers from the Perelman School of Medicine and the School of Arts and Sciences at the University of Pennsylvania aims to devise programs that help them change these risky behaviors and cut their risk of cancer.

Caryn Lerman, PhD and Joseph Kable, PhD have been awarded a $4.9 million grant through the National Cancer Institute initiative called Provocative Questions, which will allow them to study how the brain's cognitive control system can be enhanced to improve decision-making processes that contribute to risky behaviors. Lerman is deputy director of the Abramson Cancer Center and Mary W. Calkins Professor in the department of Psychiatry in the Perelman School of Medicine and in the Annenberg School for Communication. Kable is the Carol and Michael Lowenstein Term Assistant Professor of Psychology in the College of Arts and Sciences at the University of Pennsylvania.

One might think that people would be scared into doing the right thing as far as protecting their own health. But for some people, changing bad behaviors proves difficult or impossible, especially when those activities involve addictions like smoking or overeating. Lerman and Kable's proposal will break new ground by applying novel concepts and tools from behavioral economics and cognitive neuroscience to improve understanding of the brain-based decision-making that lies behind those risky behaviors.

The underlying premise, based on earlier research by Lerman, Kable, and their colleagues, is that through neurocognitive training, it is possible to improve the brain's capacity to strengthen cognitive control circuits to alter decision-making that results in risky behaviors, which over time may lead to a variety of medical conditions, including cancer.

If our intervention produces the effects on brain function and decision making that we anticipate, it can be readily used in a broad population, says Lerman. It may be possible for people to learn how to activate brain networks that help them to resist smoking or overeating. These treatments could be stand-alone approaches or used in combination with medications, such as in the case of treatment for nicotine addiction or obesity.

Specifically, the brain's executive function network supports self-control via increased sustained attention to and memory of long-term goals, goal-directed decision-making, enhanced ability to weigh the pros and cons of different choices, and inhibitory control. Thus, assessing such cognitive functions as sustained attention, working memory, and response inhibition will help understand how neurocognitive training can improve decision-making processes. This information, in turn, will be valuable for designing more novel and comprehensive interventions for behavior change. In short, the research team says, changing the brain through training may change behavior and thus, improve health.

This randomized clinical trial with neuroimaging will involve 150 young adults aged 18 to 30 who will take part in a neurocognitive training program or in an alternate program for cognitive stimulation. The study will target young people, since early adulthood is a critical period for establishing lifestyle behaviors that persist into adulthood. More than one in four young adults aged 18 to 25 report having used tobacco in the past month. Roughly 42 percent of young adults are overweight, with 16 percent meeting the criteria for obesity. These modifiable behaviors account for over 60 percent of cancer deaths and have a significant economic toll.

The field of behavioral economics has already shed light on the critical role of decision-making in behavior change. For example, people vary in how much they prefer rewards in the present over uncertain or delayed rewards later. Such differences can lead to personal decisions that increase the risk of cancer, such as choosing the immediate reward of smoking a cigarette now over the less risky, but delayed reward of better health later.

Participants will undergo functional magnetic resonance imaging (fMRI) testing during the trial while they perform decision-making tasks, both before and after training to help assess the effects of the training on the brain. A three-month follow-up assessment will test the durability of the effects of neurocognitive training beyond the training period.

The study's authors aim to show if taking part in the neurocognitive training results in better decision-making and behaviors on the part of participants. Will they, for instance, forego the short-term, risky reward of smoking a cigarette or eating a fast food meal, or use their newfound brain training to make decisions that pave the way to better long-term health?

The Provocative Questions project of the National Cancer Institute is intended to assemble a list of important but non-obvious questions that will stimulate the NCI's research communities to use laboratory, clinical, and population sciences in especially effective and imaginative ways. Fifty-six grants have been awarded across the country through this funding program.