  Simultaneous real-time fMRI and EEG neurofeedback (rtfMRI-EEG-nf) is an
emerging neuromodulation approach, that enables simultaneous volitional
regulation of both hemodynamic (BOLD fMRI) and electrophysiological (EEG) brain
activities. Here we report the first application of rtfMRI-EEG-nf for emotion
self-regulation training in patients with major depressive disorder (MDD). In
this proof-of-concept study, MDD patients in the experimental group (n=16) used
rtfMRI-EEG-nf during a happy emotion induction task to simultaneously
upregulate two fMRI and two EEG activity measures relevant to MDD. The target
measures included BOLD activities of the left amygdala (LA) and left rostral
anterior cingulate cortex (rACC), and frontal EEG asymmetries in the alpha band
(FAA, [7.5-12.5] Hz) and high-beta band (FBA, [21-30] Hz). MDD patients in the
control group (n=8) were provided with sham feedback signals. An advanced
procedure for improved real-time EEG-fMRI artifact correction was implemented.
The experimental group participants demonstrated significant upregulation of
the LA BOLD activity, FAA, and FBA during the rtfMRI-EEG-nf task, as well as
significant enhancement in fMRI connectivity between the LA and left rACC.
Average individual FAA changes during the rtfMRI-EEG-nf task positively
correlated with depression and anhedonia severities, and negatively correlated
with after-vs-before changes in depressed mood ratings. Temporal correlations
between the FAA and FBA time courses and the LA BOLD activity were
significantly enhanced during the rtfMRI-EEG-nf task. The experimental group
participants reported significant mood improvements after the training. Our
results suggest that the rtfMRI-EEG-nf may have potential for treatment of MDD.
