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.

同时实时功能磁共振成像和脑电图神经反馈（rtfMRI-EEG-nf）是一种新兴的神经调节方法，可以同时对血流动力学（BOLD fMRI）和电生理（EEG）大脑活动进行意志调节。在这里，我们报告了 rtfMRI-EEG-nf 首次应用于重度抑郁症 (MDD) 患者的情绪自我调节训练。在这项概念验证研究中，实验组中的 MDD 患者 ( n = 16) 在快乐情绪诱导任务中使用 rtfMRI-EEG-nf，同时上调与 MDD 相关的两项 fMRI 和两项 EEG 活动测量。目标测量包括左杏仁核 (LA) 和左前扣带皮层 (rACC) 的 BOLD 活动，以及 α 频带（FAA，[7.5–12.5] Hz）和高 β 频带（FBA，[ 21–30] 赫兹）。对照组（ n = 8）的 MDD 患者接受假反馈信号。实施了改进的实时 EEG-fMRI 伪影校正的先进程序。实验组参与者在 rtfMRI-EEG-nf 任务期间表现出 LA BOLD 活动、FAA 和 FBA 显着上调，以及 LA 和左侧 rACC 之间的 fMRI 连接显着增强。 rtfMRI-EEG-nf 任务期间的平均个体 FAA 变化与抑郁和快感缺乏严重程度呈正相关，与前后抑郁情绪评分的变化呈负相关。在 rtfMRI-EEG-nf 任务期间，FAA 和 FBA 时间进程与 LA BOLD 活动之间的时间相关性显着增强。实验组参与者报告训练后情绪显着改善。我们的结果表明 rtfMRI-EEG-nf 可能具有治疗 MDD 的潜力。