Emotion Regulation Training for Treating Warfighters with Combat-Related PTSD Using Real-Time fMRI and EEG-Assisted Neurofeedback

: Our main objective is to determine whether rtfMRI- and rtEEG-assisted neurofeedback emotion regulation training protocols can reduce the symptoms of combat-related post-traumatic stress disorder (PTSD), a chronic and disabling psychiatric condition. Individuals with PTSD suffer from the dysregulation of several types of emotion, including fear, anxiety, anger, and depression [1 4]. Neurocircuit models of PTSD emphasize the role of the amygdala and its reciprocal interactions with the ventromedial prefrontal cortex (vmPFC) [5 9]. To advance understanding of the treatment of combat-related PTSD, the current state-of-the-art research aims to test ways to modulate the functions of the emotion circuit implicated in PTSD. We utilize the recent advances in real-time functional magnetic resonance imaging neurofeedback (rtfMRI-nf) to directly target and modulate amygdala activity [10 11]. This technique measures neuronal activity with sufficiently high temporal resolution that information from the amygdala is immediately available to form a feedback loop. In parallel with rtfMRI-nf, we obtain simultaneous measurement of electroencephalography (EEG) signals, which directly reflect brain activity in the cerebral cortex [12]. By using the multimodal imaging data we can determine which EEG signals/leads or their combination specifically predict or correlate with clinical improvement that has been associated with the rtfMRI-nf training [11,13 16].