Highlights
- •High-frequency rTMS (10 Hz) can improve the efficacy of virtual reality exposure based therapy (VRET) in acrophobic patients.
- •Higher reduction of phobic anxiety and avoidance after VR exposure therapy in the active stimulation group.
- •R-TMS seems to primarily influence extinction processes and not extinction recall itself.
- •While the general principle of increased fear extinction after rTMS holds up across species, individual effects may differ.
Abstract
Background
Animal as well as human research indicated that the ventral medial prefrontal cortex
(vmPFC) is highly relevant for fear extinction learning. Recently, we showed that
targeting the vmPFC with high-frequency repetitive transcranial magnetic stimulation
(rTMS) in a placebo-controlled study with 45 healthy controls induced higher prefrontal
activity during extinction of conditioned stimuli (CS+) in the active compared to
the sham stimulated group and better extinction learning as indicated by ratings,
fear potentiated startles and skin conductance responses.
Objective
In this study, we aimed to proof our concept of accelerating extinction learning using
rTMS of the mPFC in a group of anxiety disorder patients.
Methods
To specifically evaluate the impact of rTMS on exposure-based therapy, we applied
a sham-controlled protocol over the vmPFC (FPz) succeeded by a virtual reality exposure
therapy (VRET) in n = 20 participants with acrophobia and n = 19 controls.
Results
We found a significantly higher reduction in active compared to sham stimulated group
for anxiety (t[37] = 2.33, p < 0.05) as well as avoidance ratings t[37] = 2.34, p
< 0.05) from pre to post therapy.
Conclusion
This study provides first clinical evidence that high-frequency rTMS over the vmPFC
improves exposure therapy response of acrophobia symptoms.
Keywords
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Article info
Publication history
Published online: November 14, 2016
Accepted:
November 13,
2016
Received in revised form:
November 10,
2016
Received:
May 11,
2016
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
