Abstract
BackgroundNoninvasive brain stimulation techniques like transcranial direct current stimulation (tDCS) offer potential new approaches to treat stress-related mental health disorders. While the acceptability of tDCS as a treatment tool plays a crucial role in its development and implementation, little is known about tDCS acceptability for users in mental healthcare, especially in the context of stress-related disorders.MethodsUsing a mixed-methods approach, we investigated tDCS acceptability among 102 active duty and post-active military patients with stress-related symptoms (posttraumatic stress disorder, anxiety and impulsive aggression) who participated in a 5-session tDCS intervention. Quantitative dropout and adverse effects data was collected for all patients involved in the sham-controlled tDCS intervention. We additionally explored perspectives on the acceptability of tDCS treatment via a theory-based semi-structured interview. A subgroup of patients as well as their caregivers were interviewed to include the views of both patients and mental healthcare professionals.ResultsQuantitative outcomes showed minimal tDCS-related adverse effects (mild itching or burning sensations on the scalp) and high tDCS treatment adherence (dropout rate: 4% for active tDCS, 0% for sham). The qualitative outcomes showed predominantly positive attitudes towards tDCS interventions for stress-related disorders, but only as complementary to psychotherapy. Remarkably, despite the perception that sufficient explanation was provided, patients and caregivers stressed that tDCS treatment comprehension was limited and should improve. Also, the travel associated with frequent on-site tDCS sessions may produce a significant barrier to care for patients with stress-related disorders and active-duty military personnel.ConclusionsAcceptability numbers and perspectives from military patients and caregivers suggest that tDCS is an acceptable complementary tool in the treatment of stress-related disorders. Critically, however, if tDCS is to be used beyond scientific studies, adequately educating users on tDCS working mechanisms is vital to further improve its acceptability. Also, the perceived potential barrier to care due to frequent travel may favor home-based tDCS solutions.Trial registrationThe tDCS intervention was part of a sham-controlled trial registered on 05-18-2016 at the Netherlands Trial Register with ID NL5709.
Highlights
Noninvasive brain stimulation techniques like transcranial direct current stimulation offer potential new approaches to treat stress-related mental health disorders
More than one third of patients with stress-related mental health disorders like posttraumatic stress disorder (PTSD) and anxiety do not benefit from current evidence-based treatments [1, 2], military patients in particular [3,4,5]
This mixed methods study is the first to examine the acceptability of transcranial direct current stimulation (tDCS) as a treatment tool for stress-related mental health disorders from both the patient and caregiver perspective
Summary
Noninvasive brain stimulation techniques like transcranial direct current stimulation (tDCS) offer potential new approaches to treat stress-related mental health disorders. While the acceptability of tDCS as a treatment tool plays a crucial role in its development and implementation, little is known about tDCS acceptability for users in mental healthcare, especially in the context of stress-related disorders. Noninvasive brain stimulation with transcranial magnetic (TMS) or direct current stimulation (tDCS) provides potential add-on treatments or may facilitate effects of pharmacological or psychological therapies [6]. Of these techniques, tDCS might be most suitable to apply in outpatient clinical and military contexts; it is a portable technique, has a better safety profile, and is easier in use [7]. It is necessary to understand the acceptability of tDCS as a treatment tool from the perspective of this particular patient population and their caregivers
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