Abstract
BackgroundSpecific phobias represent the largest category of anxiety disorders. Previous work demonstrated that stimulating the ventromedial prefrontal cortex (vmPFC) with repetitive Transcranial Magnetic Stimulation (rTMS) may improve response to exposure therapy for acrophobia.ObjectiveTo examine feasibility of accelerating extinction learning in subjects with spider phobia using intermittent Theta Burst Stimulation (iTBS) rTMS of vmPFC.MethodsIn total, 17 subjects with spider phobia determined by spider phobia questionnaires [Spider Phobia Questionnaire (SPQ) and Fear of Spiders questionnaire (FSQ)] underwent ratings of fear of spiders as well as behavioral and skin conductance data during a behavioral avoidance test (BAT). Subjects then received a sequential protocol of in vivo spider exposure followed by iTBS for three sessions administered to either active or control treatment sites (vmPFC [n = 8] or vertex [n = 9], respectively), followed 1 week later by repetition of questionnaires and BAT.ResultsAll subjects improved significantly regardless of group across both questionnaires (FSQ η2 = 0.43, p = 0.004; SPQ η2 = 0.39, p = 0.008) and skin conductance levels during BAT (Wald χ2 = 30.9, p < 0.001). Subjects in the vmPFC group tolerated lower treatment intensity than in the control group, and there was a significant correlation between treatment intensity, BAT subjective distress improvement, and physiologic measures (all ρ > 0.5).ConclusionThis proof-of-concept study provides preliminary evidence that a sequential exposure and iTBS over vmPFC is feasible and may have rTMS intensity-dependent effects on treatment outcomes, providing evidence for future areas of study in the use of rTMS for phobias.
Highlights
Specific phobias represent the largest category of anxiety disorders in the world with an estimated lifetime prevalence of 7.4–15% [1–3]
One study found that individuals with acrophobia who received Repetitive Transcranial Magnetic Stimulation (rTMS) to the ventromedial prefrontal cortex (vmPFC) along with Exposure therapy (ET) demonstrated a greater improvement compared to those receiving ET and sham stimulation [35]
Subjects completed baseline Spider Phobia Questionnaire (SPQ) and Fear of Spiders questionnaire (FSQ), and a behavioral avoidance test (BAT), followed by an exposure session and intermittent theta burst stimulation (iTBS) administered to either an active or control stimulation site based on group assignment
Summary
Specific phobias represent the largest category of anxiety disorders in the world with an estimated lifetime prevalence of 7.4–15% [1–3]. Studies suggest that rTMS may be efficacious in the treatment of anxiety disorders [14, 26–29], consistent with evidence showing that stimulation of the medial prefrontal cortex modulates discrimination of learned safety and threat cues [30] and may ameliorate symptoms in specific phobia [26, 30–33]. The ventromedial prefrontal cortex (vmPFC) is a promising rTMS treatment target [34, 35] that is thought to play a central role in the etiology, maintenance, and treatment of anxiety disorders due to its functional and structural connectivity with subcortical regions involved in fear learning and recall, such as the amygdala [36–41] and hippocampus [41–44]. Previous work demonstrated that stimulating the ventromedial prefrontal cortex (vmPFC) with repetitive Transcranial Magnetic Stimulation (rTMS) may improve response to exposure therapy for acrophobia
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