Skip to main content
Erschienen in: Current Treatment Options in Psychiatry 4/2022

01.12.2022 | PTSD (S Frankfurt, Section Editor)

Neuromodulation as an Augmenting Strategy for Behavioral Therapies for Anxiety and PTSD: a Narrative Review

verfasst von: Crystal Lantrip, PhD, Yvette Z. Szabo, PhD, F. Andrew Kozel, MD, Paul Holtzheimer, MD

Erschienen in: Current Treatment Options in Psychiatry | Ausgabe 4/2022

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Post-traumatic stress disorder (PTSD) is a prevalent problem. Despite current treatments, symptoms may persist, and neuromodulation therapies show great potential. A growing body of research suggests that transcranial magnetic stimulation (TMS) is effective as a standalone treatment for PTSD, with recent research demonstrating promising use when combined synergistically with behavioral treatments. In this review, we survey this literature including data suggesting mechanisms involved in anxiety and PTSD that may be targeted by neurostimulation.

Recent Findings

Evidence suggests the mechanism of action for TMS that contributes to behavioral change may be enhanced neural plasticity via increased functionality of prefrontal and subcortical/limbic structures and associated networks. Some research has demonstrated a behavioral change in PTSD and anxiety due to enhanced extinction learning or improved ability to think flexibly and reduce ruminative tendencies. Growing evidence suggests TMS may be best used as a therapeutic adjunct, at least acutely, for extinction-based exposure therapies in patients by accelerating therapy response.

Summary

While TMS has shown promise as a standalone intervention, augmentation with psychotherapy is one avenue of interest. Non-responders to current EBPs might particularly benefit from this sort of targeted approach, and it may shorten treatment length, which would help the successful completion of a course of therapy.
Literatur
1.
Zurück zum Zitat Kessler RC, Angermeyer M, Anthony JC, et al. Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry. 2007;6(3):168–76.PubMedPubMedCentral Kessler RC, Angermeyer M, Anthony JC, et al. Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry. 2007;6(3):168–76.PubMedPubMedCentral
6.
Zurück zum Zitat Tanielian, T. & Jaycox, L.H. (Eds.) (2008). Invisible wounds of war: psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica, CA: RAND MG-720. 2008. Tanielian, T. & Jaycox, L.H. (Eds.) (2008). Invisible wounds of war: psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica, CA: RAND MG-720. 2008.
11.
Zurück zum Zitat Trevizol AP, Downar J, Vila-Rodriguez F, Konstantinou G, Daskalakis ZJ, Blumberger DM. Effect of repetitive transcranial magnetic stimulation on anxiety symptoms in patients with major depression: an analysis from the THREE-D trial. Depress Anxiety. 2021;38(3):262–71. https://doi.org/10.1002/da.23125.CrossRefPubMed Trevizol AP, Downar J, Vila-Rodriguez F, Konstantinou G, Daskalakis ZJ, Blumberger DM. Effect of repetitive transcranial magnetic stimulation on anxiety symptoms in patients with major depression: an analysis from the THREE-D trial. Depress Anxiety. 2021;38(3):262–71. https://​doi.​org/​10.​1002/​da.​23125.CrossRefPubMed
12.
Zurück zum Zitat • Cirillo P, Gold AK, Nardi AE, et al. Transcranial magnetic stimulation in anxiety and trauma-related disorders: a systematic review and meta-analysis. Brain Behav. 2019;9(6):e01284. https://doi.org/10.1002/brb3.1284. TMS is an effective treatment option for patients with medication-resistant depression, and a growing number of studies are evaluating the efficacy of TMS for other neuropsychiatric disorders such as anxiety and trauma-related disorders. In this meta-analysis, a review of the literature revealed that TMS has been more widely studied in PTSD than GAD. Overall, TMS demonstrated a large treatment effect for both PTSD and GAD. • Cirillo P, Gold AK, Nardi AE, et al. Transcranial magnetic stimulation in anxiety and trauma-related disorders: a systematic review and meta-analysis. Brain Behav. 2019;9(6):e01284. https://​doi.​org/​10.​1002/​brb3.​1284. TMS is an effective treatment option for patients with medication-resistant depression, and a growing number of studies are evaluating the efficacy of TMS for other neuropsychiatric disorders such as anxiety and trauma-related disorders. In this meta-analysis, a review of the literature revealed that TMS has been more widely studied in PTSD than GAD. Overall, TMS demonstrated a large treatment effect for both PTSD and GAD.
14.
Zurück zum Zitat Iannone A, Cruz AP de M, Brasil-Neto JP, Boechat-Barros R. Transcranial magnetic stimulation and transcranial direct current stimulation appear to be safe neuromodulatory techniques useful in the treatment of anxiety disorders and other neuropsychiatric disorders. Arq Neuropsiquiatr. 2016;74(10):829–835. https://doi.org/10.1590/0004-282X20160115. Iannone A, Cruz AP de M, Brasil-Neto JP, Boechat-Barros R. Transcranial magnetic stimulation and transcranial direct current stimulation appear to be safe neuromodulatory techniques useful in the treatment of anxiety disorders and other neuropsychiatric disorders. Arq Neuropsiquiatr. 2016;74(10):829–835. https://​doi.​org/​10.​1590/​0004-282X20160115.
39.
Zurück zum Zitat • Kozel FA, Motes MA, Didehbani N, et al. Repetitive TMS to augment cognitive processing therapy in combat veterans of recent conflicts with PTSD: a randomized clinical trial. J Affect Disord. 2018;229:506–514. https://doi.org/10.1016/j.jad.2017.12.046. The findings of the RCT in veterans with PTSD demonstrated that TMS is effective for augmenting the effects of cognitive processing therapy (CPT), a widely used exposure-based psychotherapy, immediately after a course of CPT plus TMS and at follow-up several months later. These findings are important given that PTSD symptoms persist for some patients after completing a course of CPT, and TMS may offer a way to augment symptom improvement. • Kozel FA, Motes MA, Didehbani N, et al. Repetitive TMS to augment cognitive processing therapy in combat veterans of recent conflicts with PTSD: a randomized clinical trial. J Affect Disord. 2018;229:506–514. https://​doi.​org/​10.​1016/​j.​jad.​2017.​12.​046. The findings of the RCT in veterans with PTSD demonstrated that TMS is effective for augmenting the effects of cognitive processing therapy (CPT), a widely used exposure-based psychotherapy, immediately after a course of CPT plus TMS and at follow-up several months later. These findings are important given that PTSD symptoms persist for some patients after completing a course of CPT, and TMS may offer a way to augment symptom improvement.
41.
Zurück zum Zitat Foa EB. Psychosocial therapy for posttraumatic stress disorder. J Clin Psychiatry. 2006;67(Suppl 2):40–5.PubMed Foa EB. Psychosocial therapy for posttraumatic stress disorder. J Clin Psychiatry. 2006;67(Suppl 2):40–5.PubMed
42.
Zurück zum Zitat Faucher CR, Doherty RA, Philip NS, Harle ASM, Cole JJE, Van’t Wout-Frank M. Is there a neuroscience-based, mechanistic rationale for transcranial direct current stimulation as an adjunct treatment for posttraumatic stress disorder? Behav Neurosci. 2021;135(6):702–713. https://doi.org/10.1037/bne0000487. Faucher CR, Doherty RA, Philip NS, Harle ASM, Cole JJE, Van’t Wout-Frank M. Is there a neuroscience-based, mechanistic rationale for transcranial direct current stimulation as an adjunct treatment for posttraumatic stress disorder? Behav Neurosci. 2021;135(6):702–713. https://​doi.​org/​10.​1037/​bne0000487.
46.
Zurück zum Zitat Kalisch R, Korenfeld E, Stephan KE, Weiskopf N, Seymour B, Dolan RJ. Context-dependent human extinction memory is mediated by a ventromedial prefrontal and hippocampal network. J Neurosci. 2006;26(37):9503–11.CrossRefPubMedPubMedCentral Kalisch R, Korenfeld E, Stephan KE, Weiskopf N, Seymour B, Dolan RJ. Context-dependent human extinction memory is mediated by a ventromedial prefrontal and hippocampal network. J Neurosci. 2006;26(37):9503–11.CrossRefPubMedPubMedCentral
52.
Zurück zum Zitat Nolen-Hoeksema S. The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. J Abnorm Psychol. 2000;109(3):504–11.CrossRefPubMed Nolen-Hoeksema S. The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. J Abnorm Psychol. 2000;109(3):504–11.CrossRefPubMed
57.
Zurück zum Zitat Mohan A, Roberto AJ, Mohan A, et al. The significance of the default mode network (DMN) in neurological and neuropsychiatric disorders: a review. Yale J Biol Med. 2016;89(1):49–57.PubMedPubMedCentral Mohan A, Roberto AJ, Mohan A, et al. The significance of the default mode network (DMN) in neurological and neuropsychiatric disorders: a review. Yale J Biol Med. 2016;89(1):49–57.PubMedPubMedCentral
65.
Zurück zum Zitat Post A, Keck ME. Transcranial magnetic stimulation as a therapeutic tool in psychiatry: what do we know about the neurobiological mechanisms? J Psychiatric Res. Published online 2001:23. Post A, Keck ME. Transcranial magnetic stimulation as a therapeutic tool in psychiatry: what do we know about the neurobiological mechanisms? J Psychiatric Res. Published online 2001:23.
84.
Zurück zum Zitat O’Donnell ML, Lau W, Chisholm K, Agathos J, Little J, Terhaag S, Brand R, et al. A pilot study of the efficacy of the unified protocol for transdiagnostic treatment of emotional disorders in treating posttraumatic psychopathology: a randomized controlled trial. J Trauma Stress. 2021;34(3):563–74. https://doi.org/10.1002/jts.22650.CrossRefPubMed O’Donnell ML, Lau W, Chisholm K, Agathos J, Little J, Terhaag S, Brand R, et al. A pilot study of the efficacy of the unified protocol for transdiagnostic treatment of emotional disorders in treating posttraumatic psychopathology: a randomized controlled trial. J Trauma Stress. 2021;34(3):563–74. https://​doi.​org/​10.​1002/​jts.​22650.CrossRefPubMed
85.
Zurück zum Zitat Foa E, Hembree EA, Rothbaum BO, Rauch S. Prolonged exposure therapy for PTSD: emotional processing of traumatic experiences – therapist guide. 2nd ed. New York: Oxford University Press; 2019.CrossRef Foa E, Hembree EA, Rothbaum BO, Rauch S. Prolonged exposure therapy for PTSD: emotional processing of traumatic experiences – therapist guide. 2nd ed. New York: Oxford University Press; 2019.CrossRef
87.
Zurück zum Zitat • Isserles M, Tendler A, Roth Y, et al. Deep transcranial magnetic stimulation combined with brief exposure for posttraumatic stress disorder: a prospective multisite randomized trial. Biol Psychiatry. 2021;90(10):721–728. https://doi.org/10.1016/j.biopsych.2021.04.019. The findings of the RCT demonstrated that the order of treatment when using TMS to augment the effect of behavior therapy is likely important in PTSD. This experimental paradigm first administered the behavioral exposure, then administered deep TMS. They found that both the control and active conditions improved, but the control group experienced statistically superior improvement. • Isserles M, Tendler A, Roth Y, et al. Deep transcranial magnetic stimulation combined with brief exposure for posttraumatic stress disorder: a prospective multisite randomized trial. Biol Psychiatry. 2021;90(10):721–728. https://​doi.​org/​10.​1016/​j.​biopsych.​2021.​04.​019. The findings of the RCT demonstrated that the order of treatment when using TMS to augment the effect of behavior therapy is likely important in PTSD. This experimental paradigm first administered the behavioral exposure, then administered deep TMS. They found that both the control and active conditions improved, but the control group experienced statistically superior improvement.
Metadaten
Titel
Neuromodulation as an Augmenting Strategy for Behavioral Therapies for Anxiety and PTSD: a Narrative Review
verfasst von
Crystal Lantrip, PhD
Yvette Z. Szabo, PhD
F. Andrew Kozel, MD
Paul Holtzheimer, MD
Publikationsdatum
01.12.2022
Verlag
Springer International Publishing
Erschienen in
Current Treatment Options in Psychiatry / Ausgabe 4/2022
Elektronische ISSN: 2196-3061
DOI
https://doi.org/10.1007/s40501-022-00279-x

Weitere Artikel der Ausgabe 4/2022

Current Treatment Options in Psychiatry 4/2022 Zur Ausgabe

Novel Therapeutics in Mood Disorders (R Mansur, Section Editor)

Repurposing Anti-inflammatory Agents for Mood Disorders: an Updated Review of Current Evidence

Hörschwäche erhöht Demenzrisiko unabhängig von Beta-Amyloid

29.05.2024 Hörstörungen Nachrichten

Hört jemand im Alter schlecht, nimmt das Hirn- und Hippocampusvolumen besonders schnell ab, was auch mit einem beschleunigten kognitiven Abbau einhergeht. Und diese Prozesse scheinen sich unabhängig von der Amyloidablagerung zu ereignen.

So wirken verschiedene Alkoholika auf den Blutdruck

23.05.2024 Störungen durch Alkohol Nachrichten

Je mehr Alkohol Menschen pro Woche trinken, desto mehr steigt ihr Blutdruck, legen Daten aus Dänemark nahe. Ob es dabei auch auf die Art des Alkohols ankommt, wurde ebenfalls untersucht.

„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

17.05.2024 Klinik aktuell Nachrichten

Sie sei „ethisch geboten“, meint Gesundheitsminister Karl Lauterbach: mehr Transparenz über die Qualität von Klinikbehandlungen. Um sie abzubilden, lässt er gegen den Widerstand vieler Länder einen virtuellen Klinik-Atlas freischalten.

ADHS-Medikation erhöht das kardiovaskuläre Risiko

16.05.2024 Herzinsuffizienz Nachrichten

Erwachsene, die Medikamente gegen das Aufmerksamkeitsdefizit-Hyperaktivitätssyndrom einnehmen, laufen offenbar erhöhte Gefahr, an Herzschwäche zu erkranken oder einen Schlaganfall zu erleiden. Es scheint eine Dosis-Wirkungs-Beziehung zu bestehen.

Update Psychiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.