The effects of left frontal intermittent theta burst stimulation on the efficacy of exposure-based therapy in acrophobia

Abstract Evidence-based treatments for anxiety disorders, as cognitive behavioral and pharmacological therapy achieves good therapeutic results. However, studies have shown that the therapy can be further optimized. Transcranial magnetic stimulation (TMS) may be useful as an adjunct to exposure-based therapy for anxiety disorders, as laboratory studies in healthy subjects have shown (Raij et al., 2018) that extinction learning, as an underlying mechanism in exposure therapy, can be improved using rTMS. The aim of this double-blind, randomized, placebo-controlled clinical trial with 76 patients with acrophobia is to verify whether the stimulation localization (left frontal cortex), shown to be benefical in healthy subjects, can be effectively used to enhance exposure therapy. For this purpose, patients underwent neuronavigational stimulation over the individually defined stimulation localization using the activating intermittent theta burst stimulation (iTBS) protocol before exposure therapy in virtual reality. Clinical symptoms were evaluated via questionnaires and two behavioral approach tests before, after, and for follow-up after 6 months. Furthermore, process variables during the exposure sessions, such as duration of exposure, and maximal anxiety depending on the stimulation groups were investigated. Research Category and Technology and Methods Clinical Research: 10. Transcranial Magnetic Stimulation (TMS) Keywords: rTMS, Anxiety disorders, Psychotherapy