One-Year Clinical Outcomes Following Theta Burst Stimulation for Posttraumatic Stress Disorder

Abstract Introduction Post-traumatic stress disorder (PTSD) is a severe and debilitating condition affecting a significant proportion of the veteran community. A substantial number of veterans with PTSD fail to benefit from trauma-focused psychological therapies or pharmacotherapy or are left with residual symptoms, and therefore, investigation of new and innovative treatment is required. Theta Burst Stimulation (TBS) is a novel form of Repetitive Transcranial Magnetic Stimulation, which has been shown to improve depression symptoms and associated cognitive deficits. The current pilot study aimed to explore the acceptability, safety, and tolerability of intermittent TBS (iTBS) as a treatment for PTSD in Australian veterans. Materials and Methods This study employed a case series, repeated-measures design. Eight Australian Defence Force veterans with PTSD received 20 bilateral iTBS treatments (1 session per day, 5 days per week over a 4-week period) and were assessed on a range of mental health and neuropsychological measures, including the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and Hamilton Depression Rating Scale (HAM-D), at pretreatment, post-treatment, and a 3-month follow-up. Results Treatment was generally welltolerated, with reported side-effects including mild to moderate site-specific cranial pain and headaches during stimulation, which were relieved with the use of low dose analgesics. No serious side effects or adverse events were reported. Participants exhibited reductions in both PTSD and depression symptom severity (the repeated-measures effect size [dRM] for the CAPS-5 was −1.78, and the HAM-D was −1.16 post-treatment), as well as improvements in working memory and processing speed. Although significance cannot be inferred, these preliminary estimates of effect size indicate change over time. Conclusions Bilateral iTBS appears to be welltolerated by Australian veterans. Within this repeated-measures case series, iTBS treatment shows promise in reducing both PTSD and mood symptoms, as well as improving cognitive difficulties associated with these disorders. Large-scale randomized controlled trials of this promising treatment are warranted.

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One-year clinical outcomes following theta burst stimulation for post-traumatic stress disorder

Neuropsychopharmacology ◽

10.1038/s41386-019-0584-4 ◽

2019 ◽

Vol 45 (6) ◽

pp. 940-946 ◽

Cited By ~ 4

Author(s):

Nicholas J. Petrosino ◽

Mascha van ’t Wout-Frank ◽

Emily Aiken ◽

Hannah R. Swearingen ◽

Jennifer Barredo ◽

...

Keyword(s):

Transcranial Magnetic Stimulation ◽

Clinical Outcomes ◽

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Magnetic Stimulation ◽

Stress Disorder ◽

Post Traumatic Stress ◽

Post Traumatic ◽

One Year ◽

Theta Burst

AbstractTheta burst transcranial magnetic stimulation (TBS) is a potential new treatment for post-traumatic stress disorder (PTSD). We previously reported active intermittent TBS (iTBS) was associated with superior clinical outcomes for up to 1-month, in a sample of fifty veterans with PTSD, using a crossover design. In that study, participants randomized to the active group received a total of 4-weeks of active iTBS, or 2-weeks if randomized to sham. Results were superior with greater exposure to active iTBS, which raised the question of whether observed effects persisted over the longer-term. This study reviewed naturalistic outcomes up to 1-year from study endpoint, to test the hypothesis that greater exposure to active iTBS would be associated with superior outcomes. The primary outcome measure was clinical relapse, defined as any serious adverse event (e.g., suicide, psychiatric hospitalization, etc.,) or need for retreatment with repetitive transcranial magnetic stimulation (rTMS). Forty-six (92%) of the initial study’s intent-to-treat participants were included. Mean age was 51.0 ± 12.3 years and seven (15.2%) were female. The group originally randomized to active iTBS (4-weeks active iTBS) demonstrated superior outcomes at one year compared to those originally randomized to sham (2-weeks active iTBS); log-rank ChiSq = 5.871, df = 1, p = 0.015; OR = 3.50, 95% CI = 1.04–11.79. Mean days to relapse were 296.0 ± 22.1 in the 4-week group, and 182.0 ± 31.9 in the 2-week group. When used, rTMS retreatment was generally effective. Exploratory neuroimaging revealed default mode network connectivity was predictive of 1-year outcomes (corrected p < 0.05). In summary, greater accumulated exposure to active iTBS demonstrated clinically meaningful improvements in the year following stimulation, and default mode connectivity could be used to predict longer-term outcomes.

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A Secondary Analysis on Effects of Theta Burst Transcranial Magnetic Stimulation to Reduce Anger in Veterans With Posttraumatic Stress Disorder

Neuromodulation Technology at the Neural Interface ◽

10.1111/ner.13256 ◽

2020 ◽

Author(s):

Mascha van 't Wout‐Frank ◽

Mary Tracie Shea ◽

David O. Sorensen ◽

Christiana R. Faucher ◽

Benjamin D. Greenberg ◽

...

Keyword(s):

Posttraumatic Stress Disorder ◽

Transcranial Magnetic Stimulation ◽

Posttraumatic Stress ◽

Magnetic Stimulation ◽

Stress Disorder ◽

Secondary Analysis ◽

Theta Burst

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Cognitive Therapy for Posttraumatic Stress Disorder

Journal of Cognitive Psychotherapy ◽

10.1891/0889-8391.15.4.321 ◽

2001 ◽

Vol 15 (4) ◽

pp. 321-329 ◽

Cited By ~ 20

Author(s):

Patricia A. Resick

Keyword(s):

Posttraumatic Stress Disorder ◽

Treatment Outcome ◽

Cognitive Therapy ◽

Posttraumatic Stress ◽

Cognitive Processing ◽

Stress Disorder ◽

Exposure Therapy ◽

Cognitive Processing Therapy ◽

One Year

Cognitive therapy for posttraumatic stress disorder is in the early stages of development and study. This article will examine seven controlled studies that included at least a component of cognitive therapy. Two studies specifically focused on early intervention to treat PTSD and included both cognitive therapy and exposure therapy. Three studies examined cognitive processing therapy, which is predominantly cognitive therapy. Two other studies compared pure cognitive therapy with exposure therapy. Overall, cognitive therapy for PTSD appears to be highly effective compared to no-treatment, relaxation, or supportive counseling, and similar to exposure treatments. Treatment effects appear to continue through follow-up periods of up to one year. At this point, little is known about who benefits best with cognitive therapy or predictors of treatment outcome.

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