scholarly journals Enhancing Cognitive Restructuring with Concurrent fMRI-guided Neurostimulation for Emotional Dysregulation: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Andrada D Neacsiu ◽  
Lysianne Beynel ◽  
John Graner ◽  
Steven T Szabo ◽  
Lawrence G Appelbaum ◽  
...  
Keyword(s):  
Emotion Regulation ◽  
Emotion Dysregulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Controlled Trial ◽  
Cognitive Restructuring ◽  
Emotional Dysregulation ◽  
Double Blind ◽  
Transdiagnostic Treatment ◽  
Dorsolateral Prefrontal ◽  
The Impact

Background: Transdiagnostic clinical emotional dysregulation is a key component of psychopathology and offers an avenue to address multiple disorders with one transdiagnostic treatment. In the current study, we pilot a one-time intervention that combines cognitive restructuring (CR) with repetitive transcranial magnetic stimulation (rTMS), targeted using functional magnetic resonance imaging (fMRI). Methods: Thirty-seven clinical adults with high emotional dysregulation were enrolled in this randomized, double-blind, placebo-controlled trial. fMRI was collected as participants were reminded of lifetime stressors and asked to downregulate their distress using CR tactics. fMRI BOLD data were analyzed to identify the cluster of voxels within the left dorsolateral prefrontal cortex (dlPFC) with the highest activation when participants attempted to downregulate, versus passively remember, distressing memories. Participants underwent active or sham rTMS (10 Hz) over the target while practicing CR following autobiographical emotional induction. Results: Receiving active versus sham rTMS led to significantly higher high frequency heart rate variability during regulation, lower regulation duration, and higher likelihood to use CR during the week following the intervention. There were no differences between conditions when administering neurostimulation without CR compared to sham. Participants in the sham versus active condition experienced less distress the week after the intervention. There were no differences between conditions at the one-month follow up. Conclusion: This study demonstrated that combining active rTMS with emotion regulation training significantly enhances emotion regulation and augments the impact of training for as long as a week. These findings are a promising step towards a combined intervention for transdiagnostic emotion dysregulation.

scholarly journals Enhancing Cognitive Restructuring with Concurrent Repetitive Transcranial Magnetic Stimulation: A Transdiagnostic Randomized Controlled Trial

2021 ◽  
pp. 1-13
Author(s):  
Andrada D. Neacsiu ◽  
Lysianne Beynel ◽  
John P. Powers ◽  
Steven T. Szabo ◽  
Lawrence G. Appelbaum ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Controlled Trial ◽  
Behavioral Skills Training ◽  
Public Health Problem ◽  
Cognitive Restructuring ◽  
Skills Training ◽  
Emotional Dysregulation ◽  
Double Blind

<b><i>Introduction:</i></b> Emotional dysregulation constitutes a serious public health problem in need of novel transdiagnostic treatments. <b><i>Objective:</i></b> To this aim, we developed and tested a one-time intervention that integrates behavioral skills training with concurrent repetitive transcranial magnetic stimulation (rTMS). <b><i>Methods:</i></b> Forty-six adults who met criteria for at least one DSM-5 disorder and self-reported low use of cognitive restructuring (CR) were enrolled in a randomized, double-blind, sham-controlled trial that used a between-subjects design. Participants were taught CR and underwent active rTMS applied at 10 Hz over the right (<i>n</i> = 17) or left (<i>n</i> = 14) dorsolateral prefrontal cortex (dlPFC) or sham rTMS (<i>n</i> = 15) while practicing reframing and emotional distancing in response to autobiographical stressors. <b><i>Results:</i></b> Those who received active left or active right as opposed to sham rTMS exhibited enhanced regulation (<i>d</i>s = 0.21–0.62) as measured by psychophysiological indices during the intervention (higher high-frequency heart rate variability, lower regulation duration). Those who received active rTMS over the left dlPFC also self-reported reduced distress throughout the intervention (<i>d</i> = 0.30), higher likelihood to use CR, and lower daily distress during the week following the intervention. The procedures were acceptable and feasible with few side effects. <b><i>Conclusions:</i></b> These findings show that engaging frontal circuits simultaneously with cognitive skills training and rTMS may be clinically feasible, well-tolerated and may show promise for the treatment of transdiagnostic emotional dysregulation. Larger follow-up studies are needed to confirm the efficacy of this novel therapeutic approach.

scholarly journals Protocol for an App-Based Affective Control Training for Adolescents

2018 ◽  
Author(s):  
Susanne Schweizer ◽  
Jovita T. Leung ◽  
Rogier Kievit ◽  
Maarten Speekenbrink ◽  
William R. Tender ◽  
...  
Keyword(s):  
Mental Health ◽  
Emotion Regulation ◽  
Mental Health Problems ◽  
Controlled Trial ◽  
Self Regulation ◽  
Health Problems ◽  
Matching Task ◽  
Double Blind ◽  
Wide Range ◽  
The Impact

Abstract Background: 75% of all mental health problems have their onset before the end of adolescence. Adolescence, thus may be a particularly sensitive time period for preventing mental health problems. Affective control, the capacity to engage with goal relevant and inhibit distracting information in affective contexts, has been proposed as a potential target for prevention. In this study, we will explore the impact of improving adolescents’ affective control capacity on their mental health. Methods: The proof-of-principle double-blind randomized controlled trial will compare the effectiveness of an app-based affective control training (AC-Training) to a placebo training (P- Training) app. 200 (~50% females) adolescents (11-19 years) will train for 14 days on their training app. The AC-Training will include three different n-back tasks: visuospatial, auditory and dual (i.e., including both modalities). These tasks require participants to flexibly engage and disengage with affective and neutral stimuli (i.e., faces and words). The P-Training will present participants with a perceptual matching task. The three versions of the P-Training tasks vary in the stimuli included (i.e., shapes, words and faces). The two training groups will be compared on gains in affective control, mental health, emotion regulation and self-regulation, immediately after training, 1 month and 1 year after training. Discussion: If, as predicted, the proposed study finds that AC-Training successfully improves affective control in adolescents, there would be significant potential benefits to adolescent mental health. As a free app, the training would also be scalable and easy to disseminate across a wide range of settings. Trial registration: The trial was registered on December 10 2018 with the International Standard Randomised Controlled Trial Number (Registration number: ISRCTN17213032, http://www.isrctn.com/ISRCTN17213032). Keywords: Mental health; Adolescence; Emotion regulation; Affective control; App-based training

Repetitive transcranial magnetic stimulation reduces cortisol concentrations in bulimic disorders

2010 ◽  
Vol 41 (6) ◽  
pp. 1329-1336 ◽  
Author(s):  
A. M. Claudino ◽  
F. Van den Eynde ◽  
D. Stahl ◽  
T. Dew ◽  
M. Andiappan ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Salivary Cortisol ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Controlled Trial ◽  
Food Craving ◽  
Double Blind ◽  
The Real ◽  
Left Dlpfc ◽  
Dorsolateral Prefrontal

BackgroundIn people with bulimic eating disorders, exposure to high-calorie foods can result in increases in food craving, raised subjective stress and salivary cortisol concentrations. This cue-induced food craving can be reduced by repetitive transcranial magnetic stimulation (rTMS). We investigated whether rTMS has a similar effect on salivary cortisol concentrations, a measure of hypothalamic–pituitary–adrenal axis (HPAA) activity.MethodWe enrolled twenty-two female participants who took part in a double-blind randomized sham-controlled trial on the effects of rTMS on food craving. Per group, eleven participants were randomized to the real or sham rTMS condition. The intervention consisted of one session of high-frequency rTMS delivered to the left dorsolateral prefrontal cortex (DLPFC). Salivary cortisol concentrations were assessed at four time points throughout the 90-min trial. To investigate differences in post-rTMS concentrations between the real and sham rTMS groups, a random-effects model including the pre-rTMS cortisol concentrations as covariates was used.ResultsSalivary cortisol concentrations following real rTMS were significantly lower compared with those following sham rTMS. In this sample, there was also a trend for real rTMS to reduce food craving more than sham rTMS.ConclusionsThese results suggest that rTMS applied to the left DLPFC alters HPAA activity in people with a bulimic disorder.

scholarly journals Enhancing Cognitive Restructuring with Concurrent Repetitive Transcranial Magnetic Stimulation for Transdiagnostic Psychopathology: A Proof of Concept Randomized Controlled Trial

2021 ◽  
Author(s):  
Andrada D. Neacsiu ◽  
Lysianne Beynel ◽  
John P. Powers ◽  
Steven T. Szabo ◽  
Lawrence G. Appelbaum ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Controlled Trial ◽  
Behavioral Skills Training ◽  
Cognitive Restructuring ◽  
Skills Training ◽  
Emotional Dysregulation ◽  
Stress Disorders ◽  
Self Report

AbstractBackgroundEmotional dysregulation constitutes a serious public health problem in need of novel transdiagnostic treatments. To this aim, we developed and tested a one-time intervention that integrates behavioral skills training with concurrent repetitive transcranial magnetic stimulation (rTMS).MethodsForty-seven adults who met criteria for at least one DSM-5 disorder and self-reported low use of cognitive restructuring (CR) were enrolled in a randomized, double-blind, placebo-controlled trial. Participants were taught CR and underwent active or sham rTMS applied at 10 Hz over the right or left dorsolateral prefrontal cortex (dlPFC) while practicing reframing and emotional distancing in response to autobiographical stressors.ResultsThose who received active as opposed to sham rTMS exhibited enhanced regulation (ds = 0.20 - 0.67) and reduced distress (ds = 0.32 - 0.35), as measured by self-report and psychophysiological indices during the intervention (higher high-frequency heart rate variability, lower regulation duration) and ambulatory self-report measures during the week following the intervention. All participants improved in their use of reappraisal (d = 2.25), psychopathology (d = 0.48) and emotional dysregulation (d = 0.81) and maintained their gains at the one month follow up. The procedures were acceptable and feasible with few side effects. A secondary analysis suggested that participants with stress disorders may respond particularly well to active right rTMS.ConclusionThese findings show that engaging frontal circuits simultaneously with cognitive skills training and rTMS is clinically feasible, well-tolerated and shows promise as the next generation of treatments for transdiagnostic emotional dysregulation.

scholarly journals Ropivacaine 75mg versus placebo in perineal infiltration for analgesic efficacy at mid- and long-term for episiotomy repair in postpartum women- The ROPISIO study: a two-center, randomized, double-blind, placebo-controlled trial.

2020 ◽  
Author(s):  
Claire CARDAILLAC ◽  
Stéphane Ploteau ◽  
Aurélie Le Thuaut ◽  
Vincent Dochez ◽  
Norbert Winer ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Controlled Trial ◽  
Analgesic Efficacy ◽  
Perineal Pain ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Mediolateral Episiotomy ◽  
The Impact

Abstract Background Perineal pain due to episiotomy is commonly reported and can be severe enough to disturb the mother-infant dyad during the postpartum period. Its incidence at day 7 postpartum varies from 63% to 74%. Recent studies have already investigated the analgesic efficacy of perineal infiltration of ropivacaine after episiotomy, but have only focused on the immediate postpartum period (at 24 and 48 hours after birth). Large, adequately powered, multicenter, randomized controlled trials are required to evaluate the impact of ropivacaine infiltration on perineal pain and mid- and long-term quality of life before the widespread use of ropivacaine to prevent perineal pain after episiotomy can be recommended. Methods The ROPISIO study is a two-center, randomized, double-blind, placebo-controlled trial in La Roche sur Yon and Nantes, France. It will involve 272 women with vaginal singleton delivery and mediolateral episiotomy at term (≥ 37 weeks). Perineal infiltration (ropivacaine 75mg or placebo) will be administrated just after vaginal birth and before episiotomy repair. The primary outcome will be the analgesic efficacy at day 7 postpartum (mid-term), defined by the numerical rating scale of pain (ENS NRS) strictly superior to 3/10 on the perineal repair area. Secondary outcomes will be the analgesic efficacy (ENS NRS), the impact of pain on daily behavior, on the quality of life (36-Item Short Form Health Survey), on the occurrence of symptoms of postpartum depression (Edinburgh Postnatal Depression Scale) and on sexuality (Female Sexual Function Index) at 3 and 6 months (long-term) using validated online questionnaires. This study will have 90% power to show approximately 30% relative risk reduction in the incidence of perineal pain at day 7, from 70.0% to 50.0%. Discussion Ropivacaine is a promising candidate drug, inexpensive, easy to administer, and would be suitable to include in the routine management of deliveries in labor ward. This study will investigate if perineal ropivacaine infiltration just after birth can reduce mid- and long-term postpartum pain and increase quality of life in women with mediolateral episiotomy.

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