Repetitive TMS to augment cognitive processing therapy in combat veterans of recent conflicts with PTSD: A randomized clinical trial

JOURNAL OF AFFECTIVE DISORDERS

卷:229

Article

Kozel, F. Andrew^1,2,3,4  Motes, Michael A.⁴  Didehbani, Nyaz⁴  DeLaRosa, Bambi⁴  Bass, Christina⁴  Schraufnagel, Caitlin D.⁴  Jones, Penelope⁴  Morgan, Cassie Rae⁴  Spence, Jeffrey S.⁴  Kraut, Michael A.^4,5  Hart, John, Jr.^4,6,7 

[1] James A Haley Vet Hosp & Clin, Mental Hlth & Behav Sci, Tampa, FL USA

[2] James A Haley Vet Hosp & Clin, HSR&D Ctr Innovat Disabil & Rehabil Res CINDRR, Tampa, FL USA

[3] Univ S Florida, Dept Psychiat & Behav Sci, 3515 E Fletcher Ave,MDC 14, Tampa, FL 33613 USA

[4] Univ Texas Dallas, Dallas, TX 75080 USA

[5] Johns Hopkins Univ, Sch Med, Dept Radiol & Radiol Sci, Baltimore, MD USA

[6] Univ Texas Southwestern Med Ctr Dallas, Dept Neurol & Neurotherapeut, Dallas, TX 75390 USA

[7] Univ Texas Southwestern Med Ctr Dallas, Dept Psychiat, Dallas, TX 75390 USA

关键词: Posttraumatic Stress Disorder;    Transcranial Magnetic Stimulation TMS;    PTSD;    Cognitive Processing Therapy CPT;    Veterans;    Psychotherapy;   

DOI  :  10.1016/j.jad.2017.12.046

来源: Elsevier

【 摘 要 】

Background: The objective was to test whether repetitive Transcranial Magnetic Stimulation (rTMS) just prior to Cognitive Processing Therapy (CPT) would significantly improve the clinical outcome compared to sham rTMS prior to CPT in veterans with PTSD. Methods: Veterans 18-60 years of age with current combat-related PTSD symptoms were randomized, using a 1: 1 ratio in a parallel design, to active (rTMS+ CPT) versus sham (sham + CPT) rTMS just prior to weekly CPT for 12-15 sessions. Blinded raters evaluated veterans at baseline, after the 5th and 9th treatments, and at 1, 3, and 6 months post-treatment. Clinician Administered PTSD Scale (CAPS) was the primary outcome measure with the PTSD Checklist (PCL) as a secondary outcome measure. The TMS coil (active or sham) was positioned over the right dorsolateral prefrontal cortex (110% MT, 1 Hz continuously for 30 min, 1800 pulses/treatment). Results: Of the 515 individuals screened for the study, 103 participants were randomized to either active (n = 54) or sham rTMS (n = 49). Sixty-two participants (60%) completed treatment and 59 (57%) completed the 6-month assessment. The rTMS+ CPT group showed greater symptom reductions from baseline on both CAPS and PCL across CPT sessions and follow-up assessments, t(df >= 325) = -2.01, p <= 0.023, one-tailed and t(df >= 303) <= -2.14, p <= 0.017, one-tailed, respectively. Limitations: Participants were predominantly male and limited to one era of conflicts as well as those who could safely undergo rTMS. Conclusions: The addition of rTMS to CPT compared to sham with CPT produced significantly greater PTSD symptom reduction early in treatment and was sustained up to six months post-treatment.

【 授权许可】

Free