Exposure therapy is highly effective for anxiety-related disorders, but there is a need for enhancement. Recent trials of adjunctive neuromodulation have shown promise, warranting evaluation of transcranial direct current stimulation (tDCS) as an augmentation. In a double-blind, placebo-controlled trial, contamination- and animal-phobic participants (N = 49) were randomized to active tDCS (1.7 mA, 20 min; n = 27), or sham tDCS (1.7 mA, 30 s; n = 22), followed by 30 min of in-vivo exposure. Active tDCS targeted excitation of the left mPFC and inhibition of the right dlPFC; polarity was counterbalanced for controls. We predicted tDCS would result in accelerated and better maintained gains, contingent on the subsequent in-session response, and baseline negative prognostic indicators. Consistent with predictions, tDCS promoted engagement and reductions in threat appraisals during exposure, and greater reductions in distress and threat appraisals through 1-month, although effects did not uniformly generalize. tDCS was most beneficial given high phobic severity, anxiety sensitivity, and a suboptimal early response. tDCS may promote engagement and response among individuals who are resistant or refractory to standard treatment. tDCS should be applied to more severe anxiety-related disorders, with parameters yoked to individual differences to improve outcomes in exposure-based interventions.

暴露疗法对于与焦虑相关的疾病非常有效，但是需要加强治疗。辅助神经调节的最新试验已显示出希望，需要评估经颅直流电刺激（tDCS）作为增强。在一项双盲，安慰剂对照试验中，将污染物和动物恐惧症参与者（N = 49）随机分配到活动性tDCS（1.7 mA，20分钟；n = 27）或假tDCS（1.7 mA，30 s；对照组）。n =22），然后进行30分钟的体内暴露。主动tDCS靶向激发左mPFC并抑制右dlPFC；为控制平衡了极性。我们预测tDCS将导致加速和更好的维持收益，取决于随后的会话中响应以及基线阴性预后指标。与预测一致，tDCS促进了接触过程中接触的参与并减少了威胁评估，并在1个月内进一步减少了遇险和威胁评估，尽管影响并未统一。鉴于高恐惧度，焦虑敏感性和较差的早期反应，tDCS是最有益的。tDCS可以促进对标准治疗有抵抗力或难治性的个体的参与和反应。tDCS应该应用于更严重的焦虑相关疾病，