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Intensified electrical stimulation targeting lateral and medial prefrontal cortices for the treatment of social anxiety disorder: A randomized, double-blind, parallel-group, dose-comparison study
Brain Stimulation ( IF 7.7 ) Pub Date : 2021-06-22 , DOI: 10.1016/j.brs.2021.06.005
Eisa Jafari 1 , Jaber Alizadehgoradel 2 , Fereshteh Pourmohseni Koluri 1 , Ezzatollah Nikoozadehkordmirza 1 , Meysam Refahi 1 , Mina Taherifard 3 , Vahid Nejati 4 , Amir-Homayun Hallajian 5 , Elham Ghanavati 6 , Carmelo M Vicario 7 , Michael A Nitsche 8 , Mohammad Ali Salehinejad 6
Affiliation  

Background

Social Anxiety Disorder (SAD) is the most common anxiety disorder while remains largely untreated. Disturbed amygdala-frontal network functions are central to the pathophysiology of SAD, marked by hypoactivity of the lateral prefrontal cortex (PFC), and hypersensitivity of the medial PFC and the amygdala. The objective of this study was to determine whether modulation of the dorsolateral and medial PFC activity with a novel intensified stimulation protocol reduces SAD core symptoms, improves treatment-related variables, and reduces attention bias to threatening stimuli.

Methods

In this randomized, sham-controlled, double-blind trial, we assessed the efficacy of an intensified stimulation protocol (20 min, twice-daily sessions with 20 min intervals, 5 consecutive days) in two intensities (1 vs 2 mA) compared to sham stimulations. 45 patients with SAD were randomized in three tDCS arms (1-mA, 2-mA, sham). SAD symptoms, treatment-related variables (worries, depressive state, emotion regulation, quality of life), and attention bias to threatening stimuli (dot-probe paradigm) were assessed before and right after the intervention. SAD symptoms were also assessed at 2-month follow-up.

Results

Both 1-mA and 2-mA protocols significantly reduced fear/avoidance symptoms, worries and improved, emotion regulation and quality of life after the intervention compared to the sham group. Improving effect of the 2-mA protocol on avoidance symptoms, worries and depressive state was significantly larger than the 1-mA group. Only the 2-mA protocol reduced attention bias to threat-related stimuli, the avoidance symptom at follow-up, and depressive states, as compared to the sham group.

Conclusions

Modulation of lateral-medial PFC activity with intensified stimulation can improve cognitive control, motivation and emotion networks in SAD and might thereby result in therapeutic effects. These effects can be larger with 2-mA vs 1-mA intensities, though a linear relationship between intensity and efficacy should not be concluded. Our results need replication in larger trials.



中文翻译:

针对外侧和内侧前额叶皮质的强化电刺激治疗社交焦虑症:一项随机、双盲、平行组、剂量比较研究

背景

社交焦虑症 (SAD) 是最常见的焦虑症,但在很大程度上仍未得到治疗。杏仁核-额叶网络功能紊乱是 SAD 病理生理学的核心,表现为外侧前额叶皮层 (PFC) 活动减退以及内侧 PFC 和杏仁核的超敏反应。本研究的目的是确定用新型强化刺激方案调节背外侧和内侧 PFC 活动是否会减少 SAD 核心症状,改善治疗相关变量,并减少对威胁性刺激的注意力偏差。

方法

在这项随机、假手术对照、双盲试验中,我们评估了两种强度(1 对 2 mA)的强化刺激方案(20 分钟,每天两次,间隔 20 分钟,连续 5 天)的疗效。虚假刺激。45 名 SAD 患者随机分为三个 tDCS 组(1-mA、2-mA、假手术)。在干预前后评估 SAD 症状、治疗相关变量(担忧、抑郁状态、情绪调节、生活质量)和对威胁性刺激的注意偏向(点探针范式)。在 2 个月的随访中还评估了 SAD 症状。

结果

与假手术组相比,1-mA 和 2-mA 方案在干预后显着减少了恐惧/回避症状、担忧和改善、情绪调节和生活质量。2-mA 方案对回避症状、忧虑和抑郁状态的改善效果显着大于 1-mA 组。与假手术组相比,只有 2-mA 方案减少了对威胁相关刺激、随访时的回避症状和抑郁状态的注意偏向。

结论

通过强化刺激调节外侧-内侧 PFC 活动可以改善 SAD 的认知控制、动机和情绪网络,从而可能产生治疗效果。这些影响在 2-mA 与 1-mA 强度下可能更大,但不应得出强度和功效之间的线性关系。我们的结果需要在更大的试验中复制。

更新日期:2021-06-28
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