Introduction: Emotional dysregulation constitutes a serious public health problem in need of novel transdiagnostic treatments. Objective: To this aim, we developed and tested a one-time intervention that integrates behavioral skills training with concurrent repetitive transcranial magnetic stimulation (rTMS). Methods: 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 (n = 17) or left (n = 14) dorsolateral prefrontal cortex (dlPFC) or sham rTMS (n = 15) while practicing reframing and emotional distancing in response to autobiographical stressors. Results: Those who received active left or active right as opposed to sham rTMS exhibited enhanced regulation (ds = 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 (d = 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. Conclusions: 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.
Psychother Psychosom

中文翻译：

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通过同时重复经颅磁刺激增强认知重构：跨诊断随机对照试验

简介：情绪失调是一个严重的公共卫生问题，需要新的跨诊断治疗。目标：为此，我们开发并测试了一种一次性干预措施，将行为技能训练与并发重复经颅磁刺激 (rTMS) 相结合。方法： 46 名符合至少一种 DSM-5 障碍标准且自我报告认知重构 (CR) 使用率低的成年人参加了一项随机、双盲、假对照试验，该试验采用受试者间设计. 参与者被教导 CR 并在右侧 ( n = 17) 或左侧 ( n = 14) 背外侧前额叶皮层 (dlPFC) 或假 rTMS ( n= 15）同时练习重构和情感疏远以应对自传压力源。结果：与假 rTMS 相比，那些接受主动左或主动右的人表现出增强的调节 ( d s = 0.21–0.62)，如干预期间的心理生理指标所衡量的（更高的高频心率变异性、更短的调节持续时间）。那些在左侧 dlPFC 上接受主动 rTMS 的人也自我报告在整个干预过程中痛苦减少 ( d = 0.30)，使用 CR 的可能性更高，并且在干预后的一周内每日痛苦减少。这些程序是可以接受的和可行的，几乎没有副作用。结论：这些发现表明，将额叶回路与认知技能训练和 rTMS 同时进行可能在临床上是可行的、耐受性良好的，并且可能显示出治疗跨诊断情绪失调的希望。需要更大规模的后续研究来证实这种新型治疗方法的有效性。
心理医生