Brain Research & Innovation Centre, Ministry of Defence, Lundlaan 1, 3584 EZ, Utrecht, The Netherlands.
Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
BMC Psychiatry. 2021 Feb 15;21(1):97. doi: 10.1186/s12888-021-03086-5.
Noninvasive brain stimulation techniques like transcranial direct current stimulation (tDCS) offer potential new approaches to treat stress-related mental health disorders. While the acceptability of tDCS as a treatment tool plays a crucial role in its development and implementation, little is known about tDCS acceptability for users in mental healthcare, especially in the context of stress-related disorders.
Using a mixed-methods approach, we investigated tDCS acceptability among 102 active duty and post-active military patients with stress-related symptoms (posttraumatic stress disorder, anxiety and impulsive aggression) who participated in a 5-session tDCS intervention. Quantitative dropout and adverse effects data was collected for all patients involved in the sham-controlled tDCS intervention. We additionally explored perspectives on the acceptability of tDCS treatment via a theory-based semi-structured interview. A subgroup of patients as well as their caregivers were interviewed to include the views of both patients and mental healthcare professionals.
Quantitative outcomes showed minimal tDCS-related adverse effects (mild itching or burning sensations on the scalp) and high tDCS treatment adherence (dropout rate: 4% for active tDCS, 0% for sham). The qualitative outcomes showed predominantly positive attitudes towards tDCS interventions for stress-related disorders, but only as complementary to psychotherapy. Remarkably, despite the perception that sufficient explanation was provided, patients and caregivers stressed that tDCS treatment comprehension was limited and should improve. Also, the travel associated with frequent on-site tDCS sessions may produce a significant barrier to care for patients with stress-related disorders and active-duty military personnel.
Acceptability numbers and perspectives from military patients and caregivers suggest that tDCS is an acceptable complementary tool in the treatment of stress-related disorders. Critically, however, if tDCS is to be used beyond scientific studies, adequately educating users on tDCS working mechanisms is vital to further improve its acceptability. Also, the perceived potential barrier to care due to frequent travel may favor home-based tDCS solutions.
The tDCS intervention was part of a sham-controlled trial registered on 05-18-2016 at the Netherlands Trial Register with ID NL5709 .
非侵入性脑刺激技术，如经颅直流电刺激（tDCS），为治疗与应激相关的精神健康障碍提供了新的潜在方法。虽然 tDCS 作为一种治疗工具的可接受性在其发展和实施中起着至关重要的作用，但对于精神保健领域的用户来说，对 tDCS 的可接受性知之甚少，尤其是在与应激相关的障碍方面。
我们采用混合方法，对 102 名有应激相关症状（创伤后应激障碍、焦虑和冲动性攻击）的现役和退役军人患者进行了 tDCS 干预的 5 次治疗，调查了 tDCS 的可接受性。所有参与假刺激 tDCS 干预的患者都收集了定量脱落率和不良反应数据。我们还通过基于理论的半结构化访谈探索了 tDCS 治疗可接受性的观点。对部分患者及其护理人员进行了访谈，以纳入患者和精神保健专业人员的观点。
定量结果显示 tDCS 相关不良反应轻微（头皮有轻微瘙痒或烧灼感），tDCS 治疗依从性高（主动 tDCS 脱落率：4%，假刺激组：0%）。定性结果显示，大多数患者对 tDCS 干预治疗与应激相关的障碍持积极态度，但仅作为心理治疗的补充。值得注意的是，尽管患者和护理人员认为已经提供了足够的解释，但他们强调对 tDCS 治疗的理解有限，需要进一步提高。此外，由于频繁的现场 tDCS 治疗，与旅行相关的问题可能会成为与应激相关的障碍和现役军人治疗的一个重要障碍。
来自军人患者和护理人员的可接受性数据和观点表明，tDCS 是治疗与应激相关的障碍的一种可接受的辅助工具。然而，至关重要的是，如果 tDCS 要在科学研究之外使用，就必须充分教育用户 tDCS 的工作机制，以进一步提高其可接受性。此外，由于频繁旅行而导致的潜在护理障碍可能会倾向于使用基于家庭的 tDCS 解决方案。
tDCS 干预是一项假刺激对照试验的一部分，该试验于 2016 年 5 月 18 日在荷兰试验注册中心注册，注册号为 NL5709 。
