Department of Psychology, Payame Noor University, Tehran, Iran.
Department of Psychology, Faculty of Humanities, University of Zanjan, Zanjan, Iran.
Brain Stimul. 2021 Jul-Aug;14(4):974-986. doi: 10.1016/j.brs.2021.06.005. Epub 2021 Jun 22.
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.
背景：社交焦虑障碍（SAD）是最常见的焦虑障碍，但其大部分患者未得到治疗。杏仁核-前额叶网络功能紊乱是 SAD 病理生理学的核心，其特征为外侧前额叶皮层（PFC）活动减少，内侧 PFC 和杏仁核过度敏感。本研究旨在确定使用新型强化刺激方案调节背外侧和内侧 PFC 活动是否可以减轻 SAD 的核心症状，改善与治疗相关的变量，并减轻对威胁性刺激的注意力偏向。
方法：在这项随机、假刺激对照、双盲试验中，我们评估了强化刺激方案（20 分钟，两次每日，间隔 20 分钟，连续 5 天）在两种强度（1 mA 和 2 mA）与假刺激相比的疗效。45 名 SAD 患者被随机分为三组（1 mA、2 mA、假刺激）。在干预前后和干预后 2 个月分别评估 SAD 症状、与治疗相关的变量（担忧、抑郁状态、情绪调节、生活质量）和对威胁性刺激的注意力偏向（点探测范式）。
结果：与假刺激组相比，1 mA 和 2 mA 方案均能显著降低恐惧/回避症状、担忧并改善情绪调节和生活质量。2 mA 方案对回避症状、担忧和抑郁状态的改善效果明显大于 1 mA 组。只有 2 mA 方案能降低对威胁相关刺激的注意力偏向、随访时的回避症状和抑郁状态。
结论：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，从而产生治疗效果。与 1 mA 相比，2 mA 强度可能会产生更大的效果，但不应得出强度与疗效之间存在线性关系的结论。我们的结果需要在更大的试验中得到复制。
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