Horczak Paula, Wang Chanyu, De Witte Sara, De Smet Stefanie, Remue Jonathan, De Raedt Rudi, Vanderhasselt Marie-Anne, Wu Guo-Rong, Lemmens Gilbert M D, Baeken Chris
Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium.
Department of Head and Skin - Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium.
Front Neurol. 2023 Apr 25;14:1167029. doi: 10.3389/fneur.2023.1167029. eCollection 2023.
As part of repetitive negative thinking (RNT), rumination is a maladaptive cognitive response style to stress or negative mood which can increase the risk of depression and may prohibit complete recovery. Cognitive behavioral therapy (CBT) and transcranial direct current stimulation (tDCS) both proved to be effective in decreasing rumination. However, the combined effects of tDCS and CBT interventions on rumination have not yet been explored. The first aim of this pilot study is to investigate whether the combination of tDCS and CBT has an accumulating positive effect on modulating state rumination. The second aim is to assess the feasibility and safety profile of the proposed combined approach.
Seventeen adults aged 32-60 years, suffering from RNT, were referred by their primary care professional to participate in an 8-week group intervention for RNT ("Drop It") comprising 8 sessions of CBT. Before each CBT session, patients underwent one double-blinded prefrontal active (2 mA for 20 min) or sham tDCS (anode over F3, cathode over the right supraorbital region) combined with an internal cognitive attention task focused on individual RNT, i.e., online tDCS priming. During each session, the Brief State Rumination Inventory was used to assess state rumination.
A mixed effects model analysis revealed no significant differences between the stimulation conditions, weekly sessions, or their interaction in terms of state rumination scores.
Overall, the combination of online tDCS priming followed by group CBT was found to be safe and feasible. On the other hand, no significant additional effects of this combined approach on state rumination were established. Although our pilot study may have been too small to find significant clinical effects, future larger RCT studies on combined tDCS-CBT treatment protocols may reevaluate the selection of internal cognitive attention tasks and more objective neurophysiological measurements, consider the optimal timing of the combination (concurrently or sequentially), or may add additional tDCS sessions when following CBT.
作为反复消极思维（RNT）的一部分，沉思是对压力或负面情绪的一种适应不良的认知反应方式，它会增加患抑郁症的风险，并可能阻碍完全康复。认知行为疗法（CBT）和经颅直流电刺激（tDCS）都被证明在减少沉思方面有效。然而，tDCS和CBT干预对沉思的联合效果尚未得到探索。这项初步研究的首要目的是调查tDCS和CBT的联合是否对调节状态性沉思有累积的积极作用。第二个目的是评估所提议的联合方法的可行性和安全性。
17名年龄在32至60岁之间、患有RNT的成年人由其初级保健医生转介，参加为期8周的针对RNT的团体干预（“放下它”），包括8次CBT课程。在每次CBT课程之前，患者接受一次双盲前额叶激活（2毫安，持续20分钟）或假tDCS（阳极置于F3，阴极置于右侧眶上区域），并结合一项针对个体RNT的内部认知注意力任务，即在线tDCS启动。在每次课程期间，使用简短状态性沉思量表来评估状态性沉思。
混合效应模型分析显示，在状态性沉思分数方面，刺激条件、每周课程或它们的相互作用之间没有显著差异。
总体而言，发现在线tDCS启动后进行团体CBT的联合方法是安全可行的。另一方面，这种联合方法对状态性沉思没有显著的额外效果。尽管我们的初步研究可能规模太小，无法发现显著的临床效果，但未来关于tDCS-CBT联合治疗方案的更大规模随机对照试验研究可能会重新评估内部认知注意力任务的选择和更客观的神经生理学测量，考虑联合的最佳时机（同时或顺序进行），或者在CBT之后增加额外的tDCS疗程。
