Int-Veen Isabell, Eßer Ute, Ladegast Sandra, Liermann Leonhard, Täglich Ramona, Schopp Betti, Nuerk Hans-Christoph, Plewnia Christian, Kroczek Agnes, De Smet Stefanie, Vanderhasselt Marie-Anne, Fallgatter Andreas J, Ehlis Ann-Christine, Barth Beatrix, Rosenbaum David
Tübingen Center for Mental Health (TüCMH), Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.
Department of Psychology, University of Tübingen, Tübingen, Germany.
Cogn Affect Behav Neurosci. 2025 Jun 23. doi: 10.3758/s13415-025-01305-0.
Theta Burst Stimulation (TBS) offers a noninvasive way to modulate neural activation patterns, helping to explore the causal role of brain regions in psychiatric symptoms. Prefrontal hypoactivation is commonly observed in high ruminators and patients with depression during stress. However, the impact of modulating Dorsolateral Prefrontal Cortex (DLPFC) activity via excitatory and inhibitory TBS during stress remains unexplored. We studied 88 healthy participants (44 low, 44 high ruminators), each attending two appointments that included stress induction using the Trier Social Stress Test (TSST) and cortical oxygenation assessment with functional Near-Infrared Spectroscopy (fNIRS). Participants received either intermittent TBS (iTBS) or continuous TBS (cTBS) applied to the left DLPFC, with sessions randomized between active and sham stimulation. While TBS had no impact on positive affect, TSST performance, or heart rate, we observed effects on stress, state rumination, negative affect, and cortical oxygenation. We observed higher stress and higher negative affect during and after the TSST in high ruminators receiving iTBS compared with sham TBS (sTBS). Low ruminators showed reduced state rumination increases after iTBS compared with sTBS at their second appointment. fNIRS data revealed cortical oxygenation differences during the TSST, although only without multiple comparison corrections. Descriptively, we observed higher activation in the left Ventrolateral Prefrontal Cortex (VLPFC) following cTBS compared with sTBS in high ruminators but lower cortical oxygenation following cTBS compared with sTBS in low ruminators but only when participants received active stimulation first. This suggests stimulation sequence affects repeated-measures TMS studies in stress contexts. Findings highlight expectancy effects and suggest a potential reduction in TBS impact due to strong hemodynamic responses during stress. HIGHLIGHTS: • High ruminators showed increased stress and negative affect after iTBS during the TSST. • Neural data showed increased cortical oxygenation in the left Ventrolateral Prefrontal Cortex (VLPFC) following cTBS to the left Dorsolateral Prefrontal Cortex (DLPFC) in high ruminators. • In low ruminators, cTBS led to decreased activation, but only when active stimulation was administered first, highlighting the role of stimulation order in TBS outcomes. • Expectancy effects and habituation are important aspects to be considered in repeated measures designs involving TBS and stress-reactive rumination.
theta爆发刺激（TBS）提供了一种非侵入性方法来调节神经激活模式，有助于探索脑区在精神症状中的因果作用。在压力状态下，高反刍者和抑郁症患者中常见前额叶激活不足。然而，在压力期间通过兴奋性和抑制性TBS调节背外侧前额叶皮质（DLPFC）活动的影响仍未得到探索。我们研究了88名健康参与者（44名低反刍者，44名高反刍者），每人参加两次预约，包括使用特里尔社会压力测试（TSST）进行压力诱导以及使用功能近红外光谱（fNIRS）进行皮质氧合评估。参与者接受应用于左侧DLPFC的间歇性TBS（iTBS）或连续性TBS（cTBS），各时段在主动刺激和假刺激之间随机分配。虽然TBS对积极情绪、TSST表现或心率没有影响，但我们观察到对压力、状态反刍、消极情绪和皮质氧合有影响。与假TBS（sTBS）相比，接受iTBS的高反刍者在TSST期间和之后表现出更高的压力和更高的消极情绪。与第二次预约时的sTBS相比，低反刍者在接受iTBS后状态反刍增加减少。fNIRS数据显示TSST期间存在皮质氧合差异，不过仅未进行多重比较校正。从描述性角度来看，与高反刍者中的sTBS相比，我们观察到cTBS后左侧腹外侧前额叶皮质（VLPFC）激活更高，但与低反刍者中的sTBS相比，cTBS后皮质氧合更低，但仅当参与者首先接受主动刺激时才是如此。这表明刺激顺序会影响压力情境下的重复测量TMS研究。研究结果突出了预期效应，并表明由于压力期间强烈的血流动力学反应，TBS的影响可能会降低。要点：• 高反刍者在TSST期间接受iTBS后压力和消极情绪增加。• 神经数据显示，高反刍者左侧背外侧前额叶皮质（DLPFC）接受cTBS后，左侧腹外侧前额叶皮质（VLPFC）的皮质氧合增加。• 在低反刍者中，cTBS导致激活减少，但仅当首先给予主动刺激时才是如此，突出了刺激顺序在TBS结果中的作用。• 预期效应和习惯化是涉及TBS和应激反应性反刍的重复测量设计中需要考虑的重要方面。
