TMS for PTSD study
PI: Sanne van Rooij, PhD
The study is complete and data will soon be analyzed. Check back for study findings.
Background
Post-traumatic stress disorder (PTSD) has an estimated prevalence of 5-10% in the general population, with even higher rates in war veterans (23%) and civilians who live in high-violence inner-city areas (30-50%). Current psychotherapeutic treatments for PTSD have efficacy in about 50-70% of patients, resulting in a need for the development of alternative treatment approaches.  
Previous studies have shown abnormal brain function in patients with PTSD, including decreased prefrontal regulation of an overactive amygdala. Transcranial magnetic stimulation (TMS) is a safe and noninvasive treatment that uses magnetic fields to induce a small electric current in the brain. It is an FDA-approved treatment for major depressive disorder, and has shown positive effects for PTSD. However, it is unclear how TMS works for PTSD.
What were the goals of this study?
The goal of this study was to significantly contribute to the advancement of new treatment approaches for PTSD and better understand the mechanisms of TMS by:
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Examining the effect of TMS on PTSD neuroimaging and psychophysiological biomarkers.
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Specifying the exact location for the TMS treatment by using pre-treatment MRI scans.
What did the TMS treatment look like?
The treatment consisted of daily TMS sessions over the course of 10 consecutive weekdays (2 weeks). During this treatment participants were seated in a comfortable chair and a magnetic coil was placed close to their head. They were asked to sit still during this time, but could relax, read, watch TV or listen to music. Each treatment day consisted of two 30-minute treatments sessions with a 10-minute break in between. One half of our participants received an active treatment, and the other half received a sham treatment.
What did we measure and how?
Before and after the TMS treatment, the study collected three types of data:
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Clinical: A clinician did an interview asking about trauma, PTSD and other mental health problems.
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Neuroimaging: Structural MRI scans were taken to assess gray matter anatomy, while functional MRI scans were taken to measure brain activity. Functional neuroimaging data was collected during various tasks that participants were asked to perform as well as during rest. One highly innovative component of this study is the definition of the TMS treatment location. To define the best location for the stimulation, the resting state scan was used to find the area in the front of the brain (dorsolateral prefrontal cortex) that has the strongest functional connection with the amygdala. This location was stimulated during the treatment sessions.
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Psychophysiological: A fear conditioning and extinction paradigm was conducted, and an Acute Startle Response (eye blink) was measured using electromyography. A skin conductance (SC) was conducted during the Standard Trauma Interview (STI) using the eSense SC system.
Who are our participants?
Any PTSD patient who is not currently receiving other treatment could express interest in our study (www.refertogtp.com). Our desired sample will consist of 60 patients with PTSD.
Click here to learn more about brain areas involved in PTSD.