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Hui H, Hong A, Gao J, Yu J, Wang Z. Efficacy of tDCS to enhance virtual reality exposure therapy response in acrophobia: A randomized controlled trial. J Psychiatr Res 2024; 171:52-59. [PMID: 38244333 DOI: 10.1016/j.jpsychires.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 01/22/2024]
Abstract
[BACKGROUND]: Virtual reality exposure therapy (VRET) has been recognized as an effective treatment for specific phobias and has the potential to overcome the limitations of traditional exposure therapy. The pursuit of non-invasive brain stimulation provides a practical means of augmenting VRET. Transcranial direct current stimulation (tDCS), a non-invasive neuromodulation technique, stimulates the medial prefrontal cortex (mPFC), with the potential to enhance the effects of exposure therapy. Therefore, we conducted a randomized controlled trial to examine whether tDCS enhanced the effects of VRET in acrophobia. [METHOD]: This study recruited 64 college students with significant fear of height (based on the Acrophobia Questionnaire, AQ). Finally, 61 participants were randomly allocated to the tDCS active-stimulated group (n = 30) or the sham-stimulated group (n = 31). After stimulation, VRET was conducted, and clinical indices were recorded. The AQ was used as the first primary outcome, and Subjective Units of Distress (SUDS) and the Heights Interpretation Questionnaire (HIQ) were used as secondary outcomes. [RESULT]: There was a significant reduction in psychometric and behavioral anxiety measurements from pre to post treatment as indicated by main effects for the factor time (AQ-Anxiety: F (2.60) = 139.55, p < 0.001, η2 = 0.83; AQ-Avoidance: F (2.60) = 53.73, p < 0.001, η2 = 0.69; HIQ: F (2.60) = 128.12, p < 0.001, η2 = 0.81; STAI-Y-S: F (2.60) = 15.44, p < 0.001, η2 = 0.34; BAI: F (2.60) = 73.81, p < 0.001, η2 = 0.71). Compared with the sham-stimulated group, the reduction of AQ-Anxiety and SUDS in the first exposure trial (F (2,60) = 8.56, p = 0.001, η2 = 0.23; t = 2.34, p = 0.024, d = 0.61) was significantly faster in the active group. At follow-up, there was also a further reduction in AQ anxiety and avoidance (Anxiety: M = 56.51 ± 27.19; main effect time F (1,60) = 25.16, p < 0.001, η2 = 0.35; Avoidance: M = 12.57 ± 7.97; main effect time F (1,60) = 31.40, p < 0.001, η2 = 0.45) without interaction time*group (Anxiety: F (1.60) = 0.12, p = 0.740, η2 = 0.00; Avoidance: F (1.60) = 0.64, p = 0.430, η2 = 0.02). [CONCLUSION]: Results could be explained tDCS could accelerate the effects of VRET on acrophobia by stimulating mPFC, indicating that tDCS may be used as an enhancement technique for exposure therapy for specific phobias.
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Affiliation(s)
- Hui Hui
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ang Hong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Gao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiejing Yu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Guo M, Zhong Y, Xu J, Zhang G, Xu A, Kong J, Wang Q, Hang Y, Xie Y, Wu Z, Lang N, Tang Y, Zhang N, Wang C. Altered brain function in patients with acrophobia: A voxel-wise degree centrality analysis. J Psychiatr Res 2023; 164:59-65. [PMID: 37315355 DOI: 10.1016/j.jpsychires.2023.05.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/25/2023] [Accepted: 05/16/2023] [Indexed: 06/16/2023]
Abstract
AIM To explore the local spontaneous neural activity and whole-brain functional connectivity patterns in the resting brain of acrophobia patients. METHODS 50 patients with acrophobia and 47 healthy controls were selected for this study. All participants underwent resting-state MRI scans after enrollment. The imaging data were then analyzed using a voxel-based degree centrality (DC) method, and seed-based functional connectivity (FC) correlation analysis was used to explore the correlation between abnormal functional connectivity and clinical symptom scales in acrophobia. The severity of symptoms was evaluated using self-report and behavioral measures. RESULTS Compared to controls, acrophobia patients showed higher DC in the right cuneus and left middle occipital gyrus and significantly lower DC in the right cerebellum and left orbitofrontal cortex (p < 0.01, GRF corrected). Additionally, there were negative correlations between the acrophobia questionnaire avoidance (AQ- Avoidance) scores and right cerebellum-left perirhinal cortex FC (r = -0.317, p = 0.025) and between scores of the 7-item generalized anxiety disorder scale and left middle occipital gyrus-right cuneus FC (r = -0.379, p = 0.007). In the acrophobia group, there was a positive correlation between behavioral avoidance scale and right cerebellum-right cuneus FC (r = 0.377, p = 0.007). CONCLUSIONS The findings indicated that there are local abnormalities in spontaneous neural activity and functional connectivity in the visual cortex, cerebellum, and orbitofrontal cortex in patients with acrophobia.
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Affiliation(s)
- Meilin Guo
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Yuan Zhong
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, 210097, China
| | - Jingren Xu
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Guojia Zhang
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, 210097, China
| | - Aoran Xu
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, 210097, China
| | - Jingya Kong
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, 210097, China
| | - Qiuyu Wang
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, 210097, China
| | - Yaming Hang
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, 210097, China
| | - Ya Xie
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Zhou Wu
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, 210097, China
| | - Nan Lang
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, 210097, China
| | - Yibin Tang
- College of Internet of Things Engineering, Hohai University, Changzhou, Jiangsu, China
| | - Ning Zhang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210029, China.
| | - Chun Wang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210029, China; School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, 210097, China; Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, 210029, China.
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