Medial prefrontal cortex stimulation accelerates therapy response of exposure therapy in acrophobia
Medial prefrontal cortex stimulation accelerates therapy response of exposure therapy in acrophobia
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DOI：
10.1016/j.brs.2016.11.007
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发表时间：
2017-03-01
影响因子：
7.7
通讯作者：
Deckert, Juergen
中科院分区：
文献类型：
--
作者：
Herrmann, Martin J.;Katzorke, Andrea;Deckert, Juergen
背景：动物和人类的研究表明，腹侧内侧前额叶皮质(VmPFC)与恐惧消退学习密切相关。最近，我们在一项有45名健康对照的安慰剂对照研究中发现，与假刺激组相比，在活动者的条件刺激(CS+)消退期间，以vmPFC为靶点的高频重复经颅磁刺激(RTMS)可以诱导更高的前额叶活动，并通过评分、恐惧增强惊吓和皮肤电导反应表明更好的消退学习。目的：在本研究中，我们旨在证明我们的概念，利用mPFC的rTMS加速消亡学习的概念在焦虑障碍患者中应用。方法：具体评估rTMS对基于暴露的治疗的影响，我们在虚拟现实暴露疗法(VRET)后的vmPFC(FPz)上应用了一种假控制方案，其中n=20名患有肢端恐惧症的参与者和n=19名对照。治疗前后的回避评分t[37]=2.34，p<；0.05)。结论：本研究提供了首次临床证据表明，vmPFC上的高频rTMS改善了暴露治疗对肢端恐惧症症状的反应。(C)2016 Elsevier Inc.保留所有权利。
Background: Animal as well as human research indicated that the ventral medial prefrontal cortex (vmPFC) is highly relevant for fear extinction learning. Recently, we showed that targeting the vmPFC with high-frequency repetitive transcranial magnetic stimulation (rTMS) in a placebo-controlled study with 45 healthy controls induced higher prefrontal activity during extinction of conditioned stimuli (CS+) in the active compared to the sham stimulated group and better extinction learning as indicated by ratings, fear potentiated startles and skin conductance responses.Objective: In this study, we aimed to proof our concept of accelerating extinction learning using rTMS of the mPFC in a group of anxiety disorder patients.Methods: To specifically evaluate the impact of rTMS on exposure-based therapy, we applied a sham-controlled protocol over the vmPFC (FPz) succeeded by a virtual reality exposure therapy (VRET) in n = 20 participants with acrophobia and n = 19 controls.Results: We found a significantly higher reduction in active compared to sham stimulated group for anxiety (t[37] = 233, p < 0.05) as well as avoidance ratings t[37] = 2.34, p < 0.05) from pre to post therapy.Conclusion: This study provides first clinical evidence that high-frequency rTMS over the vmPFC improves exposure therapy response of acrophobia symptoms. (C) 2016 Elsevier Inc. All rights reserved.