Non-invasive brain stimulation to improve psychotherapy of anxiety disorders

焦虑症的终生患病率超过15%(Jacobi等人，2014年)，焦虑症是一种非常常见的精神障碍，甚至比情感障碍发生得更频繁，以“残疾调整寿命年”表示的相关负担是仅次于抑郁障碍的第二高比率(Whiteford等人，2013年)。一般来说，焦虑症患者表现出高度的心理困扰和日常功能障碍(Whiteford等人，2013年)。有效的治疗对减轻焦虑症状和提高生活质量具有特别重要的意义。在焦虑症认知行为疗法(CBT)的帮助下，已经取得了很大的进展(Carpenter等人，2018年)，但并不是所有的患者都能充分受益。非侵入性脑刺激方法被越来越多地考虑(Bajbouj和Padberg，2014，Zwanzger等人，2016)，并被描述为一种有效的新方法(Herrmann等人，2019年)，用于优化焦虑症的心理治疗和精神药物治疗。基于我们之前的工作(Herrmann等人，2017年)，应用可行性研究的目的是转让Raij等人新的和有希望的实验室成果。(2018)进入治疗研究。由于vmPFC的位置原因，非侵入性脑刺激无法直接到达vmPFC，Raij等人(2018)通过刺激左侧PFC间接激活了vmPFC，这在功能上与vmPFC有关。他们用恐惧学习范式揭示了左前额叶脑刺激可以改善恐惧的消退和减少恐惧的回归。在这个项目中，我们将首次采用安慰剂对照的双盲设计，研究rTMS诱导的左侧PFC的激活，从而间接地激活耦合的vmPFC是否显着改善了随后针对特定恐惧症的暴露治疗，所有研究患者都将在虚拟现实中接受两次暴露治疗。为此，提供了一个五面洞自动虚拟环境，它可以在四面墙和地板上直观地显示虚拟环境。评估治疗效果的主要参数是恐高症的心理测量学评估(AQ问卷)，假设动词刺激组与安慰剂刺激组相比，在治疗后立即表现出更大的症状减少。次要结果参数是治疗后即刻的接近行为(BAT)和6个月随访时的恐高症和接近行为的变化。

With a lifetime prevalence of more than 15% (Jacobi et al., 2014), anxiety disorders are a very common mental disorder, occurring even more frequently than affective, and the associated burden expressed in "Disability adjusted life years" (dalys) is the second highest rate after depressive disorders (Whiteford et al., 2013). In general, patients with anxiety disorders show a high level of psychological distress and impairment of daily functioning (Whiteford et al., 2013). Effective therapy is of particular relevance for reducing anxiety symptoms and improving the quality of life. With the help of cognitive behavioral therapy (CBT) for anxiety disorders, great progress can already be made (Carpenter et al., 2018), but not all patients benefit sufficiently. Non-invasive brain stimulation methods are increasingly considered (Bajbouj and Padberg, 2014, Zwanzger et al., 2016) and described as an effective new method (Herrmann et al., 2019) for optimizing psychotherapy and psychopharmacotherapy for anxiety disorders. Based on our own previous work (Herrmann et al., 2017) the aim of the applied feasibility study is to transfer the new and promising laboratory results of Raij et al. (2018) into a therapy study. As the vmPFC cannot be reached directly with non-invasive brain stimulation due to its location Raij et al (2018) activated the vmPFC indirectly by stimulating the left PFC, which is functionally linked to vmPFC. They revealed with a fear learning paradigm that this left PFC brain stimulation improves extinction of fear and reduces return of fear. In this project we will examine with a placebo-controlled double-blind design for the first time whether an activation of the left PFC induced by rTMS and thus indirectly of the coupled vmPFC significantly improves a subsequent exposure therapy for specific phobia All study patients will receive two exposure treatments in virtual reality. A five-sided Cave Automatic Virtual Environment (psyCAVE) is available for this purpose, which visually displays the virtual environment on four walls and the floor. The primary parameter for the evaluation of treatment efficacy is the psychometric assessment of acrophobic fear (AQ questionnaire), with the hypothesis that the verum-stimulated group compared to the placebo-stimulated group exhibits a greater decrease of symptoms immediately after therapy. The secondary outcome parameters are the approach behaviour (BAT) immediately after therapy and the changes in both acrophobic fear and approach behaviour at 6 months follow-up.