Case Series of Transcranial Direct Current Stimulation as an Augmentation Strategy for Attention Bias Modification Treatment in Adolescents with Anxiety Disorders

Abstract

This article presents the results of a case series to assess the feasibility, acceptability, and clinical promise of transcranial Direct Current Stimulation (tDCS) as an augmentation strategy in clinic referred adolescents. Attention Bias Modification Treatment (ABMT) is a computer-based attention-training protocol designed to reduce rapidly deployed attention orienting to threat and thereby reduce anxiety symptom severity. Studies of ABMT reveal overall small to medium effect sizes. Advances in the neural underpinnings of attention to threat and attention-training protocols suggest the potential of tDCS of the dorsolateral prefrontal cortex (dlPFC) as a novel augmentation strategy to enhance ABMT’s efficacy (ABMT + tDCS). However, tDCS has never been tested in a sample of adolescents with anxiety disorders. Six adolescents with a primary anxiety disorder completed all four ABMT + tDCS sessions. Adverse effects were mild and transient. Adolescents and parents independently reported fair to excellent levels of satisfaction. Impairment ratings of the primary anxiety disorder significantly decreased. Further, electrophysiological data recorded via electroencephalography (EEG) suggested decreases in neural resources allocated to threat. These findings support the feasibility, acceptability, and clinical promise of tDCS as an augmentation strategy in adolescents with anxiety disorders, and provide the impetus for further investigation using randomized controlled designs in larger samples.

Effects of transcranial direct current stimulation in children and young people with psychiatric disorders: a systematic review

“…We identified 33 eligible studies (total N = 517; age range 2-25 years, M = 15.53, SD = 6.44; 82.2% male), composed of eight double-blind RCTs [37-40, 43, 44, 46, 48], four double-blind, crossover RCTs [35,43,45,47], one doubleblind, sham-controlled trial [67], two single-blind RCTs [41,63], one single-blind controlled clinical trial [65], four openlabel studies [36,38,44,62], and 14 case series/studies [42, 51-61, 64, 66] (see Table 1 and 2). Seven studies were in ASD [35][36][37][38][39][40][41][42][43], seven in ADHD [44][45][46][47][48][49][50], four in schizophrenia [51][52][53][54], two in OCD [55,56], Tourette's syndrome [57,58], depression [59,60], anxiety [61,62], or substance abuse disorder [63,64], and one each in eating disorders…”

“…A single-arm, open-label study [62] in six adolescents with social anxiety disorder or generalized anxiety disorder reported that combined anodal-tDCS to the left-DLPFC with attention bias modification training reduced self-and parent-reported total anxiety symptoms, self-and parentrated anxiety-related emotional symptoms, and clinicianrated anxiety symptoms, compared to baseline. However, only self-reported total anxiety symptoms significantly reduced from baseline to post-stimulation [62].…”

Effects of Transcranial Direct Current Stimulation in Children and Young People with Psychiatric Disorders: A Systematic Review

“…five in ADHD [35][36][37][38][39], four in schizophrenia [40][41][42][43], two each in OCD [44,45], Tourette's syndrome [46,47], depression [48,49], anxiety [50,51], or substance abuse disorder [52,53], and one each in eating disorders [54], catatonia [55], or co-comorbid ASD, ADHD and anxiety [56]. Across studies, tDCS was typically delivered for 20 to 30-mins (M=23; SD = 4.43) once-daily over 4 to 28 sessions (M=12; SD = 7.07).…”

“…1), composed of six double-blind RCTs, one double-blind, sham-controlled trial, two single-blind RCTs, one single-blind controlled clinical trial, four open-label studies, and 14 case series/studies (see Table 1 and 2). Six studies were in ASD [29-34], five in ADHD [35-39], four in schizophrenia [40-43], two each in OCD [44,45], Tourette’s syndrome [46,47], depression [48,49], anxiety [50,51], or substance abuse disorder [52,53], and one each in eating disorders [54], catatonia [55], or co-comorbid ASD, ADHD and anxiety [56]. Across studies, tDCS was typically delivered for 20 to 30-mins (M=23; SD = 4.43) once-daily over 4 to 28 sessions (M=12; SD = 7.07).…”

“…A single-arm open-label study in six adolescents with social anxiety disorder or generalized anxiety disorder reported that combined anodal-tDCS to the left-DLPFC with attention bias modification training reduced self-and parent-reported total anxiety symptoms, self-and parent-rated anxiety related emotional symptoms, and clinician-rated anxiety symptoms, compared to baseline [51]. However, only self-reported total anxiety symptoms significantly reduced from baseline to post-stimulation.…”