Feasibility of Computerized Cognitive-Behavioral Therapy Combined With Bifrontal Transcranial Direct Current Stimulation for Treatment of Major Depression

Welch, Emma; Weigand, Anne; Hooker, Julia E; Philip, Noah S.; Tyrka, Audrey R.; Press, Daniel Z.; Carpenter, Linda L.

doi:10.1111/ner.12807

Cited by 30 publications

(17 citation statements)

References 28 publications

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“…This small (less than 1%) decrease in slow wave activity might reflect a subclinical marker of increased wakefulness due to participants having to wash then blowdry their hair twice before the post-tDCS EEGs. Active tDCS can have sleepiness as a side effect [16], [17], but there were no differences reported clinically between groups on sleepiness or other measures on the tDCS adverse effects questionnaire. The decrease in slow wave activity may alternatively relate to study parameters, as effects in the opposite direction have been seen frontocentrally when using different tDCS and EEG protocols, [18] etc.…”

Section: [Insert Figure 5 Here]mentioning

confidence: 83%

EEG modulation by different transcranial direct current stimulation (tDCS) montages: a randomized double-blind sham-control mechanistic pilot trial in healthy participants

El-Hagrassy

Duarte

Lu³

et al. 2020

Expert Review of Medical Devices

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Background: Based on our Phantom study on transcranial direct current stimulation (tDCS), we hypothesized that EEG band power and field confinement would be greater following left dorsolateral prefrontal cortex (DLPFC -F3) tDCS using circular vs. rectangular electrodes. Methods: Double-blind randomized trial comparing tDCS with anode over the left DLPFC (groups: rectangular electrodes, circular electrodes, sham) and 2 active subgroup references (right shoulder vs. right DLPFC cathodes). Results: Twenty-four randomized participants were assessed. We indeed found higher average EEG power spectral density (PSD) across bands for circular vs. rectangular electrodes, largely confined to F3 and there was a significant increase at AF3 for low alpha (p=0.037). Significant differences included: increased PSD in low beta (p=0.024) and theta bands (p=0.021) at F3, and in theta (p=0.036) at FC5 for the right DLPFC vs. shoulder with no coherence changes. We also found PSD differences between active vs. sham tDCS at Fz for alpha (p=0.043), delta (p=0.036), high delta (p=0.030); and at FC1 for alpha (p=0.031), with coherence differences for F3-Fz in beta (p=0.044), theta (p=0.044), delta (p=0.037) and high delta (p=0.009). Conclusion:This pilot study despite having low statistical power given its small sample size shows that active left DLPFC tDCS modulates EEG frontocentrally and suggests that electrode shapes/reference locations affect its neurophysiological effects, such as increased low alpha power at AF3 using circular vs. rectangular electrodes. Further research with more participants is warranted.

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Section: [Insert Figure 5 Here]mentioning

confidence: 83%

EEG modulation by different transcranial direct current stimulation (tDCS) montages: a randomized double-blind sham-control mechanistic pilot trial in healthy participants

El-Hagrassy

Duarte

Lu³

et al. 2020

Expert Review of Medical Devices

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“…Two studies were identified during the search update that could not be matched to our comparisons [ 71 , 94 ]. One study compared a guided web-based CBT tool (iFightDepression) against an active control intervention receiving progressive muscle relaxation provided via a download link [ 71 ].…”

Section: Resultsmentioning

confidence: 99%

Effectiveness and acceptance of technology-based psychological interventions for the acute treatment of unipolar depression: a systematic review and meta-analysis (Preprint)

Köhnen¹,

Kriston²,

Härter³

et al. 2020

Journal of Medical Internet Research

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Background Evidence on technology-based psychological interventions (TBIs) for the acute treatment of depression is rapidly growing. Despite extensive research in this field, there is a lack of research determining effectiveness and acceptance of TBIs considering different application formats in people with a formally diagnosed depressive disorder. Objective The goal of the review was to investigate the effectiveness and acceptance of TBIs in people with diagnosed depression with particular focus on application formats (stand-alone interventions, blended treatments, collaborative and/or stepped care interventions). Methods Studies investigating adults with diagnosed unipolar depressive disorders receiving any kind of psychotherapeutic treatment delivered (at least partly) by a technical medium and conducted as randomized controlled trials (RCTs) were eligible for inclusion. We searched CENTRAL (Cochrane Central Register of Controlled Trials; August 2020), MEDLINE, PsycINFO, PSYNDEX, CINAHL (January 2018), clinical trial registers, and sources of grey literature (January 2019). Two independent authors decided about study inclusion and extracted data. We performed random effects meta-analyses to synthesize the data. Results Database searches resulted in 15,546 records of which 78 completed studies were included. TBIs delivered as stand-alone interventions showed positive effects on posttreatment depression severity when compared to treatment as usual (SMD –0.44, 95% CI –0.73 to –0.15, k=10; I ²=86%), attention placebo (SMD –0.51, 95% CI –0.73 to –0.30; k=12; I ²=66%), and waitlist controls (SMD –1.01, 95% CI –1.23 to –0.79; k=19; I ²=73%). Superior long-term effects on depression severity were shown when TBIs were compared to treatment as usual (SMD –0.24, 95% CI –0.41 to –0.07; k=6; I ²=48%) attention placebo (SMD –0.23, 95% CI –0.40 to –0.07; k=7; I ²=21%) and waitlist controls (SMD –0.74, 95% CI –1.31 to –0.18; k=3; I ²=79%). TBIs delivered as blended treatments (providing a TBI as an add-on to face-to-face treatment) yielded beneficial effects on posttreatment depression severity (SMD –0.27, 95% CI –0.48 to –0.05; k=8; I ²=53%) compared to face-to-face treatments only. Additionally, TBIs delivered within collaborative care trials were more effective in reducing posttreatment (SMD –0.20, 95% CI –0.36 to –0.04; k=2; I ²=0%) and long-term (SMD –0.23, 95% CI –0.39 to –0.07; k=2; I ²=0%) depression severity than usual care. Dropout rates did not differ between the intervention and control groups in any comparison (all P ≥.09). Conclusions We found that TBIs are effective not only when delivered as stand-alone interventio...

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“…In a recent randomized double-blind sham-controlled trial [34], 14 patients with MDD received four weeks of computer-based CBT (12 modules) combined with 12 sessions of active or sham bifrontal tDCS (three days per week for four weeks; anode over F3 and cathode over F4, 10–20 EEG system). In each tDCS session, a 2 mA current was applied over 30 minutes.…”

Section: Noninvasive Brain Stimulation and Depressionmentioning

confidence: 99%

“…Finally, in the context of MDD, positive data were obtained following the application of left prefrontal rTMS in one case report and one open label study, and after left prefrontal anodal tDCS in one case report [31,32,33]. However, in the only available randomized controlled trial [34], the add-on value of tDCS could not be studied because of the small sample size.…”

Section: Current Knowledge and Future Perspectivesmentioning

confidence: 99%

Noninvasive Brain Stimulation and Psychotherapy in Anxiety and Depressive Disorders: A Viewpoint

Chalah

Ayache

2019

Brain Sciences

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Among the most prevalent psychiatric conditions stand anxiety and depression. Psychotherapy and medications are considered effective treatments in these clinical settings. However, pharmacotherapy and psychotherapy (i.e., cognitive behavioral therapy (CBT)) administered in monotherapy or in a combined regimen do not result in satisfactory outcomes in all patients. Therefore, finding new treatments would be of great help. In the last three decades, noninvasive brain stimulation (NIBS) has emerged as a safe tool to improve several neuropsychiatric symptoms. The following work revisits the available reports that assessed the add-on value of NIBS techniques when combined to psychotherapy (CBT or related interventions) in mood and anxiety disorders. The available protocols targeted the prefrontal cortex, a region that was previously found to have an enhanced activity or functional connectivity after psychotherapeutic interventions. Promising yet scarce evidence exists on this matter. A discrepancy exists among the available reports regarding the type and duration of interventions, the patients’ clinical profiles, and the presence of a sham intervention. NIBS may have acted by enhancing psychotherapy effects on the top-down cognitive control of emotions. Combining both therapies may result in promising effects, but future large-scale trials are needed to judge the utility of this combination in psychiatric populations.

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Feasibility of Computerized Cognitive-Behavioral Therapy Combined With Bifrontal Transcranial Direct Current Stimulation for Treatment of Major Depression

Cited by 30 publications

References 28 publications

EEG modulation by different transcranial direct current stimulation (tDCS) montages: a randomized double-blind sham-control mechanistic pilot trial in healthy participants

EEG modulation by different transcranial direct current stimulation (tDCS) montages: a randomized double-blind sham-control mechanistic pilot trial in healthy participants

Effectiveness and acceptance of technology-based psychological interventions for the acute treatment of unipolar depression: a systematic review and meta-analysis (Preprint)

Noninvasive Brain Stimulation and Psychotherapy in Anxiety and Depressive Disorders: A Viewpoint

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