Transcranial direct current stimulation targeting the medial prefrontal cortex modulates functional connectivity and enhances safety learning in obsessive‐compulsive disorder: Results from two pilot studies

Abstract

Background: Exposed-based psychotherapy is a mainstay of treatment for obsessive-compulsive disorder (OCD) and anxious psychopathology. The medial prefrontal cortex (mPFC) and the default mode network (DMN), which is anchored by the mPFC, promote safety learning. Neuromodulation targeting the mPFC might augment therapeutic safety learning and enhance response to exposure-based therapies.Methods: To characterize the effects of mPFC neuromodulation on functional connectivity, 17 community volunteers completed resting-state functional magnetic resonance imaging scans before and after 20 min of frontopolar anodal multifocal transcranial direct current stimulation (tDCS). To examine the effects of tDCS on therapeutic safety learning, 24 patients with OCD completed a pilot randomized clinical trial; they were randomly assigned (double-blind, 50:50) to receive active or sham frontopolar tDCS before completing an in vivo exposure and response prevention (ERP) challenge. Changes in subjective emotional distress during the ERP challenge were used to index therapeutic safety learning.Results: In community volunteers, frontal pole functional connectivity with the middle and superior frontal gyri increased, while connectivity with the anterior insula and basal ganglia decreased (ps < .001, corrected) after tDCS; functional connectivity between DMN and salience network also decreased after tDCS (ps < .001, corrected). OCD patients who received active tDCS exhibited more rapid therapeutic safety learning (ps < .05) during the ERP challenge than patients who received sham tDCS.Conclusions: Frontopolar tDCS may modulate mPFC and DMN functional connectivity and can accelerate therapeutic safety learning. Though limited by small samples, these findings motivate further exploration of the effects of frontopolar tDCS on neural and behavioral targets associated with exposure-based psychotherapies.

The role of hippocampus in memory reactivation: an implication for a therapeutic target against opioid use disorder

“…Besides noradrenaline-related agents, selective neural stimulation is another choice for reducing pathological memory. Recently, non-invasive brain stimulations, such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and transcranial alternating current stimulation (tACS), have been applied to intervene in many types of neuropsychiatric disorders [144][145][146][147]. Although these techniques remain unsuitable for targeting deep brain regions, some applicable approaches, such as temporal interference (TI), have been developed recently [148,149].…”

Noninvasive stimulation of the ventromedial prefrontal cortex modulates rationality of human decision-making

“…Such designs could also be used in clinical settings to test a complementary treatment option for gambling (and other behavioral) addictions. In fact, first indications for positive effects of mPFC stimulation have been demonstrated for obsessive-compulsive disorders (Adams et al, 2021), which is likewise associated with impaired impulse-control. Furthermore, the neural data of the feedback phase contained limited informative value, due to the extremely strong differential effects of the outcomes (loss >> gain, driven by loss-aversion), which explained most variance and potentially masked relevant interaction effects.…”

Noninvasive stimulation of the ventromedial prefrontal cortex increases rationality of human decision-making

“…Such designs could also be used in clinical settings to test a complementary treatment option for gambling (and other behavioral) addictions. In fact, rst indications for positive effects of mPFC stimulation have been demonstrated for obsessive-compulsive disorders 34 , which is likewise associated with impaired impulse-control. Furthermore, the neural data of the feedback phase contained limited informative value, due to the extremely strong differential effects of the outcomes (loss > > gain, driven by loss-aversion), which explained most variance and potentially masked relevant interaction effects.…”