INS NYC 2024 Program

Poster	Poster Session 04 Program Schedule 02/15/2024 12:00 pm - 01:15 pm Room: Shubert Complex (Posters 1-60) Poster Session 04: Neuroimaging \| Neurostimulation/Neuromodulation \| Teleneuropsychology/Technology Final Abstract #31 Anxiety Reduction through Continuous Theta-Burst Stimulation (cTBS) Shivani Desai, University of Arizona, Tucson, United States Nekabari Yakpogoro, University of Arizona, Tucson, United States Melissa Reich-Fuehrer, University of Arizona, Tucson, United States Lindsey Hildebrand, University of Arizona, Tucson, United States Alisa Huskey, University of Arizona, Tucson, United States William Killgore, University of Arizona, Tucson, United States Category: Neurostimulation/Neuromodulation Keyword 1: anxiety Keyword 2: neurostimulation Keyword 3: sleep Objective: Repetitive Transcranial Magnetic Stimulation (rTMS) is a procedure by which a magnetic coil is used to externally stimulate neurons in specific regions of the brain. We conducted continuous theta-burst stimulation (cTBS) to suppress cortical excitability and lower within-network connectivity in the Default Mode Network (DMN), which is associated with rumination and mind-wandering. Prior research has indicated that TMS targeting the dorsolateral prefrontal cortex is effective in improving sleep quality and duration by reducing mind-wandering. We hypothesized that cTBS would be effective in lowering anxiety, as it correlates with both sleep disturbances and pre-sleep rumination. Additionally, pre-sleep rumination has been shown to increase frequency of threatening dreams (Feng 2022), which also correlates with anxiety, so we aimed to determine if this pattern was a contributing factor to the results. Participants and Methods: We administered continuous theta burst stimulation (cTBS) to a total of 20 participants with elevated insomnia symptoms (N_males 8, Mage=31.6, SD=6.7) (N_females= 12, Mage=23.8, SD=4.3). The Disturbing Dream and Nightmare Severity Index (DDNSI) was administered to participants prior to their stimulation session, which measures nightmare frequency and intensity. Individuals who scored below a 10 were considered healthy and participants who scored a 10 or above fit the criteria for having a nightmare disorder based on the official scoring guidelines. Participants then underwent one round of sham stimulation and one round of active cTBS in a randomized order with one week in between the sessions. The State Trait Anxiety Inventory (STAI) was administered both before and after each stimulation session. We ran a repeated measures ANCOVA covarying for DDNSI category. Results: There was a significant effect of the cTBS condition on reported anxiety scores (F(1,9)=6.570; η_p²=0.422; p=.031). Even while covarying for DDNSI score, the interaction remained significant (F=(1,9)=5.415; η_p²=0.376; p=.045). Participants showed a significantly greater reduction in baseline anxiety post-stimulation (M=39.18, SD=8.681) compared to pre-stimulation (M=41.09, SD=7.803, N=11, p=0.034) during their active cTBS session. During their sham cTBS session, participants demonstrated no significant difference post-stimulation (M=40.91, SD=9.659) compared to pre-stimulation (M=40.64, SD=8.394, N=11, p=0.899). Conclusions: Our findings revealed a significant reduction in anxiety levels following active cTBS. By reducing activity in the Default Mode Network, cTBS facilitates better sleep and therefore may increase emotional regulation and mood resulting in reduced state anxiety. One of the advantages of cTBS in anxiety management is its non-invasive nature which sets it apart from other methods such as pharmacological interventions. cTBS is a safer alternative to many pharmacologic approaches as it eliminates the potential for dependency concerns. This targeted neuromodulation approach also has the potential for individualized treatment plans for patients, as stimulation can be tailored to unique neural profiles of patients. While further research is needed to clarify the precise mechanisms underlying these effects and to explore its clinical applications, our study contributes to the growing body of evidence supporting the therapeutic potential of neuromodulation techniques in addressing anxiety-related conditions.

Poster

02/15/2024
12:00 pm - 01:15 pm
Room: Shubert Complex (Posters 1-60)

Poster Session 04: Neuroimaging | Neurostimulation/Neuromodulation | Teleneuropsychology/Technology

Final Abstract #31

Anxiety Reduction through Continuous Theta-Burst Stimulation (cTBS)

Shivani Desai, University of Arizona, Tucson, United States
Nekabari Yakpogoro, University of Arizona, Tucson, United States
Melissa Reich-Fuehrer, University of Arizona, Tucson, United States
Lindsey Hildebrand, University of Arizona, Tucson, United States
Alisa Huskey, University of Arizona, Tucson, United States
William Killgore, University of Arizona, Tucson, United States

Category: Neurostimulation/Neuromodulation

Keyword 1: anxiety
Keyword 2: neurostimulation
Keyword 3: sleep

Objective:

Repetitive Transcranial Magnetic Stimulation (rTMS) is a procedure by which a magnetic coil is used to externally stimulate neurons in specific regions of the brain. We conducted continuous theta-burst stimulation (cTBS) to suppress cortical excitability and lower within-network connectivity in the Default Mode Network (DMN), which is associated with rumination and mind-wandering. Prior research has indicated that TMS targeting the dorsolateral prefrontal cortex is effective in improving sleep quality and duration by reducing mind-wandering. We hypothesized that cTBS would be effective in lowering anxiety, as it correlates with both sleep disturbances and pre-sleep rumination. Additionally, pre-sleep rumination has been shown to increase frequency of threatening dreams (Feng 2022), which also correlates with anxiety, so we aimed to determine if this pattern was a contributing factor to the results.

Participants and Methods:

We administered continuous theta burst stimulation (cTBS) to a total of 20 participants with elevated insomnia symptoms (N_males 8, Mage=31.6, SD=6.7) (N_females= 12, Mage=23.8, SD=4.3). The Disturbing Dream and Nightmare Severity Index (DDNSI) was administered to participants prior to their stimulation session, which measures nightmare frequency and intensity. Individuals who scored below a 10 were considered healthy and participants who scored a 10 or above fit the criteria for having a nightmare disorder based on the official scoring guidelines. Participants then underwent one round of sham stimulation and one round of active cTBS in a randomized order with one week in between the sessions. The State Trait Anxiety Inventory (STAI) was administered both before and after each stimulation session. We ran a repeated measures ANCOVA covarying for DDNSI category.

Results:

There was a significant effect of the cTBS condition on reported anxiety scores (F(1,9)=6.570; η_p²=0.422; p=.031). Even while covarying for DDNSI score, the interaction remained significant (F=(1,9)=5.415; η_p²=0.376; p=.045). Participants showed a significantly greater reduction in baseline anxiety post-stimulation (M=39.18, SD=8.681) compared to pre-stimulation (M=41.09, SD=7.803, N=11, p=0.034) during their active cTBS session. During their sham cTBS session, participants demonstrated no significant difference post-stimulation (M=40.91, SD=9.659) compared to pre-stimulation (M=40.64, SD=8.394, N=11, p=0.899).

Conclusions:

Our findings revealed a significant reduction in anxiety levels following active cTBS. By reducing activity in the Default Mode Network, cTBS facilitates better sleep and therefore may increase emotional regulation and mood resulting in reduced state anxiety. One of the advantages of cTBS in anxiety management is its non-invasive nature which sets it apart from other methods such as pharmacological interventions. cTBS is a safer alternative to many pharmacologic approaches as it eliminates the potential for dependency concerns. This targeted neuromodulation approach also has the potential for individualized treatment plans for patients, as stimulation can be tailored to unique neural profiles of patients. While further research is needed to clarify the precise mechanisms underlying these effects and to explore its clinical applications, our study contributes to the growing body of evidence supporting the therapeutic potential of neuromodulation techniques in addressing anxiety-related conditions.