Enhancing Cognitive Restructuring with Concurrent Repetitive Transcranial Magnetic Stimulation: A Transdiagnostic Randomized Controlled Trial

Journal Article


Emotional dysregulation constitutes a serious public health problem in need of novel transdiagnostic treatments.


To this aim, we developed and tested a one-time intervention that integrates behavioral skills training with concurrent repetitive transcranial magnetic stimulation (rTMS).


Forty-six adults who met criteria for at least one DSM-5 disorder and self-reported low use of cognitive restructuring (CR) were enrolled in a randomized, double-blind, sham-controlled trial that used a between-subjects design. Participants were taught CR and underwent active rTMS applied at 10 Hz over the right (n= 17) or left (n= 14) dorsolateral prefrontal cortex (dlPFC) or sham rTMS (n= 15) while practicing reframing and emotional distancing in response to autobiographical stressors.


Those who received active left or active right as opposed to sham rTMS exhibited enhanced regulation ( d s = 0.21 - 0.62) as measured by psychophysiological indices during the intervention (higher high-frequency heart rate variability, lower regulation duration). Those who received active rTMS over the left DLPFC also self-reported reduced distress througout the intervention ( d = 0.30), higher likelihood to use CR, and lower daily distress during the week following the intervention. The procedures were acceptable and feasible with few side effects.


These findings show that engaging frontal circuits simultaneously with cognitive skills training and rTMS may be clinically feasible, well-tolerated and may show promise for the treatment of transdiagnostic emotional dysregulation. Larger follow up studies are needed to confirm the efficacy of this novel therapeutic approach.

Full Text

Duke Authors

Cited Authors

  • Neacsiu, A; Beynel, L; Powers, J; Szabo, S; Appelbaum, L; Lisanby, S; LaBar, K

Published Date

  • January 20, 2021

Digital Object Identifier (DOI)

  • 10.1101/2021.01.18.21250060