TMS promotes emotional regulation in adults with high-level perceived stress
Poster No:
115
Submission Type:
Abstract Submission
Authors:
Youze He1, Jingsong Wu1, Xiujuan Geng2
Institutions:
1Fujian University of Traditional Chinese Medicine, Fuzhou, NA, 2The Chinese University of Hong Kong, Hong Kong, NA
First Author:
Co-Author(s):
Introduction:
The prevalence of high-level stress has been reported to be over 30% in young adults (Ramón-Arbués et al., 2021). Individuals with high-level perceived stress exhibit abhnormal activities of the dorsolateral prefrontal cortex (DLPFC), associated with low mood and anxiety symptoms (Scult et al., 2017). Repetitive transcranial magnetic resonance stimulation (rTMS) has been evidenced to be effective on modulating DLPFC functions in stress-related psychiatric disorders, such as major depression and anxiety. However, whether the modulation of DLPFC with rTMS benefits to the recovery of negative feelings in adults with high-level perceived stress remain unclear. This study aimed to explore the effect of rTMS on the recovery of stress-related symptoms and its potential neural effect on DLPFC functions.
Methods:
This was a randomized controlled trial that enrolled 50 young adults aged 18-24 years old with high-level perceived stress to verify the rTMS effect on their emotional trait: depression, anxiety, and stress. Subjects were randomly assigned to the experimental group (12-session active rTMS in four weeks, thrice per week) and control group (sham rTMS with the same dose). Outcome measurements included the negative symptoms using the Depression Anxiety Stress scale (DASS) and DLPFC functional connectivity. Both the DASS and MRI data were collected before and after the intervention.
We conducted the rTMS stimulation on the bilateral DLPFC using the Magstim Rapid 2 stimulator. The intermittent theta burst stimulation (TBS) model and continuous TBS model with both 600 pulses were used on the left and right sides, respectively (Wu et al., 2021). Both T1-weighted structural and resting-state functional MRI images were acquired under Siemens Prisma 3.0 Tesla scanner.
The resting state fMRI data were preprocessed using DPABI version 6.0 and SPM12. The ROI-wise functional connectivity (FC) analysis was performed using the MNI coordinate of left (-27, 43, 31) and right DLPFC (30, 37, 36) with 6mm radius according to the Brainnetome atlas. The changes between baseline and post-intervention of DLPFC FC were calculated and compared using the SPM12 with the threshold: voxel P<0.005 uncorrected, cluster P<0.05 FDR corrected.
Statistical analyses were conducted by an independent statistical analyst. The analysis of covariances was conducted to compare the between-group difference of outcome changes. The models included dependent variables (changes of measured outcomes), fixed factors (i.e., treatment arms), and covariance as predictors (i.e., age, gender, and years of education). Then, to examine the within-group difference of each group between baseline and end of the intervention, the paired t-test or Wilcoxon test was conducted according to data normality.
We conducted the rTMS stimulation on the bilateral DLPFC using the Magstim Rapid 2 stimulator. The intermittent theta burst stimulation (TBS) model and continuous TBS model with both 600 pulses were used on the left and right sides, respectively (Wu et al., 2021). Both T1-weighted structural and resting-state functional MRI images were acquired under Siemens Prisma 3.0 Tesla scanner.
The resting state fMRI data were preprocessed using DPABI version 6.0 and SPM12. The ROI-wise functional connectivity (FC) analysis was performed using the MNI coordinate of left (-27, 43, 31) and right DLPFC (30, 37, 36) with 6mm radius according to the Brainnetome atlas. The changes between baseline and post-intervention of DLPFC FC were calculated and compared using the SPM12 with the threshold: voxel P<0.005 uncorrected, cluster P<0.05 FDR corrected.
Statistical analyses were conducted by an independent statistical analyst. The analysis of covariances was conducted to compare the between-group difference of outcome changes. The models included dependent variables (changes of measured outcomes), fixed factors (i.e., treatment arms), and covariance as predictors (i.e., age, gender, and years of education). Then, to examine the within-group difference of each group between baseline and end of the intervention, the paired t-test or Wilcoxon test was conducted according to data normality.
Results:
Forty-eight subjects (24 in each group) were finally included after excluding two data due to over-threshold head-motion. The comparison of demographics and baseline assessments showed there was no significant group difference in age, sex, years of education, smoking, alcohol, TONI3 scores, total intracranial volume, and baseline scores of perceived stress scale and DASS (ps>0.05).
There were significant decreases in DASS total scores (p<0.001), anxiety (p=0.008), and stress (p=0.002) scores in experimental groups, while only stress scores decreased in the control group (p=0.006) (see Fig. 1). There was significant between-group difference in DASS total scores (p=0.016) after controlling age, gender, and years of education. The FC between left DLPFC and left Supplementary motor area and between right DLPFC and right frontal superior medial cortex were significantly decreased after active rTMS (Voxel p<0.005 uncorrected, Cluster p<0.05 FDR corrected) (See Fig. 2).
There were significant decreases in DASS total scores (p<0.001), anxiety (p=0.008), and stress (p=0.002) scores in experimental groups, while only stress scores decreased in the control group (p=0.006) (see Fig. 1). There was significant between-group difference in DASS total scores (p=0.016) after controlling age, gender, and years of education. The FC between left DLPFC and left Supplementary motor area and between right DLPFC and right frontal superior medial cortex were significantly decreased after active rTMS (Voxel p<0.005 uncorrected, Cluster p<0.05 FDR corrected) (See Fig. 2).
Conclusions:
The twelve-session rTMS effectively improved the stress and anxiety level of young adults with high-level perceived stress; meanwhile it also modulated the DLPFC functions.
Brain Stimulation:
TMS 1
Disorders of the Nervous System:
Psychiatric (eg. Depression, Anxiety, Schizophrenia) 2
Keywords:
Anxiety
Emotions
FUNCTIONAL MRI
Transcranial Magnetic Stimulation (TMS)
1|2Indicates the priority used for review
Provide references using author date format
De Risio, L., et al. (2020), ‘Recovering from depression with repetitive transcranial magnetic stimulation (rTMS): a systematic review and meta-analysis of preclinical studies’, Transl Psychiat 10, 393.
Ramón-Arbués, E. et al. (2020), ‘The Prevalence of Depression, Anxiety and Stress and Their Associated Factors in College Students’, Int J Env Res Pub He 17.
Scult, M.A., et al., (2017), ‘Thinking and Feeling: Individual Differences in Habitual Emotion Regulation and Stress-Related Mood are Associated with Prefrontal Executive Control’, Clin Psychol Sci 5, 150-157.
Wu, J., et al., (2021), ‘The efficacy of repetitive transcranial magnetic stimulation (rTMS) for young individuals with high-level perceived stress: study protocol for a randomized sham-controlled trial’, Trials 22, 365.