Transcranial Direct Current Stimulation as a Means of Improving Exposure Therapy Outcomes through Enhanced Retrieval Inhibition


Though cognitive behavioral techniques are generally effective in the treatment of anxiety disorders, some people fail to benefit from exposure therapy or experience a return of fear after terminating exposure therapy. The burgeoning field of non-invasive brain stimulation provides a potential method of augmenting exposure therapy so that it is more effective for treatment-resistant patients. However, very few studies have evaluated the usefulness of non-invasive brain stimulation combined with exposure therapy, and they have only done so in limited populations and with one brain stimulation method. Furthermore, these studies have not assessed the mechanism through which brain stimulation may improve exposure therapy outcomes. The current study aimed to provide more solid and generalizable evidence that brain stimulation can augment the effects of exposure therapy and to evaluate whether improvements are mediated by an increase in retrieval inhibition. These aims were addressed in a double blinded experimental study using either active or sham transcranial direct current stimulation (tDCS) in a bilateral montage over the dorsolateral prefrontal cortex (DLPFC) applied during exposure sessions for blood injection injury (BII) fear. Participants who underwent active tDCS exhibited significantly less retrieval inhibition and BII symptom reduction following exposure than did controls. These results suggest that tDCS may be a promising tool for augmenting exposure therapy outcomes and retrieval inhibition performance. Future research should assess alternate tDCS montages in the hopes of improving, rather than impairing, exposure outcomes.

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