Testing the effectiveness of combined attention modification training with right dorso-lateral prefrontal cortex theta-burst stimulation on reducing levels of anxiety and attentional bias

Neurostimulation techniques, such as continuous theta-burst stimulation (cTBS), over the dorsolateral prefrontal cortex (DLPFC) have been associated with improvements in anxiety symptoms and emotion processing. The aim of this feasibility study was the evaluation of the effectiveness of cTBS over the right DLPFC combined with Attention Modification Training (AMT) on reducing levels of anxiety and attentional bias. A 40s-cTBS session (real or sham) over the right DLPFC was administrated at 8 treatment sessions over a 2-week period, and each cTBS treatment was followed by computer-based AMT (real or control). Eighty-nine participants (Mage = 21.29, SD = 2.06, 50.56% females) differentiated on levels of anxiety were randomly assigned to the following treatment groups (i) cTBS and AMT, (ii) cTBS and control AMT, and (iii) sham cTBS and AMT. Findings suggested that cTBS combined with AMT treatment was not superior to sham cTBS and AMT on reducing self-reported anxiety symptoms. However, combined cTBS and AMT was associated with increased attention towards positive stimuli and increased gaze fixation in the mouth region of happy facial expressions. Current results provide promising evidence for the effectiveness of AMT in reducing anxiety symptoms and contribute to existing knowledge on how inhibitory stimulation over the right DLPFC combined with AMT may influence emotion processing. Present findings can inform future treatments designed to address the attention mechanisms leading to anxiety symptoms.