title: Emotional processing and rTMS: does inhibitory theta burst stimulation affect the human startle reflex?
abstract: Repetitive transcranial magnetic stimulation (rTMS) enables the local and non-invasive modulation of cortical activity and has proved to achieve antidepressant effects. To a lesser extent, rTMS is investigated as a treatment option for anxiety disorders. As the prefrontal cortex and the amygdala represent key components of human emotion regulation, we investigated how prefrontally applied rTMS affects the responsiveness of the subcortical amygdala during a fear-relevant study paradigm to examine potential cortico-limbic effects. Sham-controlled, randomised inhibitory rTMS (continuous theta burst stimulation, TBS) was applied to 102 healthy subjects (female = 54) over the right dorsolateral prefrontal cortex. Subsequently, the emotion-potentiated (unpleasant, neutral, and pleasant International Affective Picture System pictures) acoustic startle response was investigated. Subjective anxiety ratings (anxiety sensitivity, trait and state anxiety) were considered. Picture category affected the startle magnitude as expected for both TBS intervention groups (highest startle response for unpleasant, lowest for pleasant pictures). However, no modulatory effects of TBS on startle potentiation were discerned. No significant interaction effects of TBS intervention, subjective anxiety ratings, and gender were identified. Interestingly, startle habituation was influenced by TBS intervention on a trend-level, with verum TBS leading to an accelerated habituation. We found no evidence for the hypothesis that prefrontal inhibitory TBS affects the responsiveness of the amygdala during the presentation of emotionally relevant stimuli in healthy subjects. Instead, we found accelerated habituation under verum TBS on a statistical trend-level. Hence, some preliminary hints for modulatory effects of inhibitory TBS on basic learning mechanisms could be found.
authors.affiliation: School of Health, Muenster University of Applied Sciences, Leonardo Campus 8, 48149, Muenster, Germany. nadja.vennewald@web.de.|Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Gebaeude A9, 48149, Muenster, Germany. nadja.vennewald@web.de.
authors.forename: Nadja
authors.initials: N
authors.lastname: Vennewald
authors.affiliation: Catholic University of Applied Sciences North Rhine-Westphalia, Muenster, Piusallee 89, 48147, Muenster, Germany.
authors.forename: Bernward
authors.initials: B
authors.lastname: Winter
authors.affiliation: Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, University Hospital Klinikum rechts der Isar, Technische Universität München, Langerstr. 3, 81675, Munich, Germany.
authors.forename: Karina
authors.initials: K
authors.lastname: Limburg
authors.affiliation: kbo-Inn-Salzach-Hospital, Gabersee 7, 83512, Wasserburg am Inn, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Diemer
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Gebaeude A9, 48149, Muenster, Germany.
authors.forename: Swantje
authors.initials: S
authors.lastname: Notzon
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Gebaeude A9, 48149, Muenster, Germany.
authors.forename: Inga
authors.initials: I
authors.lastname: Fohrbeck
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Gebaeude A9, 48149, Muenster, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Arolt
authors.affiliation: Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Fuechsleinstrasse 15, 97080, Wuerzburg, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Domschke
authors.affiliation: Department of Psychology, University of Wuerzburg, Marcusstrasse 9-11, 97070, Wuerzburg, Germany.
authors.forename: Paul
authors.initials: P
authors.lastname: Pauli
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Gebaeude A9, 48149, Muenster, Germany.|kbo-Inn-Salzach-Hospital, Gabersee 7, 83512, Wasserburg am Inn, Germany.|Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nußbaumstraße 7, 80336, Munich, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Zwanzger
mesh_terms: D000161:Acoustic Stimulation; D000328:Adult; D000704:Analysis of Variance; D004644:Emotions / Q000502:physiology*; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D017397:Prefrontal Cortex / Q000502:physiology*; D011569:Psychiatric Status Rating Scales; D013216:Reflex, Startle / Q000502:physiology*; D012737:Sex Factors; D013826:Theta Rhythm / Q000502:physiology*; D050781:Transcranial Magnetic Stimulation; D055815:Young Adult
keywords: Acoustic startle response; Emotion regulation; Emotion-potentiated acoustic startle response; Repetitive transcranial magnetic stimulation (rTMS); Startle habituation; Theta burst stimulation (TBS)