title: Repetitive transcranial magnetic stimulation for generalised anxiety disorder: a pilot randomised, double-blind, sham-controlled trial.
abstract: Repetitive transcranial magnetic stimulation (rTMS) holds promise for treating generalised anxiety disorder (GAD) but has only been studied in uncontrolled research.
  
  
  
  This is the first randomised controlled trial (clinicaltrials.gov: NCT01659736) to investigate the efficacy and neural correlates of rTMS in GAD.
  
  
  
  Twenty five participants (active n = 13; sham, n = 12) enrolled. rTMS was targeted at the right dorsolateral prefrontal cortex (DLPFC, 1 Hz, 90% resting motor threshold).
  
  
  
  Response and remission rates were higher in the active v. sham groups and there were significant group × time interactions for anxiety, worry and depressive symptoms, favouring active v. sham. In addition, right DLPFC activation during a decision-making gambling task increased at post-treatment for active rTMS only, and changes in neuroactivation correlated significantly with changes in worry symptoms.
  
  
  
  Findings provide preliminary evidence that rTMS may improve GAD symptoms in association with modifying neural activity in the stimulation site.
authors.affiliation: Gretchen J. Diefenbach, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; Laura B. Bragdon, MA, Binghamton University, Binghamton, New York; Luis Zertuche, BSc, Christopher J. Hyatt, PhD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford, Connecticut; Lauren S. Hallion, PhD, Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut; David F. Tolin, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; John W. Goethe, MD, Burlingame Center for Research and Education, The Institute of Living, Hartford, Connecticut; Michal Assaf, MD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut, USA Gretchen.Diefenbach@hhchealth.org.
authors.forename: Gretchen J
authors.initials: GJ
authors.lastname: Diefenbach
authors.affiliation: Gretchen J. Diefenbach, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; Laura B. Bragdon, MA, Binghamton University, Binghamton, New York; Luis Zertuche, BSc, Christopher J. Hyatt, PhD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford, Connecticut; Lauren S. Hallion, PhD, Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut; David F. Tolin, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; John W. Goethe, MD, Burlingame Center for Research and Education, The Institute of Living, Hartford, Connecticut; Michal Assaf, MD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Laura B
authors.initials: LB
authors.lastname: Bragdon
authors.affiliation: Gretchen J. Diefenbach, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; Laura B. Bragdon, MA, Binghamton University, Binghamton, New York; Luis Zertuche, BSc, Christopher J. Hyatt, PhD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford, Connecticut; Lauren S. Hallion, PhD, Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut; David F. Tolin, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; John W. Goethe, MD, Burlingame Center for Research and Education, The Institute of Living, Hartford, Connecticut; Michal Assaf, MD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Luis
authors.initials: L
authors.lastname: Zertuche
authors.affiliation: Gretchen J. Diefenbach, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; Laura B. Bragdon, MA, Binghamton University, Binghamton, New York; Luis Zertuche, BSc, Christopher J. Hyatt, PhD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford, Connecticut; Lauren S. Hallion, PhD, Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut; David F. Tolin, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; John W. Goethe, MD, Burlingame Center for Research and Education, The Institute of Living, Hartford, Connecticut; Michal Assaf, MD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hyatt
authors.affiliation: Gretchen J. Diefenbach, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; Laura B. Bragdon, MA, Binghamton University, Binghamton, New York; Luis Zertuche, BSc, Christopher J. Hyatt, PhD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford, Connecticut; Lauren S. Hallion, PhD, Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut; David F. Tolin, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; John W. Goethe, MD, Burlingame Center for Research and Education, The Institute of Living, Hartford, Connecticut; Michal Assaf, MD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Lauren S
authors.initials: LS
authors.lastname: Hallion
authors.affiliation: Gretchen J. Diefenbach, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; Laura B. Bragdon, MA, Binghamton University, Binghamton, New York; Luis Zertuche, BSc, Christopher J. Hyatt, PhD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford, Connecticut; Lauren S. Hallion, PhD, Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut; David F. Tolin, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; John W. Goethe, MD, Burlingame Center for Research and Education, The Institute of Living, Hartford, Connecticut; Michal Assaf, MD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Tolin
authors.affiliation: Gretchen J. Diefenbach, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; Laura B. Bragdon, MA, Binghamton University, Binghamton, New York; Luis Zertuche, BSc, Christopher J. Hyatt, PhD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford, Connecticut; Lauren S. Hallion, PhD, Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut; David F. Tolin, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; John W. Goethe, MD, Burlingame Center for Research and Education, The Institute of Living, Hartford, Connecticut; Michal Assaf, MD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Goethe
authors.affiliation: Gretchen J. Diefenbach, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; Laura B. Bragdon, MA, Binghamton University, Binghamton, New York; Luis Zertuche, BSc, Christopher J. Hyatt, PhD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford, Connecticut; Lauren S. Hallion, PhD, Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut; David F. Tolin, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; John W. Goethe, MD, Burlingame Center for Research and Education, The Institute of Living, Hartford, Connecticut; Michal Assaf, MD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Michal
authors.initials: M
authors.lastname: Assaf
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000628:therapy*; D003657:Decision Making / Q000502:physiology; D004311:Double-Blind Method; D005260:Female; D059907:Functional Neuroimaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010865:Pilot Projects; D017397:Prefrontal Cortex / Q000502:physiology*; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome; D055815:Young Adult