title: Improvements in emotion regulation following repetitive transcranial magnetic stimulation for generalized anxiety disorder.
abstract: Generalized anxiety disorder (GAD) is characterized by emotion regulation difficulties, which are associated with abnormalities in neural circuits encompassing fronto-limbic regions including the dorsolateral prefrontal cortex (DLPFC). The aim of this study was to determine whether DLPFC neuromodulation improves emotion regulation in patients with GAD. This is a secondary analysis from a randomized-controlled trial comparing 30 sessions of low-frequency right-sided active (n=13) versus sham (n=12, sham coil) repetitive transcranial magnetic stimulation (rTMS) at the right DLPFC in patients with GAD. Results indicated statistically significant improvements in self-reported emotion regulation difficulties at posttreatment and 3-month follow-up in the active group only. Improvements were found primarily in the domains of goal-directed behaviors and impulse control and were significantly associated with a global clinician rating of improvement. These preliminary results support rTMS as a treatment for GAD and suggest improved emotion regulation as a possible mechanism of change.
authors.affiliation: The Institute of Living, Hartford, CT, USA; Yale University School of Medicine, New Haven, CT, USA. Electronic address: Gretchen.Diefenbach@hhchealth.org.
authors.forename: Gretchen J
authors.initials: GJ
authors.lastname: Diefenbach
authors.affiliation: The Institute of Living, Hartford, CT, USA; Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Michal
authors.initials: M
authors.lastname: Assaf
authors.affiliation: The Institute of Living, Hartford, CT, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Goethe
authors.affiliation: Yale University School of Public Health, New Haven, CT, USA.
authors.forename: Ralitza
authors.initials: R
authors.lastname: Gueorguieva
authors.affiliation: The Institute of Living, Hartford, CT, USA; Yale University School of Medicine, New Haven, CT, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Tolin
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy*; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057566:Self Report; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome
keywords: Anxiety; Emotion regulation; Neuromodulation; Randomized-controlled trial