title: Medial prefrontal cortex stimulation accelerates therapy response of exposure therapy in acrophobia.
abstract: Animal as well as human research indicated that the ventral medial prefrontal cortex (vmPFC) is highly relevant for fear extinction learning. Recently, we showed that targeting the vmPFC with high-frequency repetitive transcranial magnetic stimulation (rTMS) in a placebo-controlled study with 45 healthy controls induced higher prefrontal activity during extinction of conditioned stimuli (CS+) in the active compared to the sham stimulated group and better extinction learning as indicated by ratings, fear potentiated startles and skin conductance responses.
  
  
  
  In this study, we aimed to proof our concept of accelerating extinction learning using rTMS of the mPFC in a group of anxiety disorder patients.
  
  
  
  To specifically evaluate the impact of rTMS on exposure-based therapy, we applied a sham-controlled protocol over the vmPFC (FPz) succeeded by a virtual reality exposure therapy (VRET) in n = 20 participants with acrophobia and n = 19 controls.
  
  
  
  We found a significantly higher reduction in active compared to sham stimulated group for anxiety (t[37] = 2.33, p < 0.05) as well as avoidance ratings t[37] = 2.34, p < 0.05) from pre to post therapy.
  
  
  
  This study provides first clinical evidence that high-frequency rTMS over the vmPFC improves exposure therapy response of acrophobia symptoms.
authors.affiliation: Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University of Würzburg, Würzburg, Germany. Electronic address: Herrmann_m@ukw.de.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Herrmann
authors.affiliation: Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University of Würzburg, Würzburg, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Katzorke
authors.affiliation: Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University of Würzburg, Würzburg, Germany.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Busch
authors.affiliation: Department of Psychology, Center of Mental Health, University of Würzburg, Würzburg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gromer
authors.affiliation: Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University of Würzburg, Würzburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Polak
authors.affiliation: Department of Psychology, Center of Mental Health, University of Würzburg, Würzburg, Germany.
authors.forename: Paul
authors.initials: P
authors.lastname: Pauli
authors.affiliation: Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University of Würzburg, Würzburg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Deckert
mesh_terms: D000328:Adult; D000818:Animals; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D003131:Combined Modality Therapy / Q000379:methods; D003213:Conditioning, Psychological / Q000502:physiology; D004311:Double-Blind Method; D005239:Fear / Q000502:physiology / Q000523:psychology; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010698:Phobic Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D017397:Prefrontal Cortex / Q000502:physiology*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome
keywords: Acrophobia; Medial prefrontal cortex; Psychotherapy; Repetitive transcranial magnetic stimulation; Virtual reality