Reductions in posttraumatic stress disorder re-experiencing frequency from repetitive transcranial magnetic stimulation combined with Cognitive Processing Therapy

Low-frequency (1 Hz) repetitive Transcranial Magnetic Stimulation (rTMS) to right dorsolateral prefrontal cortex (rDLPFC) paired with Cognitive Processing Therapy (CPT) was shown to reduce aggregate posttraumatic stress disorder (PTSD) symptom severity. PTSD, however, consists of re-experiencing, avoidance and numbing, and hyperarousal symptoms that vary in frequency and intensity. Thus, to explore the potential of more granular effects of rTMS on PTSD, the present secondary analysis examined the influence of rTMS on symptom cluster frequency and intensity. In the original study, Post-9/11 United States military veterans with combat-related PTSD were randomly assigned to receive rTMS + CPT or sham rTMS + CPT. The Clinician-Administered PTSD Scale (CAPS), including frequency and intensity ratings for the symptom clusters, was administered at baseline, treatment session 5, treatment session 9, and at 1-, 3-, and 6-months post-treatment. A significant treatment by time interaction was observed only for re-experiencing frequency; whereas other symptom-cluster frequency and intensity effects were not significant. Compared to sham + CPT, rTMS + CPT led to significantly greater, sustained reductions in re-experiencing frequency from session 9 through the 6-month timepoint. Thus, these secondary analyses provide insight into the potential clinical specificity of rTMS in augmenting CPT in PTSD and insight into the possible role of rDLPFC in PTSD.