Transcranial Magnetic Stimulation In PTSD And Complex PTSD: Contemporary Stimulation Protocols And Integration With Psychotherapy—A Hybrid Review

A subset of patients with post-traumatic stress disorder (PTSD) and its complex form (cPTSD) fail to achieve sustained remission after standard pharmacotherapy and psychotherapy. This has driven growing interest in repetitive transcranial magnetic stimulation (rTMS) and newer variants—intermittent theta-burst stimulation (iTBS) and deep transcranial magnetic stimulation (dTMS)—which can modulate cortico-limbic networks. This review aims to outline contemporary stimulation protocols used in PTSD/cPTSD and to analyze concepts for combining TMS with psychotherapeutic approaches such as CBT and EMDR. Methods: We conducted a hybrid literature review (systematic and narrative components). PubMed (2018–2025), Google Scholar (snowballing), and ClinicalTrials.gov were searched for adult clinical studies evaluating efficacy and safety of rTMS, iTBS, and dTMS as monotherapy and as an adjunct to psychotherapy. Results: Across studies, active rTMS was associated with clinically meaningful reductions in PTSD symptom severity (commonly measured with PCL and CAPS) and a favorable safety profile. Effects tended to be stronger when TMS was combined with evidence-based psychotherapy, suggesting synergy—particularly when “priming” stimulation was delivered immediately before the therapy session. The most frequently reported adverse events were transient headache and local scalp discomfort. Conclusion: rTMS and iTBS are promising, generally well-tolerated adjuncts to established PTSD treatments and may enhance psychotherapeutic effects. Larger randomized trials—especially including cPTSD populations and neurobiological response markers—are needed to translate these signals into robust evidence.