Psychotherapy of Anxiety Disorders With Noninvasive Brain Stimulation - Using Virtual Reality

Phobia Clinical Trial

Official title:

Nicht-invasive Hirnstimulation in Der Psychotherapie Von Angsterkrankungen

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04782570
• Other study ID #: Wuerzburg45/20-am
• Secondary ID: PAN_VR
• Status: Completed
• Phase: N/A
• Start date: May 12, 2021
• Est. completion date: April 28, 2023

Study information

• Verified date: August 2023
• Source: Wuerzburg University Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The aim of the study is to transfer the rTMS stimulation protocol by Raij et al. (2018) into a therapeutic setting to improve exposure therapy in acrophobic patients. The quasi-randomized, placebo-controlled and double-blinded study will include 88 patients with height phobia (according to DSM 5). All participants will perform two exposure sessions in virtual reality (VR). Before exposure therapy, one group will receive verum rTMS of the left frontal cortex, which is indirectly functionally linked to the ventromedial prefrontal cortex (Raij et al., 2018). The control group will receive sham stimulation. A structural MRI and a TMS navigation system will be used for precise localization of the left FC. Anxiety symptoms will be measured using subjective ratings (e.g. Acrophobia Questionnaire) and the behavioural approach task (BAT) in VR and in real life before and after the treatment, and at 6 months follow-up. Furthermore, blood samples will be collected before rTMS and after exposure treatment to assess epigenetic and gene expression based changes.

Description:

The following hypotheses are derived:

1. Patients with acrophobia, who receive an active rTMS of the left FC before VRET, show a significantly stronger reduction of phobic symptoms immediately after exposure therapy, compared to the sham stimulation group.

2. Patients with acrophobia, who receive an active rTMS of the left FC before VRET, show a significantly greater increase in approach behavior and significantly less distress during the BAT immediately after exposure therapy, compared to the sham stimulation group.

3. The postulated differences in hypotheses 1 and 2 are still detectable at follow-up after 6 months.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 87
• Est. completion date: April 28, 2023
• Est. primary completion date: September 27, 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

Inclusion Criteria:

• Acrophobia (according to DSM-5)

• Right handed

• German native speaker

• Written informed consent

Exclusion Criteria:

• Neurological and/or severe physical illnesses

• Comorbid Axis I disorder (other than phobias)

• Pretreated phobia of heights

• Use of tricyclic antidepressants, antipsychotics, or other substances that increase cerebral seizure susceptibility

• Craniocerebral injuries, head surgery

• Epileptic seizures, or family history of epilepsy

• Metal parts in the head area

• Cardiac pacemakers

• Infusion pumps

• Heart diseases

• Increased intracranial pressure

• Pregnancy

• Cochlear implants

• Tattoos (done before the year 2000)

• Piercings (if not completely removable)

• Permanent make-up

• Nicotine or pain patches

• other MRI contraindications

Related Conditions & MeSH terms

• Phobia

Intervention

Device:
• Verum TMS
Intensity of 100% of the resting motor threshold with iTBS. 600 stimuli applied in bursts of three pulses at 50 Hz given every 200 ms. iTBS will be applied 20 times for 2 s every 10 s.
• Sham TMS
Sham stimulation with same protocol, but without magnetic stimulation

Locations

Country	Name	City	State
Germany	Martin J. Herrmann	Würzburg

Sponsors (2)

Lead Sponsor	Collaborator
Wuerzburg University Hospital	University of Wuerzburg

Country where clinical trial is conducted

Germany, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Subjective anxiety symptoms	Acrophobia Questionnaire (Cohen, 1977) with two subscales: 1) degree of anxiety (ACRO) and 2) degree of avoidance (AVOI) in height-related situations.	change from T1 (baseline /study start) to T4 (immediately after treatment)
Secondary	Subjective anxiety in behavioral approach tests (BAT)	anxiety measurement by a behavioral approach test (BAT) in virtual reality (glass elevator on the outside of an high-rise building, height up to 150m) and in real life (open stairwell height up to 11,6m).	change from T1 (baseline /study start) to T4 (immediately after treatment)
Secondary	Subjective anxiety symptoms (Follow-Up)	Acrophobia Questionnaire (Cohen, 1977) with two subscales: 1) degree of anxiety (ACRO) and 2) degree of avoidance (AVOI) in height-related situations.	change from T1 (baseline/ study start) to T28 (6 months follow-up)
Secondary	Subjective anxiety in behavioral approach tests (BAT) (Follow-Up)	anxiety measurement by a behavioral approach test (BAT) in virtual reality (glass elevator on the outside of an high-rise building, height up to 150m) and in real life (open stairwell height up to 11,6m).	change from T1 (baseline /study start) to T28 (6 months follow-up)