Phoenix Australia researchers have conducted a pilot study of a novel form of brain stimulation therapy for the treatment of posttraumatic stress disorder (PTSD) in veterans which shows promising results.
PTSD is a severe and debilitating condition. Evidence-based treatments as recommended in clinical practice guidelines are trauma-focussed psychological therapies, however, a significant proportion of people do not benefit from these treatments. This is particularly true of military veterans with PTSD, with around two thirds still meeting criteria for PTSD after treatment. Investigation of new and innovative treatments is needed.
Mental health conditions are associated with changes in brain connectivity. In PTSD, disrupted neural networks not only contribute to the clinical symptoms but can also cause deficits in attention, working memory and speed of processing, These difficulties can severely impact day-to-day life, affecting relationships, impacting the ability to work, as well as hampering engagement in psychological therapy.
Brain stimulation therapies aim to reconnect disconnected areas of the brain to alleviate mental health symptoms. Transmagnetic Brain Stimulation (TMS), a non-invasive brain stimulation technique has been well established as an effective treatment for depression. More recently, a novel form of TMS called Theta Burst Stimulation (TBS) has been shown to be just as effective in treating depression as traditional TMS, but with the advantage of being significantly quicker to administer. This study, led by Ms Jane Nursey, Director of Clinical Services and a neuropsychologist, tested a form of Theta Burst Stimulation (TBS) known as intermittent TBS (iTBS) for its acceptability, safety and tolerability as a treatment for PTSD in Australian veterans.
The brain region targeted in this study was the dorsolateral prefrontal cortex. Stimulation to this area is thought to activate more remote regions in the fronto-limbic network – which are involved in PTSD symptoms.
For this study, the first in Australia to explore TBS as a treatment for PTSD, an intermittent form of TBS (iTBS) was chosen and was delivered bilaterally. Eight Australian Defence Force veterans with PTSD received 20 bilateral iTBS treatments (1 session per day, 5 days per week over a 4-week period) and were assessed on a range of mental health and neuropsychological measures, including the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and Hamilton Depression Rating Scale (HAM-D), at pre-treatment, post-treatment, and a 3-month follow-up.
The results of the study showed that the iTBS treatment was well tolerated, and that there were improvements in PTSD symptoms and mood, as well as in working memory and processing speed; these changes remained three months after treatment.
Ms Nursey says that, although “very preliminary”, the results are exciting. “While the study was small, the results show that it has the potential to offer an effective, well tolerated and economical treatment option for Australian veterans with PTSD who may not respond to, or choose not to participate in, standard psychological therapies,” she says.
The research team encourages further rigorous research to explore the feasibility and efficacy of iTBS as an alternative or adjunctive treatment for PTSD.