Summary of stimulation protocol, statistical analyses, main results and additional groups and measures (part 1 of 2)
| Study | Protocol | Follow-up | Statistical analysis | Reported results | Additional groups | Additional pre/post measures |
|---|---|---|---|---|---|---|
| De Lima et al.86 (2019) | 5 consecutive days | 1 wk | ANOVA repeated-measures | Anxiety and depression symptoms did not differ between real and sham tDCS. Physical symptoms of stress were reduced at the end of treatment and at follow-up in the tDCS group v. the sham group | None | Anxiety: BAI Global evaluation: PANAS |
| Deppermann et al.115 (2014) | 5 daily sessions; 3 wk | NR | ANOVA repeated-measures | No differences in real v. sham rTMS. Both groups showed improvement in anxiety symptoms post-iTBS v. baseline | Healthy controls; only for fNIRS | Physiological: CAQ Brain activation: fNIRS Cognitive: verbal fluency |
| Diefenbach et al.116 (2016) | 5 daily sessions; 6 wk | 3 mo, 6 mo (only a subset not included in statistical analysis) | ANOVA repeated- measures; planned contrasts | Anxiety symptoms improved in post- v. pre- measurements in rTMS and sham groups that persisted at 3 mo follow-up only in the rTMS group. Worry and depressive symptoms improved only in the rTMS group at the end of treatment and at 3 mo follow-up. Brain activation increased after rTMS and tended to decrease after sham | None | Anxiety/mood: DASS-DEP Brain activation: fMRI during gambling task |
| Dilkov et al.87 (2017) | 6 wk; 5 sessions/wk for the first 4 wk; during the wk 5, sessions reduced to 3 times/wk; during wk 6, sessions reduced to 2 times/wk | 2 wk and 6 wk after the end of treatment | ANOVA repeated-measures | Anxiety and depressive symptoms improved in the stimulation v. sham condition at the end of treatment and the 2 follow-ups | None | Global evaluation: CGI |
| Herrmann et al.117 (2017) | 2 sessions | 3 mo | ANOVA repeated-measures; t test | 2 sessions of rTMS reduced anxiety and avoidance ratings compared to the sham group | None | Anxiety: AQ-avoidance subscale; BAT |
| Huang et al.118 (2018) | 10 consecutive days | 2 wk, 1 mo | ANOVA repeated- measures | Anxiety, insomnia and depressive symptoms improved in the rTMS group v. the sham group at the end of treatment and the 2 follow-ups | None | NR |
| Mantovani et al.119 (2013) | 5 d/wk; 4 wk double- blind + 4 weeks real* | 1, 3 and 6 mo | ANOVA repeated- measures; t test | 4 weeks rTMS v. sham: improvement in panic symptoms but not depression. 8 weeks of rTMS v. pre- treatment: improvement in panic and depressive symptoms, global assessment, and social adjustment | None | Anxiety: PDSS, PDSS-SR Mood: BDI; ZUNG-SAS Global evaluation: CGI; PGI; SASS |
| Movahed et al.120 (2018) | 4 wk | 2 mo | ANOVA repeated- measures | Worry, anxiety and depression scores were reduced after cathodal tDCS and pharmacotherapy v. sham tDCS. Pharmacotherapy was stronger than tDCS in reducing worry; tDCS was stronger in reducing depression. Anxiety symptoms did not differ after cathodal tDCS compared to pharmacotherapy | Pharmacotherapy | NR |
| Nasiri et al.121 (2020) | 10 daily sessions; 2 wk | 3 mo | MANCOVA | Worry, anxiety and anxiety sensitivity improved after UP + tDCS v. UP alone at the end of treatment and at follow-up | Waiting list | Anxiety: ASI; IUS; PSWQ |
| Notzon et al.88 (2015) | Single session | NR | ANOVA repeated- measures | iTBS increased sympathetic activity during the spider scene in both phobic and healthy participants | Healthy controls (real and sham) | Anxiety: FSQ; ASI Global evaluation: IPQ; SUDS; DS Physiological: HR; SCL Brain activation: fNIRS |
| Prasko et al.122 (2007) | 5 daily sessions; 2 wk | 2 wk | Nonparametric repeated- measures ANOVA | Anxiety symptoms and psychopathology global scores improved after both real and sham rTMS | None | Anxiety: BAI Global evaluation: CGI |
ANOVA = analysis of variance; AQ = Acrophobia Questionnaire; ASI = Anxiety Sensitivity Index; BAI = Beck Anxiety Inventory; BAT = Behavioral Avoidance Test; BDI = Beck Depression Inventory; CAQ = Cardiac Anxiety Questionnaire; CGI = Clinical Global Impression Scale; DASS-DEP = Depression-Anxiety Scales Depression Subscale; DS = Disgust Scale; fMRI = functional magnetic resonance imaging; fNIRS = functional near-infrared spectroscopy; FSQ = Fear of Spiders Questionnaire; HR = heart rate; IPQ = Igroup Presence Questionnaire; iTBS = intermittent theta burst stimulation; IUS = Intolerance of Uncertainty Scale; MANCOVA = multivariate analysis of covariance; NR = not reported; PANAS = Positive and Negative Affect Schedule; PDSS(−SR) = Panic Disorder Severity Scale (self-report); PGI = Patient Global Impression; PSWQ = Penn State Worry Questionnaire; rTMS = repetitive transcranial magnetic stimulation; SASS = Self-reported Social Adaptation Scale; SCL = skin conductance level; SUDS = Subjective Units of Discomfort Scale; tDCS = transcranial direct current stimulation; UP = unified protocol; ZUNG-SAS= Zung-Self Administered Scale.
↵* In our analysis, we included data for the baseline and the first 4 weeks of rTMS treatment.