PTSD Symptom Severity and Neurocognitive Performance as a Function of Combined TMS and Imaginal Exposure in OIF/OEF Combat Veterans with Treatment Resistant PTSD

Posttraumatic Stress Disorder (PTSD) is a commonly occurring mental health diagnosis, and is particularly prevalent in combat veterans. Although there has been some success treating PTSD with various forms of therapy, many cases remain refractory to the current standard of care. This pilot study combines transcranial magnetic stimulation (TMS) to the right dorsolateral prefrontal cortex (DLPFC) and the supplementary motor area (SMA) with a standardized exposure protocol for the treatment of chronic, treatment-resistant PTSD. The aims are to (1) determine if the treatment is safe and well tolerated, (2) determine if PTSD and concomitant depression and anxiety symptoms improve, and (3) determine if executive functioning and memory improve. Results indicated the treatment was safe and well tolerated, and improvements were seen across psychological symptoms. Neurocognitively, improvements were seen in executive functioning but not in non-executive memory. Statistically significant results must be interpreted with caution due to the likelihood of sampling error associated with a small sample size. However, clinical results were striking, with six of the seven participants no longer meeting criteria for PTSD by the end of the study. Clinical results for this pilot study were promising and warrant further investigation with larger sample sizes utilizing a RCT model to confirm and expand upon these preliminary findings