Developing a Novel rTMS Intervention for Transdiagnostic Psychosocial Rehabilitation: A Dose Finding Study
Overview
- Phase
- Phase 1
- Intervention
- Not specified
- Conditions
- Mental Health
- Sponsor
- VA Office of Research and Development
- Enrollment
- 21
- Locations
- 1
- Primary Endpoint
- World Health Organization Quality of Life - Brief Form (WHOQOL-BF)
- Status
- Completed
- Last Updated
- 2 years ago
Overview
Brief Summary
Mental illness rarely occurs as a single, easily categorized condition. Instead, multiple disorders often co-occur. This complicates the treatment plan for many Veterans, especially those suffering the most severe dysfunction. This also means that clinical research aimed at one specific disorder may not be optimized to treat the realworld presentation of neuropsychiatric illness. The investigators propose in this study to develop a novel, non-invasive brain stimulation treatment that would promote rehabilitation for Veterans suffering a wide range of emotional difficulties. More specifically, the investigators propose to up-regulate the brain circuitry that supports flexible problem solving and contending with daily demands. Rather than focusing on reducing the symptoms of a specific disorder to reduce the intrusion into daily life, the investigators propose to augment those brain circuits that promote adaptive cognition and thus quality of life.
Detailed Description
The investigators propose that because rTMS to dlPFC is targeting cognitive neurocircuitry integral to adaptive cognitive functioning, promoting neuroplasticity in this network with rTMS could be more precisely optimized to improve quality of life across psychosocial domains and across neuropsychiatric presentations. The investigators postulate that through up-regulating cognitive control circuitry with rTMS that an individual would have 1) enhanced capacity for successfully contending with the shifting contingencies of daily life and 2) improved ability to regulate intrusive affect and impulses. As a function of these processes an individual is expected to experience reduced psychosocial impairment. Thus, the investigators propose that rather than targeting specific symptom reductions in specific disorders, rTMS could be dosed for efficacy in enhancing psychosocial functioning. Such an approach has the potential to enhance rehabilitation for far more Veterans suffering a range of neuropsychiatric conditions. Aim 1. Establish the dose-response curve for improved psychosocial functioning secondary to accelerated rTMS in a transdiagnostic anxious and depressed sample of Veterans. Aim 2. Establish the safety, feasibility, and acceptability of an accelerated delivery schedule of therapeutic rTMS for improved psychosocial functioning in a transdiagnostic anxious and depressed sample of Veterans. Exploratory Aim 3. Establish whether neurocognitive function demonstrates a dose-response function to accelerated rTMS similar to psychosocial functioning in a transdiagnostic anxious and depressed sample. Note: COVID-19 pandemic put a pause on enrollment.
Investigators
Eligibility Criteria
Inclusion Criteria
- •A negative urine pregnancy test, if female subject of childbearing potential.
- •Able to speak English and complete study forms, adhere to treatment regimens, and be willing to return for regular visits.
- •After full explanation of the study, willingness of participant is demonstrated by signing the informed consent form.
Exclusion Criteria
- •Clinically unstable medical disease:
- •cardiovascular
- •gastrointestinal
- •pulmonary
- •metabolic
- •endocrine
- •CNS disease deemed progressive
- •Moderate or severe traumatic brain injury (TBI) - (using VA/DoD Clinical Practice Guidelines)
- •Pregnant females or those currently breast-feeding.
- •Current or history of schizophrenia or other psychotic disorder, except psychosis not otherwise specified (NOS) when the presence of sensory hallucinations is clearly related to the subject's trauma, Bipolar Type I disorder, or dementia
Outcomes
Primary Outcomes
World Health Organization Quality of Life - Brief Form (WHOQOL-BF)
Time Frame: 4 weeks post-treatment
The WHOQOL-BREF is a 26-item self-assessment form. Questions are rated on a 5 point scale (from 1-5) Likert scale. Reflects four domains: physical, psychological, social and environment.
Inventory of Psychosocial Functioning (IPF)
Time Frame: 4 weeks post-treatment
The IPF is an 80-item self-report measure used to assess functional impairment across multiple psychosocial domains of functioning. It was iteratively developed in 697 male and female Veteran stakeholders to identify relevant domains of functional impairment common in PTSD and related psychiatric dysfunction. Total score range=0-480. Increased scores pre- to 4 weeks post-treatment would indicate improved function.
Illness Intrusiveness Rating Scale (IIRS)
Time Frame: 4 weeks post-treatment
The IIRS is a self-report measure of the extent of psychosocial impairment secondary to illness. Total score range=13-91. Decreased scores pre- to 4 weeks post-treatment would indicate improved function.
Secondary Outcomes
- Inventory of Depression and Anxious Symptoms (IDAS-II)(4 weeks post-treatment)
- Hamilton Scale for Depression (HAM-D)(4 weeks post-treatment)
- Neurocognitive performance(4 weeks post-treatment)
- Mood and Anxiety Symptom Questionnaire (MASQ)(4 weeks post-treatment)