Supplementary Material for: Enhancing Cognitive Restructuring with Concurrent Repetitive Transcranial Magnetic Stimulation: A Transdiagnostic Randomized Controlled Trial

<b><i>Introduction:</i></b> Emotional dysregulation constitutes a serious public health problem in need of novel transdiagnostic treatments. <b><i>Objective:</i></b> To this aim, we developed and tested a one-time intervention that integrates behavioral skills training with concurrent repetitive transcranial magnetic stimulation (rTMS). <b><i>Methods:</i></b> Forty-six adults who met criteria for at least one DSM-5 disorder and self-reported low use of cognitive restructuring (CR) were enrolled in a randomized, double-blind, sham-controlled trial that used a between-subjects design. Participants were taught CR and underwent active rTMS applied at 10 Hz over the right (<i>n</i> = 17) or left (<i>n</i> = 14) dorsolateral prefrontal cortex (dlPFC) or sham rTMS (<i>n</i> = 15) while practicing reframing and emotional distancing in response to autobiographical stressors. <b><i>Results:</i></b> Those who received active left or active right as opposed to sham rTMS exhibited enhanced regulation (<i>d</i>s = 0.21–0.62) as measured by psychophysiological indices during the intervention (higher high-frequency heart rate variability, lower regulation duration). Those who received active rTMS over the left dlPFC also self-reported reduced distress throughout the intervention (<i>d</i> = 0.30), higher likelihood to use CR, and lower daily distress during the week following the intervention. The procedures were acceptable and feasible with few side effects. <b><i>Conclusions:</i></b> These findings show that engaging frontal circuits simultaneously with cognitive skills training and rTMS may be clinically feasible, well-tolerated and may show promise for the treatment of transdiagnostic emotional dysregulation. Larger follow-up studies are needed to confirm the efficacy of this novel therapeutic approach.

<b><i>引言：</i></b> 情绪调节障碍是一项亟待开发新型跨诊断治疗方案的严重公共卫生问题。<b><i>研究目的：</i></b> 基于此，我们开发并测试了一项整合行为技能训练与同步重复经颅磁刺激（repetitive transcranial magnetic stimulation, rTMS）的单次干预方案。<b><i>研究方法：</i></b> 招募46名符合至少一项《精神障碍诊断与统计手册第五版》（DSM-5）诊断标准，且自我报告认知重构（cognitive restructuring, CR）使用频率较低的成年被试，开展一项采用被试间设计的随机双盲假对照试验。所有被试均接受CR训练，并在针对自传体应激事件进行认知重评与情绪疏离练习的同时，接受右侧（n = 17）或左侧（n = 14）背外侧前额叶皮层（dorsolateral prefrontal cortex, dlPFC）的10 Hz活性rTMS刺激，或假rTMS刺激（n = 15）。<b><i>研究结果：</i></b> 相较于接受假rTMS的被试，接受左侧或右侧活性rTMS的被试在干预期间的心理生理指标（更高的高频心率变异性、更短的调节时长）上表现出更强的情绪调节能力（效应量d = 0.21–0.62）。其中，接受左侧背外侧前额叶皮层活性rTMS的被试，同时报告在整个干预过程中苦恼体验降低（效应量d = 0.30）、更倾向于使用CR，且在干预结束后一周内的日常苦恼程度更低。该干预流程耐受性良好，不良反应极少。<b><i>研究结论：</i></b> 本研究结果表明，同步激活前额叶环路并结合认知技能训练与rTMS的治疗方案具有临床可行性与良好耐受性，或可为跨诊断情绪调节障碍的治疗提供新的潜在方向。未来需开展更大样本量的后续研究以验证该新型治疗方法的有效性。