Noninvasive brain stimulation in combination with psychotherapy for anxiety disorders. A systematic review

Background: Although anxiety disorders can be treated very well with cognitive behavioral therapy, there are some patients who are not yet optimally benefiting from the therapy. In recent years, noninvasive brain stimulation methods have been studied as an add-on to psychotherapy.Objectives. Is there sufficient evidence for the use of noninvasive brain stimulation in the psychotherapy of anxiety disorders?Methods. A systematic review of previous therapy studies reviewing noninvasive brain stimulation in cognitive behavioral therapy of anxiety disorders.Results. In total, only 4 randomized controlled therapeutic trials could be found and were analyzed. These studies used repetitive transcranial magnetic stimulation (rTMS) shortly before or during exposure-based behavioral therapy. The use of active stimulation compared to placebo stimulation shows a positive additional effect in the medium range.Conclusions. Initial work shows an additional benefit of rTMS in cognitive behavioral therapy for the treatment of anxiety disorders. However, further studies must show which exact stimulation parameters are best suited to make a recommendation for the treatment practice