The Efficacy of Combined Transcranial Magnetic Stimulation and Exposure Prevention Response on Symptoms of Resistant Obsessive Compulsive Disorder: An Intensive Day Care Program
,
Abstract
Purpose: Obsessive-Compulsive Disorder (OCD) is a mental and behavioral disorder in which an individual has intrusive thoughts and rituals which decrease the distress. It seems that there are many treatments such as EX/RP, repetitive Transcranial Magnetic Stimulation (rTMS), medications or mindfulness for OCD, but there is no single effective treatment yet. In this study, we investigated a multi-element daily program on symptom reduction of OCD people.
Materials and Methods: In a quasi-experimental design 13 patients were included in the study and received daily rTMS with EX/RP and biofeedback. We utilized BDI, BAI, and YBOCS tools to collect data before and after the treatment and in the subsequent one-month follow-up.
Results: According to the BDI, BAI, and YBOCS results, the decrease in score was observed at the p<0.001 level and the changes were significant after a one-month follow-up period.
Conclusion: The results indicated that the combination of sequenced treatments simultaneously such as rTMS and biofeedback with exposure therapy can facilitate the engagement and enhancement of self-control and distress tolerance.
1- Michael H Bloch, Angeli Landeros-Weisenberger, Maria C Rosario, Christopher Pittenger, and James F Leckman, "Meta-analysis of the symptom structure of obsessive-compulsive disorder." American Journal of Psychiatry, Vol. 165 (No. 12), pp. 1532-42, (2008).
2- Rachel Middleton, Michael G Wheaton, Reilly Kayser, and H Blair Simpson, "Treatment resistance in obsessive-compulsive disorder." Treatment resistance in psychiatry, pp. 165-77, (2019).
3- Minah Kim, Wi Hoon Jung, Geumsook Shim, and Jun Soo Kwon, "The effects of selective serotonin reuptake inhibitors on brain functional networks during goal-directed planning in obsessive–compulsive disorder." Scientific reports, Vol. 10 (No. 1), pp. 1-8, (2020).
4- Gianluca Serafini et al., "The effects of repetitive transcranial magnetic stimulation on cognitive performance in treatment-resistant depression. A systematic review." Neuropsychobiology, Vol. 71 (No. 3), pp. 125-39, (2015).
5- Marlene Taube-Schiff, Neil A Rector, Persephone Larkin, Adrienne Mehak, and Margaret A Richter, "Effectiveness of intensive treatment services for obsessive compulsive disorder: outcomes from the first Canadian residential treatment program." International journal of psychiatry in clinical practice, Vol. 24 (No. 1), pp. 59-67, (2020).
6- Iris Sijercic, Kristen M Whitfield, Stephanie E Cassin, and Martin M Antony, "A systematic review of cognitive-behavioral therapy for pharmacotherapy treatment-resistant obsessive-compulsive disorder." Journal of Obsessive-Compulsive and Related Disorders, Vol. 26p. 100532, (2020).
7- Lars-Göran Öst, Audun Havnen, Bjarne Hansen, and Gerd Kvale, "Cognitive behavioral treatments of obsessive–compulsive disorder. A systematic review and meta-analysis of studies published 1993–2014." Clinical Psychology Review, Vol. 40pp. 156-69, (2015).
8- Edna B Foa and Carmen P McLean, "The efficacy of exposure therapy for anxiety-related disorders and its underlying mechanisms: The case of OCD and PTSD." Annual review of clinical psychology, Vol. 12pp. 1-28, (2016).
9- Nathaniel Elkins-Brown, Rimma Teper, and Michael Inzlicht, "How mindfulness enhances self-control." in Mindfulness in social psychology: Routledge, (2017), pp. 65-78.
10- Fabrizio Didonna, "Mindfulness and obsessive-compulsive disorder: Developing a way to trust and validate one's internal experience." in Clinical handbook of mindfulness: Springer, (2009), pp. 189-219.
11- A Del Casale et al., "Functional neuroimaging in obsessive-compulsive disorder." Neuropsychobiology, Vol. 64 (No. 2), pp. 61-85, (2011).
12- Mohammed R Milad and Scott L Rauch, "Obsessive-compulsive disorder: beyond segregated cortico-striatal pathways." Trends in cognitive sciences, Vol. 16 (No. 1), pp. 43-51, (2012).
13- Tomohiro Nakao et al., "Working memory dysfunction in obsessive–compulsive disorder: a neuropsychological and functional MRI study." Journal of psychiatric research, Vol. 43 (No. 8), pp. 784-91, (2009).
14- Andrea Bari and Trevor W Robbins, "Inhibition and impulsivity: behavioral and neural basis of response control." Progress in neurobiology, Vol. 108pp. 44-79, (2013).
15- Samuel R Chamberlain et al., "Orbitofrontal dysfunction in patients with obsessive-compulsive disorder and their unaffected relatives." Science, Vol. 321 (No. 5887), pp. 421-22, (2008).
16- Murat Yücel et al., "Functional and biochemical alterations of the medial frontal cortex in obsessive-compulsive disorder." Archives of General Psychiatry, Vol. 64 (No. 8), pp. 946-55, (2007).
17- Kun Li et al., "Abnormal functional network of the thalamic subregions in adult patients with obsessive-compulsive disorder." Behavioural brain research, Vol. 371p. 111982, (2019).
18- Simone Rehn, Guy D Eslick, and Vlasios Brakoulias, "A meta-analysis of the effectiveness of different cortical targets used in repetitive transcranial magnetic stimulation (rTMS) for the treatment of obsessive-compulsive disorder (OCD)." Psychiatric Quarterly, Vol. 89 (No. 3), pp. 645-65, (2018).
19- Mandana Modirrousta et al., "The efficacy of deep repetitive transcranial magnetic stimulation over the medial prefrontal cortex in obsessive compulsive disorder: Results from an open‐label study." Depression and anxiety, Vol. 32 (No. 6), pp. 445-50, (2015).
20- Antoine Pelissolo et al., "Repetitive transcranial magnetic stimulation to supplementary motor area in refractory obsessive-compulsive disorder treatment: a sham-controlled trial." International Journal of Neuropsychopharmacology, Vol. 19 (No. 8), p. pyw025, (2016).
21- Young-Ji Lee, Bon-Hoon Koo, Wan-Seok Seo, Hye-Geum Kim, Ji-Yean Kim, and Eun-Jin Cheon, "Repetitive transcranial magnetic stimulation of the supplementary motor area in treatment-resistant obsessive-compulsive disorder: an open–label pilot study." Journal of Clinical Neuroscience, Vol. 44pp. 264-68, (2017).
22- Haisan Zhang et al., "Altered functional connectivity between the cerebellum and the cortico-striato-thalamo-cortical circuit in obsessive-compulsive disorder." Frontiers in psychiatry, Vol. 10p. 522, (2019).
23- Steven I Rudoy, "Developing a model for understanding mindfulness as a potential intervention for obsessive-compulsive disorder." Pepperdine University, (2014).
24- Jonathan S Abramowitz, Edna B Foa, and Martin E Franklin, "Exposure and ritual prevention for obsessive-compulsive disorder: effects of intensive versus twice-weekly sessions." Journal of consulting and clinical psychology, Vol. 71 (No. 2), p. 394, (2003).
25- Parth Dutta et al., "Efficacy of intensive orbitofrontal continuous Theta Burst Stimulation (iOFcTBS) in Obsessive Compulsive Disorder: A Randomized Placebo Controlled Study." Psychiatry Research, Vol. 298p. 113784, (2021).
26- Madhuri H Nanjundaswamy, Shyam Sundar Arumugham, Janardhanan C Narayanaswamy, and YC Janardhan Reddy, "A prospective study of intensive in-patient treatment for obsessive-compulsive disorder." Psychiatry Research, Vol. 291, p. 113303, (2020).
27- Joseph O'Neill et al., "Effects of intensive cognitive-behavioral therapy on cingulate neurochemistry in obsessive–compulsive disorder." Journal of psychiatric research, Vol. 47 (No. 4), pp. 494-504, (2013).
28- Hjalti Jónsson, Maria Kristensen, and Mikkel Arendt, "Intensive cognitive behavioural therapy for obsessive-compulsive disorder: a systematic review and meta-analysis." Journal of Obsessive-Compulsive and related disorders, Vol. 6, pp. 83-96, (2015).
29- Victoria B Oldfield, Paul M Salkovskis, and Tracey Taylor, "Time‐intensive cognitive behaviour therapy for obsessive‐compulsive disorder: A case series and matched comparison group." British Journal of Clinical Psychology, Vol. 50 (No. 1), pp. 7-18, (2011).
30- Harpreet Singh, Lorelei-Jane Wyman, Pegah Shojaii, and Leigh A Neal, "A Comparison of final Yale-Brown Obsessive-Compulsive Scale (YBOCS) in patients receiving either Repetitive Transcranial Magnetic Stimulation (rTMS) to the Right Dorsolateral Prefrontal Cortex+ Supplementary Motor Area (rDLPFC+ SMA) or Left Medial Orbitofrontal Cortex (FP1) for the treatment of Obsessive-Compulsive Disorder (OCD)." Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation, Vol. 14 (No. 5), p. 1409, (2021).
31- Nathalie Picard and Peter L Strick, "Imaging the premotor areas." Current opinion in neurobiology, Vol. 11 (No. 6), pp. 663-72, (2001).
32- Emily R Hawken, Dancho Dilkov, Emil Kaludiev, Selcuk Simek, Felicia Zhang, and Roumen Milev, "Transcranial magnetic stimulation of the supplementary motor area in the treatment of obsessive-compulsive disorder: a multi-site study." International journal of molecular sciences, Vol. 17 (No. 3), p. 420, (2016).
33- C Nauczyciel et al., "Repetitive transcranial magnetic stimulation over the orbitofrontal cortex for obsessive-compulsive disorder: a double-blind, crossover study." Translational psychiatry, Vol. 4 (No. 9), pp. e436-e36, (2014).
34- Jesse R Cougle, Kiara R Timpano, Kristin E Fitch, and Kirsten A Hawkins, "Distress tolerance and obsessions: an integrative analysis." Depression and anxiety, Vol. 28 (No. 10), pp. 906-14, (2011).
35- Jesse R Cougle, Kristin E Fitch, Frank D Fincham, Christina J Riccardi, Meghan E Keough, and Kiara R Timpano, "Excessive reassurance seeking and anxiety pathology: Tests of incremental associations and directionality." Journal of anxiety disorders, Vol. 26 (No. 1), pp. 117-25, (2012).
36- Jean-Yves Rotge et al., "Provocation of obsessive–compulsive symptoms: a quantitative voxel-based meta-analysis of functional neuroimaging studies." Journal of psychiatry & neuroscience: JPN, Vol. 33 (No. 5), p. 405, (2008).
37- Stephen P Whiteside, John D Port, and Jonathan S Abramowitz, "A meta–analysis of functional neuroimaging in obsessive–compulsive disorder." Psychiatry Research: Neuroimaging, Vol. 132 (No. 1), pp. 69-79, (2004).
38- Flávia Paes et al., "The value of repetitive transcranial magnetic stimulation (rTMS) for the treatment of anxiety disorders: an integrative review." CNS & Neurological Disorders-Drug Targets (Formerly Current Drug Targets-CNS & Neurological Disorders), Vol. 10 (No. 5), pp. 610-20, (2011).
39- Reza Rostami et al., "Efficacy and clinical predictors of response to rTMS treatment in pharmacoresistant obsessive-compulsive disorder (OCD): a retrospective study." BMC psychiatry, Vol. 20 (No. 1), pp. 1-13, (2020).
40- Tao Yang et al., "Abnormal regional homogeneity of drug-naı¨ ve obsessive-compulsive patients." Neuroreport, Vol. 21 (No. 11), pp. 786-90, (2010).
41- Stephen W Porges, "The polyvagal theory: phylogenetic substrates of a social nervous system." International journal of psychophysiology, Vol. 42 (No. 2), pp. 123-46, (2001).
42- Gregg Henriques, Steven Keffer, Craig Abrahamson, and S Jeanne Horst, "Exploring the effectiveness of a computer-based heart rate variability biofeedback program in reducing anxiety in college students." Applied psychophysiology and biofeedback, Vol. 36 (No. 2), pp. 101-12, (2011).
43- Paul Ratanasiripong, Kevin Sverduk, Judy Prince, and Diane Hayashino, "Biofeedback and counseling for stress and anxiety among college students." Journal of College Student Development, Vol. 53 (No. 5), pp. 742-49, (2012).
44- Alberto Chiesa and Alessandro Serretti, "Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis." The journal of alternative and complementary medicine, Vol. 15 (No. 5), pp. 593-600, (2009).
45- Willem Kuyken et al., "How does mindfulness-based cognitive therapy work?" Behaviour research and therapy, Vol. 48 (No. 11), pp. 1105-12, (2010).
46- Clive J Robins, Shian‐Ling Keng, Andrew G Ekblad, and Jeffrey G Brantley, "Effects of mindfulness‐based stress reduction on emotional experience and expression: A randomized controlled trial." Journal of clinical psychology, Vol. 68 (No. 1), pp. 117-31, (2012).
47- Sapana R Patel, James Carmody, and H Blair Simpson, "Adapting mindfulness-based stress reduction for the treatment of obsessive-compulsive disorder: A case report." Cognitive and Behavioral Practice, Vol. 14 (No. 4), pp. 375-80, (2007).
48- Odile A Van Den Heuvel et al., "Frontal-striatal dysfunction during planning in obsessive-compulsive disorder." Archives of General Psychiatry, Vol. 62 (No. 3), pp. 301-09, (2005).
49- Marcelo T Berlim, Nicholas H Neufeld, and Frederique Van den Eynde, "Repetitive transcranial magnetic stimulation (rTMS) for obsessive–compulsive disorder (OCD): An exploratory meta-analysis of randomized and sham-controlled trials." Journal of psychiatric research, Vol. 47 (No. 8), pp. 999-1006, (2013).
2- Rachel Middleton, Michael G Wheaton, Reilly Kayser, and H Blair Simpson, "Treatment resistance in obsessive-compulsive disorder." Treatment resistance in psychiatry, pp. 165-77, (2019).
3- Minah Kim, Wi Hoon Jung, Geumsook Shim, and Jun Soo Kwon, "The effects of selective serotonin reuptake inhibitors on brain functional networks during goal-directed planning in obsessive–compulsive disorder." Scientific reports, Vol. 10 (No. 1), pp. 1-8, (2020).
4- Gianluca Serafini et al., "The effects of repetitive transcranial magnetic stimulation on cognitive performance in treatment-resistant depression. A systematic review." Neuropsychobiology, Vol. 71 (No. 3), pp. 125-39, (2015).
5- Marlene Taube-Schiff, Neil A Rector, Persephone Larkin, Adrienne Mehak, and Margaret A Richter, "Effectiveness of intensive treatment services for obsessive compulsive disorder: outcomes from the first Canadian residential treatment program." International journal of psychiatry in clinical practice, Vol. 24 (No. 1), pp. 59-67, (2020).
6- Iris Sijercic, Kristen M Whitfield, Stephanie E Cassin, and Martin M Antony, "A systematic review of cognitive-behavioral therapy for pharmacotherapy treatment-resistant obsessive-compulsive disorder." Journal of Obsessive-Compulsive and Related Disorders, Vol. 26p. 100532, (2020).
7- Lars-Göran Öst, Audun Havnen, Bjarne Hansen, and Gerd Kvale, "Cognitive behavioral treatments of obsessive–compulsive disorder. A systematic review and meta-analysis of studies published 1993–2014." Clinical Psychology Review, Vol. 40pp. 156-69, (2015).
8- Edna B Foa and Carmen P McLean, "The efficacy of exposure therapy for anxiety-related disorders and its underlying mechanisms: The case of OCD and PTSD." Annual review of clinical psychology, Vol. 12pp. 1-28, (2016).
9- Nathaniel Elkins-Brown, Rimma Teper, and Michael Inzlicht, "How mindfulness enhances self-control." in Mindfulness in social psychology: Routledge, (2017), pp. 65-78.
10- Fabrizio Didonna, "Mindfulness and obsessive-compulsive disorder: Developing a way to trust and validate one's internal experience." in Clinical handbook of mindfulness: Springer, (2009), pp. 189-219.
11- A Del Casale et al., "Functional neuroimaging in obsessive-compulsive disorder." Neuropsychobiology, Vol. 64 (No. 2), pp. 61-85, (2011).
12- Mohammed R Milad and Scott L Rauch, "Obsessive-compulsive disorder: beyond segregated cortico-striatal pathways." Trends in cognitive sciences, Vol. 16 (No. 1), pp. 43-51, (2012).
13- Tomohiro Nakao et al., "Working memory dysfunction in obsessive–compulsive disorder: a neuropsychological and functional MRI study." Journal of psychiatric research, Vol. 43 (No. 8), pp. 784-91, (2009).
14- Andrea Bari and Trevor W Robbins, "Inhibition and impulsivity: behavioral and neural basis of response control." Progress in neurobiology, Vol. 108pp. 44-79, (2013).
15- Samuel R Chamberlain et al., "Orbitofrontal dysfunction in patients with obsessive-compulsive disorder and their unaffected relatives." Science, Vol. 321 (No. 5887), pp. 421-22, (2008).
16- Murat Yücel et al., "Functional and biochemical alterations of the medial frontal cortex in obsessive-compulsive disorder." Archives of General Psychiatry, Vol. 64 (No. 8), pp. 946-55, (2007).
17- Kun Li et al., "Abnormal functional network of the thalamic subregions in adult patients with obsessive-compulsive disorder." Behavioural brain research, Vol. 371p. 111982, (2019).
18- Simone Rehn, Guy D Eslick, and Vlasios Brakoulias, "A meta-analysis of the effectiveness of different cortical targets used in repetitive transcranial magnetic stimulation (rTMS) for the treatment of obsessive-compulsive disorder (OCD)." Psychiatric Quarterly, Vol. 89 (No. 3), pp. 645-65, (2018).
19- Mandana Modirrousta et al., "The efficacy of deep repetitive transcranial magnetic stimulation over the medial prefrontal cortex in obsessive compulsive disorder: Results from an open‐label study." Depression and anxiety, Vol. 32 (No. 6), pp. 445-50, (2015).
20- Antoine Pelissolo et al., "Repetitive transcranial magnetic stimulation to supplementary motor area in refractory obsessive-compulsive disorder treatment: a sham-controlled trial." International Journal of Neuropsychopharmacology, Vol. 19 (No. 8), p. pyw025, (2016).
21- Young-Ji Lee, Bon-Hoon Koo, Wan-Seok Seo, Hye-Geum Kim, Ji-Yean Kim, and Eun-Jin Cheon, "Repetitive transcranial magnetic stimulation of the supplementary motor area in treatment-resistant obsessive-compulsive disorder: an open–label pilot study." Journal of Clinical Neuroscience, Vol. 44pp. 264-68, (2017).
22- Haisan Zhang et al., "Altered functional connectivity between the cerebellum and the cortico-striato-thalamo-cortical circuit in obsessive-compulsive disorder." Frontiers in psychiatry, Vol. 10p. 522, (2019).
23- Steven I Rudoy, "Developing a model for understanding mindfulness as a potential intervention for obsessive-compulsive disorder." Pepperdine University, (2014).
24- Jonathan S Abramowitz, Edna B Foa, and Martin E Franklin, "Exposure and ritual prevention for obsessive-compulsive disorder: effects of intensive versus twice-weekly sessions." Journal of consulting and clinical psychology, Vol. 71 (No. 2), p. 394, (2003).
25- Parth Dutta et al., "Efficacy of intensive orbitofrontal continuous Theta Burst Stimulation (iOFcTBS) in Obsessive Compulsive Disorder: A Randomized Placebo Controlled Study." Psychiatry Research, Vol. 298p. 113784, (2021).
26- Madhuri H Nanjundaswamy, Shyam Sundar Arumugham, Janardhanan C Narayanaswamy, and YC Janardhan Reddy, "A prospective study of intensive in-patient treatment for obsessive-compulsive disorder." Psychiatry Research, Vol. 291, p. 113303, (2020).
27- Joseph O'Neill et al., "Effects of intensive cognitive-behavioral therapy on cingulate neurochemistry in obsessive–compulsive disorder." Journal of psychiatric research, Vol. 47 (No. 4), pp. 494-504, (2013).
28- Hjalti Jónsson, Maria Kristensen, and Mikkel Arendt, "Intensive cognitive behavioural therapy for obsessive-compulsive disorder: a systematic review and meta-analysis." Journal of Obsessive-Compulsive and related disorders, Vol. 6, pp. 83-96, (2015).
29- Victoria B Oldfield, Paul M Salkovskis, and Tracey Taylor, "Time‐intensive cognitive behaviour therapy for obsessive‐compulsive disorder: A case series and matched comparison group." British Journal of Clinical Psychology, Vol. 50 (No. 1), pp. 7-18, (2011).
30- Harpreet Singh, Lorelei-Jane Wyman, Pegah Shojaii, and Leigh A Neal, "A Comparison of final Yale-Brown Obsessive-Compulsive Scale (YBOCS) in patients receiving either Repetitive Transcranial Magnetic Stimulation (rTMS) to the Right Dorsolateral Prefrontal Cortex+ Supplementary Motor Area (rDLPFC+ SMA) or Left Medial Orbitofrontal Cortex (FP1) for the treatment of Obsessive-Compulsive Disorder (OCD)." Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation, Vol. 14 (No. 5), p. 1409, (2021).
31- Nathalie Picard and Peter L Strick, "Imaging the premotor areas." Current opinion in neurobiology, Vol. 11 (No. 6), pp. 663-72, (2001).
32- Emily R Hawken, Dancho Dilkov, Emil Kaludiev, Selcuk Simek, Felicia Zhang, and Roumen Milev, "Transcranial magnetic stimulation of the supplementary motor area in the treatment of obsessive-compulsive disorder: a multi-site study." International journal of molecular sciences, Vol. 17 (No. 3), p. 420, (2016).
33- C Nauczyciel et al., "Repetitive transcranial magnetic stimulation over the orbitofrontal cortex for obsessive-compulsive disorder: a double-blind, crossover study." Translational psychiatry, Vol. 4 (No. 9), pp. e436-e36, (2014).
34- Jesse R Cougle, Kiara R Timpano, Kristin E Fitch, and Kirsten A Hawkins, "Distress tolerance and obsessions: an integrative analysis." Depression and anxiety, Vol. 28 (No. 10), pp. 906-14, (2011).
35- Jesse R Cougle, Kristin E Fitch, Frank D Fincham, Christina J Riccardi, Meghan E Keough, and Kiara R Timpano, "Excessive reassurance seeking and anxiety pathology: Tests of incremental associations and directionality." Journal of anxiety disorders, Vol. 26 (No. 1), pp. 117-25, (2012).
36- Jean-Yves Rotge et al., "Provocation of obsessive–compulsive symptoms: a quantitative voxel-based meta-analysis of functional neuroimaging studies." Journal of psychiatry & neuroscience: JPN, Vol. 33 (No. 5), p. 405, (2008).
37- Stephen P Whiteside, John D Port, and Jonathan S Abramowitz, "A meta–analysis of functional neuroimaging in obsessive–compulsive disorder." Psychiatry Research: Neuroimaging, Vol. 132 (No. 1), pp. 69-79, (2004).
38- Flávia Paes et al., "The value of repetitive transcranial magnetic stimulation (rTMS) for the treatment of anxiety disorders: an integrative review." CNS & Neurological Disorders-Drug Targets (Formerly Current Drug Targets-CNS & Neurological Disorders), Vol. 10 (No. 5), pp. 610-20, (2011).
39- Reza Rostami et al., "Efficacy and clinical predictors of response to rTMS treatment in pharmacoresistant obsessive-compulsive disorder (OCD): a retrospective study." BMC psychiatry, Vol. 20 (No. 1), pp. 1-13, (2020).
40- Tao Yang et al., "Abnormal regional homogeneity of drug-naı¨ ve obsessive-compulsive patients." Neuroreport, Vol. 21 (No. 11), pp. 786-90, (2010).
41- Stephen W Porges, "The polyvagal theory: phylogenetic substrates of a social nervous system." International journal of psychophysiology, Vol. 42 (No. 2), pp. 123-46, (2001).
42- Gregg Henriques, Steven Keffer, Craig Abrahamson, and S Jeanne Horst, "Exploring the effectiveness of a computer-based heart rate variability biofeedback program in reducing anxiety in college students." Applied psychophysiology and biofeedback, Vol. 36 (No. 2), pp. 101-12, (2011).
43- Paul Ratanasiripong, Kevin Sverduk, Judy Prince, and Diane Hayashino, "Biofeedback and counseling for stress and anxiety among college students." Journal of College Student Development, Vol. 53 (No. 5), pp. 742-49, (2012).
44- Alberto Chiesa and Alessandro Serretti, "Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis." The journal of alternative and complementary medicine, Vol. 15 (No. 5), pp. 593-600, (2009).
45- Willem Kuyken et al., "How does mindfulness-based cognitive therapy work?" Behaviour research and therapy, Vol. 48 (No. 11), pp. 1105-12, (2010).
46- Clive J Robins, Shian‐Ling Keng, Andrew G Ekblad, and Jeffrey G Brantley, "Effects of mindfulness‐based stress reduction on emotional experience and expression: A randomized controlled trial." Journal of clinical psychology, Vol. 68 (No. 1), pp. 117-31, (2012).
47- Sapana R Patel, James Carmody, and H Blair Simpson, "Adapting mindfulness-based stress reduction for the treatment of obsessive-compulsive disorder: A case report." Cognitive and Behavioral Practice, Vol. 14 (No. 4), pp. 375-80, (2007).
48- Odile A Van Den Heuvel et al., "Frontal-striatal dysfunction during planning in obsessive-compulsive disorder." Archives of General Psychiatry, Vol. 62 (No. 3), pp. 301-09, (2005).
49- Marcelo T Berlim, Nicholas H Neufeld, and Frederique Van den Eynde, "Repetitive transcranial magnetic stimulation (rTMS) for obsessive–compulsive disorder (OCD): An exploratory meta-analysis of randomized and sham-controlled trials." Journal of psychiatric research, Vol. 47 (No. 8), pp. 999-1006, (2013).
| Files | ||
| Issue | Vol 11 No 1 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/fbt.v11i1.14509 | |
| Keywords | ||
| Obsessive-Compulsive Disorder Exposure Prevention Response Repetitive Transcranial Magnetic Stimulation Biofeedback | ||
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How to Cite
1.
Khomami S, Khodabakhsh Pirkalani R. The Efficacy of Combined Transcranial Magnetic Stimulation and Exposure Prevention Response on Symptoms of Resistant Obsessive Compulsive Disorder: An Intensive Day Care Program. Frontiers Biomed Technol. 2024;11(1):31-40.
