- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05521074
Transcranial Direct Current Stimulation Potentiation of Fear Extinction in OCD
October 10, 2023 updated by: Joan A Camprodon, MD MPH PhD, Massachusetts General Hospital
Transcranial Direct Current Stimulation Potentiation of Fear Extinction in OCD: Towards Rational Design of Combination Therapies
The investigators want to learn more about how human beings learn not to fear and the impact of changing the fear network in the brain using transcranial Direct Current Stimulation (tDCS) in individuals with obsessive compulsive disorder (OCD).
The investigators hope this study will help us understand how future treatments can help patients with OCD better control unwanted fear.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Detailed Description
To address this question behaviorally and biologically, the investigators will use a, 2-day fear extinction paradigm while measuring behavioral psychophysiology (skin conductance response [SCR]) and neurophysiology (electroencephalography [EEG]).
On Day 1 participants will undergo 1) habituation, 2) fear conditioning, and 3) extinction learning.
On Day 2 they will undergo 4) extinction recall, and 5) reinstatement.
SCR and EEG will be measured in both sessions.
The investigators propose to investigate whether inhibitory tDCS to the pre-SMA before, during, or after fear extinction significantly 1) enhances the recall of extinction learning and 2) reduces fronto-medial theta power during extinction recall.
Participants will be randomized to one of the following four conditions: active tDCS before, during, or after extinction learning, or sham tDCS.
The fear extinction paradigm serves as a proxy of exposure-based CBT for OCD.
Defining the combination protocol that optimally and significantly increases extinction recall behaviorally (psychophysiology) in OCD, will have critical implications for the mechanistically informed development of tDCS-augmented CBT for OCD.
EEG measures will provide a response biomarker to characterize target engagement neurophysiologically.
This is particularly relevant given EEG's ease of use, relatively low cost, and potential for greater translation to the clinic.
Also, the higher signal-to-noise ratio (SNR) of EEG compared to SCR is a strength.
Taken together, these data should reveal treatment targets, define optimal therapeutic protocols, and provide the foundation for a future clinical trial to test the synergistic efficacy of combined tDCS-CBT for OCD.
Study Type
Interventional
Enrollment (Estimated)
120
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Peyton Miyares, BA
- Phone Number: 617-643-0850
- Email: mghocdfearstudy@partners.org
Study Locations
-
-
Massachusetts
-
Boston, Massachusetts, United States, 02114
- Recruiting
- Massachusetts General Hospital
-
Contact:
- Peyton Miyares, BA
- Phone Number: 617-643-0850
- Email: mghocdfearstudy@partners.org
-
Principal Investigator:
- Joan Camprodon, MD, MPH, PhD
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 60 years (Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Fluent in English, willing to provide informed consent, and willing to comply with the study protocol
- Primary OCD that causes at least moderate distress and/or impairment (Y-BOCS total score ≥ 16)
- Comfortable and capable of using a computer and completing computerized tasks
Exclusion Criteria:
- History of head injury resulting in prolonged (i.e., >1h) loss of consciousness and/or neurological sequelae; history of stroke; signs of increased intracranial pressure; prior neurosurgical procedure (e.g., DBS, aneurysm clips)
- Contraindications to participate in tDCS including: metallic implants in head or neck; ventriculoperitoneal (VP) shunts; pacemakers; pregnancy; epilepsy.
- Current or history of neurologic or psychiatric disease (e.g., mental retardation, dementia, brain damage, or other cognitive impairment) that would interfere with ability to participate in the study
- Impaired (or uncorrected) vision that would interfere with participation.
- Current clinically significant suicidality that requires psychiatric hospitalization, as indicated by clinical judgment.
- Current substance use disorder (within the past 12 months)
- Lifetime manic episode or psychosis
- Documented resistance to 4 or more valid pharmacological trials and previous treatment with ≥12 sessions of cognitive behavioral therapy for OCD with no response (or worsening symptoms)
- Use of most psychotropic medications (e.g., SSRIs and atypical antipsychotics) will be allowed. However, use of benzodiazepines within 2 weeks prior to the study is exclusionary (and participants will be asked to refrain from use of such medications during the study as they may interfere with the fear extinction paradigm).
- Unable to obtain low enough impedance values to ensure safe and effective application of tDCS/EEG.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Active tDCS administered before extinction phase
The investigators will stimulate using 2mA of direct current during 20 min before the extinction phase of the fear conditioning and extinction paradigm.
|
The investigators will use commercially available tDCS equipment (Neuroelectrics©, Barcelona, Spain).
The cathode will be placed over the pre-SMA using the 10-20 EEG system and the anode will be on the right deltoid.
|
Experimental: Active tDCS administered during extinction phase
The investigators will stimulate using 2mA of direct current during 20 min during the extinction phase of the fear conditioning and extinction paradigm.
|
The investigators will use commercially available tDCS equipment (Neuroelectrics©, Barcelona, Spain).
The cathode will be placed over the pre-SMA using the 10-20 EEG system and the anode will be on the right deltoid.
|
Experimental: Active tDCS administered after extinction phase
The investigators will stimulate using 2mA of direct current during 20 min after the extinction phase of the fear conditioning and extinction paradigm.
|
The investigators will use commercially available tDCS equipment (Neuroelectrics©, Barcelona, Spain).
The cathode will be placed over the pre-SMA using the 10-20 EEG system and the anode will be on the right deltoid.
|
Sham Comparator: Sham tDCS
Sham will consist of a ramp up and down of activity (from 0 to 2mA and back to 0mA) in the first 30sec and again in the last 30 sec of the 20min stimulation period (which will occur before/during/after the extinction phase).
No active tDCS will occur.
|
The investigators will use commercially available tDCS equipment (Neuroelectrics©, Barcelona, Spain).
The cathode will be placed over the pre-SMA using the 10-20 EEG system and the anode will be on the right deltoid.
tDCS will not be active in this condition.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Difference in skin conductance response (SCR) to the conditioned stimulus (CS+) versus the unconditioned stimulus (CS-) between tDCS conditions during extinction recall
Time Frame: Extinction Recall Phase (Day 2)
|
Higher skin conductance (microSiemens) indicates greater fear intensity.
|
Extinction Recall Phase (Day 2)
|
Difference in frontomedial theta power (EEG) to the conditioned stimulus (CS+) versus the unconditioned stimulus (CS-) between tDCS conditions during extinction recall
Time Frame: Extinction Recall Phase (Day 2)
|
Greater reduction of frontomedial theta power (microvolts) indicates stronger extinction recall.
|
Extinction Recall Phase (Day 2)
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Joan Camprodon, MD, MPH, PhD, Massachusetts General Hospital
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Helpful Links
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
September 15, 2022
Primary Completion (Estimated)
March 1, 2025
Study Completion (Estimated)
March 1, 2025
Study Registration Dates
First Submitted
August 26, 2022
First Submitted That Met QC Criteria
August 26, 2022
First Posted (Actual)
August 30, 2022
Study Record Updates
Last Update Posted (Actual)
October 12, 2023
Last Update Submitted That Met QC Criteria
October 10, 2023
Last Verified
October 1, 2023
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2022P001065
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
IPD Plan Description
The investigators do not have specific plans to share individual participant data in order to preserve the confidentiality of our participants.
Any data that is shared would only be done so after executing a formal Data Use Agreement from Massachusetts General Hospital.
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
Yes
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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