Using TMS to Understand Neural Processes of Social Motivation

Personalized Neuromodulation Targeting Dysregulated Motivational Responses Underlying Social Avoidance Behavior

The purpose of this study is to use transcranial magnetic stimulation (TMS) to better understand the neural circuits associated with social motivation.

Participant includes four study visits each that range from 1.5 - 3.0 hours in duration over approximately a one month period. The first study visit involves answering survey questions, a clinical interview, and computer tasks. The second study visit involves a magnetic resonance imaging (MRI) scan, computer tasks, and a brief TMS protocol. The second and third study visits involve a full session of TMS followed by an MRI scan and computer tasks.

Adults in the Auburn/Opelika area and surrounding areas who avoid social situations, experience symptoms of depression or social anxiety, and are between 25 years old and 50 years old are eligible to participate.

Study Overview

• Status: Recruiting
• Conditions: Major Depressive Disorder; Social Anxiety Disorder; Social Avoidant Behavior
• Intervention / Treatment: Device: TMS

• Study Type: Interventional
• Enrollment (Estimated): 40
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Alabama
    • Auburn, Alabama, United States, 36849
      • Recruiting
      • Auburn University
      • Contact: Travis Evans, PhD; Phone Number: 3348444550; Email: tce0018@auburn.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• A diagnosis of Major Depressive Disorder OR a diagnosis of Social Anxiety Disorder (assessed/confirmed at screening visit).
• Scoring above clinical threshold on a measure of social avoidant behavior (assessed/confirmed at phone screen).

Exclusion Criteria:

• Unstable psychotropic medication regimen (i.e., changes in psychotropic medication or dosage in past 3 months).
• Current or lifetime diagnosis of Bipolar Disorder.
• A diagnosis of substance use disorder within past 12 months.
• A diagnosis of psychotic-spectrum disorder such as Schizophrenia.
• Pregnancy or probable pregnancy.
• Medical illness or medical treatment that would preclude or inhibit study participation.
• Neurological disorder associated with brain damage.
• History of seizures or head trauma with loss of consciousness > 5 minutes.
• Family history of epilepsy or personal epilepsy/seizures
• Ferromagnetic implants or ferrmagnetic objects within body (e.g., pacemaker).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: TMS A; Active continuous thetaburst stimulation administered over right dorsolateral prefrontal cortex for 40 seconds (600 pulses total)	Device: TMS; TMS will be administered using a Cool B-65 coil to a personalized right dlPFC region.
Sham Comparator: TMS B; Sham continuous thetaburst stimulation administered over right dorsolateral prefrontal cortex for 40 seconds (600 pulses total)	Device: TMS; TMS will be administered using a Cool B-65 coil to a personalized right dlPFC region.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Social motivation	Motivational responses to facial expressions as measured by the Social Approach Avoidance Paradigm (SAAP; Evans, Esterman, & Britton, 2022). In the SAAP, participants self-report how much they would like to approach or avoid emotional facial expressions.	Immediately post-intervention
Neural circuit function	Brain connectivity during motivational responses to facial expression during the Social Approach-Avoidance Paradigm (SAAP; Evans, Esterman, & Britton, 2022) and during resting state conditions. In the SAAP, participants self-report how much they would like to approach or avoid emotional facial expressions. During resting state conditions, participants simply lie still with their eyes open without completing any type of task.	Immediately post-intervention

Collaborators and Investigators

• Sponsor: Auburn University

Study record dates

Study Major Dates

• Study Start (Actual): September 30, 2025
• Primary Completion (Estimated): July 31, 2029
• Study Completion (Estimated): July 31, 2029

Study Registration Dates

• First Submitted: February 8, 2024
• First Submitted That Met QC Criteria: February 15, 2024
• First Posted (Actual): February 23, 2024

Study Record Updates

• Last Update Posted (Actual): March 3, 2026
• Last Update Submitted That Met QC Criteria: March 1, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Mood Disorders; Phobic Disorders; Anxiety Disorders; Depressive Disorder; Phobia, Social; Depressive Disorder, Major
• Other Study ID Numbers: 1K23MH135222 (U.S. NIH Grant/Contract)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: Yes