Effects of Transcranial Magnetic Stimulation on Social Cognition, Cognitive Processing, and Functional Brain Architecture

Effects of Transcranial Magnetic Stimulation on Social Cognition, Cognitive Processing, and Functional Brain Architecture in Psychopathy

This clinical trial will examine whether transcranial magnetic stimulation (TMS), a noninvasive form of brain stimulation, can influence social cognition, cognitive processing, and brain function in adults with elevated psychopathic traits. The study will also evaluate the safety and feasibility of delivering TMS in this population.

Participants will be randomly assigned to receive either active TMS or sham (placebo-like) TMS. The study will compare outcomes between participants receiving active versus sham TMS and will evaluate changes from before to after TMS exposure.

Participants will:

• Complete a baseline magnetic resonance imaging (MRI) brain scan.
• Receive three single-session TMS interventions.
• Complete a post-intervention MRI brain scan.
• Complete assessments of social cognition.
• Complete assessments of cognitive processing.

The primary objectives are to determine whether TMS can influence social cognition, cognitive processing, and functional brain organization and connectivity in adults with elevated psychopathic traits.

Study Overview

• Status: Not yet recruiting
• Conditions: Psychopathy
• Intervention / Treatment: Device: continuous theta burst stimulation (cTBS); Device: Intermittent theta burst stimulation (iTBS); Device: Sham

Detailed Description

Psychopathic traits are associated with impairments in social cognition, cognitive processing, and alterations in functional brain network organization. Neuroimaging studies have implicated abnormalities in brain regions involved in cognitive control and social information processing, including the right dorsolateral prefrontal cortex (dlPFC) and right temporoparietal junction (TPJ). Transcranial magnetic stimulation (TMS) is a noninvasive neuromodulation technique capable of altering neural activity within targeted brain networks and provides an experimental method for examining the causal contribution of these regions to cognitive and social functioning.

This randomized, sham-controlled clinical trial will evaluate whether theta burst stimulation targeting the right dlPFC or right TPJ influences social cognition, cognitive processing, and functional brain network organization in adults with elevated psychopathic traits. Participants will be randomly assigned to receive inhibitory continuous theta burst stimulation (cTBS) targeting the right dlPFC, excitatory intermittent theta burst stimulation (iTBS) targeting the right TPJ, or sham stimulation. Stimulation targets will be individualized using participant-specific neuroimaging data.

Participants will complete baseline and post-intervention assessments that include functional magnetic resonance imaging (fMRI), measures of social cognition, and measures of cognitive processing. Functional neuroimaging will be used to evaluate changes in brain network organization and connectivity associated with stimulation. Behavioral assessments will evaluate social cognitive processes, including emotion processing and perspective taking, as well as cognitive processes related to attention and cognitive control.

Analyses will compare active stimulation conditions with sham stimulation on measures of social cognition and cognitive processing. Neuroimaging analyses will evaluate both within-subject changes from pre- to post-stimulation and between-group differences in functional brain network organization and connectivity.

The primary objectives are to determine whether theta burst stimulation can influence social cognition, cognitive processing, and functional brain network organization in adults with elevated psychopathic traits and to evaluate the safety and feasibility of delivering TMS in this population. Findings from this study may help clarify the neural mechanisms underlying psychopathic traits and inform future development of targeted neuromodulation interventions.

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Drew E Winters, PhD.; Phone Number: 303-724-1000; Email: ascend@ucdenver.edu

Study Locations

• United States
  • Colorado
    • Aurora, Colorado, United States, 80045
      • University of Colorado Anschutz Medical Campus
      • Contact: Drew E Winters, PhD.; Phone Number: 303-724-1000; Email: ascend@ucdenver.edu
      • Principal Investigator: Drew E Winters, PhD.

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• 18-60 years.
• Elevated psychopathy as defined by the self-report psychopathy scale.
• IQ >= 80.
• No prior diagnosis or current risk of Autism as defined by the autism spectrum quotient.
• Negative urine drug screen.
• At least 7 Days of abstinence from substance use (excluding nicotine)
• Able to provide informed consent.
• No change in psychiatric medication regimen, or medication-free, for 4 weeks before study.
• Adequate English proficiency to complete study procedures and assessments.

Exclusion Criteria:

• Current or lifetime DSM-5 psychotic disorder, schizophrenia, schizoaffective disorder, bipolar disorder, or autism spectrum disorder.
• IQ < 80.
• Clinically significant neurological disorder or medical illness that would make study participation unsafe, including a history of seizures or significant cardiovascular disease.
• Clinically significant abnormality identified on baseline MRI.
• Contraindication to MRI or inability to undergo MRI scanning.
• Current pregnancy or breastfeeding.
• History of head injury resulting in loss of consciousness greater than 15 minutes.
• Diagnosis of dementia.
• Current prescription for benzodiazepines or anticonvulsants.
• Metal implants or non-removable metal objects above the waist.
• Lifetime history of prior clinical treatment with transcranial magnetic stimulation (TMS).
• Serious risk of suicide or homicide.
• Unable or unwilling to comply with study procedures.
• History of intractable migraine.
• Claustrophobia or inability to tolerate enclosed spaces required for MRI procedures.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: active dlPFC sham TPJ; Subjects in this group will receive active continuous theta burst stimulation (cTBS) to the individually defined region of the dlPFC and sham to the TPJ.	Device: continuous theta burst stimulation (cTBS); Continuous theta burst stimulation (cTBS) will be delivered using transcranial magnetic stimulation (TMS) targeting the right dorsolateral prefrontal cortex (dlPFC). cTBS is a patterned form of repetitive TMS designed to modulate neural activity within targeted brain networks involved in cognitive control and social cognition. Stimulation targets will be individualized using participant-specific neuroimaging data.
Active Comparator: active TPJ sham dlPFC; Subjects in this group will receive active intermittent theta burst stimulation to the individually defined region of the TPJ and sham to the dlPFC.	Device: Intermittent theta burst stimulation (iTBS); Intermittent theta burst stimulation (iTBS) will be delivered using transcranial magnetic stimulation (TMS) targeting the right temporoparietal junction (TPJ). iTBS is a patterned form of repetitive TMS designed to modulate neural activity within targeted brain networks involved in social cognition and perspective taking. Stimulation targets will be individualized using participant-specific neuroimaging data
Sham Comparator: sham; Subjects in this group will receive sham stimulation to the dlPFC and TPJ.	Device: Sham; Sham transcranial magnetic stimulation will be delivered using procedures designed to mimic the sensory experience of active stimulation without producing the intended neuromodulatory effects. Stimulation targets and study procedures will mirror those used in the active intervention arms.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Serial and Parallel Cognitive Processing Task Performance	Performance on the Miller serial/parallel cognitive processing task. Trial-level accuracy and/or reaction time will be analyzed using mixed-effects models to compare active stimulation versus sham stimulation across serial and parallel processing conditions.	within 10 minutes after the intervention.
Social Cognition Task Battery Performance	Performance on a social cognition task battery assessing facial emotion recognition (Emotion Recognition Task), perspective taking (Visual Perspective Taking Task), theory of mind (Movie Assessment of Social Cognition Task), and social decision-making (Altruistic/Antisocial game). Accuracy and reaction time will be analyzed using mixed-effects models to compare active stimulation versus sham stimulation across tasks. Higher accuracy values indicate better performance, whereas lower reaction times indicate better performance.	within 10 minutes after the intervention.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Resting-State Functional Connectivity	Resting-state functional magnetic resonance imaging will be used to evaluate changes in functional connectivity within stimulation-relevant brain networks from baseline to post-intervention. Analyses will examine frontoparietal network connectivity for right dorsolateral prefrontal cortex stimulation and default mode network connectivity for right temporoparietal junction stimulation, including within-subject change and between-group comparisons of active versus sham stimulation.	From the date of baseline fMRI until the first TMS session, assessed 2 times (baseline and post-TMS) up to 2 months after the baseline session. Post-TMS fMRI scan will be conducted within 30 minutes after the intervention.

Collaborators and Investigators

• Sponsor: University of Colorado, Denver
• Collaborators: National Institute of Mental Health (NIMH)

Publications and helpful links

General Publications

• Tillem S, Weinstein H, Baskin-Sommers A. Psychopathy is associated with an exaggerated attention bottleneck: EEG and behavioral evidence from a dual-task paradigm. Cogn Affect Behav Neurosci. 2021 Aug;21(4):881-893. doi: 10.3758/s13415-021-00891-z. Epub 2021 Apr 5.
• Jeurissen D, Sack AT, Roebroeck A, Russ BE, Pascual-Leone A. TMS affects moral judgment, showing the role of DLPFC and TPJ in cognitive and emotional processing. Front Neurosci. 2014 Feb 13;8:18. doi: 10.3389/fnins.2014.00018. eCollection 2014.
• Saxe R, Kanwisher N. People thinking about thinking people. The role of the temporo-parietal junction in "theory of mind". Neuroimage. 2003 Aug;19(4):1835-42. doi: 10.1016/s1053-8119(03)00230-1.
• Drayton LA, Santos LR, Baskin-Sommers A. Psychopaths fail to automatically take the perspective of others. Proc Natl Acad Sci U S A. 2018 Mar 27;115(13):3302-3307. doi: 10.1073/pnas.1721903115. Epub 2018 Mar 12.
• Song Z, Jones A, Corcoran R, Daly N, Abu-Akel A, Gillespie SM. Psychopathic traits and theory of mind task performance: A systematic review and meta-analysis. Neurosci Biobehav Rev. 2023 Aug;151:105231. doi: 10.1016/j.neubiorev.2023.105231. Epub 2023 May 10.

Helpful Links

• NIH reporter

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): June 1, 2030
• Study Completion (Estimated): August 1, 2030

Study Registration Dates

• First Submitted: May 29, 2026
• First Submitted That Met QC Criteria: June 3, 2026
• First Posted (Actual): June 9, 2026

Study Record Updates

• Last Update Posted (Actual): June 11, 2026
• Last Update Submitted That Met QC Criteria: June 9, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Neuromodulation; Transcranial Magnetic Stimulation; Executive Function; Cognitive Control; Theta Burst Stimulation; Social Cognition; Dorsolateral Prefrontal Cortex; Theory of Mind; Emotion Recognition; Functional Connectivity; Psychopathy; Cognitive Processing; Social Decision Making; Resting-State fMRI; Temporal Parietal Junction
• Additional Relevant MeSH Terms: Mental Disorders; Personality Disorders; Antisocial Personality Disorder
• Other Study ID Numbers: 24-2634; 1K23MH139637-01 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES

IPD Plan Description

Upon study completion, neuroimaging and behavioral data will be shared via the brain imaging data sharing database OpenNeuro. Metadata for the study will be included, such as the study protocol.

All publications from this data by the PI or the PI's lab will first preregister the analysis, and all accepted publications will share the analytic code with a link to the GitHub repository in the publication

• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ANALYTIC_CODE

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