Accelerated Intermittent Theta Burst Stimulation in Smoking Cessation: Placebo Effects Equal to Active Stimulation When Using Advanced Placebo Coil Technology

Georgios Mikellides, Panayiota Michael, Lilia Psalta, Artemis Stefani, Teresa Schuhmann, Alexander T Sack, Georgios Mikellides, Panayiota Michael, Lilia Psalta, Artemis Stefani, Teresa Schuhmann, Alexander T Sack

Abstract

Smoking is currently one of the main public health problems. Smoking cessation is known to be difficult for most smokers because of nicotine dependence. Repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) has been shown to be effective in the reduction of nicotine craving and cigarette consumption. Here, we evaluated the efficacy of accelerated intermittent theta burst stimulation (aiTBS; four sessions per day for 5 consecutive days) over the left DLPFC in smoking cessation, and we investigated whether the exposure to smoking-related cues compared to neutral cues during transcranial magnetic stimulation (TMS) impacts treatment outcome. A double-blind, randomized, controlled study was conducted in which 89 participants (60 males and 29 females; age 45.62 ± 13.42 years) were randomly divided into three groups: the first group received active aiTBS stimulation while watching neutral videos, the second group received active aiTBS stimulation while watching smoking-related videos and the last group received sham stimulation while watching smoking-related videos. Our results suggest that aiTBS is a tolerable treatment. All treatment groups equally reduced cigarette consumption, nicotine dependence, craving and perceived stress. The effect on nicotine dependence, general craving and perceived stress lasted for at least 1 week after the end of treatment. Active aiTBS over the left DLPFC, combined with smoking related cues, is as effective as active aiTBS combined with neutral cues as well as placebo aiTBS in smoking cessation. These findings extend the results of previous studies indicating that TMS therapy is associated with considerably large placebo effects and that these placebo effects may be further increased when using advanced placebo coil technology.

Clinical trial registration: www.clinicaltrials.gov, identifier NCT05271175.

Keywords: intermittent theta burst stimulation (iTBS); placebo effect; provocative smoking cues; repetitive transcranial magnetic stimulation; smoking cessation.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Mikellides, Michael, Psalta, Stefani, Schuhmann and Sack.

Figures

Figure 1
Figure 1
Flow chart of the selection procedure.
Figure 2
Figure 2
Bar graphs showing difference in mean scores of VAS, CO, Cigarettes smoked per day over time. Data are presented as mean ± SEM.
Figure 3
Figure 3
Bar graphs showing difference in mean scores of FTND, PSS-4, TCQ-SF and Motivation to quit smoking over time. Data are presented as mean ± SEM.

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