Can Intermittent Theta Burst Stimulation as Add-On to Psychotherapy Improve Nicotine Abstinence? Results from a Pilot Study

Abstract

Smoking is among the leading causes of mortality worldwide. Discontinuing smoking can increase life expectancy to the presmoking level. Unaided attempts are often ineffective, strengthening the necessity of cognitive-behavioral therapy (CBT), nicotine replacement or pharmacotherapy. Still, relapse rates are high. Recently, a modulation of nicotine craving, which predicts relapse, through transcranial magnetic stimulation to the prefrontal cortex was shown. In a pilot study, we investigated whether 4 sessions of intermittent theta burst stimulation (iTBS) as add-on treatment to CBT reduces nicotine craving and improves long-term abstinence (at 3, 6 and 12 months). Smokers were randomly assigned to a treatment (n = 38) or a sham group (n = 36). Although we did not find reduced craving, we could show higher abstinence rates in the treatment group at 3 months. At 6 and 12 months abstinence rates did not differ significantly. Results at 12 months, however, have to be interpreted cautiously due to significant differences in the dropout rates between the two groups at this time point. We provide first evidence for a beneficial effect of additional iTBS on intermediate nicotine abstinence; however, the low number of iTBS sessions might have prevented longer effects. More lasting effects might be achieved by iTBS maintenance sessions in analogy to the treatment of depression.

A review of brain stimulation methods to treat substance use disorders

“…Eleven studies were conducted to investigate the use of rTMS on tobacco use disorder (nicotine dependence). Apart from Li et al, all studies demonstrated positive effects of rTMS, via reduction in nicotine cravings and/or overall cigarette consumption post‐active stimulation compared to baseline and sham data.…”

Prefrontal functional connectivity measured with near‐infrared spectroscopy during smoking cue exposure

“…A better understanding of cortical regions activated within the CE time course and successful inhibition of consumption yields positive future perspectives for the treatment of SUD: the dlPFC is a region of interest for neurostimulation, arising from literature investigating CR (Dieler et al . ). However, further rTMS studies focused on activation of the dlPFC are needed to elicit the exact stimulation parameters for maximal effect (Gorelick et al .…”

Non-invasive Brain Stimulation for the Treatment of Nicotine Addiction: Potential and Challenges

“…This study demonstrated that rTMS over the dlPFC reduces both cigarette consumption and craving, though the effects were not robust and seemed to dissipate over time [30]. Furthermore, rTMS may serve as an additional aid in cognitive-behavioral therapy for intermediate nicotine abstinence [31].…”