# Neuroimaging correlates and feasibility of transcranial magnetic stimulation (TMS) to improve smoking cessation outcomes in veterans with comorbid PTSD

> **NIH VA IK1** · DURHAM VA MEDICAL CENTER · 2021 · —

## Abstract

Tobacco use remains the number one preventable cause of death in the United States. Unfortunately, individuals
with mental health conditions are disproportionately affected. Tobacco use is also high among US Veterans, and
those who have experienced trauma are even more likely to smoke. Successful quitting is especially difficult for
individuals who develop posttraumatic stress disorder (PTSD). Despite the efficacy of current evidence-based
pharmacotherapies and psychotherapies for smoking cessation, alternative treatments are needed. Neuroimaging
techniques such as resting-state functional magnetic resonance imaging (rs-fMRI) have provided insight into the
neurocircuitry underlying the neurobiology of tobacco use disorder (TUD) and successful quit attempts. This
improved understanding of the TUD pathophysiology at the neural systems-level provides a platform for the use of
non-invasive brain stimulation (NIBS) techniques to modulate affected circuitry and improve outcomes. Indeed, the
US Food and Drug Administration (FDA) recently cleared a form of NIBS, repetitive transcranial magnetic stimulation
(rTMS), as a smoking cessation treatment in adults. However, the vast majority of clinical research trials on rTMS
for smoking cessation have been conducted with civilians and excluded individuals with mental health conditions.
To improve smoking cessation treatment options for Veterans with PTSD, it is critical to study novel brain stimulation
methods such as rTMS in this special population. Similarly, the development of neuroscience-informed techniques
to enhance rTMS in this treatment-resistant population are necessary. The application rs-fMRI to develop
personalized rTMS targets as a way to precisely modulate the underlying neurocircuitry has been successfully
applied to the treatment of major depressive disorder (MDD). This methodology has been demonstrated successfully
for smoking cessation, but in civilian subjects making a quit attempt who did not have psychiatric illness. It remains
unknown whether Veterans would find a combined neuroimaging-brain stimulation approach acceptable or if it is
feasible to apply and study these techniques in a population of Veterans with PTSD. To fill these knowledge gaps,
the proposed research aims to develop feasibility data for the therapeutic application of rs-fMRI-targeted rTMS for
Veterans with PTSD attempting to quit smoking. Through a single-group, open-label trial, eligible Veterans with
PTSD (n=14) seeking smoking cessation will receive rs-fMRI before and after a 5-day course of neuronavigated
rTMS the week prior to their quit date, in conjunction with nicotine replacement therapy (NRT) and cognitive
behavioral therapy. The scientific aims of the study are to demonstrate recruitment, retention, and acceptability in
the study population, as well as feasibility of study procedures. In addition, the training aim is to provide the candidate
with mentored clinical research training that supports the completio...

## Key facts

- **NIH application ID:** 10261000
- **Project number:** 1IK1CX002187-01A1
- **Recipient organization:** DURHAM VA MEDICAL CENTER
- **Principal Investigator:** Jonathan R Young
- **Activity code:** IK1 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2021-07-01 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10261000

## Citation

> US National Institutes of Health, RePORTER application 10261000, Neuroimaging correlates and feasibility of transcranial magnetic stimulation (TMS) to improve smoking cessation outcomes in veterans with comorbid PTSD (1IK1CX002187-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10261000. Licensed CC0.

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