# Developing a Novel rTMS Intervention for Transdiagnostic Psychosocial Rehabilitation: ADose-finding Study

> **NIH VA I21** · RALPH H JOHNSON VA MEDICAL CENTER · 2020 · —

## Abstract

High frequency repetitive transcranial magnetic stimulation (rTMS) to left dorsolateral prefrontal cortex (dlPFC)
is FDA-approved for the treatment of major depression. The left dlPFC site typically targeted with rTMS is
seated in an area of cortex integral to intact higher order cognition (i.e., executive function). The PI has
demonstrated that this left dlPFC region is commonly hypoactivated during cognitive tasks across
neuropsychiatric disorders. Accordingly, cognitive improvements have been reported as ancillary benefits to
rTMS treatment and that rTMS improves cognition in mild to moderate cognitive impairment.
We propose that because rTMS to dlPFC is targeting cognitive neurocircuitry integral to adaptive cognitive
functioning, promoting neuroplasticity in this network with rTMS could be more precisely optimized to improve
quality of life across psychosocial domains and across neuropsychiatric presentations. We postulate that
through up-regulating cognitive control circuitry with rTMS that an individual would have 1) enhanced capacity
for successfully contending with the shifting contingencies of daily life and 2) improved ability to regulate
intrusive affect and impulses. As a function of these processes an individual is expected to experience reduced
psychosocial impairment. Thus, we propose that rather than targeting specific symptom reductions in specific
disorders, rTMS could be dosed for efficacy in enhancing psychosocial functioning. Such an approach has the
potential to enhance rehabilitation for far more veterans suffering a range of neuropsychiatric conditions.
A therapeutic course of rTMS typically consists of approximately 30-40 minutes of high-frequency (i.e., 10 Hz)
treatment on each weekday, for 4 to 6 weeks. This schedule can be burdensome and reduce adherence.
Recently, Co-investigator Mark George, M.D. and colleagues demonstrated that delivering multiple high-dose
sessions to veterans on each of three consecutive days was safe, feasible, and suggestive of rapid
antidepressant effects. These patients received in three days, the equivalent dose (i.e., total number of pulses)
of a conventional 4- to 6-week course. We propose that establishing an efficacious accelerated protocol
delivered within 1 week would greatly increase the likelihood of implementation in the VA healthcare system.
Furthermore, an accelerated course of rTMS that enhances psychosocial functioning across disorders, would
be a ready adjunct for other modalities of rehabilitation already utilized in the VA healthcare system including
pharmacotherapy and cognitive-behavioral therapy as well as occupational and physical therapy.
In light of the goal to utilize accelerated rTMS to reduce psychosocial functional impairment, it is essential to
establish the associated dose-response curve as a first step in laying the foundation for this line of work. Prior
rTMS investigations have relied upon rational decision trees in determining TMS dose, typically founded upon
...

## Key facts

- **NIH application ID:** 9838092
- **Project number:** 5I21RX002886-02
- **Recipient organization:** RALPH H JOHNSON VA MEDICAL CENTER
- **Principal Investigator:** Lisa M McTeague
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-01-01 → 2021-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9838092

## Citation

> US National Institutes of Health, RePORTER application 9838092, Developing a Novel rTMS Intervention for Transdiagnostic Psychosocial Rehabilitation: ADose-finding Study (5I21RX002886-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9838092. Licensed CC0.

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