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The goal of this study is to learn whether combining repetitive transcranial magnetic stimulation (rTMS) with a computerized behavioral intervention (imagery cognitive bias modification, CBM-I) reduces negative interpretation bias and mild-to-moderate depressive symptoms. The study will also examine neural changes in the dorsolateral prefrontal cortex (DLPFC) and whether timing of interventions affects outcomes.
The main questions it aims to answer are:
Does active TMS reduce negative interpretation bias and depressive symptoms more than sham TMS? Is delivering CBM-I concurrently with TMS more effective than delivering it consecutively (separate sessions) at reducing negative bias and depressive symptoms? Do combined rTMS + CBM-I approaches produce greater neural changes and improved cognitive control over self-referential interpretation than controls? Researchers will compare active TMS versus sham TMS, and concurrent versus consecutive delivery of CBM-I, to test effects on negative bias and depressive symptoms.
Participants will:
Receive either active rTMS or sham TMS targeting the DLPFC Complete imagery CBM-I sessions either concurrently with TMS or in separate (consecutive) sessions Undergo assessments of negative interpretation bias, depressive symptoms, and neural measures before and after the intervention
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| CC-R-CBM | Active Comparator | Concurrent, Real TMS, CBM |
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| CC-S-CBM | Sham Comparator | Concurrent, Sham TMS, CBM |
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| CS-R-CBM | Active Comparator | Consecutive, Real TMS, CBM |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| TMS | Device | The rTMS group will receive 10 Hz stimulation to the left DLPFC at an intensity of 120% of the resting motor threshold of the right abductor pollicis brevis (APB) muscle with 4 sec trains and 11 sec intertrain intervals for 3000 pulses.Specifically in our study, we combine both intervention, but applying them concurrently and consecutively between groups. |
| Measure | Description | Time Frame |
|---|---|---|
| Cognitive Bias | Measurement: Self-Referent Encoding Task Tool: PsychoPy Unit:Self-Referential Bias Index measured by positive and negative self-description affirmation | "From enrollment to the end of treatment at 4 weeks" |
| Depressive Symptoms | Measurement: Beck's Depressive Inventory-II Tool: Qualtrics Questionnaire Unit:Beck's Depressive Inventory-II Index | "From enrollment to the end of treatment at 4 weeks" |
| Resting State functional MRI | Measurement: resting-state functional MRI Image Tool: SIGNA Premier 3T wide-bore MRI scanner Unit: functional dicom images | "From enrollment to the end of treatment at 4 weeks" |
| Measure | Description | Time Frame |
|---|---|---|
| Subjective Well Being | Measurement: Subjective Well-Being Scale Tool: Qualtrics Questionnaire Unit: Subjective Well-Being Index | "From enrollment to the end of treatment at 4 weeks" |
| Sleep Quality |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Richard Liu Mr. Liu | Contact | +85290971398 | richliu18@connect.hku.hk |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| InnoCentre of Clinical Neuropsychology, The University of Hong Kong | Recruiting | Quarry Bay | Hong Kong Island | Hong Kong |
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| Cognitive Bias Modification | Behavioral | Imagery CBM-I focuses on 2 cognitive aspects, mental imagery and interpretation. Participants will be presented with scenarios in which they have to imagine themselves to be in and practice constructing positive endings or interpretations for them. |
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| Sham TMS | Device | The TMS coil will be rotated 90 degrees, and will not be delivering active stimulation to the participant. The intensity will be set to 30 and the TMS device will be active, generating enough sound effect but no real stimulation for sham control. |
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Measurement: Pittsburgh Sleep Quality Index (PSQI) Tool: Qualtrics Questionnaire Unit: Sleep Quality Index
| "From enrollment to the end of treatment at 4 weeks" |
| Anxiety Symptoms | Measurement: Beck Anxiety Inventory Task Tool: Qualtrics Questionnaire Unit: Anxiety Index | "From enrollment to the end of treatment at 4 weeks" |
| Structural MRI | Measurement: T1 Structural MRI Brain Image Tool: SIGNA Premier 3T wide-bore MRI scanner Unit: structural dicom images | "From enrollment to the end of treatment at 4 weeks" |
| Rumination Symptoms | Measurement: Rumination Response Scale (RRS) Task Tool: Qualtrics Questionnaire Unit: Rumination Index | "From enrollment to the end of treatment at 4 weeks" |
| Anhedonia Symptoms | Measurement: Dimensional Anhedonia Rating Scale Tool: Qualtrics Questionnaire Unit: Anhedonia Index | "From enrollment to the end of treatment at 4 weeks" |
| Cognitive Measures-Attention | Measurement: Conners Continuous Performance Tests - III Tool: CPT-III (Computer Task) Unit: Reaction Time | "From enrollment to the end of treatment at 4 weeks" |
| Cognitive Measures-Attention | Measurement: Conners Continuous Performance Tests - III Tool: CPT-III (Computer Task) Unit: Correct Responses and Error responses will be used to calculate a performance index of sustained attention | "From enrollment to the end of treatment at 4 weeks" |