The Effectiveness of Direct Transcranial Electrical Stimulation on Rumination and Anxiety in Patients with Paranoid Personality Disorder

Erfanmanesh , Erfane; Mousavi , Seyed Asghar; Saeidmanesh, Mohsen

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Erfanmanesh E, Mousavi S A, Saeidmanesh M. The Effectiveness of Direct Transcranial Electrical Stimulation on Rumination and Anxiety in Patients with Paranoid Personality Disorder. MEJDS 2024; 14 :1-1
URL: http://jdisabilstud.org/article-1-3332-en.html

The Effectiveness of Direct Transcranial Electrical Stimulation on Rumination and Anxiety in Patients with Paranoid Personality Disorder

Erfane Erfanmanesh¹

, Seyed Asghar Mousavi ^*²

, Mohsen Saeidmanesh³

1- PhD Student in Psychology, Department of Psychology, Bushehr Branch, Islamic Azad University, Bushehr, Iran
2- Assistant Professor, Department of Psychology, Bushehr Branch, Islamic Azad University, Bushehr, Iran
3- Associate Professor, Department of Psychology, Science and Arts University, Yazd, Iran

Abstract: (932 Views)

Abstract
Background & Objectives: Paranoid personality disorder is a severe and challenging-to-treat mental illness that has historically been overlooked clinically, causing those affected to harbor deep and unfounded distrust toward others. Since neural variability is an important pathological component of many neurological and psychiatric diseases, non-invasive brain stimulation is a potential therapeutic option because it can modulate neural activity. Transcranial direct current stimulation is a non-invasive technique that stimulates parts of the brain for therapeutic effects and has been introduced as a promising method to increase neural flexibility. It is relatively safe, fast, and more portable, affordable, and tolerable compared to other techniques. The effects and direction of transcranial direct stimulation are influenced by the intensity of the stimulation and can be enhanced with repeated stimulation (i.e., cumulative effects). Anodic stimulation of the left prefrontal cortex and inhibition of the right prefrontal cortex are the most promising approaches for treating anxiety disorders. In the context of chronic, complex, and treatment-resistant disorders, focusing on rumination can enhance the effectiveness of psychological treatments and improve treatment outcomes. Additionally, rumination moderates the relationship between anxiety, negative affect, and paranoia. The study aimed to assess the impact of transcranial direct electrical stimulation on rumination and anxiety in paranoid personality disorder patients.
Methods: The current study was an experimental research with a pre-test, post-test, and follow-up design, including a control group. The research included all patients with paranoid personality disorder aged 30 to 45 in Yazd city who visited psychological and psychiatric clinics and hospitals in 2022. The research sample consisted of 30 volunteers selected through non-random sampling and randomly assigned to two groups: experimental (15 people) and control (15 people). During the pre-test and two-month post-test phases, participants completed questionnaires which included Hoeksma and Maro's 22-question rumination questionnaire (Hoeksma and Maro, 1991) with an alpha coefficient of 0.90 and a retest reliability of 0.67. They also completed Beck's 21-question anxiety scale (Beck et al., 1990) with a one-week retest reliability coefficient of 0.75 and an internal consistency of 0.93. During the experiment, the subjects in the experimental group received therapeutic intervention over 10 consecutive days, with 10 sessions lasting 20 minutes each. The intervention involved direct transcranial electrical stimulation of the brain in the dorso-lateral prefrontal cortex. This was done by simultaneously applying anodic stimulation to the left area and cathodic stimulation to the right area of the dorsolateral prefrontal cortex, with an intensity of 2 mA. Data analysis was conducted using the analysis of variance with repeated measurements and Bonferroni's post hoc test at a significance level of 0.05, utilizing SPSS-27 software.
Results: The results showed that direct transcranial electrical stimulation significantly improved rumination (p<0.001) and anxiety (p<0.001) in the post-test phase. Furthermore, there was no significant difference in rumination and anxiety scores between the post-test and follow-up stages, indicating that the treatment effects were durable in the follow-up stage.
Conclusion: According to the research results, implementing direct transcranial electrical stimulation treatment for patients can have beneficial effects in reducing their emotional and cognitive problems.

Keywords: Paranoid Personality Disorder, Rumination, Anxiety, Direct Transcranial Electrical Stimulation

Full-Text [PDF 382 kb] (641 Downloads)

Type of Study: Original Research Article | Subject: Psychology

References

1. Chen KS, Dwivedi Y, Shelton RC. The effect of IV ketamine in patients with major depressive disorder and elevated features of borderline personality disorder. Journal of Affective Disorders. 2022 Oct 15;315:13-6. [DOI]

2. Mu X, Xu J, Lin P, Luo Y, Zhu Y, Shi Y, Chen S, Wu Z, Li S. A Case Report of Leukocytosis During Modified Electroconvulsive Therapy of Paranoid Personality Disorder. Frontiers in Psychiatry. 2022 May 26;13:899847. [DOI]

3. Folmo EJ, Stänicke E, Johansen MS, Pedersen G, Kvarstein EH. Development of therapeutic alliance in mentalization-based treatment—Goals, Bonds, and Tasks in a specialized treatment for borderline personality disorder. Psychotherapy Research. 2021 Jul 4;31(5):604-18. [DOI]

4. Lee YJ, Keum MS, Kim HG, Cheon EJ, Cho YC, Koo BH. Defense mechanisms and psychological characteristics according to suicide attempts in patients with borderline personality disorder. Psychiatry investigation. 2020 Aug;17(8):840. [DOI]

5. Ward M, Benjamin I, Zimmerman M. The Clinical Characteristics of Patients With Borderline Personality Disorder in Different Treatment Settings. Journal of Personality Disorders. 2022 Apr;36(2):217-29.‌ [DOI]

6. Watkins ER, Roberts H. Reflecting on rumination: Consequences, causes, mechanisms and treatment of rumination. Behaviour research and therapy. 2020 Apr 1;127:103573. [DOI]

7. Moulds ML, Bisby MA, Wild J, Bryant RA. Rumination in posttraumatic stress disorder: A systematic review. Clinical Psychology Review. 2020 Dec 1;82:101910. [DOI]

8. Bortolon C, Raffard S. Pondering on how great I am: Does rumination play a role in grandiose ideas?. Journal of behavior therapy and experimental psychiatry. 2021 Mar 1;70:101596. [DOI]

9. Krkovic K, Krink S, Lincoln TM. Emotion regulation as a moderator of the interplay between self-reported and physiological stress and paranoia. European Psychiatry. 2018 Mar;49:43-9. [DOI]

10. Grant BF, Hasin DS, Stinson FS, Dawson DA, Chou SP, Ruan WJ, Huang B. Co-occurrence of 12-month mood and anxiety disorders and personality disorders in the US: results from the national epidemiologic survey on alcohol and related conditions. Journal of psychiatric research. 2005 Jan 1;39(1):1-9. [DOI]

11. Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. DSM-IV personality disorders in the National Comorbidity Survey Replication. Biological psychiatry. 2007 Sep 15;62(6):553-64. [DOI]

12. Shea MT, Stout RL, Yen S, Pagano ME, Skodol AE, Morey LC, et al. Associations in the course of personality disorders and Axis I disorders over time. Journal of abnormal psychology. 2004 Nov;113(4):499. [DOI]

13. Skodol AE, Geier T, Grant BF, Hasin DS. Personality disorders and the persistence of anxiety disorders in a nationally representative sample. Depression and Anxiety. 2014 Sep;31(9):721-8. [DOI]

14. Crawford TN, Cohen P, First MB, Skodol AE, Johnson JG, Kasen S. Comorbid Axis I and Axis II disorders in early adolescence: outcomes 20 years later. Arch Gen Psychiatry. 2008 Jun 2;65(6):641-8. [DOI]

15. Ansell EB, Pinto A, Edelen MO, Markowitz JC, Sanislow CA, Yen S, et al. The association of personality disorders with the prospective 7-year course of anxiety disorders. Psychol Med. 2011 May;41(5):1019-28. [DOI]

16. Daviu N, Bruchas MR, Moghaddam B, Sandi C, Beyeler A. Neurobiological links between stress and anxiety. Neurobiology of stress. 2019 Nov 1;11:100191. [DOI]

17. Takagi Y, Sakai Y, Abe Y, Nishida S, Harrison BJ, Martínez-Zalacaín I, et al. A common brain network among state, trait, and pathological anxiety from whole-brain functional connectivity. Neuroimage. 2018 May 15;172:506-16. [DOI]

18. Reinhart RM, Cosman JD, Fukuda K, Woodman GF. Using transcranial direct-current stimulation (tDCS) to understand cognitive processing. Attention, Perception, & Psychophysics. 2017 Jan;79:3-23. [DOI]

19. Hanenberg C, Getzmann S, Lewald J. Transcranial direct current stimulation of posterior temporal cortex modulates electrophysiological correlates of auditory selective spatial attention in posterior parietal cortex. Neuropsychologia. 2019 Aug 1;131:160-70. [DOI]

20. Vanderhasselt MA, De Raedt R, Namur V, Lotufo PA, Bensenor IM, Boggio PS, Brunoni AR. Transcranial electric stimulation and neurocognitive training in clinically depressed patients: a pilot study of the effects on rumination. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2015 Mar 3;57:93-9. [DOI]

21. De Raedt R, Remue J, Loeys T, Hooley JM, Baeken C. The effect of transcranial direct current stimulation of the prefrontal cortex on implicit self-esteem is mediated by rumination after criticism. Behav Res Ther. 2017 Dec 1;99:138-46. [DOI]

22. Abad Y, Haroon Rashidi H. The Effectiveness of Mindfulness-Based Cognitive Therapy on Rumination and Existential Anxiety in the Elderly Men. Aging Psychology. 2022 Apr 21;8(1):10. [Persian] [DOI]

23. Ahmadizadeh M, Rezaei M. Effectiveness of Transcranial Direct Current Stimulation (tDCS) on depression, anxiety and rumination of patients with Post-traumatic Stress Disorder Symptoms (PTSD). Journal of military medicine. 2020;22(3):264-72. [Persian]

24. Lolaei M, Abutalebi P, Haji Mohammad Baqer S. Effectiveness of transcranial direct current electrical stimulation (tDCS) on patients with major depressive disorder. In: 9th International Conference on Advanced Research in Science, Engineering and Technology [Internet]. Iran; 2021 Desember 21 [cited 2021 Desember 21]. [Article]

25. Majidpoor Tehrani L, Golshani F, Peimani J, Baghdasarians A, Taghiloo S. The Effectiveness of Combining Cranial Electrical Stimulation with Cognitive-Behavioral Therapy and Drug Therapy on Rumination and Depressive Syndrome in Women. Quarterly of Applied Psychology, 15 (4): 81. 2021;107:2. [Persian]

26. Vicario CM, Salehinejad MA, Felmingham K, Martino G, Nitsche MA. A systematic review on the therapeutic effectiveness of non-invasive brain stimulation for the treatment of anxiety disorders. Neuroscience & Biobehavioral Reviews. 2019 Jan 1;96:219-31.

27. Gili S, Sadeghi Zavareh V, Haghayegh SA, Alizadeh Ghavidel A, Rezayi Jamalloi H. The Comparison of Effectiveness of Emotion-Focused Therapy and Transcranial Direct Current Stmulation on Anxiety and Depression of Patients with Coronary Artery Disease. Health Psychology. 2021 Feb 19;9(36):45-62.

28. Mirmoradzehi Sibi M, Shirazi M, Kahrazei F. The effect of direct electrical stimulation of cranial vera (tDCS) and verbal neural programming (NLP) on reducing depression, anxiety and stress in women. Journal of Applied Family Therapy. 2022 Jun 22;3(2):586-97. [Persian] [DOI]

29. Springfield CR, Isa RS, Bass EL, Vanneste S, Pinkham AE. Preliminary evidence for the efficacy of single‐session transcranial direct current stimulation to the ventrolateral prefrontal cortex for reducing subclinical paranoia in healthy individuals. Br J Clin Psychol. 2021 Sep;60(3):333-8. [DOI]

30. Treynor W, Gonzalez R, Nolen-Hoeksema S. Rumination reconsidered: A psychometric analysis. Cognitive therapy and research. 2003 Jun;27:247-59. [DOI]

31. Farrokhi H, Seyedzadeh A, Mostafa Pour V. Investigating Reliability, Validity and Factor Structure of the Persian Version of the Positive and Negative Belief Rumination Scale and Rumination Response Scale. Journal of New Advances in Psychology. 2017;14(2):21-37. [Persian]

32. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. Journal of consulting and clinical psychology. 1988 Dec;56(6):893. [DOI]

33. Kaviani H, Mousavi AS. Psychometric properties of the Persian version of Beck Anxiety Inventory (BAI). Tehran University of Medical Sciences Journal. 2008 May 10;66(2):136-40. [Persian] [Article]

34. Gilmore CS, Dickmann PJ, Nelson BG, Lamberty GJ, Lim KO. Transcranial Direct Current Stimulation (tDCS) paired with a decision-making task reduces risk-taking in a clinically impulsive sample. Brain stimulation. 2018 Mar 1;11(2):302-9.

35. Allaert J, De Raedt R, van Der Veen FM, Baeken C, Vanderhasselt MA. Prefrontal tDCS attenuates counterfactual thinking in female individuals prone to self-critical rumination. Sci Rep. 2021 Jun 2;11(1):11601. [DOI]

36. Lisoni J, Vita A. Review of:" Prefrontal tDCS attenuates counterfactual thinking in female individuals prone to self-critical rumination. Qeios. 2021. [DOI]

37. Zheng S, Marcos M, Stewart KE, Szabo J, Pawluk E, Girard TA, et al. Worry, intolerance of uncertainty, negative urgency, and their associations to paranoid thinking. Personality and Individual Differences. 2022;186:111382. [DOI]

38. Hui H, Hong A, Gao J, Yu J, Wang Z. Efficacy of tDCS to enhance virtual reality exposure therapy response in acrophobia: A randomized controlled trial. Journal of Psychiatric Research. 2024 Mar 1;171:52-9. [DOI]