A Method to Provoke Obsessive Compulsive Symptoms for Basic Research and Clinical Interventions

Aron Tendler; Elyssa Sisko; Noam Barnea-Ygael; Abraham Zangen; Eric A Storch

doi:10.3389/fpsyt.2019.00814

A Method to Provoke Obsessive Compulsive Symptoms for Basic Research and Clinical Interventions

Front Psychiatry. 2019 Nov 11:10:814. doi: 10.3389/fpsyt.2019.00814. eCollection 2019.

Authors

Aron Tendler^{1

2

3}, Elyssa Sisko², Noam Barnea-Ygael³, Abraham Zangen^{1

3}, Eric A Storch⁴

Affiliations

¹ Brainsway Ltd., Jerusalem, Israel.
² Advanced Mental Health Care, Inc., Palm Beach, FL, United States.
³ Department of Life Sciences, Ben Gurion University, Beer Sheva, Israel.
⁴ Psychiatry and Behavioral Sciences Electroencephalogram, Functional Magnetic Resonance Imaging, Baylor College of Medicine, Houston, TX, United States.

Abstract

The efficacy of deep repetitive transcranial magnetic stimulation (dTMS) for obsessive compulsive disorder (OCD) was recently confirmed in a Food and Drug Administration-regulated, multicenter, sham-controlled study. In this study, patients who failed pharmacotherapy underwent individually tailored provocations just prior to each stimulation session, in the attempt to activate the relevant circuitry and making it labile to change. The procedure that was developed reliably evoked moderate intensity symptoms, making it effective on the one hand and mild enough to allow the patient to continue with the dTMS session on the other. This methodology article describes in a detailed step wise fashion how to evaluate the patient's specific symptoms and design the individualized provocations. Additionally, the article explains how to instruct relevant personnel to administer the provocations, gauge their efficacy, and overcome possible obstacles. This method, apart from its ongoing role in the clinical treatment of OCD by dTMS, may be used for provocation of symptoms in basic studies [e.g., imaging with Electroencephalogram (EEG) or Functional magnetic resonance imaging fMRI] as well as other treatments.

Keywords: cognitive paired associative stimulation; deep repetitive transcranial magnetic stimulation; exposure and response prevention; obsessive compulsive disorder; provocation.