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Published on: November 25, 2025
Repetitive transcranial magnetic stimulation for generalised anxiety disorder: a pilot randomised, double-blind,
Gretchen J Diefenbach1, Laura B Bragdon2, Luis Zertuche2
1Gretchen J. Diefenbach, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; Laura B. Bragdon, MA, Binghamton University, Binghamton, New York; Luis Zertuche, BSc, Christopher J. Hyatt, PhD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford, Connecticut; Lauren S. Hallion, PhD, Anxiety Disorders Center, The Institute of Living, Hartford, Connecticut; David F. Tolin, PhD, Anxiety Disorders Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut; John W. Goethe, MD, Burlingame Center for Research and Education, The Institute of Living, Hartford, Connecticut; Michal Assaf, MD, Olin Neuropsychiatry Research Center, The Institute of Living, Hartford and Yale University School of Medicine, New Haven, Connecticut, USA Gretchen.Diefenbach@hhchealth.org.
Background:
Repetitive transcranial magnetic stimulation (rTMS) holds promise for treating generalised anxiety disorder (GAD) but has only been studied in uncontrolled research.
Aims:
This is the first randomised controlled trial (clinicaltrials.gov: NCT01659736) to investigate the efficacy and neural correlates of rTMS in GAD.
Method:
Twenty five participants (active n = 13; sham, n = 12) enrolled. rTMS was targeted at the right dorsolateral prefrontal cortex (DLPFC, 1 Hz, 90% resting motor threshold).
Results:
Response and remission rates were higher in the active v. sham groups and there were significant group × time interactions for anxiety, worry and depressive symptoms, favouring active v. sham. In addition, right DLPFC activation during a decision-making gambling task increased at post-treatment for active rTMS only, and changes in neuroactivation correlated significantly with changes in worry symptoms.
Conclusions:
Findings provide preliminary evidence that rTMS may improve GAD symptoms in association with modifying neural activity in the stimulation site.
