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Updated: Oct 31, 2025

Individualized rTMS Treatment for Depression using an fMRI-Based Targeting Method
Published on: August 2, 2021
Depression symptom profiles and long-term response to cognitive behavioral therapy plus contingency management for
Alba González-Roz1, Roberto Secades-Villa2, Gloria García-Fernández2
1Department of Psychology/Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, Spain; Department of Psychology, University of Oviedo, Spain.
Background:
Depression is heterogeneous in nature and using diagnostic categories limits insight into understanding psychopathology and its impact on treatment efficacy. This secondary analysis sought to: 1) identify distinct subpopulations of cigarette users with depression, and 2) examine their response to cognitive-behavioral treatment (CBT) + contingency management (CM) for smoking cessation at one year.
Method:
The sample comprised 238 (74 % females) adults who smoke receiving CBT only or CBT + CM. A latent class analysis was conducted on baseline depressive symptoms measured using the Beck Depression Inventory-II. Generalized estimating equations assessed the main and interactive effects of class, time, treatment, and sex on smoking abstinence.
Results:
Three distinct classes were identified: C1 (n= 76/238), characterized by mild depression, loss of energy, pessimism, and criticism, C2 (n= 100/238) presenting moderate severity and decreased appetite, and C3 (n= 62/238) showing severe depression, increased appetite, and feelings of punishment. There was a significant cluster × treatment interaction, which indicated additive effects of CM over CBT alone for Class 1 and 2. Persons in Class 1 and 2 were 3.60 [95 % CI: 1.62, 7.97] and 2.65 [95 % CI: 1.19, 5.91] times more likely to be abstinent if CBT + CM was delivered rather than CBT only. No differential sex effects were observed on treatment response according to cluster.
Conclusions:
Profiling depression symptom subtypes of cigarette users may be more informative to improve CM treatment response than merely focusing on total scores.
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