A perspective on the necessity and brain network principles for combining tDCS with psychotherapy in OCD

Increasing evidence explores the potential of combining psychotherapy with transcranial direct current stimulation (tDCS) to facilitate meaningful clinical changes. A recent study outlines a protocol for a randomized controlled trial of tDCS-enhanced exposure and response prevention (ERP) for obsessive-compulsive disorder. In light of the variable efficacy reported for tDCS monotherapy, we discuss the theoretical support for this combined approach, emphasizing the activity-selectivity hypothesis and state-dependent fear extinction. Furthermore, we suggest that therapeutic benefits might emerge from broader network synergy and connectivity reconfiguration rather than local excitability changes alone, indicating the potential value of multimodal neuroimaging in elucidating these dynamic mechanisms.