Spectral EEG-guided adaptive neuromodulation for social anxiety disorder, performance-only subtype: a case report

Social anxiety disorder (SAD) is often complicated by anticipatory anxiety, hyperarousal, and variability in response to first-line treatments such as cognitive behavioral therapy (CBT) and pharmacotherapy. These limitations highlight the need for adjunctive modalities capable of enhancing the magnitude and durability of treatment response. This case report explores outcomes following spectral EEG-guided personalized repetitive transcranial magnetic stimulation (PrTMS) in a patient with SAD, performance-only subtype. Weekly psychometric assessments revealed reductions in social anxiety intensity, avoidance behaviors, and negative self-appraisal, along with improvements in mood and daily function. Symptom changes were quantified using the Liebowitz Social Anxiety Scale (LSAS), Social Phobia Inventory (SPIN), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-Item Scale (GAD-7), and Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF). Clinical improvements were accompanied by increased alpha band power, decreased delta band power, and an increased alpha-delta ratio on serial spectral resting-state EEGs. Our findings suggest that PrTMS may warrant further investigation as a potential adjunctive treatment for SAD. Further large-scale, blinded, and randomized studies are warranted to validate our observations on the feasibility of PrTMS for SAD.