Neuromodulation over early visual cortex reduces trauma "flashbacks" independent of conscious awareness

Neuroimaging work has repeatedly linked the visual sensory system to trauma flashbacks-vivid, spontaneous intrusions dominated by sensory-perceptual imagery-yet it remains unclear whether visual cortex plays a causal role or merely reflects downstream consequences of threat-circuit engagement. To test causality, we applied inhibitory (1 Hz) repetitive transcranial magnetic stimulation to early visual cortex (V1/V2) following either conscious or subliminal reminder cueing of trauma-film memories. Relative to vertex stimulation, V1/V2 repetitive transcranial magnetic stimulation reliably reduced the frequency, vividness, emotional distress, and daily impact of spontaneous intrusions over the following week in the conscious and unconscious cueing conditions. Explicit memory performance remained largely unaffected. Importantly, participants undergoing unconscious cueing also reported markedly reduced antipathy toward the intervention, suggesting greater emotional tolerability. These findings provide causal evidence for a contribution of visual cortex to trauma-memory intrusions and suggest a potentially low-distress intervention strategy that combines subliminal memory cueing with sensory cortical modulation. (PsycInfo Database Record (c) 2026 APA, all rights reserved).