Synergistic efficacy of cognitive-behavioral therapy and transcranial direct current Stimulation targeting the dorsolateral prefrontal cortex on baseline craving and cue-induced craving in methamphetamine dependence

Document Type : Research Paper

Authors

1 Ph.D. student in psychology, Faculty of Educational Sciences and Psychology, Islamic Azad University, Bojnord Branch, Bojnord, Iran.

2 Department of Clinical Psychology, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Assistant professor of psychology, Faculty of Educational Sciences and Psychology, Islamic Azad University, Bojnord Branch, Bojnord, Iran.

10.22038/JFMH.2025.86815.3230

Abstract

Introduction: Methamphetamine (crystal meth) is a highly addictive stimulant with devastating effects on the human mind and body. This study aimed to investigate the synergistic efficacy of combined Cognitive-Behavioral Therapy (CBT) and transcranial Direct Current Stimulation (tDCS) targeting the DorsoLateral PreFrontal Cortex (DLPFC) in reducing baseline and cue-induced craving among methamphetamine users. 
 
Materials and Methods: The statistical population included all patients with clinical symptoms of methamphetamine use disorder who attended addiction treatment centers in Mashhad, Iran, between 2022-2024. Using convenience sampling, 40 clinically diagnosed methamphetamine users were selected and randomly assigned to four groups (CBT, tDCS, CBT+ tDCS, and control). Data were analyzed using descriptive statistics, independent t-test, ANOVA, and ANCOVA. 
 
Results: Findings demonstrated that the interventions reduced both baseline and cue-induced craving in methamphetamine users. The most pronounced effects were observed in the group receiving both therapies simultaneously (CBT+ tDCS). 
 
Conclusion: The results indicate combined cognitive-behavioral therapy and transcranial direct current stimulation reduces craving among methamphetamine users.

Keywords

References

  1. Aksu S, Soyata AZ, Mursalova Z, Eskicioğlu G, Tükel R. Transcranial direct current stimulation does not improve clinical and neurophysiological outcomes in panic disorder: A randomized sham‐controlled trial. Psychiatry Clin Neurosci 2022; 76(8): 384-92.
  2. Schaeuffele C, Schulz A, Knaevelsrud, C, Renneberg B, Boettcher J. CBT at the crossroads: The rise of transdiagnostic treatments. Int J Cogn Ther 2021; 14: 86-113.
  3. Waller G, Beard J. Recent advances in cognitive-behavioural therapy for eating disorders (CBT-ED). Curr Psychiatr Rep 2024; 26(7): 351-8.
  4. Muench A, Vargas I, Grandner MA, Ellis JG, Posner D, Bastien CH, et al. We know CBT-I works, now what?. Fac Rev 2022; 11: 4.
  5. Alizadehgoradel J. The effects of Combined Transcranial Direct Current Stimulation (tDCS) with mindfulness on negative emotions and craving in adolescents with methamphetamine dependence. Int J High Risk Behav Addict 2021; 10(1): 70-86.
  6. Aust S, Brakemeier EL, Spies J, Herrera-Melendez AL, Kaiser T, Fallgatter A, et al. Efficacy of augmentation of cognitive behavioral therapy with transcranial direct current stimulation for depression: A randomized clinical trial. JAMA Psychiatry 2022; 79(6): 528-37.
  7. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988; 56(6): 893-7.
  8. Jackson-Koku G. Beck depression inventory. Occup Med 2016; 66(2): 174-5.
  9. Alizadehgoradel J, Imani S, Nejati V, Vanderhasselt MA, Molaei B, Salehinejad MA, et al. Improved executive functions and reduced craving in youths with methamphetamine addiction: evidence from combined transcranial direct current stimulation with mindfulness treatment. Clin Psychopharmacol Neurosci 2021; 19(4): 653.
  10. Alizadehgoradel J. Modification of attentional bias and reduced craving from combined mindfulness + tDCS therapy in methamphetamine addiction: A randomized, sham-controlled, single-blinded clinical trial. Journal of research in psychopathology 2023; 4(13): 6-15.
  11. Volkow ND, Blanco C. Substance use disorders: A comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention. World Psychiatry 2023; 22(2): 203-29.
  12. Fayaz Feyzi‎ Y, Vahed N, Sadeghamal Nikraftar N, Arezoomandan R. Synergistic effect of combined transcranial direct current stimulation and Matrix‎ Model on the reduction of methamphetamine craving and improvement of cognitive‎ functioning: A randomized sham-controlled study. Am J Drug Alcohol Abuse 2022; 48(3): 311-20.
  13. Wardle MC, Webber HE, Yoon JH, Heads AM, Stotts AL, Lane SD, et al. Behavioral therapies targeting reward mechanisms in substance use disorders. Pharmacol Biochem Behav 2024; 173787.
  14. Sahaf SMS, Yazdi ASH, Ramezani F. Effectiveness of transcranial-direct current stimulation in individuals with methamphetamine use disorder: A systematic review and meta-analysis. Int J High Risk Behav Addiction 2024; 13(1): e146021.
  15. Chmiel J, Malinowska A, Rybakowski F, Leszek J. The effectiveness of mindfulness in the treatment of methamphetamine addiction symptoms: Does neuroplasticity play a role?. Brain Sci 2024; 14(4): 320.
  16. McDonald MA. Stimulating mindfulness-to-meaning: Noninvasive brain stimulation targeting the upward spiral of mindful positive emotion regulation. Ph.D. Dissertation. University of Nevada, Reno; 2024.
  17. Hu Y, Wu X, Li S, Liu P, Wang D. Imagine before you leap: Episodic future thinking combined with transcranial direct current stimulation training for impulsive choice in repetitive negative thinking. Int J Clin Health Psychol 2024; 24(2): 100455.
  18. Chmiel J, Kurpas D, Rybakowski F, Leszek J. The effectiveness of transcranial direct current stimulation (tDCS) in binge eating disorder (BED)—Review and insight into the mechanisms of action. Nutrients 2024; 16(10): 1521. 
  19. Tatti E, Phillips AL, Paciorek R, Romanella SM, Dettore D, Di Lorenzo G, et al. Boosting psychological change: Combining non-invasive brain stimulation with psychotherapy. Neurosci Biobehav Rev 2022; 142: 104867.
  20. Olaitan GO, Lynch WJ, Venton BJ. The therapeutic potential of low-intensity focused ultrasound for treating substance use disorder. Front Psychiatry 2024; 15: 1466506.
  21. BrunoniAR, Amadera J, Berbel B, Volz MS, Rizzerio BG, Fregni A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation. Int J Neuropsychopharmacol 2011; 14(8): 1133-45.
  22. Ogai Y, Haraguchi A, Kondo A, Ishibashi Y, Umeno M, Kikuto H, et al. Development and validation of thd stimulant relapse risk scale for drug abusers in Japan. Drug Alcohol Depend 2007; 88(2): 174-81.
  23. Ekhtiari H, Behzadi A, Oghabian MA, Adalat H, Mokri A. [Visual cues inducing craving in addicts, heroin injection]. Quarterly journal of recent cognitive sciences 2006; 8: 43-51. (Persian)
  24. Ekhtiari H, Edalati H, Behzadi A, Safai H, Noori M, Mokri A. [Construction and performance of a visual assessment of the five tests craving in opiate addicts]. Iranian journal of psychiatry and clinical psychology 2008; 14(3): 337-49. (Persian)
  25. Nejati V, Nozari M, Mirzaian B, Pourshahriar H, Salehinejad MA. Comparable efficacy of repeated transcranial direct current stimulation, cognitive behavioral therapy, and their combination in improvement of cold and hot cognitive functions and amelioration of depressive symptoms. J Nerv Ment Dis 2024; 212(3): 141-51. 
  26. Piretti L, Pappaianni E, Gobbo S, Rumiati RI, Job R, Grecucci A. Dissociating the role of dACC and dlPFC for emotion appraisal and mood regulation using cathodal tDCS. Cogn Affect Behav Neurosci 2022; 22(2): 304-15.
  27. Rimmer R. Community-based tDCS treatment for depression: Acceptability and neuropsychological correlates. University of East London Repository; 2025.
  28. Volkow ND, Blanco C. Substance use disorders: A comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention. World Psychiatry 2023; 22(2): 203-29.
  29. Turner R, Swearer Napolitano SM. Cognitive behavioral therapy (CBT). [cited 2010]. Available from: https://digitalcommons.unl.edu/context/edpsychpapers/article/1146/viewcontent/Swearer_Napolitano_2010_ECCSP_Cognitive_Behavioral_Therapy_DC_ver.pdf
  30. Paulus W. Transcranial direct current stimulation (tDCS). Suppl Clin Neurophysiol 2003; 56: 249-54.

31. Camacho-Conde JA, del Rosario Gonzalez-Bermudez M, Carretero-Rey M, Khan ZU. Therapeutic potential of brain stimulation techniques in the treatment of mental, psychiatric, and cognitive disorders. CNS Neurosci Ther 2023; 29(1): 8-23

Fundamentals of Mental Health
Volume 27, Issue 4
July and August 2025
Pages 259-265

Files

Share

How to cite

Statistics