Comparison of the synergistic effectiveness of cognitive-behavioral therapy and transcranial direct current stimulation of the dorsolateral prefrontal cortex on clinical symptoms and neuropsychological functions in methamphetamine users

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.2025.26470

Abstract

Introduction: Methamphetamine (crystal meth) is a highly addictive stimulant substance with destructive effects on the human mind and body. The aim of this research was to investigate the synergistic effectiveness of Cognitive-Behavioral Therapy (CBT) and transcranial Direct Current Stimulation (tDCS) of the DorsoLateral PreFrontal Cortex (DLPFC) on clinical symptoms and neuropsychological functions in methamphetamine users.
Materials and Methods: The statistical population included all patients with clinical symptoms of crystal meth use disorder who were referred to addiction treatment centers in Mashhad, Iran, from 2022 to 2024. Forty patients were selected using the convenience sampling and randomly assigned to 3 experimental groups (CBT, tDCS, CBT + tDCS) and 1 control group (10 participants each). Data were analyzed using descriptive statistics, Independent t-test, ANOVA, and ANCOVA.
 Results: The findings showed that the interventions were effective therapies, especially CBT and CBT + tDCS had significant effects (P< 0.05) on reducing clinical symptoms and improving neuropsychological functions in methamphetamine users.
Conclusion: The results indicated that all interventions reduced clinical symptoms and led to an improvement in neuropsychological functions, especially in the groups of cognitive-behavioral therapy and cognitive-behavioral therapy plus tDCS.

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. Psychiatr 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 Behav 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. Brooks H, Oughli HA, Kamel L, Subramanian S, Morgan G, Blumberger DM, et al. Enhancing cognition in older persons with depression or anxiety with a combination of mindfulness-based stress reduction (MBSR) and transcranial direct current stimulation (tDCS): Results of a pilot randomized clinical trial. Mindfulness 2021; 12: 3047-59.
  10. 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.
  11. Chaudhary U. Non-invasive brain stimulation techniques: TMS, tDCS, and tACS methods. In: Expanding senses using neurotechnology: Volume 1‒foundation of brain-computer interface technology. Cham, Switzerland: Springer Nature; 2025: 281-324.
  12. Chmiel J, Stępień-Słodkowska M, Ramik-Mażewska I. Efficacy of transcranial Direct Current Stimulation (tDCS) on neuropsychiatric symptoms in Substance Use Disorder (SUD)—A review and insights into possible mechanisms of action. J Clin Med 2025; 14(4): 1337.
  13. 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 14(8); 1133-45.
  14. Ghassemzadeh H, Mojtabai R, Karamghadiri N, Ebrahimkhani N. Psychometric properties of a Persian-language version of the Beck Depression Inventory--Second edition: BDI-II-PERSIAN. Depress Anxiety 2005; 21(4): 185-92.
  15. Kaviani H, Mousavi AS. [Psychometric properties of the Persian version of Beck Anxiety Inventory (BAI)]. Tehran University of medical journal 2008; 66(2):136-140. (Persian)
  16. Van Royen A, Van Malderen E, Desmet M, Goossens L, Verbeken S, Kemps E. Go or no-go? An assessment of inhibitory control training using the GO/NO-GO task in adolescents. Appetite 2022; 179: 106303.
  17. Moore MJ, Byrne J, Gibson EC, FordL, Robinson Hayling and stroop tests tap dissociable deficits and network-level neural correlates. Brain structure and function 2024; 229: 879-96.
  18. Horczak P, Wang C, De Witte S, De Smet S, Remue J, De Raedt R, et al. Combining transcranial direct current stimulation with group cognitive behavioral therapy developed to treat rumination: a clinical pilot study. Front Neurol 2023; 14: 1167029.
  19. Kazinczi C, Szepfalusi N, Nemeth VL, Holczer A, Jakab K, Vecsei L, et al. The effect of transcranial direct current stimulation and inhibitory control training on depression and anxiety among post-stroke individuals. BMC Neurol 2025; 25(1): 38.
  20. Alimoradi Z, Jafari E, Broström A, Ohayon MM, Lin CY, Griffiths MD, et al. Effects of cognitive behavioral therapy for insomnia (CBT-I) on quality of life: A systematic review and meta-analysis. Sleep Med Rev 2022; 64: 101646.
  21. 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. 
  22. Salehinejad MA, Vosough Y, Nejati V. The impact of bilateral anodal tDCS over left and right DLPFC on executive functions in children with ADHD. Brain Sci 2022; 12(8): 1098. 
  23. 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. 
  24. Rimmer R. Community-based tDCS treatment for depression: Acceptability and neuropsychological correlates. London: University of East London Repository; 2025.
  25. Sobral M, Guiomar R, Martins V, Ganho-Ávila A. Home-based transcranial direct current stimulation in dual active treatments for symptoms of depression and anxiety: A case series. Front Psychiatry 2022; 13: 947435.
  26. Sudbrack-Oliveira P, Razza LB, Brunoni AR. Non-invasive cortical stimulation: Transcranial direct current stimulation (tDCS). Int Rev Neurobiol 2021; 159: 1-22.
  27. Vanderhasselt M-A, Dedoncker J, De Raedt R, Baeken C. Combination of tDCS with psychotherapy and neurobehavioral interventions: Systematic review and mechanistic principles for future clinical trials. In: Transcranial direct current stimulation in neuropsychiatric disorders. Cham: Springer; 2021: 741-55.
  28. Kendall PC, Ney JS, Maxwell CA, Lehrbach KR, Jakubovic RJ, McKnight DS, et al. Adapting CBT for youth anxiety: Flexibility, within fidelity, in different settings. Front Psychiatry 2023; 14: 1067047.
  29. Wang J, Yao X, Ji Y, Li H. Cognitive potency and safety of tDCS treatment for major depressive disorder: A systematic review and meta-analysis. Front Hum Neurosci 2024; 18: 1458295.
  30. Guimarães AN, Porto AB, Marcori AJ, Lage GM, Altimari LR, Okazaki VHA. Motor learning and tDCS: A systematic review on the dependency of the stimulation effect on motor task characteristics or tDCS assembly specifications. Neuropsychologia 2023; 179: 108463.
  31. Senkowski D, Sobirey R, Haslacher D, Soekadar SR. Boosting working memory: uncovering the differential effects of tDCS and tACS. Cereb Cortex Commun 2022; 3(2):tgac018.
  32. Evans C, Zich C, Lee JS, Ward N, Bestmann S. Inter-individual variability in current direction for common tDCS montages. Neuroimage 2022; 260: 119501.
  33. Teymoori H, Amiri E, Tahmasebi W, Hoseini R, Grospretre S, Machado DGDS. Effect of tDCS targeting the M1 or left DLPFC on physical performance, psychophysiological responses, and cognitive function in repeated all-out cycling: a randomized controlled trial. J Neuroeng Rehabil 2023; 20(1): 97.
Fundamentals of Mental Health
Volume 27, Issue 3
May and June 2025
Pages 199-206

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