Comparing neuromodulation targets to reduce cigarette craving and withdrawal: a randomized clinical trial

Figures

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  Fig. 1. Effects of TMS on craving, withdrawal, and negative affect. Raincloud plots depict the change in Urge to Smoke scale scores (Panel A), Shiffman-Jarvik Withdrawal scale scores (Panel B), and Negative Affect scores (Panel C) from pre- to post-stimulation for the four stimulation targets. Each plot combines a density curve (left) indicating the distribution of scores, individual data points (middle) showing individual scores for pre- and post-stimulation conditions, and boxplots (right) summarizing the median and spread of the data. Symbols: Asterisk (*) denotes a significant interaction, indicating a significantly greater change in the experimental condition compared to the control. Hashtag (#) denotes a significant main effect of time (i.e., significant change from pre- to post-stimulation). The site-by-time interaction was significant for the effect of TMS to SFG vs. control (p = 0.047) on craving and withdrawal (p = 0.01). The main effect of time on craving was significant for the SFG (p = 0.0013) and dlPFC (p = 0.0053) conditions. The main effect of time on withdrawal was significant for the SFG (p = 0.0012) and dlPFC (p = 0.0016). The main effect of time on negative affect was…

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  Fig. 2. Effect sizes showing TMS’ effect on each inventory’s subscales, separated by stimulation target. Stimulation to SFG and dlPFC produced some medium-sized effects, whereas stimulation to PPC and v5 led to no or small effects.

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  Fig. 3. Effect sizes of each stimulation type separated by sex. The pattern of effect sizes appears different for men and women. Men show a small-medium change (reduction) in craving and withdrawal as a response to TMS to the SFG and dlPFC. The largest effect in the trial is a reduction in psychological withdrawal resulting from SFG stimulation in men only. Women show smaller effects overall, especially with respect to reductions in psychological withdrawal.

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  Fig. 4. Effects of TMS on canonical network connectivity. Only TMS to dlPFC produced changes in network connectivity that survived familywise error correction. These changes included both increases in connectivity (between the somatomotor network and the default mode network, and between the somatomotor network and dorsal attention network), and decreases in connectivity (within the visual network, and between the somatomotor network and executive control network).