Feasibility of a Brief, CBT-Informed Cognitive Workbook as an Adjunct to Transcranial Magnetic Stimulation for Major Depressive Disorder: A Proposal
Year: 2026
Type: conference-abstract
Abstract: Repetitive transcranial magnetic stimulation (rTMS) is effective for treatment-resistant depression. While combining rTMS with psychotherapy has theoretical appeal, meta-analyses show no significant benefit of concurrent or pre-rTMS psychological interventions over rTMS alone. However, rTMS induces neuroplastic changes that persist beyond stimulation, and the immediate post-rTMS window (0-10 minutes) remains unexplored. Brief cognitive exercises completed after rTMS may leverage this plasticity period for skill consolidation without the sensory interference that has limited during-session interventions. Objective: To assess the feasibility and acceptability of a brief (5-10 minute), CBT-informed cognitive workbook completed immediately after rTMS sessions for major depressive disorder. Methods: We propose a single-arm feasibility study to enroll 20-30 patients receiving rTMS for major depressive disorder. Participants would complete a structured, progressive workbook with CBT-informed exercises (cognitive restructuring, behavioral activation, thought records) immediately after each rTMS session. Minimal guidance would be provided through brief weekly check-ins. Primary outcome would be workbook completion rate across sessions. Secondary outcomes would include Patient Health Questionnaire-9 (PHQ-9) scores at baseline, week 3, and week 6; patient satisfaction; and qualitative feedback on barriers to engagement. Expected Results: We anticipate the possibility of establishing feasibility benchmarks for completion rates and identifying patient-reported barriers and preferences. Preliminary depression symptom trajectories will inform future controlled trials. Significance: This study addresses a critical gap by testing a novel post-rTMS timing approach that differs from previously studied concurrent or pre-rTMS interventions. This scalable, theoretically-grounded intervention targets the unexplored post-stimulation neuroplasticity window and may inform strategies to enhance rTMS outcomes in treatment-resistant depression.
Source: RVU Elevate
DOI: 10.82451/k51257
Institution: Rocky Vista University
Language: English
Subfield: Neurology
Field: Neuroscience
Domain: Life Sciences
Open Access status: green
OpenAlex ID: W7204570020