Author(s): Maia, Ana ; Almeida, Sílvia ; Cotovio, Gonçalo ; Rodrigues da Silva, Daniel ; Viana, Francisco Faro ; Grácio, Jaime ; Oliveira-Maia, AJ
Date: 2022
Persistent ID: http://hdl.handle.net/10362/143611
Origin: Repositório Institucional da UNL
Subject(s): guide; obsessive-compulsive disorder; structured training; symptom provocation; transcranial magnetic stimulation; Psychiatry and Mental health; SDG 3 - Good Health and Well-being
Funding Information: AM and GC were supported by doctoral fellowships from Fundação para a Ciência e Tecnologia (FCT, references SFRH/BD/144508/2019 and SFRH/BD/130210/2017, respectively). GC and AO-M were supported by grant PTDC/MED-NEU/31331/2017 from FCT and AO-M was supported by grant FCT-PTDC/MEC-PSQ/30302/2017-IC&DT-LISBOA-01-0145-FEDER, funded by national funds from FCT/Ministério da Ciência, Tecnologia e do Ensino Superior (MCTES) and cofounded by Fundo Europeu de Desenvolvimento Regional (FEDER), under the Partnership Agreement Lisboa 2020—Programa Operacional Regional de Lisboa. This work was supported by the Brain and Behavior Research Foundation (BBRF) through grant BBRF-27595-2018 NARSAD to AM and AO-M. FCT/MCTES, FEDER, and the BBRF did not have a role in the design and conduct of this work, in the preparation, review, or approval of the manuscript, nor in the decision to submit the manuscript for publication. Funding Information: Author AO-M was national coordinator for Portugal of a non-interventional study (EDMS-ERI-143085581, 4.0) to characterize a Treatment-Resistant Depression Cohort in Europe, sponsored by Janssen-Cilag, Ltd. (2019-2020), is recipient of a grant from Schuhfried GmBH for norming and validation of cognitive tests, and is national coordinator for Portugal of trials of psilocybin therapy for treatment-resistant depression, sponsored by Compass Pathways, Ltd. (EudraCT numbers: 2017-003288-36 and 2020-001348-25), and of esketamine for treatment-resistant depression, sponsored by Janssen-Cilag, Ltd. (EudraCT number: 2019-002992-33). The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Transcranial Magnetic Stimulation (TMS) is a non-invasive brain stimulation technique that was cleared by the Food and Drug Administration (FDA) for the treatment of Obsessive-Compulsive Disorder (OCD) in 2018. The approved protocol includes individualized symptom provocation before each stimulation session, to elicit a moderate level of obsessional distress. Although symptom provocation can be a delicate, demanding, and uncomfortable procedure, structured training methods for those who are going to apply it are not available. Here, we describe a model for training in symptom provocation for TMS technicians, developed at the Champalimaud Clinical Centre in Lisbon, Portugal. Our programme includes two-sessions dedicated to clinical communication and symptom provocation techniques from a theoretical and practical perspective. Additionally, supervision meetings are conducted during treatment of patients, allowing regular case discussion and redefinition of symptom provocation hierarchy, as needed. In addition to having a strong practical component, our training program is short and pragmatic, allowing for easy implementation and fluid transition to clinical practice. By sharing our experience, we hope to contribute to systematize training procedures required for symptom provocation in the context of TMS, and to qualitatively describe a methodology that can be used for implementation of TMS programmes for the treatment of OCD.
