General psychiatry and psychotherapy with outpatient clinic

Theta Burst Stimulation (TBS) is a new TMS protocol that was first used successfully in our clinic in a controlled pilot clinical trial for the treatment of depressive symptoms (Plewniaet al. J Aff Neurosci 2014). More recently, it has been confirmed to have comparable good efficacy in the treatment of depression although considerably faster (Blumbergeret al. Lancet 2018). Therefore, this procedure is now being used worldwide in the treatment of depression. Against the background of the still lacking acceptance and availability of TMS in Germany, the BMBF has been funding a multicenter controlled clinical trial initiated and coordinated by us since the beginning of 2020 in which the efficacy of bilateral TBS in depression will be further proven in comparison to placebo treatment.

With tDCS it is possible to temporarily influence the activity of the brain by a weak current flow. First studies from our group and others could show effects on cognitive processes and performance. This makes it possible to investigate the conditions and mechanisms of cognitive processing in more detail. We are currently investigating whether and with which stimulation parameters tDCS can actually support the effects of cognitive training in the sense of adaptive neuroplasticity (Ruf et al.Scientific Reports 2017, Weller et al. Brain Stimulation 2020).

Executive functions are the group of cognitive skills responsible for planning and controlling complex goal-directed behavior. More or less specific disorders in this area are found in most mental illnesses. In many cases, these impairments are an essential part of the disease symptomatology and are often associated with disturbances of local brain activity. Improvement of executive function deficits can contribute to the treatment of specific clinical pictures. Non-invasive brain stimulation techniques such as TMS and tDCS can modulate regional cortical activity. Accordingly, we are investigating the complex effects of focal modulation of physiological and pathological brain activity on executive functions in healthy individuals (Dockeryet al. J Neurosci 2009, Zwissler et al. J Neurosci 2014, Schroeder et al. J Cogn Neurosci 2016, Wiegand et al. Sci Rep 2019) and patients with mental illness (Wolkenstein & Plewnia Biol Psych 2013, Wolkenstein et al. Cortex 2014, Schwippel et al. 2018). We are also particularly interested in individual predictors of effect such as genetics (Plewniaet al. Cortex 2013, Nieratschker et al. Brain Stim 2015), gender, hemodynamic (Ehlis et al.Neuroimage 2016) and oscillatory activity (Faehling & PlewniaFront Cell Neurosci 2016). These studies expand our understanding of normal and impaired executive functions and contribute to the development of new therapies (Plewniaet al. Lancet Psychiatry 2015).

Lack of cognitive control of perception, processing, and memory of negative information is a central feature of depressive symptomatology. Training this skill can significantly support the treatment of depression. However, the implementation of such a treatment has so far also been very limited due to the specific symptomatology of the patients and has therefore hardly been used. With the current digital possibilities, however, a much more low-threshold application of this therapy method is possible through different playful elements and the use of mobile devices. We are investigating the extent and mechanisms of the effect of these techniques, particularly in depression, and are using in-depth documentation of user experiences to continuously improve these applications.

• C. Plewnia, A. Fallgatter (BMBF FKZ 01KG2003): 'C. Plewnia, A. Fallgatter: Treatment of major depressive disorder with bilateral theta burst stimulation' (2020-2023)
• C. Plewnia, P. Schröder (EU DESIGNSCAPES #763784): 'Back in the Game: Gamified Cognitive Training to treat Depression' (2020-2021)
• C. Plewnia, A. Fallgatter, A. Hasan (BMBF FKZ 01EE1407H): Research Network for Mental Illness, ESPRIT Network, Project 'Transcranial Direct Current Stimulation to Improve Cognitive Training in Schizophrenia' (2015-2020)
• C. Plewnia, A. Fallgatter BMBF (FKZ 01EE1403D): Research Network for Mental Diseases, Collaborative GCBS, Project 'Sustained improvement of poor cognitive control by training supported with transcranial direct current stimulation (tDCS)' (2015-2020)
• C. Plewnia (DFG PL 525/4-1): clinical trial 'Treatment of auditory hallucinations in schizophrenia with bilateral theta burst stimulation' (2016-2020)
• C. Plewnia, K. Giel (DFG (PL 525/7-1): in-kind grant 'Enhancing cognitive control in binge eating disorder by electrical brain stimulation' (2016-2019) *€280,390*.
• J Svaldi, A Fallgatter, B Tuschen-Caffier, C Plewnia (DFG PL 525/6-1;: In-kind grant 'Augmentative effects of tDCS on body-based attention modification training in women with bulimia nervosa'.