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Adult Depression

Combining Transcranial Magnetic Stimulation and Internet-Based Cognitive Behavioral Coaching Program is Associated with Improvements in Cognition: A Multilevel Model Analysis

(PS1-87) Combining Transcranial Magnetic Stimulation and Internet-based Cognitive Behavioral Coaching Program Is Associated with Improvements in Cognition: A Multilevel Model Analysis

Friday, November 21, 2025

10:00 AM - 11:00 AM CST

Location: Elite Hall A, Level 1

Author(s)

Aleeza West, B.A.

Lab Manager
University of California Los Angeles
Huntington Beach, California, United States

Co-Author(s)

Nora Barnes-Horowitz, M.A.

Graduate Student Researcher
University of California Los Angeles
Los Angeles, California, United States
DN

Doan Ngo, B.A.

Research Manager
University of California, Los Angeles
Los Angeles, California, United States
TV

Thomas Valles, M.A.

Programmer/Analyst
University of California, Los Angeles
Los Angeles, California, United States
CM

Cole Matthews, B.A.

Research Technician
University of California, Los Angeles
Los Angeles, California, United States
Jung Park, B.A.

Research Assistant
University of Notre Dame
Los Angeles, California, United States
OA

Ossanna Amran, B.A.

Graduate Student
Fuller Theological Seminary
Los Angeles, California, United States
JL

Jiani Li, B.A.

Graduate Student
University of Southern California
Los Angeles, California, United States
CY

Chiana Yang, B.A.

Research Assistant
University of California, Los Angeles
Los Angeles, California, United States
KC

Kelly Cai, B.A.

Research Assistant
University of California, Los Angeles
Los Angeles, California, United States
AC

Anastassia Costello, B.A.

Prior Lab Manager
University of California, Los Angeles
Los Angeles, California, United States
EK

Ekin Kiyici, B.A.

Graduate Student
Ferkauf Graduate School of Psychology
New York, New York, United States
IL

Isabelle Lanser, B.A.

Project Policy Analyst
University of California, Los Angeles
Los Angeles, California, United States
AL

Andrew Leuchter, Ph.D.

Director of the TMS Clinical and Research Program and the Neuromodulation Division, and Associate Di
University of California, Los Angeles
Los Angeles, California, United States
Michelle G. Craske, Ph.D.

Distinguished Professor
University of California Los Angeles
Los Angeles, California, United States
BR

Benjamin Rosenberg, Ph.D. (he/him/his)

Postdoctoral Scholar
University of California, Los Angeles
Los Angeles, California, United States

Abstract Text: Approximately 5% of adults globally have depression and this number is rising. Individuals with depression display deficits in cognitive functioning, such as impaired learning and memory. Cognitive behavioral therapy (CBT) is one of the most effective treatments for depression and associated cognitive deficits. Coach-supported digital mental health programs can enhance accessibility of CBT content with high fidelity. Another form of treatment which has been seen to improve depressive symptoms and cognitive impairment is transcranial magnetic stimulation (TMS). The combined effects of concurrent coach-supported digital CBT and TMS on cognitive functioning remains unknown.

Participants (n=19) enrolled in standard-of-care MDD treatment at the UCLA TMS Clinical and Research Service and agreed to participate in a research study. Participants were randomized to one of two coach-supported digital mental health programs: internet-based cognitive behavioral therapy (This Way Up; iCBT) or supportive videos (Stories of The Mind; STM). Participants completed the color-word Stroop task at baseline and at post-treatment sessions. Multilevel models in Stata evaluated participant response time (RT) during the task. We hypothesized that all participants would have 1) faster RTs for the congruent versus incongruent trials, and 2) faster RTs at post-treatment versus baseline. We further hypothesized that individuals in the iCBT group would have a greater decrease in RTs compared to the STM group over the course of treatment, resulting in faster RTs in both incongruent and congruent trials at post-treatment, compared to the STM group.

Across all participants, there were significant main effects of task block (p < 0.001), task trial (p=0.005), and task condition (p=0.008) on RTs (all effects showed decreasing RTs as expected for the Stroop task). There was also a significant main effect of time (p <.001) across all participants, such that treatment was associated with faster RTs over time. There was a significant Group x Time x Task Condition interaction (p < 0.001), such that RTs decreased during treatment in the iCBT group for both incongruent and congruent trials, whereas RTs decreased in the STM group specifically in the congruent trials, but not for the incongruent trials. These results suggest that treatment effects may be particularly strong for the iCBT condition, as clinical improvement during TMS has previously been linked to faster RTs specifically in the incongruent condition.

These results highlight the utility of coach-supported digital mental health programs, and particularly iCBT, in conjunction with standard of care treatment as one strategy for optimizing treatments for MDD. One limitation includes the iCBT group having faster RTs at baseline as compared to the STM group, specifically in the incongruent condition, which may inform interpretation of these results. Future research can look toward the effects of coach-supported digital mental health programs on cognitive functioning over a follow-up period, to determine if there are lasting effects.