Effects of Frontopolar TMS in Alcohol Craving

TMS-induced changes in psychological alcohol craving assessed with the Penn Alcohol Craving Scale (PACS)

The primary outcome measure is the TMS-induced changes in psychological craving intensity. Self-reported psychological alcohol craving as measured by the Penn Alcohol Craving Scale (PACS) will be assessed before the frontopolar TMS intervention (pre-TMS at baseline) and after the final frontopolar TMS session (post-TMS). The PACS is a five-item, self-report measure that includes questions about the frequency, intensity, and duration of craving, the ability to resist drinking, and asks for an overall rating of craving for alcohol for the previous week. Each question is scored on a scale of 0 to 6. The mean total score across the five items (range 0-6) will be calculated, with higher scores indicating greater craving. In exploratory analyses, individual PACS items can also be examined separately to capture distinct dimensions of craving (e.g., frequency, intensity, or duration).

TMS-induced change in heart rate (BPM) during virtual reality alcohol cue exposure

TMS-related changes in heart rate (HR; beats per minute) during VR-based alcohol craving induction will be assessed. HR is continuously recorded throughout each VR cue exposure session. For each session, the difference in minimum and maximum HR (within-session change) will be calculated as an index of physiological craving reactivity. These within-session changes are then compared between sessions (Day 1 → Day 5) to evaluate TMS-induced modulation of HR responses. Further indices that can be derived from this assessment are mean, maximum, and minimum HR.

TMS-induced change in skin conductance (µS) during Virtual reality alcohol cue exposure

TMS-related changes in skin conductance (SC; µS) will be assessed during VR-based alcohol craving induction. SC is continuously recorded throughout each VR cue exposure session. For each session, the difference in minimum and maximum SC (within-session change) will be calculated as an index of physiological craving reactivity. These within-session changes are then compared between sessions (Day 1 → Day 5) to evaluate TMS-induced modulation of SC responses. Further indices that can be derived from this assessment are mean, maximum, and minimum SC.

TMS-induced change in skin temperature (°C) during Virtual reality alcohol cue exposure

TMS-related changes in skin temperature (ST; °C) are assessed during VR-based alcohol craving induction. ST is continuously recorded throughout each VR cue exposure session. For each session, the difference in minimum and maximum ST (within-session change) will be calculated as an index of physiological craving reactivity. These within-session changes are then compared between sessions (Day 1 → Day 5) to evaluate TMS-induced modulation of ST responses. Further indices that can be derived from this assessment are mean, maximum, and minimum ST.

TMS-induced change in self-reported craving during VR exposure using Visual Analogue Scale (VAS)

TMS-related changes in subjective craving ratings will be measured before and after each VR alcohol cue exposure. Participant reactivity during VR alcohol cue exposure is assessed using a 10-item Visual Analog Scale (VAS; 0-100). Items measure both general affective/physiological states (e.g., tension, stress, feeling challenged, control) and alcohol-related urges (e.g., thoughts, desire, craving for alcohol). Each item is rated from 0 ("not at all") to 100 ("very"/"strong"). The mean score across all 10 items will be calculated. Additionally, individual item scores will be calculated separately to investigate item-specific/domain-specific changes. VAS ratings are obtained immediately before and immediately after each VR session to assess changes in reactivity following alcohol cue exposure. Additionally, VAS rating assessed before the TMS intervention and after the final TMS session will be compared to assess TMS-related changes in craving reactivity.