Insight Into the Cognitive Processes Behind Craving in Addiction A Transcranial Magnetic Stimulation (TMS) Study on Delay Discounting

This article investigates the mechanisms underlying addiction cravings and explores the role of the psychological and cognitive domains involved. The study includes patients suffering from addiction, who went through a fourweek transcranial magnetic stimulation (TMS) protocol based on intermittent theta-burst stimulation (iTBS) of the left dorsolateral prefrontal cortex. Impulsivity, delay discounting (DD), desire thinking, and cognitive performance were assessed in the participants. The results show that DD predicts craving levels, indicating that greater devaluation of rewards is associated with stronger cravings. Interestingly, the clinical TMS protocol effectively reduced craving without altering DD performance. In addition, no significant effects of craving level on impulsivity traits, thinking style, or cognitive performance were found. Our findings suggest that DD is a strong predictor of substance craving before TMS treatment, and that the latter likely targets other cognitive processes which sustain craving and addiction. Alternative brain stimulation techniques and acceptance-based/mindfulness-based training could be explored to regulate impulsive choices in these patients. In conclusion, this study highlights the effectiveness of the iTBS TMS protocol in reducing craving in patients with addiction. Further research is needed to investigate the relationship between DD and craving in the context of addiction and TMS treatment.