Effects of Continuous Theta Burst Stimulation to the Dorsolateral Prefrontal Cortex on Attention to Emotional Stimuli: A Randomized Controlled Trial.

Background/Objectives: The use of theta-burst stimulation (TBS) over the dorsolateral prefrontal cortex (DLPFC) to modulate cognitive function is gaining increasing interest, since it is more time-efficient than standard repetitive transcranial magnetic stimulation. However, the impact of TBS protocols on specific cognitive processes, such as emotional attention, remains understudied. This study aimed to examine the differential effect of continuous TBS (cTBS) over the left and right DLPFC on the facilitation of attention towards emotional (i.e., pleasant and distressing) versus neutral stimuli. Methods: In this randomized controlled trial, ninety-one healthy young adults were randomly allocated to receive either real or sham stimulation over the right or left DLPFC (i.e., left/right real cTBS and left/right sham cTBS), and then completed a computerized dot-probe task that included distressing, pleasant, and neutral images. Results: Participants who received real cTBS showed slower response times to probes replacing neutral images compared to emotional images, whereas no differences were found between stimuli in the sham conditions. No hemisphere-dependent effects were observed for distressing or pleasant images, suggesting that cTBS modulated attentional performance in a comparable manner when administered over the left or right DLPFC. Conclusions: These findings contribute to the literature on emotional attention, underscoring the role of DLPFC in attentional control, which is a valuable cognitive target for advancing the design and implementation of cTBS protocols.