NAVIGATED transcranial magnetic stimulation improved PTSD outcomes when added to intensive residential therapy for combat-related symptoms.
Navigated Transcranial Magnetic Stimulation in Residential PTSD Care
Adding navigated transcranial magnetic stimulation to an intensive residential program was associated with greater symptom improvement in military personnel and veterans with combat related posttraumatic stress disorder. In this randomized clinical trial, 119 participants were assigned to active or sham treatment alongside standard residential care, which included prolonged exposure delivered twice weekly and daily trauma focused cognitive behavioral treatment.
Both groups improved over the course of treatment, but the active treatment arm showed a greater reduction in PTSD symptom burden by the end of therapy. For the primary outcome, the modeled difference in PTSD Checklist for DSM 5 score at end of treatment was minus 5.94 in favor of active treatment. Clinician rated symptoms also favored the active group, with a mean CAPS 5 difference of minus 6.03 at the 1 month follow up point used for that analysis.
PTSD Symptom Durability After Treatment
The findings were especially notable during follow up. From end of treatment to 3 months, symptoms returned significantly in the sham group but remained essentially stable in the active treatment arm on the PTSD Checklist for DSM 5. The modeled between group difference at 3 months was minus 12.30, again favoring active treatment. Reliable change analysis also supported more durable benefit, with clinically significant symptom reductions seen in 85% of active treatment recipients versus 59% of sham recipients at 1 month.
Depressive symptoms improved in both groups during treatment, but durability again appeared stronger with active stimulation at follow up. Headache was the most common adverse event, muscle contractions were more frequent with active treatment, and no serious adverse events were reported.
The authors noted that the study was conducted in a residential military mental health setting, with severe and extreme PTSD predominating, which may limit generalizability to less severe or nonmilitary populations. Even so, the trial provides evidence that navigated transcranial magnetic stimulation may be an effective addition to trauma focused behavioral therapy for combat related PTSD.
Reference
Fox PT et al. Residential therapy with navigated transcranial magnetic stimulation for combat-related PTSD. JAMA Netw Open. 2026;9(4):e265110. doi:10.1001/jamanetworkopen.2026.5110.
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