# Therapeutic Improvement in People With Schizophrenia Undergoing tACS/CBTp (Transcranial Alternating Current Stimulation/Cognitive Behavioral Therapy for Psychosis) Associated With Usual Medication Regimen: Protocol for a Pilot, Randomized, Single-Blind Trial

## TL;DR

This study explores combining tACS and CBTp with standard medication to improve outcomes for people with schizophrenia.

## Contribution

The novel approach combines tACS with CBTp to enhance therapeutic outcomes in schizophrenia treatment.

## Key findings

- tACS/CBTp is expected to improve psychological and psychosocial test scores more than sham tACS/CBTp.
- Therapeutic response may vary by gender due to hormonal and sociocultural factors.
- Heart rate variability is anticipated to predict symptom improvement during therapy.

## Abstract

Transcranial alternating current stimulation (tACS) applies a low-intensity sinusoidal electrical current through electrodes placed on the scalp to boost the brain’s own oscillation by way of entrainment. When a single frequency is applied, this exogenous oscillation synchronizes with the brain’s endogenous frequency. Gamma frequency synchrony stands out as a binding mechanism for integrating disparate brain networks, mediating perception, cognition, and memory, typically disturbed in schizophrenia. The treatment of schizophrenia includes medication and cognitive behavioral therapy for psychosis (CBTp). We are adding tACS to these usual treatments, targeting gamma oscillation stimulation, to augment the CBTp efficacy in people living with schizophrenia.

This study aims to elicit cognitive readiness and therapeutic engagement by adding tACS to each CBTp session in individuals with schizophrenia taking their usual medication, to evaluate the possible improvement of the level of functioning, and to determine if the response to intervention is gender specific.

This is a pilot, prospective, randomized, repeated-measures, single-blind study design. We expect to enroll 28 participants randomly assigned to one of two treatment arms: arm 1 (tACS/CBTp, n=14) or arm 2 (sham tACS/CBTp, n=14; tACS is sham, but CBTp is active). The intervention with active or sham tACS/CBTp will take place weekly for 16 weeks. Primary outcome measures—electroencephalogram, Positive and Negative Syndrome Scale, 16-item Negative Symptom Assessment, and Cognitive Flexibility Scale—will evaluate the efficacy of treatment at the end of the intervention and at the two follow-ups. We will use SPSS (version 29, IBM Corp); the main tests will include repeated measures and mixed design ANOVA.

The timeline for recruitment, treatment, and follow-ups is 18 months, followed by 6 months for data analysis, writing manuscripts, and dissemination activities. By November 1, 2025, we have enrolled 15 participants: 12 are following the intervention protocol (8 active and 4 sham tACS). Two participants were screening failures, and one participant withdrew after intervention 2.

Our expectations are as follows. CBTp will improve the scores of psychological and psychosocial tests at the end of therapy for both groups, but it will be superior for the group with tACS intervention. Considering that cognitive and emotional status is gender dependent (hormonal differences, brain structure, and sociocultural influences), we expect that the therapeutic response could be gender specific. CBTp will enhance electroencephalogram activity and the heart in clients with schizophrenia at the end of therapy for both groups, but it will be superior for the group with tACS preintervention. The baseline heart rate variability will predict symptom improvement and will increase over the course of therapy. We hope our research will improve the treatment of people living with schizophrenia, thereby enhancing their quality of life, reducing the rate of relapse, and lowering the costs of care.

ClinicalTrials.gov NCT06889025; https://clinicaltrials.gov/study/NCT06889025

PRR1-10.2196/80593