{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T06:05:48Z","timestamp":1784009148446,"version":"3.55.0"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"\n Background<\/jats:title>\n Repetitive transcranial magnetic stimulation (rTMS) and cognitive behavioral therapy (CBT) are established treatments for depression. However, the incremental benefit of combining these approaches remains uncertain, partly because prior reviews have pooled studies with clinically heterogeneous comparator conditions. This study systematically reviewed the efficacy of rTMS combined with CBT for depression and conducted a meta-analysis restricted to trials using rTMS-based control conditions.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We systematically searched Web of Science, PubMed, Embase, EBSCOhost, China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Database, and PsyArXiv from inception to 1 December 2025. Randomized controlled trials enrolling patients with depression and evaluating rTMS combined with CBT-spectrum interventions were eligible. Comparator conditions were stratified into rTMS controls, medication-based CBT controls, and medication controls. All eligible studies were included in the qualitative synthesis, whereas the quantitative synthesis was limited to studies comparing the combined intervention with rTMS controls. Standardized mean differences (Hedges\u2019 g) were estimated using a random-effects model.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Ten randomized controlled trials involving 1,320 participants met the inclusion criteria. Qualitative synthesis suggested that the combined intervention may have advantages over both medication-based CBT controls and medication controls. Seven trials comparing the combined intervention with rTMS controls were included in the meta-analysis. The pooled analysis showed a small-to-moderate benefit of the combined intervention over rTMS control for reducing depressive symptoms (Hedges\u2019\n g<\/jats:italic>\n \u202f=\u202f0.38, 95% CI 0.13 to 0.63,\n p<\/jats:italic>\n \u202f=\u202f0.003), with moderate heterogeneity (\n I<\/jats:italic>\n 2<\/jats:sup>\n \u202f=\u202f57.8%). Leave-one-out sensitivity analysis and cumulative meta-analysis indicated that the pooled estimate was stable. Egger\u2019s test did not detect significant publication bias (\n p<\/jats:italic>\n \u202f=\u202f0.3914).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Repetitive transcranial magnetic stimulation combined with CBT appears to provide additional benefit for the treatment of depression. Meta-analytic evidence supports greater symptom improvement relative to rTMS controls, and qualitative evidence suggests possible advantages over medication-based CBT controls and medication controls. These findings provide systematic support for the clinical potential of combining neuromodulation with psychotherapy while highlighting the need for larger, higher-quality trials with standardized protocols and longer follow-up.<\/jats:p>\n <\/jats:sec>\n \n Systematic review registration<\/jats:title>\n \n https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251267093<\/jats:ext-link>\n , PROSPERO: CRD420251267093.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpsyg.2026.1867678","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T05:38:24Z","timestamp":1784007504000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of repetitive transcranial magnetic stimulation combined with cognitive behavioral therapy for depression: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Qinxin","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Psychology, Anhui University of Chinese Medicine","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yihan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Psychology, Anhui University of Chinese Medicine","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengyuan","family":"Qi","sequence":"additional","affiliation":[{"name":"Department of Psychology, Anhui University of Chinese Medicine","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linhui","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Psychology, Anhui University of Chinese Medicine","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Psychology, Anhui University of Chinese Medicine","place":["Hefei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"293","DOI":"10.3390\/brainsci13020293","article-title":"Apparent lack of benefit of combining repetitive transcranial magnetic stimulation with internet-delivered cognitive behavior therapy for the treatment of resistant depression: patient-centered randomized controlled pilot trial","volume":"13","author":"Adu","year":"2023","journal-title":"Brain Sci."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1401","DOI":"10.2147\/PPA.S110632","article-title":"Long-term antidepressant use: patient perspectives of benefits and adverse effects","volume":"10","author":"Cartwright","year":"2016","journal-title":"Patient Prefer. Adherence"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1038\/s41392-024-01738-y","article-title":"Major depressive disorder: hypothesis, mechanism, prevention and treatment","volume":"9","author":"Cui","year":"2024","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1001\/jamapsychiatry.2019.0268","article-title":"Effectiveness and acceptability of cognitive behavior therapy delivery formats in adults with depression: a network meta-analysis","volume":"76","author":"Cuijpers","year":"2019","journal-title":"JAMA Psychiatry"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.copsyc.2014.12.026","article-title":"Internet-based treatment of depression","volume":"4","author":"Cuijpers","year":"2015","journal-title":"Curr. Opin. Psychol."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1111\/acps.13782","article-title":"Cost-effectiveness of rTMS as a next step in antidepressant non-responders: a randomized comparison with current antidepressant treatment approaches","volume":"151","author":"Dalhuisen","year":"2024","journal-title":"Acta Psychiatr. Scand."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1007\/7854_2024_483","article-title":"Mechanisms of action of TMS in the treatment of depression","volume":"66","author":"Downar","year":"2024","journal-title":"Curr. Top. Behav. Neurosci."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"366","DOI":"10.3390\/brainsci15040366","article-title":"Utilization of medicinal plants in mental disorders: neuroplasticity and neuroprotection in biomodels","volume":"15","author":"Estela-Zape","year":"2025","journal-title":"Brain Sci."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"149643","DOI":"10.1016\/j.brainres.2025.149643","article-title":"The neuroplastic brain: current breakthroughs and emerging frontiers","volume":"1858","author":"Gazerani","year":"2025","journal-title":"Brain Res."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1703","DOI":"10.3390\/jcm14051703","article-title":"Mindfulness-based cognitive therapy in clinical practice: a systematic review of neurocognitive outcomes and applications for mental health and well-being","volume":"14","author":"Gkintoni","year":"2025","journal-title":"J. Clin. Med."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.cortex.2021.02.024","article-title":"Effects of rTMS on the brain: is there value in variability?","volume":"139","author":"Goldsworthy","year":"2021","journal-title":"Cortex"},{"key":"ref13","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0)","author":"Higgins","year":"2011"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1037\/1082-989X.11.2.193","article-title":"Assessing heterogeneity in meta-analysis: Q statistic or I2 index","volume":"11","author":"Huedo-Medina","year":"2006","journal-title":"Psychol. Methods"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1016\/j.jad.2024.05.033","article-title":"Long-term remission and relapse of anxiety and depression in older adults after cognitive behavioural therapy (CBT): a 10-year follow-up of a randomised controlled trial","volume":"358","author":"Johnco","year":"2024","journal-title":"J. Affect. Disord."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1139\/jpn.0245","article-title":"Pharmacotherapy to sustain the fully remitted state","volume":"27","author":"Kennedy","year":"2002","journal-title":"J. Psychiatry Neurosci."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s12888-019-2418-7","article-title":"Treatment patterns and sequences of pharmacotherapy for patients diagnosed with depression in the United States: 2014 through 2019","volume":"20","author":"Kern","year":"2020","journal-title":"BMC Psychiatry"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"117011","DOI":"10.1016\/j.psychres.2026.117011","article-title":"The potential for synergistic effect of non-invasive brain stimulation and cognitive behavioural therapy for depressive and cognitive outcomes in major depressive disorder: a scoping review","volume":"359","author":"Khanna","year":"2026","journal-title":"Psychiatry Res."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1016\/j.rehab.2015.05.005","article-title":"Basic principles of transcranial magnetic stimulation (TMS) and repetitive TMS (rTMS)","volume":"58","author":"Klomjai","year":"2015","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1016\/j.clinph.2019.11.002","article-title":"Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): an update (2014\u20132018)","volume":"131","author":"Lefaucheur","year":"2020","journal-title":"Clin. Neurophysiol."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"399","DOI":"10.3969\/j.issn.1005-3220.2023.05.016","article-title":"Effect of repetitive transcranial magnetic stimulation combined with cognitive behavior therapy on successful aging of elderly patients with depression","volume":"33","author":"Li","year":"2023","journal-title":"J. Clin. Psychiatry"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1016\/j.psychres.2018.07.020","article-title":"Cognitive behavioral therapy for treatment-resistant depression: a systematic review and meta-analysis","volume":"268","author":"Li","year":"2018","journal-title":"Psychiatry Res."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"66","DOI":"10.3969\/j.issn.1672-0369.2022.03.022","article-title":"Effects of cognitive behavior therapy combined with ultra-low frequency transcranial magnetic stimulation on patients with depression","volume":"34","author":"Mao","year":"2022","journal-title":"Med. J. Chin. Peoples Health"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1001\/jamapsychiatry.2020.2993","article-title":"Adjunctive psychotherapy for bipolar disorder: a systematic review and component network meta-analysis","volume":"78","author":"Miklowitz","year":"2021","journal-title":"JAMA Psychiatry"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1007\/s002210100843","article-title":"Motor cortex excitability following short trains of repetitive magnetic stimuli","volume":"140","author":"Modugno","year":"2001","journal-title":"Exp. Brain Res."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e9","DOI":"10.2196\/jmir.1052","article-title":"Methodological challenges in online trials","volume":"11","author":"Murray","year":"2009","journal-title":"J. Med. Internet Res."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1467","DOI":"10.1002\/jclp.20135","article-title":"Clinical psychologists across the years: the division of clinical psychology from 1960 to 2003","volume":"61","author":"Norcross","year":"2006","journal-title":"J. Clin. Psychol."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1016\/j.jclinepi.2021.03.001","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"134","author":"Page","year":"2021","journal-title":"J. Clin. Epidemiol."},{"key":"ref29","year":"2022"},{"key":"ref30","first-page":"111","article-title":"Effects of repetitive transcranial magnetic stimulation combined with mindfulness-based cognitive therapy on cognitive function and sleep disturbance in patients with depression","volume":"28","author":"Qi","year":"2021","journal-title":"China Mod. Med."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1222","DOI":"10.16050\/j.cnki.issn1674-6309.2024.12.006","article-title":"Clinical study of drug combined with rTMS and CBT in the treatment of adolescent depressive disorder","volume":"46","author":"Qiu","year":"2024","journal-title":"J. Ningxia Med. Univ."},{"key":"ref32","year":"2022"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1186\/s12875-019-1005-9","article-title":"Psychological intervention at a primary health care center: predictors of success","volume":"20","author":"Ricou","year":"2019","journal-title":"BMC Fam. Pract."},{"key":"ref34","volume-title":"iCBT with TMS in Patients with MDD","author":"Rosenberg","year":"2025"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"104867","DOI":"10.1016\/j.neubiorev.2022.104867","article-title":"Boosting psychological change: combining non-invasive brain stimulation with psychotherapy","volume":"142","author":"Tatti","year":"2022","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"60","DOI":"10.3969\/j.issn.1674-4985.2016.31.017","article-title":"The clinical effect of low frequency repetitive transcranial magnetic stimulation combined with cognitive behavioral therapy in the treatment of adolescent depression","volume":"13","author":"Wang","year":"2016","journal-title":"Chin. J. Med. Innov."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"132","DOI":"10.15971\/j.cnki.cmdi.2020.16.066","article-title":"Clinical effect analysis of repetitive transcranial magnetic stimulation combined with cognitive psychology in the treatment of senile depression","volume":"26","author":"Wang","year":"2020","journal-title":"China Med. Device Inf."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1016\/j.biopsych.2018.09.004","article-title":"Leveraging neuroplasticity to enhance adaptive learning: the potential for synergistic somatic-behavioral treatment combinations to improve clinical outcomes in depression","volume":"85","author":"Wilkinson","year":"2019","journal-title":"Biol. Psychiatry"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1665","DOI":"10.3390\/brainsci13121665","article-title":"Efficacy of repetitive transcranial magnetic stimulation (rTMS) combined with psychological interventions: a systematic review and meta-analysis of randomized controlled trials","volume":"13","author":"Xu","year":"2023","journal-title":"Brain Sci."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1016\/j.bpsc.2017.12.006","article-title":"Cognitive behavioral therapy is associated with enhanced cognitive control network activity in major depression and posttraumatic stress disorder","volume":"3","author":"Yang","year":"2018","journal-title":"Biol. Psychiatry Cogn. Neurosci. Neuroimaging"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1426","DOI":"10.13479\/j.cnki.jip.2024.05.067","article-title":"The effect of cognitive therapy combined with transcranial magnetic stimulation in first-episode adolescent depression patients","volume":"51","author":"Yao","year":"2024","journal-title":"Int. J. Psychiatry"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"61","DOI":"10.3969\/j.issn.2096-5516.2025.01.009","article-title":"Progress in the research of rTMS in the rehabilitation treatment of post-stroke cognitive impairment","volume":"8","author":"Zhang","year":"2025","journal-title":"Chin. J. Alzheimers Dis. Relat. Disord."}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1867678\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T05:38:32Z","timestamp":1784007512000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2026.1867678\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,14]]},"references-count":42,"alternative-id":["10.3389\/fpsyg.2026.1867678"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2026.1867678","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,14]]},"article-number":"1867678"}}