{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T10:47:24Z","timestamp":1789469244145,"version":"build-2803163510"},"reference-count":77,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003495","name":"Hessian Ministry for Science and the Arts","doi-asserted-by":"publisher","award":["LOEWE 1\/16\/519\/03\/09.001 (0009)\/98"],"award-info":[{"award-number":["LOEWE 1\/16\/519\/03\/09.001 (0009)\/98"]}],"id":[{"id":"10.13039\/501100003495","id-type":"DOI","asserted-by":"publisher"}]},{"award":["LOEWE 1\/16\/519\/03\/09.001 (0009)\/98"],"award-info":[{"award-number":["LOEWE 1\/16\/519\/03\/09.001 (0009)\/98"]}],"id":[{"id":"https:\/\/ror.org\/00zd5gr55","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Obsessive\u2013compulsive disorder (OCD) is a chronic and disabling condition. Despite first-line treatment with cognitive behavioral therapy (CBT) including exposure and response prevention (ERP) and selective serotonin reuptake inhibitors (SSRIs), many patients remain severely symptomatic. This highlights the need for further research into innovative multimodal treatment strategies for OCD. We report two inpatients with severe OCD, comorbid depressive symptoms, and insufficient response to previous pharmacological and psychotherapeutic treatments. Methods: Both patients completed 30 multimodal treatment units over six weeks consisting of sequential multi-target repetitive transcranial magnetic stimulation (rTMS) targeting the left dorsolateral prefrontal cortex (DLPFC), right DLPFC, and supplementary motor area (SMA), combined with a modified, largely self-administered, clinician-supervised exposure and response prevention protocol. Results: Both patients demonstrated large observed reductions in OCD symptom severity. Y-BOCS total scores decreased from 29 to 11 in Patient 1 and from 29 to 10 in Patient 2, corresponding to reductions of 62.1% and 65.5%, respectively, with improvements apparent after approximately four weeks and largely maintained at follow-up. Depressive symptoms also improved, and no clinically relevant adverse effects were observed. Conclusions: These cases provide an initial description of the feasibility and tolerability of this specific protocol architecture but do not establish efficacy, long-term durability, or the contribution of individual components. The protocol-level novelty lies in integrating a repeated three-target TBS schedule with a response-limited, cue-terminated exposure procedure, a combination not previously described in the OCD neuromodulation literature.<\/jats:p>","DOI":"10.3390\/jcm15187155","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T09:31:57Z","timestamp":1789464717000},"page":"7155","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: A Multimodal Treatment Approach Combining Multi-Target rTMS with a Modified, Largely Self-Administered, Clinician-Supervised Exposure and Response Prevention Protocol Using a Verbal Termination Cue in Two Patients with Severe Obsessive\u2013Compulsive Disorder"],"prefix":"10.3390","volume":"15","author":[{"given":"Mohammad","family":"Mari","sequence":"first","affiliation":[{"name":"Center for Psychiatry and Psychotherapy, Justus Liebig University Giessen, Klinikstrasse 36, 35392 Giessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6872-0763","authenticated-orcid":false,"given":"Markus","family":"Stingl","sequence":"additional","affiliation":[{"name":"Center for Psychiatry and Psychotherapy, Justus Liebig University Giessen, Klinikstrasse 36, 35392 Giessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8616-1950","authenticated-orcid":false,"given":"Bernd","family":"Hanewald","sequence":"additional","affiliation":[{"name":"Center for Psychiatry and Psychotherapy, Justus Liebig University Giessen, Klinikstrasse 36, 35392 Giessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Mulert","sequence":"additional","affiliation":[{"name":"Center for Psychiatry and Psychotherapy, Justus Liebig University Giessen, Klinikstrasse 36, 35392 Giessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1038\/s41572-019-0102-3","article-title":"Obsessive\u2013Compulsive Disorder","volume":"5","author":"Stein","year":"2019","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_2","unstructured":"Brock, H., Rizvi, A., and Hany, M. (2026, September 07). Obsessive-Compulsive Disorder, StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK553162\/."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Cheng, S., Chen, Z., Wu, C., Li, X., Shen, X., Qiu, R., Tang, N., Feng, C., Wang, W., and Lv, J. (2025). The Comorbidity of Anxiety and Depression Symptoms in Obsessive\u2013Compulsive Disorder: A Network Analysis. Front. Psychiatry, 16.","DOI":"10.3389\/fpsyt.2025.1567448"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.4088\/JCP.v63n1204","article-title":"Comorbidity of Obsessive-Compulsive Disorder and Depression: Prevalence, Symptom Severity, and Treatment Effect","volume":"63","author":"Overbeek","year":"2002","journal-title":"J. Clin. Psychiatry"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"152223","DOI":"10.1016\/j.comppsych.2021.152223","article-title":"Cognitive Behavioural Therapy with Exposure and Response Prevention in the Treatment of Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis of Randomised Controlled Trials","volume":"106","author":"Reid","year":"2021","journal-title":"Compr. Psychiatry"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1192\/bjp.2025.87","article-title":"Individual Patient Data Meta-Analysis of Placebo-Controlled Trials of Selective Serotonin Reuptake Inhibitors Submitted for Regulatory Approval in Adult Obsessive\u2013Compulsive Disorder","volume":"227","author":"Cohen","year":"2025","journal-title":"Br. J. Psychiatry"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Swierkosz-Lenart, K., Dos Santos, J.F.A., Elowe, J., Clair, A.-H., Bally, J.F., Riquier, F., Bloch, J., Draganski, B., Clerc, M.-T., and Pozuelo Moyano, B. (2023). Therapies for Obsessive-Compulsive Disorder: Current State of the Art and Perspectives for Approaching Treatment-Resistant Patients. Front. Psychiatry, 14.","DOI":"10.3389\/fpsyt.2023.1065812"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Mao, L., Hu, M., Luo, L., Wu, Y., Lu, Z., and Zou, J. (2022). The Effectiveness of Exposure and Response Prevention Combined with Pharmacotherapy for Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis. Front. Psychiatry, 13.","DOI":"10.3389\/fpsyt.2022.973838"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.psc.2014.05.006","article-title":"Pharmacological Treatment of Obsessive-Compulsive Disorder","volume":"37","author":"Pittenger","year":"2014","journal-title":"Psychiatr. Clin. N. Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"710","DOI":"10.2174\/1570159X16666180813155017","article-title":"Psychopharmacological Treatment of Obsessive-Compulsive Disorder (OCD)","volume":"17","author":"Sorice","year":"2019","journal-title":"Curr. Neuropharmacol."},{"key":"ref_11","first-page":"S26","article-title":"Defining and Understanding Treatment Resistance in Obsessive-Compulsive Disorder","volume":"66","year":"2023","journal-title":"Eur. Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"5632","DOI":"10.2174\/0929867324666170712114445","article-title":"Combining Drug and Psychological Treatments for Obsessive- Compulsive Disorder: What is the Evidence, When and for Whom","volume":"25","author":"Albert","year":"2018","journal-title":"Curr. Med. Chem."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1177\/00048674211043047","article-title":"The Evidence Is in: Repetitive Transcranial Magnetic Stimulation Is an Effective, Safe and Well-Tolerated Treatment for Patients with Major Depressive Disorder","volume":"56","author":"Fitzgerald","year":"2022","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1097\/HRP.0000000000000364","article-title":"Accelerated Repetitive Transcranial Magnetic Stimulation to Treat Major Depression: The Past, Present and Future","volume":"31","author":"Chen","year":"2023","journal-title":"Harv. Rev. Psychiatry"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Grassi, G., Moradei, C., and Cecchelli, C. (2023). Will Transcranial Magnetic Stimulation Improve the Treatment of Obsessive\u2013Compulsive Disorder? A Systematic Review and Meta-Analysis of Current Targets and Clinical Evidence. Life, 13.","DOI":"10.3390\/life13071494"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1016\/j.brs.2020.10.003","article-title":"Sequential Multi-Locus Transcranial Magnetic Stimulation for Treatment of Obsessive-Compulsive Dis-order with Comorbid Major Depression: A Case Series","volume":"13","author":"Tadayonnejad","year":"2020","journal-title":"Brain Stimul."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"114856","DOI":"10.1016\/j.psychres.2022.114856","article-title":"Use of Right Orbitofrontal Repetitive Transcranial Magnetic Stimulation (rTMS) Aug-mentation for Treatment-Refractory Obsessive-Compulsive Disorder with Comorbid Major Depressive Disorder","volume":"317","author":"Tadayonnejad","year":"2022","journal-title":"Psychiatry Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2852","DOI":"10.1002\/hbm.22371","article-title":"Reduced Functional Connectivity within the Limbic Cortico-striato-thalamo-cortical Loop in Unmedicated Adults with Obsessive-compulsive Disorder","volume":"35","author":"Posner","year":"2013","journal-title":"Hum. Brain Mapp."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Calz\u00e0, J., G\u00fcrsel, D.A., Schmitz-Koep, B., Bremer, B., Reinholz, L., Berberich, G., and Koch, K. (2019). Altered Cortico\u2013Striatal Functional Connectivity During Resting State in Obsessive\u2013Compulsive Disorder. Front. Psychiatry, 10.","DOI":"10.3389\/fpsyt.2019.00319"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1136\/jnnp-2020-324478","article-title":"Defining Functional Brain Networks Underlying Obsessive\u2013Compulsive Disorder (OCD) Using Treatment-Induced Neuroimaging Changes: A Systematic Review of the Literature","volume":"92","author":"Bijanki","year":"2021","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1007\/s11126-018-9566-7","article-title":"A Meta-Analysis of the Effectiveness of Different Cortical Targets Used in Repetitive Transcranial Magnetic Stimulation (rTMS) for the Treatment of Obsessive-Compulsive Disorder (OCD)","volume":"89","author":"Rehn","year":"2018","journal-title":"Psychiatr. Q."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3833","DOI":"10.1002\/hbm.25468","article-title":"Pre-supplementary Motor Network Connectivity and Clinical Out-come of Magnetic Stimulation in Obsessive\u2013Compulsive Disorder","volume":"42","author":"Ji","year":"2021","journal-title":"Hum. Brain Mapp."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1038\/s41398-021-01453-0","article-title":"Efficacy and Tolerability of Repetitive Transcranial Magnetic Stimulation for the Treatment of Obsessive-Compulsive Disorder in Adults: A Systematic Re-view and Network Meta-Analysis","volume":"11","author":"Liang","year":"2021","journal-title":"Transl. Psychiatry"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.jpsychires.2022.10.025","article-title":"A Double Blind Randomized Clinical Trial of the Effectiveness of Low Frequency rTMS over Right DLPFC or OFC for Treatment of Obsessive-Compulsive Disorder","volume":"156","author":"Khedr","year":"2022","journal-title":"J. Psychiatr. Res."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Launes, G., Hagen, K., Sunde, T., \u00d6st, L.-G., Klovning, I., Laukvik, I.-L., Himle, J.A., Solem, S., Hystad, S.W., and Hansen, B. (2019). A Randomized Controlled Trial of Concentrated ERP, Self-Help and Waiting List for Obsessive- Compulsive Disor-der: The Bergen 4-Day Treatment. Front. Psychol., 10.","DOI":"10.3389\/fpsyg.2019.02500"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Skjold, S.H., Hagen, K., Wheaton, M.G., Hjelle, K.M., Bj\u00f6rgvinsson, T., and Hansen, B. (2024). The Effectiveness and Acceptability of the Bergen 4-Day Treatment for Adolescents with OCD: A Replication and Extension. BMC Psychiatry, 24.","DOI":"10.1186\/s12888-024-05601-w"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.2147\/PRBM.S211117","article-title":"Exposure and Response Prevention in the Treatment of Obsessive-Compulsive Disorder: Current Perspectives","volume":"12","author":"Law","year":"2019","journal-title":"Psychol. Res. Behav. Manag."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"97","DOI":"10.31083\/j.jin2103097","article-title":"The Efficacy and Neural Correlates of ERP-Based Therapy for OCD & TS: A Systematic Review and Meta-Analysis","volume":"21","author":"Yan","year":"2022","journal-title":"J. Integr. Neurosci."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Huang, Y., Yang, H., Zhu, C., Jiang, X., Zhu, W., Liang, Y., Ma, L., Wang, Y., and Tang, W. (2022). An Exploratory Study of a Novel Combined Therapeutic Modality for Obses-sive-Compulsive Disorder. Brain Sci., 12.","DOI":"10.3390\/brainsci12101309"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"773","DOI":"10.9758\/cpn.2022.20.4.773","article-title":"Targeting Three Brain Regions (Bilateral SMA, Left and Right DLPFC) Sequentially in One Session Using Combined Repetitive Transcranial Magnetic Stimulation and Intermittent Theta-Burst Stimulation in Treatment-Refractory Obsessive-Compulsive Disorder: A Case Report","volume":"20","author":"Chou","year":"2022","journal-title":"Clin. Psychopharmacol. Neurosci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1017\/S1461145702002900","article-title":"International Treatment Refractory OCD Consortium. Treatment Non-Response in OCD: Methodological Issues and Operational Definitions","volume":"5","author":"Pallanti","year":"2002","journal-title":"Int. J. Neuropsychopharmacol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.jpsychires.2025.01.002","article-title":"EEG Alpha Activity as Predictor for TBS-rTMS Treatment Outcome in Depression","volume":"182","author":"Provaznikova","year":"2025","journal-title":"J. Psychiatr. Res."},{"key":"ref_33","first-page":"206","article-title":"Consensus Review and Considerations on TMS to Treat Depression: A Comprehensive Update Endorsed by the National Network of Depression Centers, the Clinical TMS Socie-ty, and the International Federation of Clinical Neurophysiology","volume":"170","author":"Trapp","year":"2025","journal-title":"Clin. Neuro-Physiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3404","DOI":"10.1111\/ejn.15195","article-title":"Selecting Stimulation Intensity in Repetitive Transcranial Magnetic Stimulation Studies: A Systematic Review between 1991 and 2020","volume":"53","author":"Turi","year":"2021","journal-title":"Eur. J. Neurosci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1016\/j.clinph.2009.08.016","article-title":"Safety, Ethical Considerations, and Application Guidelines for the Use of Transcranial Magnetic Stimulation in Clinical Practice and Research","volume":"120","author":"Rossi","year":"2009","journal-title":"Clin. Neurophysiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.clinph.2020.10.003","article-title":"Safety and Recommendations for TMS Use in Healthy Subjects and Patient Populations, with Up-dates on Training, Ethical and Regulatory Issues: Expert Guidelines","volume":"132","author":"Rossi","year":"2021","journal-title":"Clin. Neurophysiol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Diao, X., Lu, Q., Qiao, L., Gong, Y., Lu, X., Feng, M., Su, P., Shen, Y., Yuan, T.-F., and He, C. (2022). Cortical Inhibition State-Dependent iTBS Induced Neural Plasticity. Front. Neurosci., 16.","DOI":"10.3389\/fnins.2022.788538"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"E153","DOI":"10.1503\/jpn.210201","article-title":"Frontoparietal Paired Associative Stimulation versus Single-Site Stimulation for Generalized Anxiety Disorder: A Pilot rTMS Study","volume":"47","author":"Wang","year":"2022","journal-title":"J. Psychiatry Neurosci."},{"key":"ref_39","first-page":"744","article-title":"A New Angle on Transcranial Magnetic Stimulation Coil Orientation: A Targeted Narrative Review","volume":"9","author":"Cerins","year":"2024","journal-title":"Biol. Psychiatry Cogn. Neurosci. Neuroimaging"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1176\/appi.neuropsych.11100242","article-title":"A Randomized, Double-Blind Trial of Repetitive Transcranial Magnetic Stimulation in Obsessive-Compulsive Disorder With Three-Month Follow-Up","volume":"24","author":"Gomes","year":"2012","journal-title":"J. Neuropsychiatry Clin. Neurosci."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"g2183","DOI":"10.1136\/bmj.g2183","article-title":"Obsessive-Compulsive Disorder","volume":"348","author":"Veale","year":"2014","journal-title":"BMJ"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1192\/S0007125000297870","article-title":"Neuroimaging and Frontal-Subcortical Circuitry in Obsessive-Compulsive Disorder","volume":"173","author":"Saxena","year":"1998","journal-title":"Br. J. Psychiatry Suppl."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Hawken, E.R., Dilkov, D., Kaludiev, E., Simek, S., Zhang, F., and Milev, R. (2016). Transcranial Magnetic Stimulation of the Supplementary Motor Area in the Treatment of Obsessive-Compulsive Disorder: A Multi-Site Study. Int. J. Mol. Sci., 17.","DOI":"10.3390\/ijms17030420"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e1224","DOI":"10.1038\/tp.2017.189","article-title":"The Neural Correlates of Obsessive-Compulsive Disorder: A Multimodal Perspective","volume":"7","author":"Moreira","year":"2017","journal-title":"Transl. Psychiatry"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"3531","DOI":"10.1111\/ejn.16117","article-title":"Abnormal Voxel-Mirrored Homotopic Connectivity in First-Episode, Drug-Na\u00efve Patients with Obsessive\u2013Compulsive Disorder","volume":"58","author":"Xu","year":"2023","journal-title":"Eur. J. Neurosci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"4307","DOI":"10.1038\/s41380-023-02077-0","article-title":"The Functional Connectome in Obsessive-Compulsive Disorder: Resting-State Mega-Analysis and Machine Learning Classification for the ENIGMA-OCD Consortium","volume":"28","author":"Bruin","year":"2023","journal-title":"Mol. Psychiatry"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"bhae327","DOI":"10.1093\/cercor\/bhae327","article-title":"Exploring Functional Connectivity in Large-Scale Brain Networks in Obsessive-Compulsive Disorder: A Systematic Review of EEG and fMRI Studies","volume":"34","author":"Perera","year":"2024","journal-title":"Cerebral. Cortex."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"134449","DOI":"10.1016\/j.neulet.2019.134449","article-title":"Abnormalities with-in and beyond the Cortico-Striato-Thalamo-Cortical Circuitry in Medication-Free Patients with OCD Revealed by the Fractional Amplitude of Low-Frequency Fluctuations and Resting-State Functional Connectivity","volume":"712","author":"Gao","year":"2019","journal-title":"Neurosci. Lett."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1007\/s12264-018-0214-x","article-title":"The Mechanism of Cortico-Striato-Thalamo-Cortical Neurocircuitry in Response Inhibition and Emotional Responding in Attention Deficit Hyperactivity Disorder with Comorbid Disruptive Behavior Disorder","volume":"34","author":"Zhu","year":"2018","journal-title":"Neurosci. Bull."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1038\/s41386-021-01130-2","article-title":"The Prefrontal Cortex and OCD","volume":"47","author":"Ahmari","year":"2022","journal-title":"Neuropsychopharmacology"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1017\/S0033291708003462","article-title":"Antidepressant Efficacy of High-Frequency Transcranial Magnetic Stimulation over the Left Dorsolateral Prefrontal Cortex in Double-Blind Sham-Controlled Designs: A Meta-Analysis","volume":"39","author":"Schutter","year":"2009","journal-title":"Psychol. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1016\/j.biopsych.2016.08.009","article-title":"Specific Frontostriatal Circuits for Impaired Cognitive Flexibility and Goal-Directed Planning in Obsessive-Compulsive Disorder: Evidence From Resting-State Functional Connectivity","volume":"81","author":"Vaghi","year":"2017","journal-title":"Biol. Psychiatry"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.jad.2013.12.025","article-title":"Treatment of Major Depression with Bilateral Theta Burst Stimulation: A Randomized Controlled Pilot Trial","volume":"156","author":"Plewnia","year":"2014","journal-title":"J. Affect. Disord."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1007\/s00406-021-01280-w","article-title":"Treatment of Major Depressive Disorder with Bilateral Theta Burst Stimulation: Study Protocol for a Randomized, Double-Blind, Placebo-Controlled Multicenter Trial (TBS-D)","volume":"271","author":"Plewnia","year":"2021","journal-title":"Eur. Arch. Psychiatry Clin. Neurosci."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"S9","DOI":"10.4103\/psychiatry.IndianJPsychiatry_525_18","article-title":"Neuroimaging Findings in Obsessive\u2013Compulsive Disorder: A Narrative Review to Elucidate Neurobiological Underpinnings","volume":"61","author":"Hazari","year":"2019","journal-title":"Indian J. Psychiatry"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.psychres.2016.02.031","article-title":"Repetitive Transcranial Magnetic Stimulation in the Treatment of Obsessive-Compulsive Disorders: Double Blind Randomized Clinical Trial","volume":"238","author":"Elbeh","year":"2016","journal-title":"Psychiatry Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"T155","DOI":"10.1016\/j.neuroimage.2007.03.034","article-title":"The Role of the Pre-Supplementary Motor Area in the Control of Action","volume":"36","author":"Nachev","year":"2007","journal-title":"Neuroimage"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1002\/hbm.25699","article-title":"Increased Functional Connectivity between Presupplementary Motor Area and Inferior Frontal Gyrus Associated with the Ability of Motor Response Inhibition in Obsessive\u2013Compulsive Disorder","volume":"43","author":"Tomiyama","year":"2021","journal-title":"Hum. Brain Mapp."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/j.neubiorev.2008.08.016","article-title":"Insights into the Neural Basis of Response Inhibition from Cognitive and Clinical Neuroscience","volume":"33","author":"Chambers","year":"2009","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"498","DOI":"10.4103\/ipj.ipj_54_25","article-title":"Efficacy of Repetitive Transcranial Magnetic Stimulation as an Adjunctive Treatment in Resistant Obsessive\u2013Compulsive Disorder: A Randomized Controlled Trial","volume":"34","author":"Singh","year":"2025","journal-title":"Ind. Psychiatry J."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1038\/s41398-024-02736-y","article-title":"Targeting the Prefrontal-Supplementary Motor Network in Obsessive-Compulsive Disorder with Intensified Electrical Stimulation in Two Dosages: A Randomized, Con-trolled Trial","volume":"14","author":"Alizadehgoradel","year":"2024","journal-title":"Transl. Psychiatry"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Dehghani-Arani, F., Kazemi, R., Hallajian, A.-H., Sima, S., Boutimaz, S., He-dayati, S., Koushamoghadam, S., Safarifard, R., and Salehinejad, M.A. (2024). Metaanalysis of Repetitive Transcranial Magnetic Stimulation (rTMS) Efficacy for OCD Treatment: The Impact of Stimulation Parameters, Symptom Subtype and rTMS-Induced Electrical Field. J. Clin. Med., 13.","DOI":"10.3390\/jcm13185358"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"100189","DOI":"10.1016\/j.transm.2025.100189","article-title":"Multi-Target Theta Burst Stimulation (cTBS) as an Adjunctive Strategy for Refractory Obsessive-Compulsive and Major Depressive Disorders: A Case Report","volume":"5","author":"Lopes","year":"2025","journal-title":"Transcranial. Magn. Stimul."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1038\/s41386-023-01599-z","article-title":"Accelerated TMS\u2014Moving Quickly into the Future of Depression Treatment","volume":"49","author":"Arulpragasam","year":"2024","journal-title":"Neuropsychopharmacology"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1016\/j.biopsych.2024.06.029","article-title":"Transcranial Magnetic Stimulation\u2013Induced Plasticity Improving Cognitive Control in Obsessive-Compulsive Disorder, Part I: Clinical and Neuroimaging Outcomes From a Randomized Trial","volume":"97","author":"Fitzsimmons","year":"2025","journal-title":"Biol. Psychiatry"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"4845","DOI":"10.1113\/jphysiol.2009.179101","article-title":"Primary Motor Cortical Metaplasticity Induced by Priming over the Supplementary Motor Area","volume":"587","author":"Hamada","year":"2009","journal-title":"J. Physiol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"E292","DOI":"10.1503\/jpn.200053","article-title":"Augmentation of Fear Extinction by Theta-Burst Transcranial Magnetic Stimulation of the Prefrontal Cortex in Humans","volume":"46","author":"Deng","year":"2021","journal-title":"J. Psychiatry Neurosci."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"(1997). Obsessive-Compulsive Cognitions Working Group. Cognitive Assessment of Obsessive-Compulsive Disorder. Behav. Res. Ther., 35, 667\u2013681.","DOI":"10.1016\/S0005-7967(97)00017-X"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1758","DOI":"10.1093\/scan\/nsv066","article-title":"Mindfulness Meditation Training Alters Stress-Related Amygdala Resting State Functional Connectivity: A Randomized Controlled Trial","volume":"10","author":"Taren","year":"2015","journal-title":"Soc. Cogn. Affect Neurosci."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.jad.2020.12.082","article-title":"A Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy vs Stress Management Training for Obsessive-Compulsive Disorder","volume":"282","author":"Mathur","year":"2021","journal-title":"J. Affect. Disord."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1176\/appi.ajp.2012.12010073","article-title":"Presupplementary Motor Area Hyperactivity During Response Inhibition: A Candidate Endophenotype of Obsessive-Compulsive Disorder","volume":"169","year":"2012","journal-title":"Am. J. Psychiatry"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1017\/S1355617716000540","article-title":"Stop Signal Reaction Time Deficits in a Lifetime Obsessive-Compulsive Disorder Sample","volume":"22","author":"McLaughlin","year":"2016","journal-title":"J. Int. Neuropsychol. Soc."},{"key":"ref_73","first-page":"100501","article-title":"\u201cNot Just Right Experiences\u201d in Children and Adolescents: Phenomenology and Relation to OCD Symptoms","volume":"24","author":"Ravid","year":"2020","journal-title":"J. Obs.-Compuls. Relat. Disord."},{"key":"ref_74","first-page":"100762","article-title":"Not Just Right Experiences and In-completeness as a Predictor of Obsessive Compulsive Symptoms in Clinical and Community Samples: A Meta-Analysis","volume":"35","author":"Horncastle","year":"2022","journal-title":"J. Obs.-Compuls. Relat. Disord."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1037\/0033-295X.111.1.111","article-title":"Obsessive-Compulsive Disorder as a Disturbance of Security Motivation","volume":"111","author":"Szechtman","year":"2004","journal-title":"Psychol. Rev."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Zor, R., Szechtman, H., Hermesh, H., Fineberg, N.A., and Eilam, D. (2011). Manifestation of Incompleteness in Obsessive-Compulsive Disorder (OCD) as Reduced Functionality and Extended Activity beyond Task Completion. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0025217"},{"key":"ref_77","unstructured":"(2026, August 13). Ensuring Consent for Publishing Medical Case Reports. Available online: https:\/\/publicationethics.org\/guidance\/guideline\/ensuring-consent-publishing-medical-case-reports."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7155\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T09:58:32Z","timestamp":1789466312000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7155"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,15]]},"references-count":77,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15187155"],"URL":"https:\/\/doi.org\/10.3390\/jcm15187155","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,15]]}}}