اثربخشی تحریک جریان مستقیم فراجمجمه‌ای بر بهبود کارکردهای شناختی و نظم‌بخشی شناختی هیجانی در مصرف‌کنندگان کانابیس: یک مطالعه تصادفی کنترل شده با تحریک ساختگی

نوع مقاله : مقاله پژوهشی اصیل

نویسندگان
1 دانشجوی دکتری تخصصی، گروه روان‌شناسی، واحد بین‌الملل کیش، دانشگاه آزاد اسلامی، کیش، ایران
2 دانشیار، گروه مشاوره، دانشکده علوم تربیتی و روان‌شناسی، دانشگاه شهید بهشتی، تهران، ایران
3 استادیار، گروه روان‌شناسی و مشاوره، دانشکده علوم انسانی، واحد ابهر، دانشگاه آزاد اسلامی، ابهر، ایران
4 متخصص روان‌پزشکی، مرکز تحقیقات اعتیاد و رفتارهای پرخطر، پژوهشکده سلامت روانی- اجتماعی، دانشگاه علوم پزشکی ایران، تهران، ایران
10.48305/jrrs.2026.46457.1152
چکیده
مقدمه: پژوهش حاضر با هدف تعیین اثربخشی تحریک جریان مستقیم فراجمجمه‌ای (Transcranial direct current stimulation یا tDCS) بر بهبود کارکردهای شناختی و راهبردهای نظم‌بخشی شناختی هیجانی در مصرف‌کنندگان کانابیس انجام شد. با توجه به اختلالات شناختی و هیجانی ناشی از مصرف کانابیس و نقش این عوامل در تداوم مصرف و دشواری فرایند ترک، بررسی اثربخشی مداخلات غیر تهاجمی مغزی در بهبود این مشکلات از اهمیت ویژه‌ای برخوردار است.
مواد و روش‌ها: در این مطالعه از طرحی تصادفی کنترل ‌شده با تحریک ساختگی (Sham) استفاده شد. در مرحله ترک، 30 مرد مصرف‌کننده کانابیس به ‌صورت کاملاً تصادفی در دو گروه آزمایش و شم قرار گرفتند. گروه آزمایش طی 10 جلسه، روزانه تحریک آندی قشر پیش‌پیشانی پشتی‌ جانبی (DLPFC یا
Dorsolateral prefrontal cortex) چپ و تحریک کاتدی DLPFC راست را دریافت کردند؛ در حالی که گروه شم تنها تحت تحریک ساختگی قرار گرفت. پیش و پس از مداخله، کارکردهای شناختی و راهبردهای نظم‌بخشی شناختی هیجانی در هر دو گروه مورد ارزیابی قرار گرفت.
یافته‌ها: مداخله tDCS موجب بهبود معنی‌دار انعطاف‌پذیری شناختی، توجه و حافظه کاری در گروه آزمایش شد. همچنین، استفاده از راهبردهای انطباقی نظم‌بخشی شناختی هیجان در گروه tDCS افزایش یافت و در مقابل، راهبردهای ناانطباقی کاهش پیدا کرد.
نتیجه‎گیری: تحریک جریان مستقیم فراجمجمه‌ای با تنظیم فعالیت DLPFC، علاوه بر بهبود کارکردهای شناختی، موجب ارتقای راهبردهای سازگارانه نظم‌بخشی شناختی هیجان در مصرف‌کنندگان کانابیس می‌شود. از این‌رو، این روش می‌تواند به‌ عنوان یک مداخله کمکی مؤثر در فرایند ترک مصرف کانابیس و افزایش پایبندی افراد به درمان مورد استفاده قرار گیرد.
کلیدواژه‌ها
موضوعات

1.     Merrill RM, Palmer JC, Larson HT. Reasons for using cannabis among adults in the United States: associations with demographics, health behaviors, chronic conditions, and legal status. Int J Environ Res Public Health. 2026; 23: 421-43.
2.     Aletraris L, Graves BD, Ndung’u JJ. Assessing the impact of recreational cannabis legalization on cannabis use disorder and admissions to treatment in the United States. Curr Addict Rep. 2023; 10(2): 198-209.
3.     Connor JP, Stjepanović D, Le Foll B, Hoch E, Budney AJ, Hall WD. Cannabis use and cannabis use disorder. Nat Rev Dis Primers. 2021; 7(1): 16-53.
4.     Caulkins JP. Changes in self-reported cannabis use in the United States from 1979 to 2022. Addiction. 2024; 119(9):1648-52.
5.     Baldwin GT, Vivolo-Kantor A, Hoots B, Roehler DR, Ko JY. Current cannabis use in the United States: implications for public health research. Am J Public Health. 2024; 114(S8): S624-27.
6.     Saberi-Zafarghandi MB, Arezoomandan R, Fayazfeyzi Y. Efficacy of transcranial direct current stimulation on the dorsolateral prefrontal cortex in reducing craving, depression, and improving working memory in patients with cannabis use disorders: a randomized, double-blind, sham-controlled trial. Iran J Psychiatry Behav Sci. 2024; 18(3): e142498.
7.     Pilloni G, Pehel S, Ko T, Sammarco C, Charlson RE, Hanlon CA, Charvet L. Telehealth tDCS to reduce cannabis use: a pilot randomized controlled trial in multiple sclerosis as a framework for generalized use. Drug Alcohol Depend. 2025; 272: 112706.
8.     Mehra K, Rup J, Wiese JL, Watson TM, Bonato S, Rueda S. Changes in self-reported cannabis use during the COVID-19 pandemic: a scoping review. BMC Public Health. 2023; 23(1): 2139.
9.     Kitchigina VF. Cannabinoids, the endocannabinoid system, and cognitive functions: enemies or friends? Neurosci Behav Physiol. 2021; 51(7): 893–914.
10.  Mavaddat H, Fouladi A, Sabbagh Kashani A, Khayatan I, Andarzbaksh K, Razavi SM, Rezazadeh A. Cannabinoids and ADHD: a new frontier in neuropharmacology? J Mol Neurosci. 2025; 75: 146-74.
11.  Mattingly DT, Richardson MK, Hart JL. Prevalence of and trends in current cannabis use among US youth and adults, 2013–2022. Drug Alcohol Depend Rep. 2024; 12: 100253.
12.  Kramer J, Koller G, Pogarell O. Cannabinoids and the heart—a psychiatrist’s perspective. Herz. 2024; 49: 428-33.
13.  Koob GF, Volkow ND. Neurocircuitry of addiction. Neuropsychopharmacology. 2010; 35(1): 217-38.
14.  Koob GF, Volkow ND. Neurobiology of addiction: a neurocircuitry analysis. Lancet Psychiatry. 2016; 3(8): 760-73.
15.  Hoch E, Volkow ND, Friemel CM, Lorenzetti V, Freeman TP, Hall W. Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits. Eur Arch Psychiatry Clin Neurosci. 2025; 275: 281-92.
16.  Fang Y, Sun Y, Liu Y, Liu T, Hao W, Liao Y. Neurobiological mechanisms and related clinical treatment of addiction: a review. Psychoradiology. 2022; 2(4): 180-9.
17.  Neacsiu AD, Beynel L, Graner JL, et al. Enhancing cognitive restructuring with concurrent fMRI-guided neurostimulation for emotional dysregulation: a randomized controlled trial. J Affect Disord. 2022; 301: 378-89.
18.  Kinney KR, Kirse HA, Stewart NE, Ip EH, Saldana S, DeMaioNewton HE, Kimber M, Smith HR, Douglas HE, Kiraly DD, Hanlon CA, Addicott MA. Theta burst stimulation as a tool to decrease drinking in treatment-seeking alcohol users: study protocol for a randomized, double-blind, sham-controlled clinical trial. Trials. 2025; 26: 487-503.
19.  Ertl N, Freeman TP, Mokrysz C, Ofori S, Borissova A, Petrilli K, Curran HV, Lawn W, Wall MB. Acute effects of different types of cannabis on young adult and adolescent resting-state brain networks. Neuropsychopharmacology. 2024; 49: 1640-51.
20.  Elrassas HH, Elsayed YAR, Abdeen MS, Mohamed AT, El Nagar ZM. Synthetic cannabinoids impact on cognitive functions. Egypt J Neurol Psychiatry Neurosurg. 2023; 59: 151-9.
21.  Chu KY, Cheng KH. Effects of transcranial direct-current stimulation and cognitive training on individuals with mild cognitive impairment and dementia: a systematic review and meta-analysis. J Mod Rehabil. 2025; 19(1): 1-13.
22.  Chmiel J, Stepien-Słodkowska M, Ramik-Mazewska I. Efficacy of transcranial direct current stimulation (tDCS) on neuropsychiatric symptoms in substance use disorder (SUD): a review and insights into possible mechanisms of action. J Clin Med. 2025; 14: 1337-75.
23.  Chen J, Qin J, He Q, Zou Z. A meta-analysis of transcranial direct current stimulation on substance and food craving: what effect do modulators have? Front Psychiatry. 2020; 11: 598-610.
24.  Biernacki K, Goldstein RZ, Güth MR, Alia-Klein N, Cole S, Ray S, Baker TE. Blunted anterior midcingulate response to reward in opioid users is normalized by prefrontal transcranial magnetic stimulation. Transl Psychiatry. 2025; 15: 340-51.
25.  Bagheban-Sadati F, Imani S, Sadeghi-Firoozabadi V, Alizadehgoradel J. Comparison of the effectiveness of tACS and tDCS on craving reduction and cognitive functions. Appl Psychol. 2025; 19(3): 30-54. [In Persian].
26.  Michel A, Kang D, Fillingim RB, Balderston NL, Bond DS, Steele VR. Repetitive transcranial magnetic stimulation for substance use disorders and chronic pain: a review of the evidence and call for increased mechanistic understanding. Curr Addict Rep. 2025; 12: 14-48.
27.  Sahay S, Reddy MVSRR, Lennox C, Wolinsky E, McCullumsmith RE, Singh T. Harnessing neuroimaging-guided transcranial magnetic stimulation for precision therapy in substance use disorders. Mol Psychiatry. 2025; 30: 3804-816.
28.  Vollstädt-Klein S, Türkmen C, Grundinger N, Wieland A, Aggensteiner PM, Stock NK, Stein M, Moggi F, Bublatzky F, Kiefer F, Link T, Gerhard S. Modification of inhibitory control and craving through transcranial direct current stimulation as an add-on treatment for substance use disorder: protocol for a randomized controlled study. BMC Psychol. 2025; 13: 1132-44.
29.  Zhang M, Chen L, Ren Z, Wang Z, Luo W. Applications of TMS in individuals with methamphetamine use disorder: a review. Heliyon. 2024; 10: e25565.
30.  Zhang X, Huang M, Yu Y, Zhong X, Dai S, Dai Y, Jiang C. Is transcranial direct current stimulation effective for cognitive dysfunction in substance use disorders? a systematic review. Brain Sci. 2024; 14: 754.
31.  Salmani A, Basharpoor S, Vaziri Z, Salehinejad MA. Repeated prefrontal tDCS improves cognitive emotion regulation and readiness for treatment in substance use disorder: a randomized sham-controlled study. Addict Behav Rep. 2025; 21: 100614.
32.  Ekhtiari H, Tavakoli H, Addolorato G, Baeken C, Bonci A, Campanella S, CasteloBranco L, Challet-Bouju G, Clark VP, Claus E, Dannon PN, Del Felice A, den Uyl T, Diana M, di Giannantonio M, Fedota JR, Fitzgerald P, Gallimberti L, Grall-Bronnec M, Hanlon CA. Transcranial electrical and magnetic stimulation (tES and TMS) for addiction medicine: a consensus paper on the present state of the science and the road ahead. Neurosci Biobehav Rev. 2019; 104: 118-40.
33.  Stellern J, Xiao KB, Grennell E, Sanches M, Gowin JL, Sloan ME. Emotion regulation in substance use disorders: a systematic review and meta-analysis. Addiction. 2023; 118(1): 30-47.
34.  Zoghipaydar M, Hasany Khosh Z, Yar Mohammadi Wasel M, Mohagheghi H. Comparing transcranial direct current stimulation (tDCS) and methadone maintenance treatment (MMT) on emotion regulation, distress tolerance and decreased craving in people with substance use disorder (SUD). Neuropsychology. 2022; 7(27): 95-109.
35.  Zakibakhsh N, Basharpoor S, Ghalyanchi Langroodi H, Narimani M, Nitsche MA, Salehinejad MA. Repeated prefrontal tDCS for improving mental health and cognitive deficits in multiple sclerosis: a randomized, double-blind, parallel-group study. J Transl Med. 2024; 22(1): 843.
36.  Alizadehgoradel J, Nejati V, Sadeghi Movahed F, Imani S, Taherifard M, MosayebiSamani M, Vicario CM, Nitsche MA, Salehinejad MA. Repeated stimulation of the dorsolateral prefrontal cortex improves executive dysfunctions and craving in drug addiction: a randomized, double-blind, parallel-group study. Brain Stimul. 2020; 13(3): 582-93.
37.  Ghanavati E, Salehinejad MA, Beaupain MC, Melo L, Frese A, Kuo MF, Nitsche MA. Contribution of glutamatergic and GABAergic mechanisms to the plasticity-modulating effects of dopamine in the human motor cortex. Hum Brain Mapp. 2025; 46(3): e70162.
38.  Nyhus E, Barceló F. The Wisconsin Card Sorting Test and the cognitive assessment of prefrontal executive functions: a critical update. Brain and cognition. 2009; 71(3): 437-51.
39.  Miles S, Howlett CA, Berryman C, Nedeljkovic M, Moseley GL, Phillipou A. Considerations for using the Wisconsin Card Sorting Test to assess cognitive flexibility. Behavior research methods. 2021; 53(5): 2083-91.
40.  Javanmard GH. A study of executive functions in schizophrenic patients with positive and negative symptoms and healthy individuals using the Wisconsin Card Sorting neuropsychological test. Neuropsychology Quarterly. 2015; 1(2): 6-16. [In Persian].
41.  Rempfer M, Hamera E, Brown C, Bothwell RJ. Learning proficiency on the Wisconsin Card Sorting Test in people with serious mental illness: what are the cognitive characteristics of good learners? Schizophr Res. 2006; 87(1–3): 316-22.
42.  Khalafbeigi M, Akbarfahimi M, Ashayeri H, Doostdar H. Investigating the impact of musical activities on executive functions in patients with schizophrenia. J Army Med Sci Univ. 2013; 2: 120-9. [In Persian].
43.  Jensen AR, Rohwer Jr WD. The Stroop color-word test: a review. Acta psychologica. 1966; 25: 36-93.
44.  Nejati V. The relationship between executive functions of the brain and risky decision-making among university students. Journal of Behavioral Sciences Research. 2013; 11(3): 270-8.
45.  Alilo MM, Khamidi S, Shirvani A. Comparison of executive functions and sustained attention in students with
obsessive–compulsive symptoms, high schizotypal traits, and overlapping symptoms with normal group. J Behav Sci Res. 2011; 9(3): 216-21.
46.  Shiri V, Hosseini SA, Pishyareh E, Biglarian A. Studying the relationship of executive functions with behavioral symptoms in children with high-functioning autism. Journal of Rehabilitation. 2015; 16(3): 208–17.
47.  Drozdick LW, Raiford SE, Wahlstrom D, Weiss LG. The Wechsler Adult Intelligence Scale—Fourth Edition and the Wechsler Memory Scale—Fourth Edition. In: Flanagan DP, McDonough EM, editors. Contemporary intellectual assessment: Theories, tests, and issues. 4th ed. New York: The Guilford Press; 2018. p. 486–511.
48.  Khoddadadi M, Amani H. Wechsler Working Memory Software. Tehran: Sina Institute for Behavioral and Cognitive Sciences Research; 2014.
49.  Khanjani Z, Nazari MA, Ab-ravani P. Effectiveness of cognitive rehabilitation on executive functions in stroke patients. Journal of Clinical Psychopathology Studies. 2019; 9(34): 197-226. [In Persian].
50.  Khanjani Z, Farhoudi M, Nazari MA, Saeedi MT, Abravani P. Effectiveness of cognitive rehabilitation on selective and divided attention and executive function in adults with stroke. Shenakht Journal of Psychology and Psychiatry. 2018;5(3):81-94. Available from: http://shenakht.muk.ac.ir/article-1-493-fa.html. [In Persian].
51.  Garnefski N, Kraaij V. The cognitive emotion regulation questionnaire. European journal of psychological assessment. 2007; 23(3): 141-9.
52.  Hosseini-Abadi M, Shokri A. Factor structure equivalence test of the short form of the Cognitive Emotion Regulation Questionnaire. Developmental Psychology Quarterly: Iranian Psychologists. 2015; 12(46): 199-211. [In Persian].
53.  Garnefski N, Kraaij V, Spinhoven P. Negative life events, cognitive emotion regulation and emotional problems. Personality and Individual Differences. 2001; 30(8): 1311-27.
54.  Entezam-Din F, Shokri A, Fattah-Abadi J. The mediating role of cognitive coping strategies in the relationship between psychological resilience and psychological well-being in gifted boys and girls students. Developmental Psychology Quarterly: Iranian Psychologists. 2024; 21(81): 73-90. [In Persian].
55.  Salehinejad MA, Ghanavati E, Rashid MHA, Nitsche MA. Hot and cold executive functions in the brain: A prefrontal-cingular network. Brain and Neuroscience Advances. 2021; 5: 1-19.
56.  Molavi P, Aziziaram S, Basharpoor S, Atadokht A, Nitsche MA, Salehinejad MA. Repeated transcranial direct current stimulation of dorsolateral prefrontal cortex improves executive functions, cognitive reappraisal emotion regulation, and control over emotional processing in borderline personality disorder: A randomized, sham-controlled, parallel-group study. Journal of Affective Disorders. 2020; 274: 93-102.
57.  Vicario CM, Salehinejad MA, Felmingham K, Martino G, Nitsche MA. A systematic review on the therapeutic effectiveness of non-invasive brain stimulation for the treatment of anxiety disorders. Neuroscience & Biobehavioral Reviews. 2019; 96: 219-31.