Comparative Effectiveness of Cognitive Behavioral Therapy With and Without Transcranial Direct Current Stimulation on Psychological Distress in Patients With Musculoskeletal Pain

Abstract

This study aimed to compare the effectiveness of cognitive behavioral therapy (CBT) alone and combined with transcranial direct current stimulation (tDCS) in reducing psychological distress among patients with musculoskeletal pain. This applied quasi-experimental research used a pretest–posttest and follow-up design with a non-equivalent control group. Forty-five patients with chronic musculoskeletal pain for at least three months were purposively recruited and assigned to three groups of 15: CBT plus tDCS, CBT alone, and control. Both intervention groups received 12 sessions of CBT based on the McFarlane protocol, while the combined group additionally underwent 20 sessions of tDCS at 2 mA over the dorsolateral prefrontal cortex. Psychological distress was measured using the DASS-21 scale. Data were analyzed using repeated-measures ANCOVA and Bonferroni post hoc tests in SPSS version 26. ANCOVA revealed a significant main effect of group on psychological distress (F=123.79, p<0.001, η²=0.864). Both CBT and CBT plus tDCS groups showed significantly greater reductions in distress compared to the control group (p<0.001). The difference between the two intervention groups was not statistically significant (p=1.000), although the CBT plus tDCS group showed slightly greater clinical improvement. CBT alone is effective in reducing psychological distress in patients with musculoskeletal pain, and adding tDCS may provide additional clinical benefit, although further large-scale research is needed to confirm its statistical superiority.