Theta Burst Stimulation (TBS) for Auditory Hallucinations in Schizophrenia: Findings from a Phase 3 Trial
This content is intended for healthcare professionals and is provided for educational purposes only. Transcranial magnetic stimulation (TMS) is not approved for the treatment of auditory hallucinations in schizophrenia.MS is not approved for treating suicidal ideation.
Auditory verbal hallucinations are among the most disabling symptoms associated with schizophrenia spectrum disorders, with many individuals continuing to experience persistent symptoms despite pharmacological and psychotherapeutic interventions. In this context, transcranial magnetic stimulation (TMS) and related neuromodulation approaches are being investigated as potential strategies to target neural circuits involved in auditory processing.
A multicentre, randomized, triple-blind, sham-controlled phase 3 trial published in The Lancet Psychiatry evaluated the use of theta burst stimulation (TBS) in adults aged 18 to 65 years with schizophrenia spectrum disorders and persistent auditory verbal hallucinations. Participants experienced hallucinations at least once per week for a minimum of three months prior to enrollment.
In this study, 138 participants received either active or sham bilateral continuous theta burst stimulation (cTBS) targeting temporo-parietal regions associated with auditory processing. Stimulation was delivered over 15 sessions across three weeks, with 600 pulses per hemisphere per session, reflecting a structured and intensive neuromodulation protocol.
Active cTBS was associated with a reduction in the severity of auditory hallucinations, as measured by the PSYRATS-AH score, compared to sham stimulation. This finding represents a key outcome of the study and provides evidence on how targeted neuromodulation of temporo-parietal circuits may influence symptom severity in this population.
These results contribute to ongoing research exploring theta burst stimulation (TBS) in schizophrenia, particularly in patients with persistent symptoms despite prior treatment.
As a phase 3 randomized controlled trial, the study provides a high level of clinical evidence. However, interpretation should remain within the context of the study parameters, and the findings do not establish clinical recommendations or regulatory approval for this indication.
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