Mental health conditions are complex. They are influenced by a combination of biological, psychological, and social factors, including brain activity, genetics, life experiences, stress, thoughts, emotions, and behaviours (Magomedova et al., 2025). As everyone's experience is unique, there is rarely a one-size-fits-all treatment. Many people benefit from exploring different therapies or combining treatments to find an approach that best suits their individual needs.
One combination receiving increasing attention is transcranial magnetic stimulation (TMS) alongside psychological therapy. TMS is a non-invasive treatment that uses magnetic pulses to stimulate specific brain regions involved in mood regulation. Psychological therapies, such as Cognitive Behavioural Therapy (CBT), Dialectical Behaviour Therapy (DBT), Eye Movement Desensitisation and Reprocessing (EMDR), counselling, and Interpersonal Therapy (IPT), help people understand their thoughts, emotions, and behaviours while developing practical strategies for managing life's challenges.
Because TMS and psychological therapies work in different ways, researchers are increasingly exploring how these treatments may complement one another as part of a personalised mental healthcare plan. While TMS targets the brain's neural activity, talking therapies focus on developing new ways of understanding and responding to thoughts, emotions, and behaviours. Together, these approaches may offer complementary benefits for some individuals, although research is still ongoing to determine who is most likely to benefit and how best to combine them. In this article, we explore how TMS and psychological therapy can work together and what the current evidence suggests.
Transcranial Magnetic Stimulation (TMS) is a form of neuromodulation that uses magnetic fields to stimulate specific areas of the brain (Breda & Freire, 2024). For conditions such as depression, TMS commonly targets regions involved in mood regulation and emotional processing, including the dorsolateral prefrontal cortex. The aim is to help regulate activity in brain networks that may become disrupted.
TMS is:
Non-invasive
Delivered without general anaesthesia
Performed in a clinic setting
Associated with fewer side effects than many medication-based treatments
While TMS targets the brain directly by using magnetic pulses to influence the activity of specific brain regions involved in mood regulation, psychological therapies help people understand and change the patterns of thinking, feeling, and behaving that contribute to emotional distress.
Psychological therapy provides a safe, structured, and collaborative space to explore challenges, gain insight into thoughts and emotions, and develop practical strategies for improving mental health and wellbeing. Depending on the type of therapy, treatment may help people process difficult experiences, manage symptoms, improve relationships, build resilience, and develop healthier ways of responding to stress and life's challenges.
Many psychological therapies are supported by strong scientific evidence and are effective for treating conditions such as depression, anxiety disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), eating disorders, and personality disorders. Psychological therapies may be used on their own or alongside treatments such as medication or TMS, depending on an individual's needs and treatment goals.
Cognitive Behavioural Therapy (CBT) is one of the most extensively researched and widely used psychological therapies. It is based on the idea that our thoughts, emotions, behaviours, and physical sensations are closely connected. Unhelpful patterns of thinking and behaviour can contribute to emotional distress, but these patterns can be identified and changed (Royal College of Psychiatrists, 2022).
CBT helps people:
Recognise and challenge negative or unhelpful thinking patterns.
Develop more balanced and realistic ways of interpreting situations.
Change behaviours that may maintain symptoms of depression or anxiety.
Learn practical coping strategies and problem-solving skills.
Build confidence and resilience in managing future challenges.
CBT has been shown to be effective for a wide range of mental health conditions, including depression, anxiety disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and some eating disorders.
Dialectical Behaviour Therapy (DBT) is a structured, evidence-based psychological therapy that combines cognitive behavioural techniques with mindfulness and acceptance-based strategies. It is designed to help people better understand and manage intense emotions while developing practical skills for navigating everyday challenges, improving relationships, and responding to stress in healthier ways (Guy-Evans, 2023).
DBT is based on the idea that people can learn to accept themselves and their experiences while also working towards change. Therapy typically combines individual therapy with structured skills training and encourages the regular practice of new skills in everyday life.
DBT focuses on developing practical skills in four key areas:
Mindfulness – becoming more aware of thoughts, emotions, and the present moment without judgement.
Emotion regulation – understanding emotions and learning effective strategies to manage them.
Distress tolerance – coping with emotional crises and difficult situations without making them worse.
Interpersonal effectiveness – communicating more effectively, setting healthy boundaries, and building stronger relationships.
Research has shown that DBT can reduce self-harm and suicidal behaviours, improve emotion regulation, decrease emotional distress, and enhance quality of life and day-to-day functioning for many people experiencing significant emotional difficulties.
TMS and psychological therapies work in complementary ways. While TMS works by stimulating specific brain networks involved in mood, emotion, and thinking, psychological therapies such as CBT and DBT focus on helping people develop healthier ways of thinking, coping, and responding to life's challenges.
Researchers are increasingly interested in whether combining these approaches could enhance treatment outcomes beyond either treatment alone. This is based on the brain's remarkable ability to change and adapt throughout life, a process known as neuroplasticity. Neuroplasticity allows the brain to form new connections and strengthen existing ones in response to learning, experiences, and stimulation.
Some researchers believe that TMS may temporarily increase the brain's capacity for adaptive change, potentially making it more receptive to the learning and behavioural changes encouraged during psychological therapy. In theory, this could help people apply new coping strategies more effectively and reinforce positive changes over time.
Although this is a promising area of research, evidence is still emerging. Scientists are continuing to investigate whether combining TMS with different forms of psychological therapy offers additional benefits, which therapies work best alongside TMS, and the most effective timing for delivering these treatments together.
Research into combining TMS with psychological therapy is growing, particularly for depression. Early evidence suggested that delivering CBT alongside TMS was both feasible and potentially beneficial. In one of the first published case studies, a patient successfully engaged in CBT during TMS sessions, with the authors proposing that stimulating the prefrontal cortex while practising cognitive restructuring may help strengthen the brain circuits involved in emotional regulation and resilience. As this was a single case study, the researchers emphasised that larger clinical trials were needed to determine whether combining these treatments offers additional benefits (Vedeniapin et al., 2010).
Since then, larger studies have begun to provide stronger evidence. A 2023 systematic review and meta-analysis examined 27 randomised controlled trials involving more than 1,100 participants and found preliminary evidence that combining TMS with psychological therapies produced small but significant improvements in clinical symptoms compared with psychological therapy alone (Xu et al., 2023). A subgroup analysis also found that when 10 or more sessions of TMS were combined with CBT, outcomes were significantly better than CBT combined with sham stimulation. However, the authors noted that the studies varied considerably in their methods and concluded that further high-quality research is needed to identify which patients benefit most and the optimal way to combine these treatments.
More recently, a 2026 systematic review and meta-analysis specifically examined the combination of TMS and CBT for depression (Liu et al., 2026). Analysing 10 randomised controlled trials involving 1,320 participants, the researchers found that people who received TMS alongside CBT experienced greater improvements in depressive symptoms than those receiving TMS alone. The findings suggest that TMS and CBT may have complementary effects, although the authors highlighted the need for larger studies with longer follow-up to establish the most effective treatment protocols.
Research is also beginning to explore whether TMS can complement other forms of psychological therapy. A 2024 randomised, sham-controlled pilot trial investigated whether adding intermittent theta burst stimulation (iTBS), a form of TMS, to an eight-week Dialectical Behaviour Therapy (DBT) programme could improve outcomes for people with borderline personality disorder (Kujovic et al., 2025). Although participants receiving active iTBS showed a small trend towards greater improvement than those receiving sham stimulation, the difference was not statistically significant. Importantly, all participants benefited from DBT, and the researchers concluded that iTBS may still have potential as an add-on treatment that warrants investigation in larger clinical trials.
Overall, the evidence suggests that combining TMS with psychological therapy is a promising area of research. While the strongest evidence currently supports combining TMS with CBT for depression, researchers are increasingly exploring how TMS may enhance other therapies by potentially creating a brain state that is more receptive to learning and behavioural change. More high-quality clinical trials are still needed, but the findings so far suggest that combining brain stimulation with talking therapy could offer additional benefits for some people.
As our understanding of the brain continues to grow, researchers are exploring how TMS and psychological therapy can be combined in the most effective way. Key questions include:
Which people are most likely to benefit from combining TMS with psychological therapy?
Is therapy most effective before, during, or after a course of TMS?
Which psychological approaches, such as CBT, DBT, or Acceptance and Commitment Therapy (ACT), work best alongside TMS?
Can combining TMS with psychological therapy improve long-term recovery and help reduce the risk of relapse?
Although many of these questions remain unanswered, the research to date is encouraging. Rather than viewing biological and psychological treatments as separate approaches, future mental healthcare is likely to focus increasingly on personalised treatment plans that combine the strengths of both. By targeting brain networks while also supporting changes in thoughts, emotions, and behaviours, these integrated approaches may help some people achieve better and more lasting outcomes.
At Smart TMS, we recognise that every person's mental health journey is unique. TMS is an evidence-based treatment for treatment-resistant depression and obsessive-compulsive disorder, and emerging research continues to explore how it may complement established psychological therapies to support recovery.
We are committed to delivering compassionate, personalised care informed by the latest scientific evidence. As research continues to evolve, we will continue to monitor new developments to help ensure our patients receive treatment based on current best practice.
If you would like to learn more about whether TMS could be suitable for you, our clinical team can provide a personalised assessment, answer your questions, and discuss the treatment options that may be most appropriate for your individual needs.
Written by Holly, Smart TMS Newcastle Practitioner
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