Table 1.
Methodological details and key findings of available TMS studies on mentalizing sorted by targeted brain region.
| Study | Brain region | Technique | Targeting procedure | Stimulation and Control | Paradigm | Outcome measure | Effect size* | Key findings |
|---|---|---|---|---|---|---|---|---|
| RTPJ | ||||||||
| Costa et al., 2008 | LTPJ; RTPJ | rTMS | Neuronavigation to a priori defined coordinates | 1 Hz, 15 min, 90% RMT; sham | Short stories: false belief/faux pas/control | PCR; RT | n/a | rTMS over RTPJ impaired performance in false belief task and in faux pas test |
| Giardina et al., 2011 | LTPJ; RTPJ | rTMS | Neuronavigation to a priori defined coordinates | 1 Hz, 600 stimuli, 90% RMT; control (10/20 EEG position Oz) | Social interaction scenarios requiring either hostile or non-hostile intentionality attributions | Number of respective intentionality attribution responses; RT | n/a | rTMS over RTPJ increased hostile intention interpretations and decreased non-hostile intention interpretations; rTMS over LTPJ tended to show the reverse pattern |
| Kelly et al., 2014 | LTPJ; RTPJ | Single-pulse TMS | fMRI-guided neuronavigation | 70% MSO; control (2 cm ant. to stimulation site) | Social attribution task: attribution of awareness to others (fMRI experiment); Visual detection task (subsequent TMS experiment) | Degree of awareness; PCR | n/a | single-pulse TMS over LTPJ/RTPJ associated with attribution of awareness to others disrupted subjects' attribution of awareness to themselves |
| Silani et al., 2013 | rSMG** | rTMS | MRI-guided neuronavigation | 1 Hz, 15 min, 110% RMT; Control (vertex); (between subj. design) | Judgments of pleasantness of self- or other-experienced visuo-tactile stimulation | Stimulation pleasantness rating | η2p = 0.098 | rTMS increased egocentric empathic judgments |
| Sowden and Catmur, 2013 | RTPJ | online rTMS | MRI-guided neuronavigation | 10 Hz, 6 pulses, 110% RMT; control (mid-occipital) | Imitation-inhibition task: inhibition of other-imitation; | RT; percent error | η2p = 0.25 | rTMS decreased imitation inhibition tendency |
| Young et al., 2010 | RTPJ | rTMS; online rTMS (Exp.2) | fMRI-guided neuronavigation | 1 Hz, 25 min, 70% MSO (Exp.2: 10 Hz, 500 ms, 60% MSO); control (5 cm post. to RTPJ) | Moral scenarios manipulating protagonists' beliefs and action outcomes | moral judgments; RT | η2p = 0.50–0.56 | rTMS disrupted participants' mentalizing in moral judgments, especially when actions had the goal to harm others |
| MPFC | ||||||||
| Enticott et al., 2011 | bilateral dmPFC | rTMS | 7 cm anterior to M1 along the midline | 5 Hz, 30 10 s rTMS trains (20 s inter-train interval), 100% RMT; 9 sessions in 11 days | Interpersonal Reactivity Index: self-report measure of empathy; Autism Spectrum Quotient: self-report measure of autistic traits; Ritvo Autism Asperger Diagnostic Scale; Non-standardized interviews | Self-report: pre, post, 1 MO, 6 MO follow up | n/a | high-frequency rTMS lessened autistic symptoms and symptom intensity and improved social functioning in a 20-year-old woman with Asperger's syndrome |
| Enticott et al., 2014 | bilateral dmPFC | rTMS | 7 cm anterior to M1 along the midline | 5 Hz, 30 10 s rTMS trains (20 s inter-train interval), 100% RMT; Sham; (between subj./double-blind design) 10 sessions every consecutive weekday | Interpersonal Reactivity Index: self-report measure of empathy; Autism Spectrum Quotient: self-report measure of autistic traits; Ritvo Autism Asperger Diagnostic Scale; Non-standardized interviews; Reading the mind in the eyes test: decoding of mental states from facial expressions; Frith-Happé-animations: mental state attribution to geometric shapes; | Self-report: pre, post, 1 MO follow up; PCR; Amount and appropriateness of mentalizing | Cohen's d = 0.41–1.41 | high-frequency rTMS (compared to sham stimulation) reduced social relating impairments and anxiety in social situations in individuals with Asperger's syndrome or high-functioning autism; No effects on experimental tasks |
| Krause et al., 2012 | bilateral dmPFC | rTMS | 7 cm anterior to M1 along the midline | 1 Hz, 15 min, 100% RMT; Sham | Yoni task: cognitive and affective mentalizing; Reading the mind in the eyes test: decoding of mental states from facial expressions | PCR; RT | Cohen's d = 0.66–0.81 | rTMS reduced affective ToM performance in subjects with high self-reported empathy and increased affective ToM performance in subjects with low self-reported empathy |
| Lev-Ran et al., 2012 | Ventromedial MPFC | rTMS | MRI-guided neuronavigation (based on scans from 3 subjects) to BA11,12 | 1 Hz, 100 stimuli before each of 4 subtests, 100% RMT (of right foot); Sham (to a superior temporal region); (between subj. design) | Yoni task: affective mentalizing, judgment of character's gaze direction | RT | n/a | rTMS affected learning mechanisms in the affective mentalizing task |
| Schuwerk et al., 2014b | pMPFC | rTMS | 1.5 cm anterior to 1/3 of the distance from nasion to inion | 1 Hz; 33 min, 100% RMT; sham | False belief task requiring the computation of another's and one's own belief | PCR; RT | η2p = 0.24 | rTMS impaired the ability to distinguish the other's from one's own perspective |
| DLPFC/IFG | ||||||||
| Berlim et al., 2012 | lDLPFC | rTMS | 10/20 EEG position F3 | 10 Hz, 75 4 s rTMS trains (26 s inter-train interval); 120% RMT; daily for 4 weeks | Reading the mind in the eyes test: decoding of mental states from facial expressions; HaM-d21 (Hamilton, 1960): clinician-rated measure of major depression intensity | PCR; Rating scores | n/a | Performance in Reading the mind in the eyes test improved in proportion to major depression symptoms improvement |
| Costa et al., 2008 | lDLPFC; rDLPFC; | rTMS | Neuronavigation to a priori defined coordinates | 1 Hz, 15 min, 90% RMT; sham | Short stories: false belief/faux pas/control | PCR; RT | n/a | rTMS over rDLPFC impaired performance in false belief task; rTMS over rDLPFC and lDLPFC impaired performance in faux pas test |
| Kalbe et al., 2010 | rDLPFC | rTMS | MRI-guided neuronavigation, combined with 10/20 EEG position F4 and 5 cm-rule | 1 Hz, 15 min; 100% RMT; control (vertex) | Yoni task: cognitive and affective mentalizing | PCR; RT | n/a | rTMS over rDLPFC accelerated RTs in cognitive mentalizing and had no effect on affective mentalizing |
| Keuken et al., 2011 | lIFG | rTMS | 10/20 EEG position F7 | 1 Hz, 5 min; 45% MSO; control (vertex, 10/20 EEG position Cz); (between subj. design) | Modification of the Reading the mind in the eyes test: decoding of mental states from facial expressions; Modification of cartoon task Brunet et al., 2000: attribution of belief and intentions; reasoning about physical causations | PCR; RT | n/a | No effect of rTMS on task performance |
RTPJ, right temporoparietal junction; LTPJ, left temporoparietal junction; rTMS, repetitive transcranial magnetic stimulation; RMT, resting motor threshold; RT, reaction time; PCR, percentage of correct responses; (f)MRI, (functional) magnetic resonance imaging; MSO, maximum stimulator output; rSMG, right supramarginal gyrus; dmPFC, dorsomedial PFC; M1, primary motor cortex; BA, Brodmann area; MPFC, medial prefrontal cortex; (r/l)DLPFC (right/left) dorsolateral PFC, lIFG, left inferior frontal gyrus;
*
effect size of statistical analysis/analyses which was/were central for the interpretation of TMS effects
**
the rSMG as targeted in this study is anterior to the RTPJ.