Expectations May Influence the Effects of Transcranial Direct Current Stimulation

Growing interest surrounds transcranial direct current stimulation (tDCS) as a safe and inexpensive method for improving cognitive functions and mood. Nevertheless, tDCS studies rarely examine psychological factors such as expectations of outcomes, which may influence tDCS responsiveness through placebo-like effects. Here we sought to evaluate the potential influence of expectations on tDCS intervention outcomes. We assessed expectations of tDCS outcomes in 88 healthy young adults on three occasions: i) at baseline; ii) after reading information implying either high or low effectiveness of stimulation; and iii) after a single-session of sham-controlled anodal tDCS applied to the left dorsolateral prefrontal cortex, during working memory (WM) training. Participants were largely uncertain about the effectiveness of stimulation in improving cognitive function at baseline. High or low expectation priming using simple positive or cautionary messages significantly increased or decreased expectation ratings, respectively, but ratings significantly decreased following stimulation in all groups. We found greater improvement in participants who received high compared to low expectation priming. Participants who received active stimulation and low expectation priming exhibited the lowest performance, suggesting that expectation priming and stimulation may have interacted. We did not find a significant effect of baseline expectations, belief of group assignment, or individual characteristics on measures of WM and verbal fluency. However, controlling for baseline expectations revealed greater post-intervention improvement on the executive function measures in participants who received high (compared to low) expectation priming. People randomly assigned to receive high expectation priming reported having a more pleasant experience overall, including greater satisfaction. Our findings suggest that expectations of outcomes should be taken into account in tDCS-based experimental studies and clinical trials.\n\nHighlights- Based on prior knowledge, healthy subjects are uncertain about NIBS effectiveness.\n\n- Expectations of NIBS can change after a single exposure to simple written messages.\n\n- Expectations of outcomes may influence cognitive performance.\n\n- High expectations may lead to a more positive experience and motivation to perform.\n\n- Low expectations may be counterproductive to NIBS.