Repetitive Transcranial Magnetic Stimulation and Acceptance and Commitment Therapy

Veterans with comorbid chronic pain and depression are highly prevalent, have poor functional status and low quality of life, are at increased risk of suicide and lack access to effective treatments. To address this problem, the proposed research will examine the feasibility of a novel approach that integrates repetitive Transcranial Magnetic Stimulation and Acceptance and Commitment Therapy with the overall goal of maximizing functional improvement in Veterans with chronic pain and depression. This is an important first-step in preparation for a future randomized efficacy trial. The investigators will also include two cognitive control tasks with concurrent electroencephalography to explore as a potential objective indicator of treatment response. This application addresses a critical need within the Veterans Health Administration and is closely aligned with the focus area of developing suicide prevention treatments that influence participation in life roles.

Inclusion Criteria: * Diagnosis of a chronic, non-terminal pain condition (pain most days for at least 6 months) * Average pain intensity and interference with enjoyment of life and/or general activity rated \> 4/10 over the past week, as measured by the PEG * Meet clinical criteria for major depression via DSM5 criteria, as assessed by the Mini International Neuropsychiatric Interview (MINI) Exclusion Criteria: * Serious or unstable medical illness (e.g., cardiovascular disease) * Lifetime history of psychotic disorder, bipolar disorder, obsessive-compulsive disorder * Active substance abuse or psychosocial instability (e.g., homelessness) that could compromise study participation * Changes to professionally delivered pain or mood treatment (e.g., no discontinuation of a treatment; no increasing the dose of medication) one month preceding the baseline assessment * Significant neurologic disorder, increased risk of seizure for any reason or family/personal history of seizure * Contraindications to rTMS treatment as outlined by the Safety of TMS Consensus group, which includes implanted metallic objects above the neck, implanted electrical devices (pacemakers/spinal cord stimulators), and pregnancy * Prior trial of rTMS for any condition and/or lack of responsiveness to electroconvulsive therapy