Patient Identification: Rohan (pseudonym), 21-year-old male

Clinical Status: Long-standing Obsessive Compulsive Disorder (OCD 2–3 years), presenting with intrusive thoughts and repetitive compulsive behaviors. No significant comorbid psychiatric conditions reported.

Primary Complaint: Persistent obsessive–compulsive symptoms with marked distress, functional interference, and desire for faster symptom reduction

Diagnosis: Obsessive Compulsive Disorder (F42)

Baseline Status: Moderate–severe compulsions with partial response to medication

Additional Context: The patient had been on stable psychiatric medications for more than 2–3 years before initiation of neuromodulation. Although improving, he sought accelerated recovery and reduction of compulsive rituals.

Intervention

Treatment Modality: Active anodal tDCS administered through the Ease device, paired with Cognitive Emotional Training (CET) modules.

Protocol Parameters:

• Electrode Montage: Anode – Left DLPFC (F3); Cathode – Right DLPFC (F4)

• Current Intensity: 2 mA

• Session Duration: 20 minutes

• Total Sessions: 50 sessions (initial 30-session package extended based on clinical response)

• Frequency: Once daily (modified from the standard twice-daily protocol due to feasibility)

• Maintenance: Continues weekly booster sessions

Cognitive Emotional Training Components:

• Emotional N-Back Task: targeting affective working memory

• Flanker Task: improving cognitive control and interference resolution

• Corsi Block Task: enhancing visuospatial working memory

• Go/No-Go Task: strengthening response inhibition

Each CET task was delivered with adaptive difficulty based on accuracy, ensuring sustained engagement and progressive activation of cognitive–emotional regulatory circuits.

Rationale for tDCS addition: The objective was to reduce compulsions faster.

Outcome Measures

Symptom severity was evaluated pre- and post-treatment using validated clinician-rated scales:

• Clinical-rated improvements in compulsive frequency and severity

• Patient self-reports regarding intrusive thoughts, compulsive urges, distress and functional capacity

• Longitudinal observations during booster sessions.
  
  

Results

After 50 sessions, the patient demonstrated marked clinical improvement ( > 60%).

Symptom change

Clinical Observations

• Major reduction in compulsive frequency and urgency

• Improved cognitive control over intrusive thoughts

• Enhanced daily functioning and emotional stability

• Greater confidence and autonomy in managing OCD triggers

• No adverse effects were reported; sessions were well tolerated.

“Working on this case taught me the compounding effects of neuromodulation & the importance of consistency. ”

Dr. Pooja Dubey