Behavioral and neural modulation effects of transcranial pulse stimulation of the dorsal cingulate cortex and anterior insula cortex in healthy adults: A prospective, randomized, sham-controlled trial
This prospective, randomized, sham-controlled trial demonstrates that ten sessions of transcranial pulse stimulation targeting the dorsal anterior cingulate cortex and anterior insular cortex are feasible and safe in healthy adults, producing bidirectional, target-specific modulation of risk-taking behavior and associated resting-state functional connectivity changes.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of a preprint that has not been peer-reviewed. It is not medical advice. Do not make health decisions based on this content. Read full disclaimer
The human brain is not a single, uniform organ but a vast network of specialized regions that constantly communicate to guide our thoughts, feelings, and actions. Among these regions, two deep structures—the dorsal anterior cingulate cortex and the anterior insula—act as critical hubs for how we notice important signals and decide whether to take a chance. Scientists have long known that when these areas function differently, it can influence everything from anxiety to addiction, yet reaching them without surgery has remained a difficult challenge. While some tools can gently nudge the surface of the brain, few methods can safely send a signal deep enough to reach these hidden centers. A new study explores a relatively fresh technique called transcranial pulse stimulation, which uses focused shock waves to reach deep brain tissue without cutting the skin, aiming to see if it can safely change how these specific regions work and, in turn, alter how people make risky choices.
In a controlled experiment involving seventy-five healthy adults, researchers at the Hong Kong Polytechnic University set out to test whether this non-invasive method could precisely target these deep brain areas and change behavior. The volunteers were divided into three groups. One group received ten sessions of active stimulation aimed at the dorsal anterior cingulate cortex, another group received the same number of sessions aimed at the anterior insula, and a third group received a sham treatment that sounded and felt similar but delivered no actual energy. Over two weeks, the participants underwent these sessions while their brain activity was scanned before and after the treatment. To measure how their decision-making changed, the researchers asked them to play a computerized game where they had to inflate a virtual balloon. In this game, each pump earned a small reward, but if the balloon popped, they lost the money for that round. The game was designed to reveal how much risk a person was willing to take to gain more reward.
The results showed that the stimulation was not only safe but also produced distinct, opposite changes in behavior depending on which brain area was targeted. Participants who received stimulation to the dorsal anterior cingulate cortex became more cautious; they pumped the virtual balloon fewer times on average, showing a clear reduction in risk-taking. In contrast, those who received stimulation to the anterior insula became more willing to take chances, pumping the balloon more often than before. The group that received the sham treatment showed no such shifts. These behavioral changes were accompanied by measurable shifts in how the brain's networks talked to each other. After stimulating the dorsal anterior cingulate cortex, the connections between that area and other parts of the brain involved in attention and planning became stronger. Conversely, stimulating the anterior insula weakened its connections to the striatum, a region deep in the brain linked to reward and habit.
The study also confirmed that this technique is feasible for repeated use in healthy people. Most participants experienced only mild side effects, such as a tingling sensation or slight pain at the spot where the device touched their head, which usually faded within hours. Only a very small number of people dropped out of the study, and the few who did so had reasons unrelated to the procedure itself. While the researchers found clear links between the specific brain targets and the changes in behavior, they noted that the connection between the brain scans and the game results was not perfectly linear, suggesting that the brain's response to this stimulation is complex. The findings provide a foundational proof that focused shock waves can safely reach deep brain structures and tune their activity in specific ways, offering a new tool for scientists to explore how these hidden circuits shape human behavior.
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