The Relationship Between Emotion Processing Assessed by an Affect Rating Task and Depression Symptoms Following the Accelerated Sequential Dorsolateral–Dorsomedial Prefrontal rTMS Treatment

Chen, Ruiqin; Dong, Zerun; Geng, Ruijie; Li, Haibin; Wang, Yuan; Li, Yuanyuan; Ding, Qiong; Zhang, Yingying; Ding, Xuechen; Huang, Jingjing; Zhao, Hui; Liu, Wenjuan; Voon, Valerie; Zhao, Yi-Jie

doi:10.3390/bs16020178

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The Relationship Between Emotion Processing Assessed by an Affect Rating Task and Depression Symptoms Following the Accelerated Sequential Dorsolateral–Dorsomedial Prefrontal rTMS Treatment

by

Ruiqin Chen

^1,2,†,

Zerun Dong

^1,3,†,

Ruijie Geng

^4,†,

Haibin Li

⁴

,

Yuan Wang

⁴,

Yuanyuan Li

⁴,

Qiong Ding

⁵,

Yingying Zhang

²,

Xuechen Ding

³

,

Jingjing Huang

¹,

Hui Zhao

¹,

Wenjuan Liu

^4,6,*,

Valerie Voon

^2,5,* and

Yi-Jie Zhao

^1,2,*

¹

Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai 200124, China

²

Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai 200433, China

³

Department of Psychology, Shanghai Normal University, Shanghai 200234, China

⁴

Department of Psychological Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China

⁵

Department of Psychiatry, University of Cambridge, Cambridge CB2 0QQ, UK

⁶

Department of Psychiatry, Shanghai United Family Pudong Hospital, Shanghai 201206, China

^*

Authors to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

Behav. Sci. 2026, 16(2), 178; https://doi.org/10.3390/bs16020178

Submission received: 31 August 2025 / Revised: 21 November 2025 / Accepted: 4 December 2025 / Published: 26 January 2026

(This article belongs to the Topic Risk and Protective Factors in Social Interactions: Behavioral and Neural Evidence)

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Abstract

Background: Emotion processing is critical in the neuropathology of major depressive disorder (MDD), while its relationship with clinical treatment remains unclear. This study aims to indicate the associations between emotion processing and treatment effects following a sequential dual-site accelerated repetitive transcranial magnetic stimulation (rTMS) protocol. Methods: MDD patients were recruited to receive rTMS treatment with four sessions per day for four consecutive days, with stimulation sequentially delivered to the left dorsolateral prefrontal cortex (dlPFC) and the dorsomedial prefrontal cortex (dmPFC). Symptoms were assessed at baseline, end of treatment, and week 4 using the Montgomery–Åsberg Depression Rating Scale (MADRS), Snaith-Hamilton Pleasure Scale (SHAPS), and Fatigue Severity Scale (FSS). Emotional valence and arousal were evaluated with the Affect Rating Task (ART). Results: A total of 51 participants completed the clinical assessments and ART, with two excluded due to missing baseline data in the SHAPS and FSS. The linear mixed-effects models revealed significant improvement in depressive (p < 0.001, d = −0.343) and fatigue symptoms (p = 0.010, d = −0.572) following rTMS treatment. Neutral valence was correlated with MADRS scores at baseline (R² = 0.096, p = 0.027). In addition, changes in arousal for positive images (p = 0.047, adjusted R² = 0.097) and neutral images (p = 0.019, adjusted R² = 0.160) at treatment end were significantly correlated with MADRS improvement at week 4. Conclusions: Our study highlights the association between changes in emotional arousal and improvement in MDD following accelerated dlPFC-dmPFC dual-site rTMS treatment.

Keywords: major depressive disorder; accelerated rTMS; affect; emotion; Affect Rating Task (ART); predictor

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MDPI and ACS Style

Chen, R.; Dong, Z.; Geng, R.; Li, H.; Wang, Y.; Li, Y.; Ding, Q.; Zhang, Y.; Ding, X.; Huang, J.; et al. The Relationship Between Emotion Processing Assessed by an Affect Rating Task and Depression Symptoms Following the Accelerated Sequential Dorsolateral–Dorsomedial Prefrontal rTMS Treatment. Behav. Sci. 2026, 16, 178. https://doi.org/10.3390/bs16020178

AMA Style

Chen R, Dong Z, Geng R, Li H, Wang Y, Li Y, Ding Q, Zhang Y, Ding X, Huang J, et al. The Relationship Between Emotion Processing Assessed by an Affect Rating Task and Depression Symptoms Following the Accelerated Sequential Dorsolateral–Dorsomedial Prefrontal rTMS Treatment. Behavioral Sciences. 2026; 16(2):178. https://doi.org/10.3390/bs16020178

Chicago/Turabian Style

Chen, Ruiqin, Zerun Dong, Ruijie Geng, Haibin Li, Yuan Wang, Yuanyuan Li, Qiong Ding, Yingying Zhang, Xuechen Ding, Jingjing Huang, and et al. 2026. "The Relationship Between Emotion Processing Assessed by an Affect Rating Task and Depression Symptoms Following the Accelerated Sequential Dorsolateral–Dorsomedial Prefrontal rTMS Treatment" Behavioral Sciences 16, no. 2: 178. https://doi.org/10.3390/bs16020178

APA Style

Chen, R., Dong, Z., Geng, R., Li, H., Wang, Y., Li, Y., Ding, Q., Zhang, Y., Ding, X., Huang, J., Zhao, H., Liu, W., Voon, V., & Zhao, Y.-J. (2026). The Relationship Between Emotion Processing Assessed by an Affect Rating Task and Depression Symptoms Following the Accelerated Sequential Dorsolateral–Dorsomedial Prefrontal rTMS Treatment. Behavioral Sciences, 16(2), 178. https://doi.org/10.3390/bs16020178

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The Relationship Between Emotion Processing Assessed by an Affect Rating Task and Depression Symptoms Following the Accelerated Sequential Dorsolateral–Dorsomedial Prefrontal rTMS Treatment

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