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It's the Thought That Counts: Examining the Task-dependent Effects of Transcranial Direct Current Stimulation on Executive Function
Open accessAbstract
Background Prior investigations employing transcranial direct current stimulation (tDCS) have shown that stimulation can elicit subsequent improvement on tests of various cognitive abilities, including working memory. While stimulation parameters such as intensity and duration are known to determine the effects of tDCS, the degree to which stimulation effects are influenced by the nature of cognitive activities during stimulation remains unclear. Objective/hypothesis To determine whether manipulating the working memory load of a task performed during stimulation would modulate tDCS-induced enhancement of performance on a different, related measure after stimulation. Methods In two separate but closely related sham-controlled experiments, two groups of healthy subjects underwent anodal tDCS (2 mA) of the left dorsolateral prefrontal cortex (DLPFC) for 20 min. In Experiment 1, subjects (n = 11) trained on a letter 3Back task during stimulation. In Experiment 2 subjects (n = 11) trained on a letter 1Back task, which resembled the 3Back task but featured a lower working memory load. In both experiments, before and after stimulation, subjects completed an adjusting Paced Auditory Serial Addition Task (A-PASAT). Both the experimenter and subjects were blind to stimulation conditions in both experiments. Results Subjects were both faster and more accurate on the A-PASAT task after receiving real tDCS paired with 3Back training (Experiment1) compared to sham+3Back, real+1Back, and sh…
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“Cognitive training task difficulty may also impact the efficacy of tDCS, as behavioral improvements occur specifically when stimulation is paired with higher demanding tasks [67].”
From Primary outcome from the augmenting cognitive training in older adults study (ACT): A tDCS and cognitive training randomized clinical trial (2023) · cites this paper as [67]
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“The current employed in tDCS is insufficient to directly stimulate action potentials in neurons, and is instead believed to induce incremental shifts in neuronal membrane potentials that alter the likelihood of neurons firing over time [22,23].”
MethodSustained excitability elevations induced by transcranial DC motor cortex stimulation in humans
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“The current employed in tDCS is insufficient to directly stimulate action potentials in neurons, and is instead believed to induce incremental shifts in neuronal membrane potentials that alter the likelihood of neurons firing over time [22,23].”
MethodPaced Auditory Serial-Addition Task: A Measure of Recovery from Concussion
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“Methods: In two separate but closely related sham-controlled experiments, two groups of healthy subjects underwent anodal tDCS (2 mA) of the left dorsolateral prefrontal cortex (DLPFC) for 20 min.”
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“direction of current flow impact changes in neural excitability [6] and cognitive function [3,7,8].”
BackgroundFunctional MRI studies of spatial and nonspatial working memory
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“Numerous studies have paired tDCS with specific cognitive or behavioral tasks [5,11,12], operating under the assumption that a complementary or additive relationship exists between stimulation and task rehearsal.”
BackgroundA comprehensive review of the Paced Auditory Serial Addition Test (PASAT)
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“We tested this hypothesis by administering an adjusting version of the Paced Auditory Serial Addition Test (A-PASAT) before and after stimulation [20].”
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Effects of Anodal tDCS on Arithmetic Performance and Electrophysiological Activity
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“This would also be in line with one study finding beneficial effects of left frontal a-tDCS on a serial addition task only when the stimulation conducted before the task was accompanied by a difficult WM task (Gill et al., 2015).”
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Transcranial direct current stimulation facilitates category learning
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Transcranial Direct Current Stimulation to Ameliorate Post-Stroke Cognitive Impairment
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“In healthy adults, tDCS can improve performance in the learned tasks [132] and result in enhanced functional connectivity of working memory networks on fMRI evaluation [133].”
Self-citationNo Interaction between tDCS Current Strength and Baseline Performance: A Conceptual Replication
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“Moreover, earlier studies observed the effect of tDCS only when the task included a three-back (Fregni et al., 2005; Ohn et al., 2008; Gill et al., 2015), a more difficult task compared to the two-back conducted in the present study.”
ResultBrain stimulation, mathematical, and numerical training
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“…Popescu et al. (2016) examined whether tRNS would facilitate learning relative to sham, and more specifically, whether the magnitude of facilitation would differ depending on task difficulty, given its influence on previous tDCS and training outcomes (Gill et al., 2015; Pope and Miall, 2012).”
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tDCS as a treatment for anxiety and related cognitive deficits
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Anodal stimulation of inhibitory control and craving in satiated restrained eaters
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Parietotemporal Stimulation Affects Acquisition of Novel Grapheme-Phoneme Mappings in Adult Readers
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“, whether they are engaged by the experimental task or another demanding task), duration and intensity of stimulation, the use of bipolar versus monopolar montage configurations, and many others (Garnett et al., 2015; Gill et al., 2015; Nozari et al., 2014).”
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Got chocolate? Bilateral prefrontal cortex stimulation augments chocolate consumption
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“Cognitive training task difficulty may also impact the efficacy of tDCS, as behavioral improvements occur specifically when stimulation is paired with higher demanding tasks [67].”
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“Importantly, this study fulfilled the suggested criteria in a recent consensus and critical position article on tDCS [28] by enhancing transparency, reproducibility, and standardization.”
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“Studies on both tDCS and tACS have shown that the cognitive brain state influences stimulation-induced effects (Antal et al., 2007; Feurra et al., 2013; Gill et al., 2015; Hsu et al., 2016; Neuling et al., 2013; Violante et al., 2017).”
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Neurocognitive Effects of tDCS in the Healthy Brain
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Transcranial Direct Current Stimulation in Cognitive Neuroscience
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“30 Positive results have been observed with fewer than 10 tDCS sessions, as seen in a study that reported enhanced task performance in typically developing individuals 31 and another that found improved verbal fluency.”
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“improved performance relating to the specific task, which highlights the importance of using an online task that is specific to the outcome measure of interest (90,91).”
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“On the one hand, when measuring the intervention effects of tDCS, tasks of different levels of difficulty within the same cognitive domain produced different results [60].”
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Non-Invasive Neuromodulation Therapies for Parkinson’s Disease
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“Additionally, we speculate that the underlying mechanism of anodal-tDCS over LSMG to selectively improve performance on longer targets may be associated with the state-dependent effects of tDCS (Gill et al., 2015).”
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“As Gill et al. (2015) outlined, the effects of a tDCS program on the DLPFC may be influenced by the cognitive demands of a task performed during stimulation.”
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“Secondly, several studies have shown that tDCS-effects become especially apparent in complex tasks, possibly because higher demands are posed on the involved networks (Gill et al., 2015; Pope and Miall, 2012; Wu et al., 2014).”
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“Prior studies show that tDCS-induced shifts in neuronal membrane potentials that increase the likelihood of neurons firing preferentially affect neuronal networks that are already engaged in activity [15] and that prefrontal tDCS yielded larger effects when a behavioral outcome was assessed after, rather than during s…”
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“It has been shown that left PFC tDCS (Gill et al., 2015; Plewnia et al., 2015; Pope et al., 2015; Luft et al., 2017; Mosbacher et al., 2020), as well as bilateral PFC high-frequency tRNS with training (Snowball et al., 2013; Popescu et al., 2016) or without training (Pasqualotto, 2016; Bieck et…”
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No evidence of improvements in inhibitory control with tRNS
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“In this way, previous studies have observed an effect of the tES only on cognitive tasks with a high difficulty (e.g., for tDCS see Gill et al., 2015; for tACS see Moliadze et al., 2019; for tRNS see Popescu et al., 2016).”
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Clinical Research and Methodological Aspects for tDCS Research
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Transcranial Direct-Current Stimulation May Improve Discourse Production in Healthy Older Adults
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“It has been previously found that the task completed during stimulation can impact the effects of tDCS on poststimulation performance (78), where greater post-stimulation tDCS effects are observed in tasks which require similar cognitive abilities to the one completed during stimulation.”
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“…2015; Javadi & Walsh, 2012; Wiegand et al., 2019), improved decision-making speed and reaction time (Dedoncker et al., 2016; Filmer et al., 2016; Gill et al., 2015; Mulquiney et al., 2011; Quinn et al., 2020), increased proactive control and response inhibition (Boudewyn et al., 2019; Hogeveen…”
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“In any case, behav - ior (or rest) during tDCS influences both online and offline effects (Gill et al., 2015; Horvath et al., 2014 ).”
BackgroundMultimodal Association of tDCS with Electroencephalography
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“, 2015), working memory (Gill et al., 2015; Vergallito et al., 2018) and attention (Nelson et al.”
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de Oliveira, P. V., de Castro, M. L., Grecco, L. A. C., Rizzutti, S., & Muszkat, M. (2023) · Brain Imaging and Stimulation · doi:10.17267/2965-3738bis.2023.e4954 · Cited by 3
Methodological Considerations for Transcranial Direct Current Stimulation in Clinical Trials
Hamilton, R. H., Kessler, S. K., Castillo-Saavedra, L., Fregni, F., Martin, D. M., Loo, C. K. A., Knotková, H., & Woods, A. J. (2019) · Springer eBooks · doi:10.1007/978-3-319-95948-1_12 · Cited by 4
Self-citationWillms, M., & Virji‐Babul, N. (2020) · Developments in neuroethics and bioethics · doi:10.1016/bs.dnb.2020.03.006 · Cited by 3
Li, H., Shi, H., Jiang, S., Hou, C., Pei, H., Wu, H., Bringas-Vega, M. L., Yao, G., Yao, D., & Luo, C. (2025) · NeuroImage · doi:10.1016/j.neuroimage.2025.121318 · Cited by 3
“Greater effects of non-invasive brain stimulation have been observed under high versus low working memory loads (Beynel et al., 2019; Gill et al., 2015).”
Schroeder, P. A., & Plewnia, C. (2020) · Springer eBooks · doi:10.1007/978-3-030-43356-7_23 · Cited by 3
Causal Relationships and Programming Outcomes: A Transcranial Magnetic Stimulation Experiment
Ahmad, H., Endres, M., Newman, K., Santiesteban, P., Shedden, E., & Weimer, W. R. (2024) · ACM/IEEE International Conference on Software Engineering: Companion Proceedings (ICSE-Companion) · doi:10.1145/3597503.3639096 · Cited by 3
Barth, B., Kroczek, A., Deppermann, S., Dresler, T., Fallgatter, A. J., & Ehlis, A. (2015) · SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice · doi:10.1024/0939-5911.a000384 · Cited by 3
Ethical Aspects of tDCS Use in Neuropsychiatry and the Risk of Misuse
Wurzman, R. P., & Hamilton, R. H. (2016) · Springer eBooks · doi:10.1007/978-3-319-33967-2_24 · Cited by 3
Self-citationSchroeder, P. A., Artemenko, C., Cipora, K., & Svaldi, J. (2019) · Journal of Neuroscience Research · doi:10.1002/jnr.24559 · Cited by 3
A Systematic Review of Cognitive Enhancement Interventions for Use in Military Operations
Kelley, A. M., Feltman, K. A., Nwala, E., Bernhardt, K. A., Hayes, A., Basso, J., & Mathews, C. (2019) · Cited by 3
Coronel, J. C., O’Donnell, M. B., Beard, E. C., Hamilton, R. H., & Falk, E. B. (2019) · Communication Research · doi:10.1177/0093650219876844 · Cited by 3
Self-citationDanon, M., Perrain, R., Gorwood, P. A. P. M., & Jollant, F. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119682 · Cited by 2
A neural model of private information disclosure decisions
Li, W., Turel, O., Hu, J., Shi, J., & He, Q. (2025) · Acta Psychologica · doi:10.1016/j.actpsy.2025.106108 · Cited by 2
Manouilidou, C., & Nerantzini, M. (2020) · Contemporary clinical neuroscience · doi:10.1007/978-3-030-35687-3_3 · Cited by 1
Clinical Research and Methodological Aspects for tDCS Research
Woods, A. J., & Martin, D. M. (2021) · Springer eBooks · doi:10.1007/978-3-030-76136-3_14 · Cited by 3
Imperio, C. M., & Chua, E. F. (2024) · PLoS ONE · doi:10.1371/journal.pone.0300779 · Cited by 3
“However, given the neuropsychological [62–64], fMRI [5,22,23,66,70], and TBS evidence [74], we think a more likely explanation for the lack of effects relates the task being too difficult for HD-tDCS to induce meaningful effects on cognition [28,131,140].”
BackgroundGranadillo, E. D., Fellmeth, M., Youssofzadeh, V., Heffernan, J., Shah‐Basak, P. P., Pillay, S. B., Ustine, C., Kraegel, P., Schold, S., Mueller, K. D., et al. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1492447 · Cited by 2
“Importantly, synaptic changes sufficient to impact behavior only outlast initial stimulation when delivered simultaneously with a behavioral task (Gill et al., 2015; Nozari et al., 2014; Baker et al., 2010; Fertonani et al., 2014; Marangolo et al., 2013; Monti et al., 2008).”
Self-citationConklin, C. A., Coffman, B. A., Greco, C. M., Tyagi, S., & Clarkson, B. D. (2025) · Continence · doi:10.1016/j.cont.2025.101765 · Cited by 2
“…is thought to lead to increased cognitive control during cue exposure, thereby reducing the impact of cues and attenuating the conditioned response. tDCS effects are enhanced if stimulation is paired with behavioral training that simultaneously activates the brain region being targeted [17].”
Alrasheed, A. S., Alshamrani, R., Ameer, A. A. A., Alkahtani, R. M., AlMohish, N. M., Alqarni, M., & Alabdali, M. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14093063 · Cited by 3
“Effects of brain-induced stimulation frequently seem to rely on individuals’ level of effort or state [22].”
Ethical Aspects of tDCS Use in Neuropsychiatry and the Risk of Misuse
Wurzman, R. P., Friedman, L., & Hamilton, R. H. (2021) · Springer eBooks · doi:10.1007/978-3-030-76136-3_37 · Cited by 3
Self-citationInsights into interoceptive and emotional processing: Lessons from studies on insular HD ‐ tDCS
Kipping, M., Mai‐Lippold, S. A., Herbert, B. M., Desdentado, L., Kammer, T., & Pollatos, O. (2024) · Psychophysiology · doi:10.1111/psyp.14639 · Cited by 2
The effects of multimodal training on working memory in younger and older adults
Frau, L., Cazzato, V., McGlone, F. P., & Bruno, D. (2022) · The Cognitive Psychology Bulletin · doi:10.53841/bpscog.2022.1.7.23 · Cited by 1
Masson‐Trottier, M., Tippett, D. C., Rapp, B. C., Harvey, D. Y., Roncero, C. T., Vnenchak, L., Faria, A. V., Frangakis, C., Chertkow, H. M., Hamilton, R. H., et al. (2025) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2025.1611272 · Cited by 1
Self-citationLin, S., & Yang, Y. K. (2019) · Medical Hypotheses · doi:10.1016/j.mehy.2019.02.013 · Cited by 1
“Several previous studies of healthy subjects may have provided supportive evidence for our hypothesis [35,36].”
BackgroundResultDing, H., Chen, W., Chen, J.-W., Yu, F., Wang, X., & Zhang, Y. (2025) · Frontiers in Neurology · doi:10.3389/fneur.2025.1585901 · Cited by 1
Brain Stimulation and Behavioral Change
Lucchiari, C., Kelley, N., Vanutelli, M., & Ferrucci, R. (2019) · Frontiers research topics · doi:10.3389/978-2-88945-838-7 · Cited by 1
Multimodal Association of tDCS with Electroencephalography
Bolognini, N., & Diana, L. (2021) · Springer eBooks · doi:10.1007/978-3-030-76136-3_7 · Cited by 1
Wilson, J. E. (2022) · Developmental Medicine & Child Neurology · doi:10.1111/dmcn.15490 · Cited by 1
“However, it has been repeatedly shown that there are taskdependent effects from using tDCS to stimulate a brain region while the participant completes a task that engages that same brain region.(4) The development of individualized treatment plans for children with ASD which utilize tDCS should also include a careful…”
BackgroundTrans-spinal direct current stimulation for the modulation of the lumbar spinal motor networks
Kuck, A. (2017) · doi:10.3990/1.9789036544740 · Cited by 1
“[15] Harkema S, Gerasimenko Y, Hodes J, Burdick J, Angeli C, Chen Y, Ferreira C, Willhite A, Rejc E, Grossman R G and Edgerton V R 2011 Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study.”
McMillan, I. (2017) · Research Explorer (The University of Manchester) · Cited by 1
Metadata
- Authors
- Gill, J., Shah-Basak, P. P., & Hamilton, R.
- Affiliations
- University of Pennsylvania (US)
- Corresponding author
- Hamilton, Roy
- Venue
- Brain Stimulation
- Publisher
- Elsevier BV
- Published
- 2015-03
- Volume
- 8
- Issue
- 2
- Pages
- 253-259
- ISSN
- 1876-4754 (ISSN-L)
- 1935-861X
- OpenAlex
- W2047762347
- Cited by
- 224
- References
- 30
- Citations by year
- 2026: 8 · 2025: 11 · 2024: 15 · 2023: 12 · 2022: 15 · 2021: 26 · 2020: 23 · 2019: 21 · 2018: 21 · 2017: 27 · 2016: 33 · 2015: 10
- FWCI
- 12.33
- Type
- journal article
- Language
- en
- Open access
- green
- doaj.org
- Licence
- Locations
- Brain stimulation (publishedVersion)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- University of Pennsylvania – Center for Undergraduate Research for funding this research
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Abilities and Testing
- Keywords
- transcranial direct current stimulation, executive function, working memory load, dorsolateral prefrontal cortex, anodal tDCS, Paced Auditory Serial Addition Test, 3-back task, non-invasive brain stimulation
- MeSH terms
- Adolescent, Adult, Double-Blind Method, Female, Humans, Male, Memory, Short-Term, Psychomotor Performance, Prefrontal Cortex, Young Adult, Executive Function, Transcranial Direct Current Stimulation
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