Is Your TMS Target Actually in the Right Place?

See why the difference between a population average and your exact brain coordinate can determine whether treatment works

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Treatment Outcomes: Standard TMS vs. fMRI-Guided TMS
Treatment-resistant depression populations
100%75%50%25%0%
50%
78%
Response Rate
33%
79%
Remission Rate
Standard TMS (scalp-based targeting) fMRI-Guided TMS (personalized targeting)
1 Cole EJ et al. Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial. Am J Psychiatry. 2022;179(2):132–141. PMID 34711062. (Response 85.7%, Remission 78.6% in fMRI-guided group; ~50% response / ~33% remission for standard rTMS per FDA trial data cited therein.)
2 Shahi N et al. Naturalistic Outcomes with fMRI-Guided and Non-fMRI-Guided Accelerated TMS for Depression. medRxiv. 2025. doi:10.1101/2025.09.03.25334813. (Real-world: fMRI-guided 77.5% vs. standard 62% response; 2.3× odds of response with fMRI guidance, n=195.)
3 O’Reardon JP et al. Efficacy and Safety of Transcranial Magnetic Stimulation in the Acute Treatment of Major Depressive Disorder. Biol Psychiatry. 2007;62(11):1208–1216. PMID 17573044. (Standard rTMS ~33% remission in pivotal FDA trial.)

What Most Clinics Do

  • Uses skull measurements or EEG landmarks
  • No brain imaging — one coordinate for everyone
  • Target can land up to 3cm from your actual circuit
  • If it doesn’t work, most clinics have no way to know why

What CFX Does

  • fMRI maps the specific circuit driving your depression
  • Finds your exact DLPFC coordinate — not a population average
  • Accounts for how your anatomy differs from everyone else
  • If the first treatment doesn’t land perfectly, we can adjust

Standard TMS protocols use a single coordinate derived from population averages. That coordinate may be centimeters away from the specific spot in your prefrontal cortex that connects to your depression circuit. When the target is off, the magnetic pulse stimulates tissue that isn’t driving your depression — and treatment fails, not because TMS doesn’t work, but because it didn’t treat your brain.

This is likely the most common reason people try TMS and feel like it “didn’t work.” The technology worked. The address was wrong.

Look at the dots on the brain above. The spread between the population-average targets and any custom coordinate you place represents real anatomical variance — variance that determines treatment outcome.

Before your first pulse, Cognitive FX runs a resting-state fMRI scan. That scan maps the connectivity between your prefrontal cortex and the subgenual cingulate — the specific circuit that drives depression. We find the exact voxel in your DLPFC with the strongest connection to that circuit. That voxel becomes your treatment coordinate.

No other clinic in Utah does this. Most TMS providers pick a coordinate from a chart and apply the same protocol to every patient. We treat the brain in front of us.

Use the panel on the left to enter approximate coordinates and see where your target might fall — or schedule a consultation and we’ll find your exact location with imaging.

The data is clear: fMRI-guided targeting produces significantly better outcomes than scalp-based methods. If you’re considering TMS for depression, the question isn’t whether imaging guidance matters. It’s whether your provider is using it. Talk to us before you start treatment.
Talk to a CFX Specialist →

How the week works

How does the 5-day TMS program work?

FriArrive, fMRI scan
SatTarget mapped. You rest.
SunRest
Mon10 sessions
Tue10 sessions
Wed10 sessions
Thu10 sessions
Fri10 sessions, then home Fri night or Sat

Treatment days run about 7 AM to 5 PM. A Monday-morning scan is sometimes possible.

1 · Friday

Scan

A resting fMRI shows how your brain regions work together. It runs on our own MRI in Provo, so there's no outside imaging center to schedule.

2 · Weekend

Target

Your team chooses your treatment spot from your scan. Navigation software then tracks the coil against that spot at every session.

3 · Mon to Fri

Treat

Intermittent theta-burst sessions of about 10 minutes, with rest between them and supportive therapies during the day.

Scanner
TMS system
Navigation
Our own MRI, on site
Magstim, FDA-cleared for depression
ANT Neuro Visor 2, every session

The evidence

Does accelerated fMRI-guided TMS work?

The research is promising and still early. Trials show that short theta-burst sessions work as well as standard TMS sessions, and that stacking many sessions into a few days can bring remission for some people. Results on aiming TMS with each person's fMRI, instead of standard targeting, are mixed. One recent trial found a benefit, and a larger one did not. No trial has tested our exact protocol, and these results are not Cognitive FX results.

2018

Shorter sessions held up

In the THREE-D trial of 414 people, 3-minute theta-burst sessions matched standard 37-minute sessions: 32% vs 27% remission.7

2020 to 2026

Stanford stacked sessions and aimed them by fMRI

In the Stanford randomized trial, 11 of 14 people on active treatment (78.6%) met remission at some point in the month after treatment, vs 2 of 15 on sham (13.3%). A 2026 trial from the same group found 50.0% vs 20.8% remission at the one-month visit.8,9

2024 and 2026

Scan-chosen targets: two trials, two answers

Taylor, Siddiqi, Fox et al., 2026 (40 people). Targets chosen from each person's fMRI gave about one-third more improvement than scalp-measured targets. About 1 more person in every 5 did better.10
BRIGhTMIND, 2024 (255 people). Connectivity-guided targeting did not beat standard targeting in this larger UK trial of standard-length TMS.11

We aim with your own scan because we think it's the best information available about your brain. The evidence is still growing, and no trial has tested our exact protocol.

Price

How much does fMRI-guided accelerated TMS cost?

$9,900 for the 5-day program, all-inclusive and self-pay. That covers the fMRI scan, your personal target, about 50 TMS sessions and the supportive therapies. Travel, lodging and meals are extra.

5-day TMS program
$9,900
  • fMRI scan and personal targetingIncluded
  • About 50 TMS sessions with neuronavigationIncluded
  • CBT, physical therapy, massage, photobiomodulationIncluded
  • Private treatment suiteIncluded
  • Targeting report to keepIncluded
  • Follow-up after you go homeIncluded
You arrange flights, a hotel for about a week (partner hotels offer discounts) and meals.
To book
A deposit holds your dates. The balance is due when you arrive.
Pay with
HSA or FSA funds, CareCredit (subject to credit approval), or card.
Insurance
We don't bill insurance, and most plans don't cover accelerated TMS. If your plan covers standard TMS and 6 to 9 weeks of daily visits works for you, that is a reasonable place to start. Our sister clinic, Neural Effects, offers standard TMS that many insurance plans cover.
If you need more later
Booster courses and returning patients receive discounted pricing.
Why one price
We own our MRI scanner, run fMRI in-house and don't bill insurance, so we can post a single self-pay price.

How does Cognitive FX compare with standard TMS and SAINT®?

Cognitive FX does not offer SAINT®. We include it here because people often compare the two.

Cognitive FX 5-dayStandard TMSSAINT® providers
Self-pay price$9,900, posted$6,000 to $15,000$30,000 to $36,000
SessionsAbout 50, 10 a dayAbout 36, 1 a day50, 10 a day
Time in treatment5 days plus a scan day6 to 9 weeks5 days
How the target is foundYour own fMRI, read by our teamUsually a scalp measurementfMRI, with licensed software
CBT, PT, massage, light therapyIncludedVaries by clinicVaries by clinic
InsuranceNot billed. HSA, FSA, CareCredit acceptedOften coveredMedicare at some hospital sites
FDA statusFDA-cleared TMS device; the 5-day schedule is off-labelFDA-cleared for depressionFDA-cleared system (2022)

Other prices are published estimates and vary by clinic.12 SAINT® is a registered trademark of Stanford University, exclusively licensed to Magnus Medical. Cognitive FX does not provide SAINT® and is not affiliated with either. The programs differ and shouldn't be assumed to have the same results.

See if I'm a candidate Call (385) 332-3908

More than TMS

What else is included besides TMS?

Your team plans supportive therapies around your sessions. Which ones you get, and how often, depends on your plan. They support TMS and don't replace it or your current care.

Cognitive behavioral therapy

One-on-one with a therapist. You practice spotting the thought and behavior patterns that keep depression going, and leave with skills you can keep using at home.

Physical therapy

Depression drains energy and makes it hard to stay active. A physical therapist helps you move again at a level that fits you, and gives you a routine to continue.

Massage

Treatment days are long. Massage for the neck, shoulders and scalp eases the tension some people feel during TMS.

Photobiomodulation

Painless low-level red and near-infrared light. It's being studied for brain health and mood. We include it as supportive care, not as a treatment for depression on its own.

Is it a fit?

Am I a candidate for accelerated TMS?

Tried 2 or more antidepressants and still depressedOften a fit
Can be in Provo from a Friday to the following Friday or SaturdayOften a fit
Paying yourself (HSA, FSA or CareCredit is fine)Often a fit
Teen ages 14 to 17, with a parent or guardian involvedTalk with us first
Over 65Consult and doctor visit first
History of seizures, or a pacemaker, implant or metal in the head or neckTalk with us first
Need insurance to payStandard TMS may fit better
Haven't tried an antidepressant yetStart with your doctor

If you are in crisis or thinking about suicide, call or text 988 now.

Your clinical team

Who will treat me?

Your consult, your target, your prescription and your week are each handled by a named clinician.

Dr. Lynn GaufinDr. Lynn M. Gaufin, MDPrescribes your TMS and sets your treatment target from your fMRI.
Headshot
Lynn McMillanPrescribes your TMS, oversees your treatment week and leads free consults.
Dr. Diane SpanglerDr. Diane Spangler, PhDPsychologist. Oversees your treatment week.
Dr. Mark AllenDr. Mark D. Allen, PhDSets your treatment target from your fMRI and leads free consults.
Dr. Alina FongDr. Alina K. Fong, PhDCo-founder and clinical neuropsychologist. Leads free consults.
OWNER: add Lynn McMillan's credentials (for example NP or PA) and a headshot, and swap in Dr. Spangler's final headshot (current one is a temporary file).

Planning the trip

Where is the clinic, and how do I plan the trip?

Getting here
Fly into Provo (PVU), 15 minutes from the clinic, or Salt Lake City (SLC), about 45 minutes away.
Where to stay
Lodging isn't included. Several nearby hotels offer our patients discounted rates, and our team sends you the list.
Nights
Plan on arriving Friday and leaving the next Friday evening or Saturday.
Bringing someone
A spouse, parent or friend is welcome in Provo and at the clinic, though some treatment areas are for patients only.
Working that week
Some light remote work is fine. Keep it small so you have energy for treatment.
Teens
We treat patients from age 14, with a parent or guardian involved all week.

Questions

Questions people ask before they book

Does insurance cover this?
We don't bill insurance, and most plans don't cover accelerated TMS. HSA and FSA funds and CareCredit work. If your plan covers standard TMS and about 36 visits over 6 to 9 weeks works for you, that's a reasonable first step.
Can I keep taking my medications?
Most patients stay on their current medications during TMS. Bring your medication list to your consult. Our clinical team reviews it and coordinates with your prescriber if anything needs to change.
Is TMS safe? What might I feel?
TMS is non-invasive and needs no anesthesia. The most common side effects are scalp discomfort or a headache during or after sessions. Seizures are rare, which is why we screen for seizure history, implanted devices and anything that makes an MRI unsafe before treatment.
How soon will I know if it helped?
It varies. Some people notice changes during the week. For others it takes a few weeks after they go home. Your follow-up check-ins track how you're doing.
How long do results last?
Research on how long accelerated TMS results last is still limited. In Stanford's research, people who stayed well over a year generally had booster sessions along the way. We plan follow-up after your week, and booster courses for returning patients are discounted.
I already tried TMS and it didn't help. Why would this be different?
Your target comes from your own scan, and the full course happens in one week. That doesn't guarantee a different result. Bring your earlier treatment records to the consult so we can look at them with you.
Can teenagers be treated?
Yes, from age 14, with a parent or guardian involved all week. Using our 5-day program for anyone under 18 is off-label, and your clinician will explain what that means for your teen.
I'm over 65. Can I be treated?
Possibly. We start with a consultation and a doctor visit before we can confirm you're a good fit.
I also have anxiety. Can I still come?
Yes. Many people with depression also have anxiety. Using TMS for anxiety itself is off-label, and we can't promise changes in anxiety. Your clinician will talk through what to expect.
Is this SAINT®? How is it different?
No. Cognitive FX does not offer SAINT® and is not affiliated with Stanford University, which owns the SAINT® trademark, or Magnus Medical, its exclusive licensee. SAINT® is a specific accelerated TMS system offered by licensed providers. Our program is our own protocol, built on the same published research on accelerated, fMRI-targeted TMS. It was not studied in the SAINT® trials, and we deliver it off-label on a standard FDA-cleared TMS system. The two programs differ, and you shouldn't assume they have the same results.
Where can I get SAINT® TMS?
SAINT® is offered only at clinics licensed by Magnus Medical, and Magnus lists them on its website. Published self-pay prices run about $30,000 to $36,000, and some hospital sites take Medicare. Cognitive FX is not a SAINT® provider. If you're comparing options, our 5-day program is $9,900 and also uses your own fMRI to choose your target, with our own protocol.
Is fMRI-guided TMS better than standard TMS?
The evidence is mixed. A 2026 randomized trial of 40 people found that targets chosen from each person's fMRI gave about one-third more improvement than scalp-measured targets during accelerated TMS. A larger 2024 UK trial of 255 people found that connectivity-guided targeting did not beat standard targeting with standard-length TMS. No trial has tested our exact protocol.
Is accelerated TMS FDA-approved?
TMS devices are FDA-cleared to treat depression in adults, and one accelerated system (SAINT®) has its own clearance. Our program uses an FDA-cleared TMS device on an accelerated schedule that is off-label, as is treating anyone under 18. Your clinician will explain what that means before you book.
What happens on the free consult?
It's a 30-minute call by video or phone with Dr. Mark Allen, Dr. Alina Fong or Lynn McMillan. You go over your history, the medications you've tried and whether the 5-day program fits. If another option suits you better, we'll tell you.

See if the 5-day program fits you

Answer a few questions about your history. It takes about 2 minutes and doesn't commit you to anything. Then book a free 30-minute consult by video or phone with one of our clinicians, who will tell you whether TMS is right for you.

See if I'm a candidate Call (385) 332-3908

Or call (385) 332-3908 and talk to a person.