Targeted memory reactivation to augment treatment in post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a psychiatric disorder with traumatic memories at its core. Post-treatment sleep may offer a unique time window to increase therapeutic efficacy through consolidation of therapeutically modified traumatic memories. Targeted memory reactivation (TMR) enhances...

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Vydané v:	Current biology Ročník 34; číslo 16; s. 3735
Hlavní autori:	van der Heijden, Anna C, van der Werf, Ysbrand D, van den Heuvel, Odile A, Talamini, Lucia M, van Marle, Hein J F
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	England 19.08.2024
Predmet:	Adult Eye Movement Desensitization Reprocessing - methods Female Humans Magnetic Resonance Imaging Male Memory - physiology Memory Consolidation - physiology Middle Aged Polysomnography Sleep - physiology Stress Disorders, Post-Traumatic - physiopathology Stress Disorders, Post-Traumatic - psychology Stress Disorders, Post-Traumatic - therapy Young Adult PTSD sleep post-traumatic stress disorder eye movement desensitization and reprocessing script-driven imagery memory consolidation EMDR TMR targeted memory reactivation SDI
ISSN:	1879-0445, 1879-0445
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Abstract	Post-traumatic stress disorder (PTSD) is a psychiatric disorder with traumatic memories at its core. Post-treatment sleep may offer a unique time window to increase therapeutic efficacy through consolidation of therapeutically modified traumatic memories. Targeted memory reactivation (TMR) enhances memory consolidation by presenting reminder cues (e.g., sounds associated with a memory) during sleep. Here, we applied TMR in PTSD patients to strengthen therapeutic memories during sleep after one treatment session with eye movement desensitization and reprocessing (EMDR). PTSD patients received either slow oscillation (SO) phase-targeted TMR, using modeling-based closed-loop neurostimulation (M-CLNS) with EMDR clicks as a reactivation cue (n = 17), or sham stimulation (n = 16). Effects of TMR on sleep were assessed through high-density polysomnography. Effects on treatment outcome were assessed through subjective, autonomic, and fMRI responses to script-driven imagery (SDI) of the targeted traumatic memory and overall PTSD symptom level. Compared to sham stimulation, TMR led to stimulus-locked increases in SO and spindle dynamics, which correlated positively with PTSD symptom reduction in the TMR group. Given the role of SOs and spindles in memory consolidation, these findings suggest that TMR may have strengthened the consolidation of the EMDR-treatment memory. Clinically, TMR vs. sham stimulation resulted in a larger reduction of avoidance level during SDI. TMR did not disturb sleep or trigger nightmares. Together, these data provide first proof of principle that TMR may be a safe and viable future treatment augmentation strategy for PTSD. The required follow-up studies may implement multi-night TMR or TMR during REM sleep to further establish the clinical effect of TMR for traumatic memories.
AbstractList	Post-traumatic stress disorder (PTSD) is a psychiatric disorder with traumatic memories at its core. Post-treatment sleep may offer a unique time window to increase therapeutic efficacy through consolidation of therapeutically modified traumatic memories. Targeted memory reactivation (TMR) enhances memory consolidation by presenting reminder cues (e.g., sounds associated with a memory) during sleep. Here, we applied TMR in PTSD patients to strengthen therapeutic memories during sleep after one treatment session with eye movement desensitization and reprocessing (EMDR). PTSD patients received either slow oscillation (SO) phase-targeted TMR, using modeling-based closed-loop neurostimulation (M-CLNS) with EMDR clicks as a reactivation cue (n = 17), or sham stimulation (n = 16). Effects of TMR on sleep were assessed through high-density polysomnography. Effects on treatment outcome were assessed through subjective, autonomic, and fMRI responses to script-driven imagery (SDI) of the targeted traumatic memory and overall PTSD symptom level. Compared to sham stimulation, TMR led to stimulus-locked increases in SO and spindle dynamics, which correlated positively with PTSD symptom reduction in the TMR group. Given the role of SOs and spindles in memory consolidation, these findings suggest that TMR may have strengthened the consolidation of the EMDR-treatment memory. Clinically, TMR vs. sham stimulation resulted in a larger reduction of avoidance level during SDI. TMR did not disturb sleep or trigger nightmares. Together, these data provide first proof of principle that TMR may be a safe and viable future treatment augmentation strategy for PTSD. The required follow-up studies may implement multi-night TMR or TMR during REM sleep to further establish the clinical effect of TMR for traumatic memories.Post-traumatic stress disorder (PTSD) is a psychiatric disorder with traumatic memories at its core. Post-treatment sleep may offer a unique time window to increase therapeutic efficacy through consolidation of therapeutically modified traumatic memories. Targeted memory reactivation (TMR) enhances memory consolidation by presenting reminder cues (e.g., sounds associated with a memory) during sleep. Here, we applied TMR in PTSD patients to strengthen therapeutic memories during sleep after one treatment session with eye movement desensitization and reprocessing (EMDR). PTSD patients received either slow oscillation (SO) phase-targeted TMR, using modeling-based closed-loop neurostimulation (M-CLNS) with EMDR clicks as a reactivation cue (n = 17), or sham stimulation (n = 16). Effects of TMR on sleep were assessed through high-density polysomnography. Effects on treatment outcome were assessed through subjective, autonomic, and fMRI responses to script-driven imagery (SDI) of the targeted traumatic memory and overall PTSD symptom level. Compared to sham stimulation, TMR led to stimulus-locked increases in SO and spindle dynamics, which correlated positively with PTSD symptom reduction in the TMR group. Given the role of SOs and spindles in memory consolidation, these findings suggest that TMR may have strengthened the consolidation of the EMDR-treatment memory. Clinically, TMR vs. sham stimulation resulted in a larger reduction of avoidance level during SDI. TMR did not disturb sleep or trigger nightmares. Together, these data provide first proof of principle that TMR may be a safe and viable future treatment augmentation strategy for PTSD. The required follow-up studies may implement multi-night TMR or TMR during REM sleep to further establish the clinical effect of TMR for traumatic memories. Post-traumatic stress disorder (PTSD) is a psychiatric disorder with traumatic memories at its core. Post-treatment sleep may offer a unique time window to increase therapeutic efficacy through consolidation of therapeutically modified traumatic memories. Targeted memory reactivation (TMR) enhances memory consolidation by presenting reminder cues (e.g., sounds associated with a memory) during sleep. Here, we applied TMR in PTSD patients to strengthen therapeutic memories during sleep after one treatment session with eye movement desensitization and reprocessing (EMDR). PTSD patients received either slow oscillation (SO) phase-targeted TMR, using modeling-based closed-loop neurostimulation (M-CLNS) with EMDR clicks as a reactivation cue (n = 17), or sham stimulation (n = 16). Effects of TMR on sleep were assessed through high-density polysomnography. Effects on treatment outcome were assessed through subjective, autonomic, and fMRI responses to script-driven imagery (SDI) of the targeted traumatic memory and overall PTSD symptom level. Compared to sham stimulation, TMR led to stimulus-locked increases in SO and spindle dynamics, which correlated positively with PTSD symptom reduction in the TMR group. Given the role of SOs and spindles in memory consolidation, these findings suggest that TMR may have strengthened the consolidation of the EMDR-treatment memory. Clinically, TMR vs. sham stimulation resulted in a larger reduction of avoidance level during SDI. TMR did not disturb sleep or trigger nightmares. Together, these data provide first proof of principle that TMR may be a safe and viable future treatment augmentation strategy for PTSD. The required follow-up studies may implement multi-night TMR or TMR during REM sleep to further establish the clinical effect of TMR for traumatic memories.
Author	van Marle, Hein J F van der Heijden, Anna C van den Heuvel, Odile A Talamini, Lucia M van der Werf, Ysbrand D
Author_xml	– sequence: 1 givenname: Anna C surname: van der Heijden fullname: van der Heijden, Anna C organization: Amsterdam UMC, Vrije Universiteit Amsterdam, Department Anatomy & Neuroscience, Boelelaan 1081 HV Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Oldenaller 1081 HJ Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood Anxiety Psychosis Stress Sleep, Boelelaan 1081 HV Amsterdam, the Netherlands; University of Amsterdam, Department of Psychology, Brain & Cognition, Nieuwe Achtergracht 1018 WS Amsterdam, the Netherlands – sequence: 2 givenname: Ysbrand D surname: van der Werf fullname: van der Werf, Ysbrand D organization: Amsterdam UMC, Vrije Universiteit Amsterdam, Department Anatomy & Neuroscience, Boelelaan 1081 HV Amsterdam, the Netherlands; Amsterdam Neuroscience, Compulsivity Impulsivity and Attention, Boelelaan 1081 HV Amsterdam, the Netherlands – sequence: 3 givenname: Odile A surname: van den Heuvel fullname: van den Heuvel, Odile A organization: Amsterdam UMC, Vrije Universiteit Amsterdam, Department Anatomy & Neuroscience, Boelelaan 1081 HV Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Oldenaller 1081 HJ Amsterdam, the Netherlands; Amsterdam Neuroscience, Compulsivity Impulsivity and Attention, Boelelaan 1081 HV Amsterdam, the Netherlands – sequence: 4 givenname: Lucia M surname: Talamini fullname: Talamini, Lucia M organization: University of Amsterdam, Department of Psychology, Brain & Cognition, Nieuwe Achtergracht 1018 WS Amsterdam, the Netherlands; University of Amsterdam, Amsterdam Brain and Cognition, Nieuwe Achtergracht 1001 NK Amsterdam, the Netherlands – sequence: 5 givenname: Hein J F surname: van Marle fullname: van Marle, Hein J F email: h.j.vanmarle@amsterdamumc.nl organization: Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Oldenaller 1081 HJ Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood Anxiety Psychosis Stress Sleep, Boelelaan 1081 HV Amsterdam, the Netherlands; GGZ inGeest Mental Health Care, Oldenaller 1081 HJ Amsterdam, the Netherlands; ARQ National Psychotrauma Center, Nienoord 1112 XE Diemen, the Netherlands. Electronic address: h.j.vanmarle@amsterdamumc.nl
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SubjectTerms	Adult Eye Movement Desensitization Reprocessing - methods Female Humans Magnetic Resonance Imaging Male Memory - physiology Memory Consolidation - physiology Middle Aged Polysomnography Sleep - physiology Stress Disorders, Post-Traumatic - physiopathology Stress Disorders, Post-Traumatic - psychology Stress Disorders, Post-Traumatic - therapy Young Adult
Title	Targeted memory reactivation to augment treatment in post-traumatic stress disorder
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