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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| Published in: | Current biology Vol. 34; no. 16; p. 3735 |
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| Main Authors: | , , , , |
| Format: | Journal Article |
| Language: | English |
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England
19.08.2024
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| 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. |
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| 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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| CitedBy_id | crossref_primary_10_1038_s41380_025_02995_1 crossref_primary_10_1007_s40675_025_00331_1 crossref_primary_10_1016_j_sleep_2024_12_037 crossref_primary_10_1016_j_concog_2025_103869 crossref_primary_10_1016_j_tics_2025_07_010 crossref_primary_10_1093_nc_niaf017 crossref_primary_10_1080_20008066_2025_2458406 |
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| Keywords | PTSD sleep post-traumatic stress disorder eye movement desensitization and reprocessing script-driven imagery memory consolidation EMDR TMR targeted memory reactivation SDI |
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| Title | Targeted memory reactivation to augment treatment in post-traumatic stress disorder |
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