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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Bibliographic Details
Published in:Current biology Vol. 34; no. 16; p. 3735
Main Authors: van der Heijden, Anna C, van der Werf, Ysbrand D, van den Heuvel, Odile A, Talamini, Lucia M, van Marle, Hein J F
Format: Journal Article
Language:English
Published: England 19.08.2024
Subjects:
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
Online Access:Get more information
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Summary: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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ISSN:1879-0445
1879-0445
DOI:10.1016/j.cub.2024.07.019