Health
Processing traumatic memories during sleep leads to brain changes associated with improved PTSD symptoms
Currently, the first-line treatment for PTSD is exposure-based psychotherapy, in which therapists help patients restructure emotions associated with traumatic memories in their brains, transforming fear and arousal into more neutral responses. But up to 50 percent of patients don't respond well to this treatment, according to a new study published August 7 in the journal Cell Press. Current BiologyScientists have demonstrated for the first time that reactivating therapeutically altered memories during sleep increases brain activity related to memory processing, leading to a reduction in PTSD symptoms.
“Our goal is to unlock sleep as a new therapeutic tool for PTSD,” said Hein van Maar, lead author of the paper and principal investigator of the study at the University Medical Center Amsterdam. “This is the first demonstration that sleep can enhance the effects of a daytime treatment.”
PTSD is a mental illness that can develop after experiencing or witnessing a traumatic event. People with PTSD may experience flashbacks, nightmares, heightened vigilance, hyperarousal, and mood and sleep disorders. Currently available treatments for PTSD include eye movement desensitization and reprocessing (EMDR), in which therapists induce traumatic memories in patients while using moving lights and clicking sounds to distract them.
Although EMDR has shown positive results, the emotional toll of reliving traumatic memories means success rates are low and patients often drop out of the treatment program, Van Marl said.
So van Maar and his colleagues, including lead author Christa van der Heyden of the Amsterdam University Medical Center and Lucia Talamini of the University of Amsterdam, set out to investigate ways to improve and prolong the effects of EMDR treatment.
Sleep provides a unique opportunity to consolidate newly formed memories of your emotional reactions to the traumatic event: during sleep, your brain focuses on consolidating memories and storing information for the long term.
Previous research has shown that if a new memory is formed in the presence of an ly administered sound or scent, then exposing it to that sound or scent while you sleep can improve your ability to recall that memory after waking up. This memory-enhancing technique is called targeted memory reactivation (TMR).
In Van Marl's experiment, the team first conducted an EMDR session with 33 PTSD patients in the evening, with standard click sounds playing in the background. At night, the team recorded the patients' brainwaves while they slept in the lab. The team then performed TMR on 17 patients, replaying the click sounds from the EMDR session while they slept, with the goal of improving memory retention of the EMDR treatment and reducing PTSD symptoms.
They found that patients who received the clicks while they slept had higher levels of brainwave activity associated with memory processing and consolidation compared to participants who did not receive the clicks while they slept.
These induced changes in EEG activity were associated with greater reductions in PTSD symptoms in the TMR group. Additionally, the team found that patients who underwent TMR were less likely to avoid traumatic memories (a core symptom of PTSD) when they listened to audio clips recreating the traumatic event.
However, the researchers found no improvement in PTSD symptoms when comparing patients who received TMR with those who received EMDR alone.
“We found that presenting EMDR clicks on the night of TMR stimulation effectively enhanced the sleep physiology responsible for memory consolidation, and the greater the enhancement, the greater the reduction in symptoms. However, the stimulation during our experiments was not enough to make a difference in most clinical outcomes, in part because the EMDR sessions were already quite effective,” van Marl said.
In a follow-up study scheduled to begin this fall, the team plans to treat patients for five consecutive nights of TMR treatment, and the researchers are interested in seeing whether repeated TMR might be even more effective at reducing PTSD symptoms.
“The sleep and memory field has been cautious about applying TMR to patients with PTSD, so we're really pleased to see that it doesn't have any negative effects in these patients,” says van Maar. No patients reported more nightmares or worse sleep after TMR. “This gives us confidence in applying TMR more frequently in future studies,” he says.
Many psychiatric disorders, including phobias, anxiety disorders and addictions, are also linked to maladaptive memories, and van Marl hopes that this study will inspire future research exploring the beneficial effects of TMR in treating other disorders.
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