创伤后应激障碍(PTSD)是一种以创伤记忆为核心的精神疾病。治疗后的睡眠可以提供独特的时间窗口,以通过巩固治疗修饰的创伤记忆来提高治疗功效。目标记忆再激活(TMR)通过呈现提醒提示(例如,与记忆相关的声音)。这里,我们在PTSD患者中应用了TMR,以在一次眼动脱敏和再处理(EMDR)治疗后增强睡眠期间的治疗记忆.PTSD患者接受慢振荡(SO)相位靶向TMR,使用基于建模的闭环神经刺激(M-CLNS)与EMDR点击作为再激活提示(n=17),或假刺激(n=16)。通过高密度多导睡眠图评估TMR对睡眠的影响。对治疗结果的影响通过主观评估,自主性,和fMRI对目标创伤记忆和整体PTSD症状水平的脚本驱动图像(SDI)的反应。与假刺激相比,TMR导致SO和主轴动态的刺激锁定增加,与TMR组PTSD症状减轻呈正相关。鉴于SO和主轴在内存整合中的作用,这些研究结果表明,TMR可能增强了EMDR治疗记忆的巩固.临床上,TMRvs.假刺激导致SDI期间回避水平的较大降低。TMR不会打扰睡眠或引发噩梦。一起,这些数据首次证明了TMR可能是创伤后应激障碍安全可行的未来治疗增强策略.所需的随访研究可能会在REM睡眠期间实施多夜TMR或TMR,以进一步确定TMR对创伤性记忆的临床效果。
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.