TMR-TRAUMA

Post-traumatic stress disorder (PTSD) is a severe mental disorder associated with significant personal and societal burden. Traumatic memories are at the core of its pathophysiology, resulting in key-symptoms such as nightmares and flashbacks. Currently, first-choice treatment, consisting of exposure-based psychotherapy, such as eye movement desensitization and reprocessing (EMDR), proves ineffective in half of PTSD-patients. Hence, there is an urgent need to improve treatment. Sleep is crucial in the treatment of traumatic memories. During exposure-based treatment, traumatic memories get reactivated and subsequently re-encoded with lower fear. This treatment effect is then solidified during memory consolidation while asleep when the 'neutralized' memories get integrated in long-term storage, stabilizing them and further reducing their affective charge. Recent advances in basic memory research show that memory consolidation can be significantly enhanced by presenting reminder cues (sounds/scents that were linked to the memory at encoding) during subsequent sleep (targeted memory reactivation (TMR)). Here, we apply these memory reactivation strategies during sleep for the first time in (PTSD) patients to increase therapeutic effectiveness. Using a controlled design, we predict that re-administering auditory cues, that are already part of a specific PTSD treatment during post-treatment sleep, will increase therapeutic outcome. This is measured as reduced subjective and physiological fear in relation to the targeted memory, as well as reduced overall PTSD symptom level. To visualize the underlying transfer of the memory trace to higher-order memory networks, we will obtain functional MRI during scripted recall of the traumatic event pre/post study.

The two primary objectives of this study are: 1. To increase therapeutic effectiveness of an eye movement desentization and reprocessing (EMDR) treatment session in patients with post-traumatic stress disorder (PTSD) by reactivating the updated traumatic memory during post-treatment sleep using targeted memory reactivation; and 2. To provide a neural base for this augmented treatment effect by showing a (enhanced) system-level reorganization of the targeted memory trace using functional MRI.

Total participation time will be approximately 22 hours over a 2,5-week time period, consisting of 4 lab visits (including 1 night of polysomnographically-monitored sleep).

Patients will be treated with a single session of EMDR by a certified therapist. EMDR is a first-choice treatment for PTSD, which has been shown to be safe and effective. After successful EMDR treatment, patients will undergo TMR during post-treatment sleep. TMR is a recently described experimental procedure which aims at strengthening memory consolidation processes during sleep by re-administering context cues, such as auditory or olfactory stimuli, that are linked to the targeted memory at awake encoding.