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使用行为和药理学再巩固干扰策略调节自然发生的适应不良记忆:临床和“亚临床”研究的系统评价和荟萃分析。

Modulation of naturalistic maladaptive memories using behavioural and pharmacological reconsolidation-interfering strategies: a systematic review and meta-analysis of clinical and 'sub-clinical' studies.

机构信息

Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK.

Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, USA.

出版信息

Psychopharmacology (Berl). 2018 Sep;235(9):2507-2527. doi: 10.1007/s00213-018-4983-8. Epub 2018 Aug 8.

Abstract

BACKGROUND

Consolidated memories can undergo enduring modification through retrieval-dependent treatments that modulate reconsolidation. This represents a potentially transformative strategy for weakening or overwriting the maladaptive memories that underlie substance use and anxiety/trauma-related disorders. However, modulation of naturalistic maladaptive memories may be limited by 'boundary conditions' imposed on the reconsolidation process by the nature of these memories.

METHODS

We conducted a systematic review and meta-analyses of behavioural and pharmacological studies examining retrieval-dependent modulation of reward- and threat-related memories in (sub) clinical substance use and anxiety/trauma, respectively.

RESULTS

Of 4938 publications assessed for eligibility, 8 studies of substance use and 10 of anxiety (phobia)- and trauma-related symptoms were included in the meta-analyses. Overall, the findings were in the predicted direction, with most studies favouring the 'retrieval + treatment' condition. However, the magnitude of effects was dependent upon the nature of treatment, with pharmacological interventions showing a medium-sized effect (g = 0.59, p = 0.03) and behavioural treatments, a relatively small effect (g = 0.32, p = 0.10) in studies of phobia/trauma. Among studies of substance use, post-retrieval behavioural interventions yielded a larger effect (g = 0.60, p < 0.001) relative to pharmacological treatments (g = - 0.03, p = 0.91), with treatment type being a statistically significant moderator (χ(1) = 4.20, p = 0.04).

CONCLUSION

Modification of naturalistic maladaptive memories during reconsolidation appears to be a viable treatment strategy for substance use and phobias/trauma disorders. However, high levels of heterogeneity and methodological variation limit the strength of conclusions that can be drawn from the reviewed studies at this stage.

摘要

背景

通过依赖检索的治疗来调节再巩固,整合的记忆可以经历持久的改变。这代表了一种潜在的变革性策略,可以削弱或覆盖导致物质使用和焦虑/创伤相关障碍的适应不良记忆。然而,由于这些记忆的性质对再巩固过程施加了“边界条件”,因此对自然发生的适应不良记忆的调节可能会受到限制。

方法

我们对行为和药理学研究进行了系统评价和荟萃分析,分别检查了在(亚)临床物质使用和焦虑/创伤中,与奖励和威胁相关的记忆的检索依赖性调节。

结果

在评估合格性的 4938 篇出版物中,有 8 项物质使用研究和 10 项焦虑(恐惧症)和创伤相关症状研究被纳入荟萃分析。总的来说,结果符合预期,大多数研究支持“检索+治疗”条件。然而,效应的大小取决于治疗的性质,药理学干预显示出中等大小的效应(g=0.59,p=0.03),而行为治疗则显示出相对较小的效应(g=0.32,p=0.10)在恐惧症/创伤研究中。在物质使用研究中,检索后行为干预的效果更大(g=0.60,p<0.001),而药物治疗的效果较小(g=-0.03,p=0.91),治疗类型是一个具有统计学意义的调节因素(χ(1)=4.20,p=0.04)。

结论

在再巩固期间对自然发生的适应不良记忆进行修饰似乎是治疗物质使用和恐惧症/创伤障碍的一种可行策略。然而,高水平的异质性和方法学差异限制了从目前综述研究中得出结论的强度。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/14a9/6132663/af38512f622c/213_2018_4983_Fig1_HTML.jpg

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