Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland; Swiss Center for Affective Sciences, University of Geneva, 1202 Geneva, Switzerland.
Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland.
Curr Biol. 2022 Nov 21;32(22):4808-4816.e4. doi: 10.1016/j.cub.2022.09.032. Epub 2022 Oct 27.
Nightmare disorder (ND) is characterized by dreams with strong negative emotions occurring during rapid eye movement (REM) sleep. ND is mainly treated by imagery rehearsal therapy (IRT), where the patients are asked to change the negative story line of their nightmare to a more positive one. We here used targeted memory reactivation (TMR) during REM sleep to strengthen IRT-related memories and accelerate remission of ND. Thirty-six patients with ND were asked to perform an initial IRT session and, while they generated a positive outcome of their nightmare, half of the patients were exposed to a sound (TMR group), while no such pairing took place for the other half (control group). During the next 2 weeks, all patients performed IRT every evening at home and were exposed to the sound during REM sleep with a wireless headband, which automatically detected sleep stages. The frequency of nightmares per week at 2 weeks was used as the primary outcome measure. We found that the TMR group had less frequent nightmares and more positive dream emotions than the control group after 2 weeks of IRT and a sustained decrease of nightmares after 3 months. By demonstrating the effectiveness of TMR during sleep to potentiate therapy, these results have clinical implications for the management of ND, with relevance to other psychiatric disorders too. Additionally, these findings show that TMR applied during REM sleep can modulate emotions in dreams.
梦魇障碍（ND）的特征是在快速眼动（REM）睡眠期间出现强烈负面情绪的梦境。ND 主要通过意象排练疗法（IRT）进行治疗，要求患者将噩梦的负面故事情节转变为更积极的情节。在这里，我们在 REM 睡眠期间使用靶向记忆再激活（TMR）来增强与 IRT 相关的记忆并加速 ND 的缓解。要求 36 名 ND 患者进行初始 IRT 疗程，当他们产生噩梦的积极结果时，一半患者会暴露于声音（TMR 组），而另一半则不会（对照组）。在接下来的 2 周内，所有患者每天晚上在家中进行 IRT，并使用无线头带在 REM 睡眠期间暴露于声音，该头带可自动检测睡眠阶段。第 2 周每周的噩梦频率被用作主要的结果衡量指标。我们发现，与 IRT 后 2 周的对照组相比，TMR 组的噩梦频率更低，梦境情绪更积极，3 个月后噩梦持续减少。通过证明睡眠期间 TMR 的有效性可以增强治疗效果，这些结果对 ND 的管理具有临床意义，对其他精神障碍也具有相关性。此外，这些发现表明，在 REM 睡眠期间应用 TMR 可以调节梦境中的情绪。
