With this protocol, investigators examine whether targeted memory reactivation (TMR), a technique used to strengthen memories, can accelerate remission of nightmare disorder. This protocol uses TMR during REM sleep to strengthen positive memories generated by Imagery Rehearsal Therapy (IRT), a recommended treatment of nightmares. Patients with nightmare disorder are asked to perform an initial IRT session and, while they generate a positive outcome of their recurrent nightmare, half of the patients are exposed to a sound (TMR group), while no such pairing with a sound takes place for the other half (control group). During the next two weeks, all patients perform IRT every evening at home and are exposed to the sound during REM sleep with a wireless headband, which automatically detects sleep stages. Clinical evaluation of the severity of nightmares before and after (2-weeks follow-up and 3-months follow-up) this intervention takes place using the validated Nightmare Frequency Questionnaire (NFQ, primary outcome measure), which retrospectively identifies the frequency of nightmares. We hypothesize that patients treated with IRT and who are exposed, during REM sleep and over 14 nights, to a sound that had previously been associated with the new positive dream scenario of IRT (TMR group), will have more reduced frequency of nightmares compared to participants with stimulation of the same, but non-associated, sound during REM sleep (control group).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
36
Emerging evidence shows that REM sleep plays a causal role in extinction learning, emotion regulation and consolidation of emotionally positive memories. By using targeted memory reactivation (TMR), a known method where we associate a sound with a waking experience (i.e., a positive outcome of imagery rehearsal therapy in this study) and strengthening it during REM sleep, we want to accelerate the remission of nightmares.
These patients will receive the classic treatment of Imagery Rehearsal Therapy (IRT) for nightmares without any association with a sound.
Center for Sleep Medicine, University Hospitals of Geneva
Geneva, Switzerland
Nightmare Frequency Questionnaire (NFQ)
Validated self-report scale to assess the number of nightmares per week
Time frame: 2 weeks
Nightmare Frequency Questionnaire (NFQ)
Validated self-report scale to assess the number of nightmares per week
Time frame: 3 months
Nightmare Distress Questionnaire (NDQ)
Validated self-report scale to assess the emotional disturbance attributed to the nightmares
Time frame: 2 weeks
Beck Depression Inventory (BDI-II)
Validated self-report scale to assess depressive symptoms
Time frame: 2 weeks
Pittsburgh Sleep Quality Index (PSQI)
Validated self-report scale to assess the quality of sleep
Time frame: 2 weeks
Proportion of the emotion 'joy' in dreams
Use of a dream diary
Time frame: 2 weeks
Proportion of the emotion 'fear' in dreams
Use of a dream diary
Time frame: 2 weeks
Nightmare Distress Questionnaire (NDQ)
Validated self-report scale to assess the emotional disturbance attributed to the nightmares
Time frame: 3 months
Beck Depression Inventory (BDI-II)
Validated self-report scale to assess depressive symptoms
Time frame: 3 months
Pittsburgh Sleep Quality Index (PSQI)
Validated self-report scale to assess the quality of sleep
Time frame: 3 months
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