With this study, the investigators aim to use sleep and dreaming in order to enhance exposure therapy for social anxiety disorder (SAD), by pairing the positive feedback phase of exposure (public talk) to an auditory stimulus during wake (associated sound) and subsequently applying this stimulus during sleep (targeted memory reactivation, TMR). Exposure therapy sessions will take place in a virtual reality (VR) environment, while physiological measures during the preparation phase of public talk such as heart rate variability (HRV), skin conductance response (SCR) and subjective level of anxiety (SUDS) will be used in order to assess treatment efficiency across the sessions. Patients with SAD according to DSM-5 criteria will be included. The main hypothesis of this study is that participants who are presented with the associated sound during sleep (TMR group) will have reduced intensity of social anxiety compared to participants with no such association (control group), after both a full night's sleep with auditory stimulation during REM sleep in the laboratory, and after 1 week of stimulation during REM sleep at home. In addition, it is expected that fear-related dreams may correlate with anxiety levels during wakefulness after 1 week of stimulation at home.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
51
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 a sound is associated with a waking experience (i.e., positive feedback in this study) and strengthening it during REM sleep, the investigators aim to accelerate the remission of social anxiety disorder.
These patients will receive the classic treatment of Exposure Therapy (ET) for social anxiety disorder without any association with a sound.
Center for Sleep Medicine, University Hospitals of Geneva
Geneva, Switzerland
Root mean square of the successive [R-R intervals] differences
The RMSSD is used to estimate the vagally mediated changes in heart rate variability.
Time frame: 1 day
Root mean square of the successive [R-R intervals] differences
The RMSSD is used to estimate the vagally mediated changes in heart rate variability.
Time frame: 1 week
Subjective Units of Distress Scale
Validated rating of subjective distress on a scale of 0 to 10 (higher values reflect a worse outcome)
Time frame: 1 day
Subjective Units of Distress Scale
Validated rating of subjective distress on a scale of 0 to 10 (higher values reflect a worse outcome)
Time frame: 1 week
Non-specific skin conductance responses
The skin conductance response measures sympathetic nervous system activation.
Time frame: 1 day
Non-specific skin conductance responses
The skin conductance response measures sympathetic nervous system activation.
Time frame: 1 week
Change of fear in dreams (average of fear during the second week with stimulations minus the first week without stimulations)
Use of a dream diary where the emotion of fear is graded in a dichotomous way (presence/absence).
Time frame: 1 week
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