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Yu X, Nollet M, Franks NP, Wisden W. Sleep and the recovery from stress. Neuron 2025:S0896-6273(25)00311-3. [PMID: 40409251 DOI: 10.1016/j.neuron.2025.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 01/06/2025] [Accepted: 04/25/2025] [Indexed: 05/25/2025]
Abstract
The relationship between stress and sleep is multifaceted, with stress capable of both disrupting and promoting sleep depending on the nature, intensity, and duration of the stressor. While stress commonly leads to sleep fragmentation and arousal in both humans and animals, certain selective stressors, such as immune challenges and psychosocial stress, promote sleep in rodent models. Specific neural circuits, such as those involving the ventral tegmental area and lateral habenula, mediate this stress-induced sleep. Post-stress sleep may facilitate recovery, reduce anxiety, and enhance stress resilience, but the extent to which sleep versus wakefulness post-stress aids long-term adaptation is unclear. Both human and animal studies highlight a bidirectional relationship, where stress-induced changes in sleep architecture may have adaptive or maladaptive consequences. Here, we propose that post-stress sleep contributes to resilience and discuss potential mechanisms underlying this process. A deeper understanding of these pathways may provide new strategies for enhancing stress recovery and improving mental health outcomes.
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Affiliation(s)
- Xiao Yu
- Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai 200031, China.
| | - Mathieu Nollet
- Department of Life Sciences, Imperial College London, London SW7 2AZ, UK; UK Dementia Research Institute, Imperial College London, London SW7 2AZ, UK
| | - Nicholas P Franks
- Department of Life Sciences, Imperial College London, London SW7 2AZ, UK; UK Dementia Research Institute, Imperial College London, London SW7 2AZ, UK.
| | - William Wisden
- Department of Life Sciences, Imperial College London, London SW7 2AZ, UK; UK Dementia Research Institute, Imperial College London, London SW7 2AZ, UK.
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2
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Devignes Q, Clancy KJ, Ren B, Pollmann Y, Baker JT, Rosso IM. Intrinsic functional connectivity of right dorsolateral prefrontal cortex and hippocampus subregions relates to emotional and sensory-perceptual properties of intrusive trauma memories. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2025:S2451-9022(25)00093-X. [PMID: 40118343 DOI: 10.1016/j.bpsc.2025.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Revised: 02/26/2025] [Accepted: 03/12/2025] [Indexed: 03/23/2025]
Abstract
BACKGROUND Trauma-related intrusive memories (TR-IMs) are core symptoms of posttraumatic stress disorder (PTSD). Prior research links reexperiencing symptoms with resting-state functional coupling between the right dorsolateral prefrontal cortex (dlPFC) and right hippocampus. However, prior work has not examined whether this negative coupling relates to TR-IMs, nor differentiated between the anterior and posterior hippocampus (aHPC/pHPC). This study examined relationships of TR-IM frequency and properties with resting-state negative coupling between the right dlPFC and right aHPC/pHPC in symptomatic trauma-exposed individuals with TR-IMs. METHODS Participants (N=109; 88 female) completed two weeks of ecological momentary assessments capturing TR-IM frequency and properties (intrusiveness, emotional intensity, vividness, visual properties, and reliving). Using resting-state functional magnetic resonance imaging, participant-specific 4-mm spheres were placed at the right dlPFC voxel most anticorrelated with the right aHPC and pHPC. Quasi-Poisson and linear mixed-effects models assessed relationships of TR-IM frequency and properties with right dlPFC-right aHPC and pHPC anticorrelation. RESULTS TR-IM emotional intensity was positively associated with right dlPFC-aHPC connectivity, while vividness and visual properties correlated with right dlPFC-pHPC connectivity. These associations remained significant after controlling for PTSD symptom severity and time since trauma. No significant associations emerged between TR-IM frequency, intrusiveness, or reliving, and anticorrelation with either hippocampal subregion. CONCLUSIONS This study provides novel insights into the neural correlates of TR-IMs, highlighting the relevance of intrinsic negative coupling between the right dlPFC and aHPC/pHPC to their phenomenology. Further research on this circuit could advance understanding of component processes of trauma reexperiencing, a severe and treatment-refractory PTSD symptom.
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Affiliation(s)
- Quentin Devignes
- Center for Depression, Anxiety and Stress Disorders, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kevin J Clancy
- Center for Depression, Anxiety and Stress Disorders, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Boyu Ren
- Center for Depression, Anxiety and Stress Disorders, McLean Hospital, Belmont, MA, USA; Psychiatric Biostatistics Laboratory, McLean Hospital, Belmont, MA, USA
| | - Yara Pollmann
- Center for Depression, Anxiety and Stress Disorders, McLean Hospital, Belmont, MA, USA
| | - Justin T Baker
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Isabelle M Rosso
- Center for Depression, Anxiety and Stress Disorders, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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3
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Meffert SM, Mathai MA, Ongeri L, Neylan TC, Mwai D, Onyango D, Akena D, Rota G, Otieno A, Obura RR, Wangia J, Opiyo E, Muchembre P, Oluoch D, Wambura R, Mbwayo A, Kahn JG, Cohen CR, Bukusi DE, Aarons GA, Burger RL, Jin C, McCulloch CE, Njuguna Kahonge S. Defining a screening tool for post-traumatic stress disorder in East Africa: a penalized regression approach. Front Public Health 2024; 12:1383171. [PMID: 38947359 PMCID: PMC11211862 DOI: 10.3389/fpubh.2024.1383171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/13/2024] [Indexed: 07/02/2024] Open
Abstract
Background Scalable PTSD screening strategies must be brief, accurate and capable of administration by a non-specialized workforce. Methods We used PTSD as determined by the structured clinical interview as our gold standard and considered predictors sets of (a) Posttraumatic Stress Checklist-5 (PCL-5), (b) Primary Care PTSD Screen for the DSM-5 (PC-PTSD) and, (c) PCL-5 and PC-PTSD questions to identify the optimal items for PTSD screening for public sector settings in Kenya. A logistic regression model using LASSO was fit by minimizing the average squared error in the validation data. Area under the receiver operating characteristic curve (AUROC) measured discrimination performance. Results Penalized regression analysis suggested a screening tool that sums the Likert scale values of two PCL-5 questions-intrusive thoughts of the stressful experience (#1) and insomnia (#21). This had an AUROC of 0.85 (using hold-out test data) for predicting PTSD as evaluated by the MINI, which outperformed the PC-PTSD. The AUROC was similar in subgroups defined by age, sex, and number of categories of trauma experienced (all AUROCs>0.83) except those with no trauma history- AUROC was 0.78. Conclusion In some East African settings, a 2-item PTSD screening tool may outperform longer screeners and is easily scaled by a non-specialist workforce.
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Affiliation(s)
- Susan M. Meffert
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | | | | | - Thomas C. Neylan
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Daniel Mwai
- Department of Health Economics, University of Nairobi, Nairobi, Kenya
| | | | - Dickens Akena
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - Grace Rota
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - Ammon Otieno
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | | | | | | | | | - Dennis Oluoch
- Global Programs for Research and Training, Nairobi, Kenya
| | | | - Anne Mbwayo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - James G. Kahn
- Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Craig R. Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - David E. Bukusi
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Gregory A. Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Rachel L. Burger
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Chengshi Jin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
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4
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Devignes Q, Ren B, Clancy KJ, Howell K, Pollmann Y, Martinez-Sanchez L, Beard C, Kumar P, Rosso IM. Trauma-related intrusive memories and anterior hippocampus structural covariance: an ecological momentary assessment study in posttraumatic stress disorder. Transl Psychiatry 2024; 14:74. [PMID: 38307849 PMCID: PMC10837434 DOI: 10.1038/s41398-024-02795-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 02/04/2024] Open
Abstract
Trauma-related intrusive memories (TR-IMs) are hallmark symptoms of posttraumatic stress disorder (PTSD), but their neural correlates remain partly unknown. Given its role in autobiographical memory, the hippocampus may play a critical role in TR-IM neurophysiology. The anterior and posterior hippocampi are known to have partially distinct functions, including during retrieval of autobiographical memories. This study aimed to investigate the relationship between TR-IM frequency and the anterior and posterior hippocampi morphology in PTSD. Ninety-three trauma-exposed adults completed daily ecological momentary assessments for fourteen days to capture their TR-IM frequency. Participants then underwent anatomical magnetic resonance imaging to obtain measures of anterior and posterior hippocampal volumes. Partial least squares analysis was applied to identify a structural covariance network that differentiated the anterior and posterior hippocampi. Poisson regression models examined the relationship of TR-IM frequency with anterior and posterior hippocampal volumes and the resulting structural covariance network. Results revealed no significant relationship of TR-IM frequency with hippocampal volumes. However, TR-IM frequency was significantly negatively correlated with the expression of a structural covariance pattern specifically associated with the anterior hippocampus volume. This association remained significant after accounting for the severity of PTSD symptoms other than intrusion symptoms. The network included the bilateral inferior temporal gyri, superior frontal gyri, precuneus, and fusiform gyri. These novel findings indicate that higher TR-IM frequency in individuals with PTSD is associated with lower structural covariance between the anterior hippocampus and other brain regions involved in autobiographical memory, shedding light on the neural correlates underlying this core symptom of PTSD.
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Affiliation(s)
- Quentin Devignes
- Center for Depression, Anxiety and Stress Disorders, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Boyu Ren
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Psychiatric Biostatistics Laboratory, McLean Hospital, Belmont, MA, USA
| | - Kevin J Clancy
- Center for Depression, Anxiety and Stress Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kristin Howell
- Center for Depression, Anxiety and Stress Disorders, McLean Hospital, Belmont, MA, USA
| | - Yara Pollmann
- Center for Depression, Anxiety and Stress Disorders, McLean Hospital, Belmont, MA, USA
| | | | - Courtney Beard
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Poornima Kumar
- Center for Depression, Anxiety and Stress Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Isabelle M Rosso
- Center for Depression, Anxiety and Stress Disorders, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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5
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Isaac F, Toukhsati SR, Klein B, Di Benedetto M, Kennedy GA. Differences in Anxiety, Insomnia, and Trauma Symptoms in Wildfire Survivors from Australia, Canada, and the United States of America. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:38. [PMID: 38248503 PMCID: PMC10815777 DOI: 10.3390/ijerph21010038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/17/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024]
Abstract
Many survivors of wildfires report elevated levels of psychological distress following the trauma of wildfires. However, there is only limited research on the effects of wildfires on mental health. This study examined differences in anxiety, depression, insomnia, sleep quality, nightmares, and post-traumatic stress disorder (PTSD) symptoms following wildfires in Australia, Canada, and the United States of America (USA). One hundred and twenty-six participants from Australia, Canada, and the USA completed an online survey. The sample included 102 (81%) women, 23 (18.3%) men, and one non-binary (0.8%) individual. Participants were aged between 20 and 92 years (M age = 52 years, SD = 14.4). They completed a demographic questionnaire, the Disturbing Dream and Nightmare Severity Index (DDNSI), Generalized Anxiety Disorder Questionnaire (GAD-7), the Insomnia Severity Index (ISI), Patient Health Questionnaire (PHQ-9), the Pittsburgh Sleep Quality Index (PSQI), and PTSD Checklist (PCL-5). Results showed that participants from the USA scored significantly higher on the GAD-7 (p = 0.009), ISI (p = 0.003), and PCL-5 (p = 0.021) than participants from Australia and Canada. The current findings suggest a need for more international collaboration to reduce the severity of mental health conditions in Australia, Canada, and the USA.
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Affiliation(s)
- Fadia Isaac
- Institute of Health and Wellbeing, Federation University, Mt Helen, VIC 3350, Australia (G.A.K.)
| | - Samia R. Toukhsati
- Institute of Health and Wellbeing, Federation University, Mt Helen, VIC 3350, Australia (G.A.K.)
| | - Britt Klein
- Health Innovation and Transformation Centre, Federation University, Mt Helen, VIC 3350, Australia;
- Biopsychosocial & eHealth Research & Innovation (BeRI) Hub, Federation University, Mt Helen, VIC 3350, Australia
| | | | - Gerard A. Kennedy
- Institute of Health and Wellbeing, Federation University, Mt Helen, VIC 3350, Australia (G.A.K.)
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC 3083, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Melbourne, VIC 3084, Australia
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6
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Abstract
Sleep disturbances, namely insomnia and recurrent nightmares, are ubiquitous following trauma exposure and are considered hallmarks of posttraumatic stress disorder (PTSD). Other sleep disorders frequently co-occur with PTSD. This article describes research examining sleep problems most common in PTSD, including prevalence and clinical characteristics. Sleep disturbances are often robust to trauma-focused treatment; thus, evidence for psychological and pharmacological interventions for insomnia and nightmares in PTSD are discussed. Given the high prevalence of sleep problems in PTSD, more work is needed to empirically study putative mechanisms linking trauma exposure and sleep, as well as how to best target these symptoms in patients with PTSD.
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Affiliation(s)
- Christine J So
- Mental Illness Research, Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania (CJS, PRG), the Minneapolis VA Health Care System, Minneapolis, Minnesota (KEM), and the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (PRG)
| | - Katherine E Miller
- Mental Illness Research, Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania (CJS, PRG), the Minneapolis VA Health Care System, Minneapolis, Minnesota (KEM), and the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (PRG)
| | - Philip R Gehrman
- Mental Illness Research, Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania (CJS, PRG), the Minneapolis VA Health Care System, Minneapolis, Minnesota (KEM), and the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (PRG)
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7
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Reffi AN, Cheng P. Healthy sleep may bolster resilience to depression and posttraumatic stress disorder in new paramedics. Sleep 2023; 46:zsad064. [PMID: 36883766 DOI: 10.1093/sleep/zsad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Indexed: 03/09/2023] Open
Affiliation(s)
- Anthony N Reffi
- Division of Sleep Medicine, Thomas Roth Sleep Disorders & Research Center, Henry Ford Health, Detroit, MI, USA
| | - Philip Cheng
- Division of Sleep Medicine, Thomas Roth Sleep Disorders & Research Center, Henry Ford Health, Detroit, MI, USA
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8
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Schäfer SK, Lüder CC, Porcheret K, Hu X, Margraf J, Michael T, Holmes EA, Werner GG, Wilhelm I, Woud ML, Zeng S, Friesen E, Haim-Nachum S, Lass-Hennemann J, Lieb K, Kunzler AM, Wirth BE, Sopp MR. To sleep or not to sleep, that is the question: A systematic review and meta-analysis on the effect of post-trauma sleep on intrusive memories of analog trauma. Behav Res Ther 2023; 167:104359. [PMID: 37422952 DOI: 10.1016/j.brat.2023.104359] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/05/2023] [Accepted: 06/18/2023] [Indexed: 07/11/2023]
Abstract
Distressing intrusive memories of a traumatic event are one of the hallmark symptoms of posttraumatic stress disorder. Thus, it is crucial to identify early interventions that prevent the occurrence of intrusive memories. Both, sleep and sleep deprivation have been discussed as such interventions, yet previous studies yielded contradicting effects. Our systematic review aims at evaluating existing evidence by means of traditional and individual participant data (IPD) meta-analyses to overcome power issues of sleep research. Until May 16th, 2022, six databases were searched for experimental analog studies examining the effect of post-trauma sleep versus wakefulness on intrusive memories. Nine studies were included in our traditional meta-analysis (8 in the IPD meta-analysis). Our analysis provided evidence for a small effect favoring sleep over wakefulness, log-ROM = 0.25, p < .001, suggesting that sleep is associated with a lower number of intrusions but unrelated to the occurrence of any versus no intrusions. We found no evidence for an effect of sleep on intrusion distress. Heterogeneity was low and certainty of evidence for our primary analysis was moderate. Our findings suggest that post-trauma sleep has the potential to be protective by reducing intrusion frequency. More research is needed to determine the impact following real-world trauma and the potential clinical significance.
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Affiliation(s)
- Sarah K Schäfer
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany; Leibniz Institute for Resilience Research (LIR), Mainz, Germany; Technische Universität Braunschweig, Department of Clinical Psychology, Psychotherapy and Psychodiagnostics, Brunswick, Germany.
| | - Charina C Lüder
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany.
| | - Kate Porcheret
- Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Xiaoqing Hu
- Department of Psychology, The University of Hong Kong, Jockey Club Tower, Centennial Campus, Hong Kong, China; The State Key Laboratory of Brian and Cognitive Sciences, The University of Hong Kong, Jockey Club Tower, Centennial Campus, Hong Kong, China; HKU-Shenzhen Institute of Research and Innovation, Shenzhen, China.
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany; DZPG (German Center for Mental Health), Germany.
| | - Tanja Michael
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany.
| | - Emily A Holmes
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, Uppsala University, Uppsala, Sweden.
| | - Gabriela G Werner
- Department of Clinical Psychology & Psychotherapy, LMU Munich, Munich, Germany.
| | - Ines Wilhelm
- Division of Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland; Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany.
| | - Marcella L Woud
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany.
| | - Shengzi Zeng
- Department of Psychology, The University of Hong Kong, Jockey Club Tower, Centennial Campus, Hong Kong, China.
| | - Edith Friesen
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany.
| | - Shilat Haim-Nachum
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.
| | - Johanna Lass-Hennemann
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany.
| | - Klaus Lieb
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany; Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Angela M Kunzler
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany; Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Benedikt E Wirth
- Divison of Cognition & Action, Department of Psychology, Saarland University, Saarbrücken, Germany; Department of Cognitive Assistants, German Research Center for Artificial Intelligence (DFKI), Saarbrücken, Germany.
| | - M Roxanne Sopp
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany.
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9
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Singh L, Ahmed Pihlgren S, Holmes EA, Moulds ML. Using a daily diary for monitoring intrusive memories of trauma: A translational data synthesis study exploring convergent validity. Int J Methods Psychiatr Res 2023; 32:e1936. [PMID: 35976618 PMCID: PMC9976599 DOI: 10.1002/mpr.1936] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/16/2022] [Accepted: 08/01/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Intrusive memories are a core feature of posttraumatic stress disorder and have transdiagnostic relevance across mental disorders. Establishing flexible methods to monitor intrusions, including patterns and characteristics, is a key challenge. A daily diary has been developed in experimental settings to provide symptom count data, without the need for retrospective self-report over extended time periods (e.g., 1 week, 1 month). We conducted an exploratory, pre-registered data synthesis investigating convergence between the diary and questionnaire measures of intrusive symptoms long used in clinical practice (Impact of Event Scale, IES, and revised version, IES-R, Intrusion subscale). RESULTS Utilising datasets using the daily diary from 11 studies (4 real-world trauma studies, seven analogue trauma studies; total N = 578), we found significant positive associations between the diary and IES/IES-R Intrusion subscale. Exploratory analyses indicated that the magnitude of this association was stronger for the IES (vs. the IES-R), and in individuals with real-world (vs. analogue) trauma. CONCLUSION This study provides first evidence of convergent validity of a daily diary for monitoring intrusions with a widely used questionnaire. A diary may be a more flexible methodology to obtain information about intrusions (frequency, characteristics, triggers, content), relative to questionnaires which rely on retrospective reporting of symptoms over extended timeframes. We discuss potential benefits of daily monitoring of intrusions in clinical and research contexts.
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Affiliation(s)
- Laura Singh
- Department of Psychology, Uppsala University, Uppsala, Sweden.,Swedish Collegium for Advanced Study, Uppsala, Sweden
| | | | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Michelle L Moulds
- School of Psychology, UNSW Sydney, Sydney, New South Wales, Australia
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10
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Cohen H, Ephraim‐Oluwanuga OT, Akintunde OT, Gureje O, Matar MA, Todder D, Zohar J. The potential beneficial effect of sleep deprivation following traumatic events to preventing PTSD: Review of current insight regarding sleep, memory, and trauma resonating with ancient rituals-Àìsùn Oku (African) and Tsuya (Japanese). Neuropsychopharmacol Rep 2023; 43:2-11. [PMID: 36622038 PMCID: PMC10009425 DOI: 10.1002/npr2.12311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/17/2022] [Accepted: 12/05/2022] [Indexed: 01/10/2023] Open
Abstract
Sleep figures in numerous ancient texts, for example, Epic of Gilgamesh, and has been a focus for countless mystical and philosophical texts. Even in the present century, sleep remains one of the most complex behaviors whose function still remains to be further explored. Current hypotheses suggest that among other functions, sleep contributes to memory processes. Memory is a core topic of study in post-traumatic stress disorder (PTSD) and other stress-related phenomena. It is widely accepted that sleep plays a major role in the consolidation of newly encoded hippocampus-dependent memories to pre-existing knowledge networks. Conversely, sleep deprivation disrupts consolidation and impairs memory retrieval. Along this line, sleep deprivation following a potentially traumatic event may interfere with the consolidation of event-related memories and, thereby, may reduce long-term post-traumatic stress-related symptoms. This review consolidates clinical and animal studies on the relationships between sleep, sleep deprivation, memory processes, and trauma exposure while introducing new contemporary insights into an ancient African tribal ritual (Àìsùn Oku) and Japanese ceremony ritual (Tsuya). We propose that these findings, focusing specifically on the effects of sleep deprivation in the immediate aftermath of traumatic events, may be explored as a possible therapeutic measure. Along with a summary of the field questions on whether sleep is performed "to remember" or "to forget" we lay the rationale for using sleep deprivation as a clinical tool. A tool that may partially prevent the long-term persistence of these traumatic events' memory and thereby, at least partly, attenuating the development of PTSD.
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Affiliation(s)
- Hagit Cohen
- Ministry of Health, Anxiety and Stress Research Unit, Faculty of Health Sciences, Beer‐Sheva Mental Health CenterBen‐Gurion University of the NegevBeer‐ShevaIsrael
| | | | - Orunmuyi T. Akintunde
- Department of Nuclear Medicine, College of MedicineUniversity of IbadanIbadanNigeria
| | - Oye Gureje
- Department of PsychiatryCollege of Health Sciences University of AbujaAbujaNigeria
| | - Michael A. Matar
- Ministry of Health, Anxiety and Stress Research Unit, Faculty of Health Sciences, Beer‐Sheva Mental Health CenterBen‐Gurion University of the NegevBeer‐ShevaIsrael
| | - Doron Todder
- Ministry of Health, Anxiety and Stress Research Unit, Faculty of Health Sciences, Beer‐Sheva Mental Health CenterBen‐Gurion University of the NegevBeer‐ShevaIsrael
| | - Joseph Zohar
- Post‐Trauma Center, Sheba Medical CenterTel Aviv UniversityTel AvivIsrael
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11
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Davidson P, Marcusson-Clavertz D. The effect of sleep on intrusive memories in daily life: a systematic review and meta-analysis of trauma film experiments. Sleep 2023; 46:6844013. [PMID: 36420573 PMCID: PMC9905779 DOI: 10.1093/sleep/zsac280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/04/2022] [Indexed: 11/25/2022] Open
Abstract
STUDY OBJECTIVES To synthesize the literature on the effect of sleep versus wake on the frequency and distress of intrusive memories in everyday life after watching film clips with distressing content as a proxy for traumatic experiences. METHODS We conducted a systematic review by searching PubMed and PsychInfo. The last search was conducted on January 31, 2022. We included experimental studies comparing sleep and wake groups on intrusions using ecological diary methods, whereas studies lacking a wake control condition or relying solely on intrusion-triggering tasks or retrospective questionnaires were excluded. Meta-analyses were performed to evaluate the results. Risks of biases were assessed following the Cochrane guidelines. RESULTS Across 7 effect sizes from 6 independent studies, sleep (n = 192), as compared to wake (n = 175), significantly reduced the number of intrusive memories (Hedges' g = -0.26, p = .04, 95% CI [-0.50, -0.01]), but not the distress associated with them (Hedges' g = -0.14, p = .25, 95% CI [-0.38, 0.10]). CONCLUSIONS Although the results suggest that sleep reduces the number of intrusions, there is a strong need for high-powered pre-registered studies to confirm this effect. Risks of biases in the reviewed work concern the selection of the reported results, measurement of the outcome, and failure to adhere to the intervention. Limitations with the current meta-analysis include the small number of studies, which comprised only English-language articles, and the fact that it was not pre-registered.
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Affiliation(s)
- Per Davidson
- Department of Psychology, Lund University, Lund, Sweden.,Department of Psychiatry, Massachusetts General Hospital, MA, USA.,Department of Psychiatry, Harvard Medical School, MA, USA
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12
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Schenker MT, Theoswin PM, Qian H, Jordan AS, Nicholas CL, Felmingham KL. Sleep and day-to-day PTSD symptom variability: an ecological momentary assessment and actigraphy monitored study in trauma-exposed young adults. Eur J Psychotraumatol 2023; 14:2202058. [PMID: 37096587 PMCID: PMC10132228 DOI: 10.1080/20008066.2023.2202058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Disrupted sleep and post-traumatic stress disorder (PTSD) are bi-directionally linked and have been found to mutually reinforce each other on a day-to-day basis. However, most of the previous research has focused on subjective measures of sleep only. OBJECTIVE Here, we investigated the temporal relationship between sleep and PTSD symptoms using both subjective (sleep diary) and objective measures of sleep (actigraphy). METHODS Forty-one non-treatment seeking, trauma exposed young adults (age M = 24.68, SD = 8.15) with a range of PTSD symptom severities (PTSS, 0-53 on PCL-5) were recruited. Participants completed two surveys per day over four weeks to measure day-time PTSD symptoms (i.e. PTSS and number of intrusions) and night-time sleep subjectively, while wearing an actigraphy watch to measure sleep objectively. RESULTS Linear mixed models revealed that subjectively reported sleep disruptions were associated with elevated next-day PTSS and increasing number of intrusive memories both within and between participants. Similar results were found for daytime PTSD symptoms on night-time sleep. However, these associations were not found using objective sleep data. Exploratory moderator analyses including sex (male vs. female) found that these associations differed in strength between sexes but were generally in the same direction. DISCUSSION These results were in line with our hypothesis with regards to the sleep diary (subjective sleep), but not actigraphy (objective sleep). Several factors which have implications on both PTSD and sleep, such as the COVID-19 pandemic and/ or sleep-state misperception, may be potential reasons behind those discrepancies. However, this study had limited power and needs to be replicated in larger samples. Nonetheless, these results add to the current literature about the bi-directional relationship between sleep and PTSD and have clinical implications for treatment strategies.
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Affiliation(s)
- Maya T Schenker
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | | | - Hang Qian
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Amy S Jordan
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Christian L Nicholas
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Kim L Felmingham
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
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13
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Pace-Schott EF, Seo J, Bottary R. The influence of sleep on fear extinction in trauma-related disorders. Neurobiol Stress 2022; 22:100500. [PMID: 36545012 PMCID: PMC9761387 DOI: 10.1016/j.ynstr.2022.100500] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/21/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022] Open
Abstract
In Posttraumatic Stress Disorder (PTSD), fear and anxiety become dysregulated following psychologically traumatic events. Regulation of fear and anxiety involves both high-level cognitive processes such as cognitive reattribution and low-level, partially automatic memory processes such as fear extinction, safety learning and habituation. These latter processes are believed to be deficient in PTSD. While insomnia and nightmares are characteristic symptoms of existing PTSD, abundant recent evidence suggests that sleep disruption prior to and acute sleep disturbance following traumatic events both can predispose an individual to develop PTSD. Sleep promotes consolidation in multiple memory systems and is believed to also do so for low-level emotion-regulatory memory processes. Consequently sleep disruption may contribute to the etiology of PTSD by interfering with consolidation in low-level emotion-regulatory memory systems. During the first weeks following a traumatic event, when in the course of everyday life resilient individuals begin to acquire and consolidate these low-level emotion-regulatory memories, those who will develop PTSD symptoms may fail to do so. This deficit may, in part, result from alterations of sleep that interfere with their consolidation, such as REM fragmentation, that have also been found to presage later PTSD symptoms. Here, sleep disruption in PTSD as well as fear extinction, safety learning and habituation and their known alterations in PTSD are first briefly reviewed. Then neural processes that occur during the early post-trauma period that might impede low-level emotion regulatory processes through alterations of sleep quality and physiology will be considered. Lastly, recent neuroimaging evidence from a fear conditioning and extinction paradigm in patient groups and their controls will be considered along with one possible neural process that may contribute to a vulnerability to PTSD following trauma.
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Affiliation(s)
- Edward F. Pace-Schott
- Massachusetts General Hospital, Department of Psychiatry, Charlestown, MA, USA
- Harvard Medical School, Department of Psychiatry, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Corresponding author. Harvard Medical School, Massachusetts General Hospital - East, CNY 149 13th Street, Charlestown, MA, 02129, USA.
| | - Jeehye Seo
- Massachusetts General Hospital, Department of Psychiatry, Charlestown, MA, USA
- Harvard Medical School, Department of Psychiatry, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Korea University, Department of Brain & Cognitive Engineering, Seongbuk-gu, Seoul, South Korea
| | - Ryan Bottary
- Massachusetts General Hospital, Department of Psychiatry, Charlestown, MA, USA
- Harvard Medical School, Department of Psychiatry, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Psychology and Neuroscience, Boston College, Chestnut Hill, MA, USA
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14
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Swift KM, Thomas CL, Balkin TJ, Lowery-Gionta EG, Matson LM. Acute sleep interventions as an avenue for treatment of trauma-associated disorders. J Clin Sleep Med 2022; 18:2291-2312. [PMID: 35678060 PMCID: PMC9435330 DOI: 10.5664/jcsm.10074] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022]
Abstract
Scientific evidence that acute, posttrauma sleep disturbances (eg, nightmares and insomnia) can contribute significantly to the pathogenesis of trauma-induced disorders is compelling. Sleep disturbances precipitating from trauma are uniquely predictive of daytime posttrauma symptom occurrence and severity, as well as subsequent onset of mental health disorders, including post-traumatic stress disorder. Conversely, adequate sleep during the acute posttrauma period is associated with reduced likelihood of adverse mental health outcomes. These findings, which are broadly consistent with what is known about the role of sleep in the regulation of emotion, suggest that the acute posttrauma period constitutes a "window of opportunity" during which treatment of sleep disturbances may be especially effective for preventing or mitigating progression of aberrant psychophysiological processes. At this point, the weight of the scientific evidence supporting this possibility warrants initiation of clinical trials to confirm the benefits of targeted prophylactic sleep enhancement, and to establish treatment guidelines as appropriate. CITATION Swift KM, Thomas CL, Balkin TJ, Lowery-Gionta EG, Matson LM. Acute sleep interventions as an avenue for treatment of trauma-associated disorders. J Clin Sleep Med. 2022;18(9):2291-2312.
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Affiliation(s)
- Kevin M. Swift
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Connie L. Thomas
- Department of Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
- Department of Psychiatry, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Thomas J. Balkin
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Emily G. Lowery-Gionta
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Liana M. Matson
- Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland
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15
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Accelerated forgetting of a trauma-like event in healthy men and women after a single dose of hydrocortisone. Transl Psychiatry 2022; 12:354. [PMID: 36045119 PMCID: PMC9433412 DOI: 10.1038/s41398-022-02126-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 11/23/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is characterised by dysregulated hypothalamic-pituitary-adrenal axis activity and altered glucocorticoid receptor sensitivity. Early treatment with glucocorticoids may reduce PTSD risk, although the effect of such treatment on the aetiologically critical step of traumatic-memory-formation remains unclear. Here we examine the effects of exogenous cortisol (hydrocortisone) in a preclinical model of PTSD, using a factorial (Drug × Sex), randomised-controlled, double-blind design. Healthy men and women (n = 120) were randomised to receive 30 mg oral hydrocortisone or matched placebo immediately after watching a stressful film. Effects on film-related intrusions were assessed acutely in the lab, and ecologically using daily memory diaries for one week. We found that participants receiving hydrocortisone showed a faster reduction in daily intrusion frequency. Voluntary memory was assessed once, at the end of the week, but was unaffected by hydrocortisone. Exploratory analyses indicated sex-dependent associations between intrusions and baseline estradiol and progesterone levels. In men receiving hydrocortisone, higher baseline estradiol levels were associated with fewer intrusions, whereas women exhibited the opposite pattern. By contrast, progesterone levels were positively associated with intrusions only in men treated with hydrocortisone. The findings suggest that hydrocortisone promotes an accelerated degradation of sensory-perceptual representations underlying traumatic intrusive memories. In addition, while sex alone was not an important moderator, the combination of sex and sex-hormone levels (especially estradiol) influenced hydrocortisone's effects on involuntary aversive memories. Future well-powered experimental studies may provide a basis for a precision-psychiatry approach to optimising early post-traumatic glucocorticoid treatments that target intrusive memories, based on individual endocrinological profiles.
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16
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Cárdenas-Egúsquiza AL, Berntsen D. Sleep well, mind wander less: A systematic review of the relationship between sleep outcomes and spontaneous cognition. Conscious Cogn 2022; 102:103333. [PMID: 35623268 DOI: 10.1016/j.concog.2022.103333] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/03/2022]
Abstract
Despite an upsurge of research on spontaneous cognition, little is known about its associations with sleep-related outcomes. This systematic review, following PRISMA guidelines, examined the relationship between sleep and spontaneous thoughts, across different definitions and measurements of sleep outcomes and spontaneous cognition, and a diversity of methodologies. Twenty-one articles with survey and/or experimental designs were identified. Self-reported disturbed sleep-comprising poor sleep quality, more insomnia symptoms, more daytime sleepiness and a tendency towards eveningness-and experimentally induced sleep deprivation were associated with a tendency to engage in disruptive mind wandering and daydreaming, but not positive-constructive daydreaming. Findings regarding circadian fluctuation in spontaneous thoughts were mixed and inconclusive. This systematic review bridges the gap between the sleep and spontaneous cognition research by contributing to the understanding of potential psychological and cognitive mechanisms of spontaneous cognition, as well as by elucidating the emotional and cognitive consequences of disturbed sleep.
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Affiliation(s)
- Ana Lucía Cárdenas-Egúsquiza
- Department of Psychology and Behavioral Sciences, Center on Autobiographical Memory Research, Aarhus University, Denmark.
| | - Dorthe Berntsen
- Department of Psychology and Behavioral Sciences, Center on Autobiographical Memory Research, Aarhus University, Denmark
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17
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Luo Q, Chen J, Li Y, Wu Z, Lin X, Yao J, Yu H, Peng H, Wu H. Altered regional brain activity and functional connectivity patterns in major depressive disorder: A function of childhood trauma or diagnosis? J Psychiatr Res 2022; 147:237-247. [PMID: 35066292 DOI: 10.1016/j.jpsychires.2022.01.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 12/26/2022]
Abstract
Childhood trauma (CT) is a non-specific risk factor for major depressive disorder (MDD). However, the neurobiological mechanisms of MDD with CT remain unclear. In the present study, we sought to determine the specific brain regions associated with CT and MDD etiology. Fractional amplitude of low-frequency fluctuation (fALFF) and functional connectivity (FC) analyses were performed to assess alterations of intrinsic brain activity in MDD with CT, MDD without CT, healthy controls with CT, and healthy controls without CT. Two-by-two factorial analyses were performed to examine the effects of the factors "MDD" and "CT" on fALFF and FC. Moderator analysis was used to explore whether the severity of depression moderated the relationship between CT and aberrant fALFF. We found that the etiological effects of MDD and CT exhibited negative impacts on brain dysfunction including altered fALFF in the left postcentral gyrus, left lingual gyrus, left paracentral lobule (PCL), and left cuneus. Decreased FC was observed in the following regions: (i) the left lingual gyrus seed and the left fusiform gyrus as well as the right calcarine cortex; (ii) the left PCL seed and the left supplementary motor area, left calcarine cortex, left precentral gyrus, and right cuneus; (iii) the left postcentral gyrus seed and left superior parietal lobule, right postcentral gyrus, and left precentral gyrus. Furthermore, the severity of depression acted as a moderator in the relationship between CT and aberrant fALFF in the left PCL. These data indicate that MDD patients with and without trauma exposure are clinically and neurobiologically distinct.
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Affiliation(s)
- Qianyi Luo
- Department of Clinical Psychology, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, 510370, China
| | - Juran Chen
- Department of Clinical Psychology, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, 510370, China
| | - Yuhong Li
- Department of Clinical Psychology, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, 510370, China
| | - Zhiyao Wu
- Department of Clinical Psychology, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, 510370, China
| | - Xinyi Lin
- Department of Clinical Psychology, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, 510370, China
| | - Jiazheng Yao
- Department of Clinical Psychology, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, 510370, China
| | - Huiwen Yu
- Department of Clinical Psychology, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, 510370, China
| | - Hongjun Peng
- Department of Clinical Psychology, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, 510370, China.
| | - Huawang Wu
- Department of Radiology, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, 510370, China.
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18
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Hoppe JM, Walldén YS, Kanstrup M, Singh L, Agren T, Holmes EA, Moulds ML. Hotspots in the immediate aftermath of trauma – Mental imagery of worst moments highlighting time, space and motion. Conscious Cogn 2022; 99:103286. [DOI: 10.1016/j.concog.2022.103286] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 11/03/2022]
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19
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Saguin E, Gomez-Merino D, Sauvet F, Leger D, Chennaoui M. Sleep and PTSD in the Military Forces: A Reciprocal Relationship and a Psychiatric Approach. Brain Sci 2021; 11:brainsci11101310. [PMID: 34679375 PMCID: PMC8533994 DOI: 10.3390/brainsci11101310] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 11/29/2022] Open
Abstract
Sleep disturbances are well-recognised symptoms of Post-Traumatic Stress Disorder (PTSD). This review updates knowledge regarding the relationship between sleep during deployment, combat-related trauma, and PTSD in military personnel, from which the importance of restorative sleep results. The description of the characteristics of sleep in military forces with the considerable roles of the operational and training contexts highlights the important consequences of degraded sleep. Indeed, a lot of data suggest a dynamic link between sleep and the onset and chronicity of PTSD. We propose a reciprocal relationship model with strategies strongly recommended or already adopted by the military to promote restorative sleep before and after combat exposure. Among the alterations in a variety of sleep architecture and sleep patterns described in PTSD, the physiological hypothesis of REM sleep fragmentation in the development of PTSD symptoms may be important because REM sleep is generally associated with emotional memory. Finally, we address clinical and research perspectives that could be used to detect or restore sleep continuity before and during military deployment to possibly alleviate nightmares and insomnia related to combat exposure and PTSD occurrence and improve our understanding of sleep in PTSD.
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Affiliation(s)
- Emeric Saguin
- Psychiatric Department, Begin Military Teaching Hospital, 94160 Saint-Mandé, France
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, 75005 Paris, France
- Correspondence: ; Tel.: +33-0143985440
| | - Danielle Gomez-Merino
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, 75005 Paris, France
- French Armed Forces Biomedical Research Institute, 91220 Brétigny-sur-Orge, France; (D.G.-M.); (F.S.); (M.C.)
| | - Fabien Sauvet
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, 75005 Paris, France
- French Armed Forces Biomedical Research Institute, 91220 Brétigny-sur-Orge, France; (D.G.-M.); (F.S.); (M.C.)
| | - Damien Leger
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, 75005 Paris, France
- Centre du Sommeil et de la Vigilance, Hôtel-Dieu, APHP, 75004 Paris, France;
| | - Mounir Chennaoui
- VIFASOM (Vigilance Fatigue Sommeil et Santé Publique) EA 7330, Université de Paris, 75005 Paris, France
- French Armed Forces Biomedical Research Institute, 91220 Brétigny-sur-Orge, France; (D.G.-M.); (F.S.); (M.C.)
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20
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Weber FC, Wetter TC. The Many Faces of Sleep Disorders in Post-Traumatic Stress Disorder: An Update on Clinical Features and Treatment. Neuropsychobiology 2021; 81:85-97. [PMID: 34474413 PMCID: PMC9153357 DOI: 10.1159/000517329] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/17/2021] [Indexed: 11/19/2022]
Abstract
Sleep disorders and nightmares are core symptoms of post-traumatic stress disorder (PTSD). The relationship seems to be bidirectional, and persistent disturbed sleep may influence the course of the disorder. With regard to sleep quality, insomnia and nocturnal anxiety symptoms, as well as nightmares and stressful dreams, are the most prominent sleep symptoms. Polysomnographic measurements reveal alterations of the sleep architecture and fragmentation of rapid eye movement sleep. In addition, sleep disorders, such as sleep-related breathing disorders and parasomnias are frequent comorbid conditions. The complex etiology and symptomatology of trauma-related sleep disorders with frequent psychiatric comorbidity require the application of multimodal treatment concepts, including psychological and pharmacological interventions. However, there is little empirical evidence on the effectiveness of long-term drug treatment for insomnia and nightmares. For nondrug interventions, challenges arise from the current lack of PTSD-treatment concepts integrating sleep- and trauma-focused therapies. Effective therapy for sleep disturbances may consequently also improve well-being during the day and probably even the course of PTSD. Whether early sleep interventions exert a preventive effect on the development of PTSD remains to be clarified in future studies.
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Affiliation(s)
- Franziska C. Weber
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Thomas C. Wetter
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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21
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Sleep and fear conditioning, extinction learning and extinction recall: A systematic review and meta-analysis of polysomnographic findings. Sleep Med Rev 2021; 59:101501. [PMID: 34090064 DOI: 10.1016/j.smrv.2021.101501] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/30/2021] [Accepted: 04/28/2021] [Indexed: 11/21/2022]
Abstract
Sleep may contribute to the long-lasting consolidation and processing of emotional memories. Experimental fear conditioning and extinction paradigms model the development, maintenance, and treatment of anxiety disorders. The literature provides compelling evidence for the involvement of rapid eye movement (REM) sleep in the consolidation of such memories. This meta-analysis correlated polysomnographic sleep findings with psychophysiological reactivity to the danger (CS+) and safety stimuli (CS-), to clarify the specific role of sleep stages before and after fear conditioning, extinction learning and extinction recall. Overall, there was evidence that more pre-learning sleep stage two and less slow wave sleep was associated with higher psychophysiological reactivity to the safety stimulus during extinction learning. Preliminary evidence found here support the role of REM sleep during the post-extinction consolidation sleep phase in clinical populations with disrupted sleep, but not in healthy controls. Furthermore, the meta-regressions found that sex moderated the associations between sleep and psychophysiological reactivity throughout the paradigm providing evidence for diverging correlations in male and females. Specifically, increased post-extinction REM was associated with poorer extinction and safety recall in females while the opposite was found in males. These results have implications for future research in the role of sleep in emotional memory processing.
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22
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De Rozario MR, Van Velzen LS, Davies P, Rice SM, Davey CG, Robinson J, Alvarez-Jimenez M, Allott K, McKechnie B, Felmingham KL, Schmaal L. Mental images of suicide: Theoretical framework and preliminary findings in depressed youth attending outpatient care. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 4:100114. [PMID: 36567757 PMCID: PMC9785063 DOI: 10.1016/j.jadr.2021.100114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- MR De Rozario
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia,Corresponding author at: Centre for Youth Mental Health, University of Melbourne, 35 Poplar Rd, Parkville, Melbourne, VIC 3052, Australia. (M. De Rozario)
| | - LS Van Velzen
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - P Davies
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - SM Rice
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - CG Davey
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - J Robinson
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - M Alvarez-Jimenez
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - K Allott
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | | | - KL Felmingham
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - L Schmaal
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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23
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Davidson P, Pace-Schott E. Go to Bed and You MIGHT Feel Better in the Morning—the Effect of Sleep on Affective Tone and Intrusiveness of Emotional Memories. CURRENT SLEEP MEDICINE REPORTS 2021. [DOI: 10.1007/s40675-020-00200-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Abstract
Purpose of Review
It is important to examine what effect sleep has after an emotional experience. More knowledge about this topic could help inform us whether there are any potential sleep interventions that could help make sure that memories of negative emotional experiences are processed in the most adaptive manner possible.
Recent Findings
Findings on the role of sleep in altering reactivity to emotional stimuli have been highly varied, with significant findings in opposite directions. A new exciting development in the field is several studies finding that sleep seems to make memories of negative experiences less intrusive.
Summary
This review has mainly aimed to give an overview of the field, and of which issues need to be resolved. We argue for there being a strong need for standardization of how data are analyzed and presented, as well as for better methods for determining to what extent the effects of sleep are specific for a particular memory, or represent general changes in emotional reactivity.
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24
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Kanstrup M, Singh L, Göransson KE, Widoff J, Taylor RS, Gamble B, Iyadurai L, Moulds ML, Holmes EA. Reducing intrusive memories after trauma via a brief cognitive task intervention in the hospital emergency department: an exploratory pilot randomised controlled trial. Transl Psychiatry 2021; 11:30. [PMID: 33431807 PMCID: PMC7798383 DOI: 10.1038/s41398-020-01124-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/10/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023] Open
Abstract
Intrusive memories are common after trauma, and can cause significant distress. Interventions to prevent/reduce the occurrence of this core clinical feature of posttraumatic stress disorder are needed; they should be easy to deliver, readily disseminated and scalable. A novel one-session intervention by Iyadurai et al. 2018, Molecular Psychiatry, resulted in intrusion reduction over the subsequent week. Its feasibility in a different setting and longer-term effects (>1 month) need investigation. We conducted an exploratory open-label pilot randomised controlled trial (RCT) to investigate the feasibility and effects of a brief behavioural intervention to reduce intrusive memories in trauma-exposed patients in a Swedish hospital emergency department (ED). Participants (final N = 41) were randomly allocated to either intervention (including memory reminder cue then visuospatial cognitive task "Tetris" with mental rotation instructions) or active control (podcast) condition within 72 h of presenting to the ED (both conditions using their smartphone). Findings were examined descriptively. We estimated between-group effect sizes for the number of intrusive memories post-intervention at week 1 (primary outcome) and week 5 (secondary outcome). Compared to the control condition, participants in the intervention condition reported fewer intrusive memories of trauma, both at week 1 and week 5. Findings extend the previous evaluation in the UK. The intervention was readily implemented in a different international context, with a mixed trauma sample, with treatment gains maintained at 1 month and associated with some functional improvements. Findings inform future trials to evaluate the capacity of the cognitive task intervention to reduce the occurrence of intrusive memories after traumatic events.
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Affiliation(s)
- Marie Kanstrup
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Functional Area Medical Psychology, Karolinska University Hospital, Stockholm, Sweden.
| | - Laura Singh
- Department of Psychology, Uppsala University, Uppsala, Sweden.
| | - Katarina E Göransson
- Emergency and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Julia Widoff
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - Beau Gamble
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | | | - Michelle L Moulds
- School of Psychology, The University of New South Wales, UNSW Sydney, Sydney, Australia
| | - Emily A Holmes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
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Davidson P, Jönsson P, Carlsson I, Pace-Schott E. Does Sleep Selectively Strengthen Certain Memories Over Others Based on Emotion and Perceived Future Relevance? Nat Sci Sleep 2021; 13:1257-1306. [PMID: 34335065 PMCID: PMC8318217 DOI: 10.2147/nss.s286701] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/24/2021] [Indexed: 12/12/2022] Open
Abstract
Sleep has been found to have a beneficial effect on memory consolidation. It has furthermore frequently been suggested that sleep does not strengthen all memories equally. The first aim of this review paper was to examine whether sleep selectively strengthens emotional declarative memories more than neutral ones. We examined this first by reviewing the literature focusing on sleep/wake contrasts, and then the literature on whether any specific factors during sleep preferentially benefit emotional memories, with a special focus on the often-suggested claim that rapid eye movement sleep primarily consolidates emotional memories. A second aim was to examine if sleep preferentially benefits memories based on other cues of future relevance such as reward, test-expectancy or different instructions during encoding. Once again, we first focused on studies comparing sleep and wake groups, and then on studies examining the contributions of specific factors during sleep (for each future relevance paradigm, respectively). The review revealed that although some support exists that sleep is more beneficial for certain kinds of memories based on emotion or other cues of future relevance, the majority of studies does not support such an effect. Regarding specific factors during sleep, our review revealed that no sleep variable has reliably been found to be specifically associated with the consolidation of certain kinds of memories over others based on emotion or other cues of future relevance.
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Affiliation(s)
- Per Davidson
- Department of Psychology, Lund University, Lund, Sweden.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Peter Jönsson
- School of Education and Environment, Centre for Psychology, Kristianstad University, Kristianstad, Sweden
| | | | - Edward Pace-Schott
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
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26
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Optogenetic sleep enhancement improves fear-associated memory processing following trauma exposure in rats. Sci Rep 2020; 10:18025. [PMID: 33093538 PMCID: PMC7581760 DOI: 10.1038/s41598-020-75237-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/12/2020] [Indexed: 01/08/2023] Open
Abstract
Sleep disturbances are commonly found in trauma-exposed populations. Additionally, trauma exposure results in fear-associated memory impairments. Given the interactions of sleep with learning and memory, we hypothesized that increasing sleep duration following trauma exposure would restore overall function and improve trauma-induced fear-associated memory dysfunction. Here, we utilized single prolonged stress, a validated rodent model of post-traumatic stress disorder, in combination with optogenetic activation of hypothalamic melanin-concentrating hormone containing cells to increase sleep duration. The goal of this work was to ascertain if post-trauma sleep increases are sufficient to improve fear-associated memory function. In our laboratory, optogenetic stimulation after trauma exposure was sufficient to increase REM sleep duration during both the Light and Dark Phase, whereas NREM sleep duration was only increased during the Dark Phase of the circadian day. Interestingly though, animals that received optogenetic stimulation showed significantly improved fear-associated memory processing compared to non-stimulated controls. These results suggest that sleep therapeutics immediately following trauma exposure may be beneficial and that post-trauma sleep needs to be further examined in the context of the development of post-traumatic stress disorder.
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Singh L, Espinosa L, Ji JL, Moulds ML, Holmes EA. Developing thinking around mental health science: the example of intrusive, emotional mental imagery after psychological trauma. Cogn Neuropsychiatry 2020; 25:348-363. [PMID: 32847486 DOI: 10.1080/13546805.2020.1804845] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION One route to advancing psychological treatments is to harness mental health science, a multidisciplinary approach including individuals with lived experience and end users (e.g., Holmes, E. A., Craske, M. G., & Graybiel, A. M. (2014). Psychological treatments: A call for mental-health science. Nature, 511(7509), 287-289. doi:10.1038/511287a). While early days, we here illustrate a line of research explored by our group-intrusive imagery-based memories after trauma. METHOD/RESULTS We illustrate three possible approaches through which mental health science may stimulate thinking around psychological treatment innovation. First, focusing on single/specific target symptoms rather than full, multifaceted psychiatric diagnoses (e.g., intrusive trauma memories rather than all of posttraumatic stress disorder). Second, investigating mechanisms that can be modified in treatment (treatment mechanisms), rather than those which cannot (e.g., processes only linked to aetiology). Finally, exploring novel ways of delivering psychological treatment (peer-/self-administration), given the prevalence of mental health problems globally, and the corresponding need for effective interventions that can be delivered at scale and remotely for example at times of crisis (e.g., current COVID-19 pandemic). CONCLUSIONS These three approaches suggest options for potential innovative avenues through which mental health science may be harnessed to recouple basic and applied research and transform treatment development.
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Affiliation(s)
- Laura Singh
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Lisa Espinosa
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Julie L Ji
- School of Psychological Science, The University of Western Australia, UWA Perth, Australia
| | - Michelle L Moulds
- School of Psychology, The University of New South Wales, UNSW Sydney, Australia
| | - Emily A Holmes
- Department of Psychology, Uppsala University, Uppsala, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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