Combined Treatment of Nightmares With Targeted Memory Reactivation and Imagery Rehearsal Therapy

The Nightmare Catcher: Modulating Dreams With Targeted Memory Reactivation

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 Overview

• Status: Completed
• Conditions: Nightmares, REM-Sleep Type
• Intervention / Treatment: Behavioral: Imagery Rehearsal Therapy and Targeted memory reactivation during REM sleep; Behavioral: Imagery Rehearsal Therapy

• Study Type: Interventional
• Enrollment (Actual): 36
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Switzerland
  • Geneva, Switzerland, 1225
    • Center for Sleep Medicine, University Hospitals of Geneva

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 60 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Diagnosis of nightmare disorder according to the International Classification of Sleep Disorders (ICSD-3) diagnostic and coding manual
• Patients with at least moderate severity (>1 episode per week)

Exclusion Criteria:

• severe depression
• insomnia disorder
• psychosis or anxiety disorder
• other sleep disorder (e.g.,obstructive sleep apnea syndrome, restless legs syndrome)
• neurological disease
• use of medications that would be likely to produce nightmares (e.g. hypnotics, β-blockers, amphetamines, antimicrobial agents)
• use of anxiolytics, antipsychotic or antidepressant medication were excluded.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: TMR group; Patients will receive a sound while they generate a positive outcome of imagery rehearsal therapy (IRT). They will also receive the sound during REM sleep.	Behavioral: Imagery Rehearsal Therapy and Targeted memory reactivation during REM sleep; 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.
Active Comparator: Control group; Patients will not receive a sound while they generate a positive outcome of imagery rehearsal therapy (IRT). They will receive the same sound as the experimental group during REM sleep under the same conditions.	Behavioral: Imagery Rehearsal Therapy; These patients will receive the classic treatment of Imagery Rehearsal Therapy (IRT) for nightmares without any association with a sound.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Nightmare Frequency Questionnaire (NFQ)	Validated self-report scale to assess the number of nightmares per week	2 weeks
Nightmare Frequency Questionnaire (NFQ)	Validated self-report scale to assess the number of nightmares per week	3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Nightmare Distress Questionnaire (NDQ)	Validated self-report scale to assess the emotional disturbance attributed to the nightmares	2 weeks
Beck Depression Inventory (BDI-II)	Validated self-report scale to assess depressive symptoms	2 weeks
Pittsburgh Sleep Quality Index (PSQI)	Validated self-report scale to assess the quality of sleep	2 weeks
Proportion of the emotion 'joy' in dreams	Use of a dream diary	2 weeks
Proportion of the emotion 'fear' in dreams	Use of a dream diary	2 weeks
Nightmare Distress Questionnaire (NDQ)	Validated self-report scale to assess the emotional disturbance attributed to the nightmares	3 months
Beck Depression Inventory (BDI-II)	Validated self-report scale to assess depressive symptoms	3 months
Pittsburgh Sleep Quality Index (PSQI)	Validated self-report scale to assess the quality of sleep	3 months

Collaborators and Investigators

• Sponsor: University Hospital, Geneva

Study record dates

Study Major Dates

• Study Start (Actual): February 1, 2020
• Primary Completion (Actual): January 31, 2022
• Study Completion (Actual): January 31, 2022

Study Registration Dates

• First Submitted: February 2, 2022
• First Submitted That Met QC Criteria: February 11, 2022
• First Posted (Actual): February 14, 2022

Study Record Updates

• Last Update Posted (Actual): February 14, 2022
• Last Update Submitted That Met QC Criteria: February 11, 2022
• Last Verified: February 1, 2022

More Information

Terms related to this study

• Other Study ID Numbers: 2019-02270

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No