Mental Imagery and Targeted Memory Reactivation in PTSD

Augmentation of Imagery Rehearsal Therapy With Targeted Memory Reactivation for Post-Traumatic Stress Disorder (PTSD)

With this protocol, investigators examine whether targeted memory reactivation (TMR), a technique used to strengthen memories, can accelerate remission of traumatic nightmares and post-traumatic stress disorder (PTSD) symptomatology. This protocol uses TMR during REM sleep to strengthen positive memories generated by Imagery Rehearsal Therapy (IRT), a recommended treatment of nightmares. Patients with PTSD are asked to perform 3 weekly IRT sessions and, while they generate a positive outcome of their recurrent nightmare, half of the patients are exposed to a sound S1 (TMR group), while the other half is not exposed to this sound (control group). All patients will perform IRT every evening at home and will be exposed to the sound S1 during REM sleep with a wireless headband, which automatically detects sleep stages. Clinical evaluation of the severity of PTSD and nightmares before and after (1-month follow-up and 3-months follow-up) this intervention takes place using the validated Clinically Administered PTSD Scale for DSM-5 (CAPS-5, primary outcome measure). The investigators hypothesize that patients treated with IRT and who are exposed, during REM sleep to a sound that had previously been associated with the new positive dream scenario of IRT (TMR group), will have more reduced frequency of PTSD severity and nightmares compared to participants with stimulation of the same, but non-associated, sound during REM sleep (control group).

Study Overview

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

• Study Type: Interventional
• Enrollment (Actual): 46
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Switzerland
  • Geneva, Switzerland
    • Center for Sleep Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• with untreated persistent PTSD according to DSM-5 (> 1 month), suffering from chronic nightmares
• with no active specific treatment for PTSD

Exclusion Criteria:

• patients with active specific treatment for PTSD
• patients with neurological disorders

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 S1 while they generate a positive outcome of imagery rehearsal therapy (IRT). They will also receive the sound S1 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 a sound S1 is associated with a waking experience (i.e., a positive outcome of imagery rehearsal therapy in this study) and strengthening it during REM sleep, the investigators want to accelerate the remission of traumatic nightmares and PTSD symptomatology.
Active Comparator: Control group; Patients will not receive the sound S1 while they generate a positive outcome of imagery rehearsal therapy (IRT). During REM sleep, they will receive the same sound as the experimental group (S1) under the same conditions.	Behavioral: Imagery Rehearsal Therapy; These patients will receive the classic treatment of Imagery Rehearsal Therapy (IRT) for nightmares without association with the sound S1.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Clinician-Administered PTSD Scale for DSM-5	Validated questionnaire that assesses PTSD symptoms, the score ranges from 0-80, zero indicating no symptom severity and 80 indicating the higher symptom severity.	1 month
Clinician-Administered PTSD Scale for DSM-5	Validated questionnaire that assesses PTSD symptoms, the score ranges from 0-80, zero indicating no symptom severity and 80 indicating the higher symptom severity.	3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Nightmare Frequency	Number of nightmares per week	1 month
Nightmare Frequency	Number of nightmares per week	3 months
Positive emotions in dreams	Use of a dream diary	1 month
Positive emotions in dreams	Use of a dream diary	3 months
Nightmare Distress Questionnaire	Validated self-report scale to assess the emotional disturbance attributed to the nightmares, the score ranges from 0-52, zero indicating no symptom severity and 52 indicating the higher symptom severity.	1 month
Nightmare Distress Questionnaire	Validated self-report scale to assess the emotional disturbance attributed to the nightmares, the score ranges from 0-52, zero indicating no symptom severity and 52 indicating the higher symptom severity.	3 months
PTSD Checklist for DSM5	Validated self-report measure of PTSD, the score ranges from 0-80, zero indicating no symptom severity and 80 indicating the higher symptom severity.	1 month
PTSD Checklist for DSM5	Validated self-report measure of PTSD, the score ranges from 0-80, zero indicating no symptom severity and 80 indicating the higher symptom severity.	3 months
Beck Depression Inventory	Validated self-report scale to assess depressive symptoms, the score ranges from 0-63, zero indicating no symptom severity and 63 indicating the higher symptom severity.	1 month
Beck Depression Inventory	Validated self-report scale to assess depressive symptoms, the score ranges from 0-63, zero indicating no symptom severity and 63 indicating the higher symptom severity.	3 months
Pittsburgh Sleep Quality Index	Validated self-report scale to assess the quality of sleep, the score ranges from 0-21, zero indicating no symptom severity and 21 indicating the higher symptom severity.	1 month
Pittsburgh Sleep Quality Index	Validated self-report scale to assess the quality of sleep, the score ranges from 0-21, zero indicating no symptom severity and 21 indicating the higher symptom severity.	3 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Sleep efficiency	The ratio between total sleep time and total bed time	1 month
REM arousal index	The ratio between number of arousals in stage REM x 60 and REM duration	1 month
Arousal index	The ratio between number of arousals in sleep x 60 and sleep duration	1 month

Collaborators and Investigators

• Sponsor: University Hospital, Geneva

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2023
• Primary Completion (Actual): July 27, 2025
• Study Completion (Actual): October 27, 2025

Study Registration Dates

• First Submitted: June 20, 2023
• First Submitted That Met QC Criteria: June 27, 2023
• First Posted (Actual): July 6, 2023

Study Record Updates

• Last Update Posted (Actual): March 4, 2026
• Last Update Submitted That Met QC Criteria: March 2, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Trauma and Stressor Related Disorders; Mental Disorders; Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
• Other Study ID Numbers: 2019-02270_TR

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