MGH Trauma-related Nightmares SDI Study
Condition: Posttraumatic Stress Disorder
MeSH terms: Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      Interested individuals will first complete a telephone screening followed by a series of
      structured clinical interviews to diagnose PTSD and comorbid psychiatric disorders, confirm
      initial inclusion criteria, rule out exclusion criteria and create an audio-recorded account
      of their index trauma. Participants passing screenings will then complete 2 weeks of at-home
      sleep and nightmare diaries and time-stamped audio-recorded reports of dream content upon
      awakening from any nightmare. They will also wear a wrist actigraph throughout this period,
      complete 2 nights of ambulatory PSG, and complete on-line questionnaires. Nightmare data will
      be examined for frequency and thematic similarity of nightmares to a participant's reported
      index trauma. Participants' nightmare and index trauma reports will be audio-recorded for use
      as scripts during SDI. The participant will then undergo two SDI sessions on a single day,
      one with a nightmare script and one with an index-trauma script, during which they will wear
      the NINscan. Sessions will be separated by 1 hour and counterbalanced across participants for
      script order.
    

Detailed description: 
      Trauma-related nightmares (TRNs) are a hallmark re-experiencing symptom of Posttraumatic
      Stress Disorder (PTSD) and a severe, re-traumatizing source of distress to those with this
      condition. Proposed research will investigate whether such nightmares might serve as targets
      for imaginal exposure during prolonged exposure therapy (PE), a first-line treatment for
      PTSD. Learning and memory of fear extinction are the neurocognitive underpinnings of PE and
      increased physiological arousal during PE can aid in extinction learning. Thus, PE using TRNs
      might enhance treatment outcomes because of the greater immediacy and salience of nightmares
      relative to the more temporally distant traumatic event. Our research group has developed
      standardized script-driven imagery (SDI) procedures whereby the degree of psychophysiological
      arousal induced by recollection of the traumatic event that precipitated posttraumatic
      symptoms (index trauma) can be assessed. Our team has also developed a novel ambulatory
      device, the NINscan, that can record skin conductance (SC), facial electromyography (EMG) and
      electrocardiography (ECG) along with simultaneous functional near-infrared spectroscopic
      (fNIRS) imaging of the lateral prefrontal cortex (LPFC). The LPFC encompasses regions that
      activate and/or deactivate during SDI in persons with PTSD and includes the right inferior
      frontal gyrus (rIFG), an area that plays an important role in inhibiting unwanted behavior
      and cognition and shows reduced inhibitory performance in PTSD. Following screenings that
      include a structured clinical evaluation establishing PTSD diagnosis and self-report of a
      least 2 TRNs per week, qualified participants will record an account of their index trauma.
      They will then complete 2 weeks of sleep diaries and wrist actigraphy with 4 nights of
      ambulatory polysomnography (PSG), during which they will audio-record, on a time-stamped
      digital recorder, a detailed nightmare report following any nightmare-induced awakening. A
      TRN report having sufficient length, clarity and resemblance to the index trauma will be
      selected and, along with the index-trauma report, will be re-recorded as a script for SDI.
      Only participants who generated a TRN suitable for SDI (N=40) will then undergo 2 SDI
      sessions on a single day while wearing the NINscan. One script will be derived from their
      index trauma and the other from their TRN, the order of which will be counterbalanced across
      participants. Psychophysiological response and fNIRS LPFC activation will be compared between
      scripts using 2 primary outcome measures: (1) a validated canonical psychophysiological
      variable combining SC, EMG and ECG, and (2) script-related activation of the rIFC. We
      hypothesize that both activations will be greater for the TRN than for the index-trauma
      script. Exploratory aims will include (1) examination of the sleep stage and
      electroencephalographic characteristics of sleep preceding awakenings when a nightmare
      occurred on a night with PSG.
    

Intervention name(s): imaginal probe
Intervention type(s): Other
Intervention description(s): trauma and nightmare imaginal probe/challenge for which psychophysiological and CNS responses are recorded
Intervention model: Single Group Assignment
Intervention model description: Single group study of trauma nightmares, sleep and psychophysiological and neural (fNIRS) responses to imagery of actual trauma and of trauma-related nightmares. Within-subject comparison of psychophysiological and neural responses to imagery of trauma compared to trauma-related nightmare and imagery of unrelated neutral content. Correlational study of psychophysiological and neural responses with clinical self-report measures.
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: nightmares; script driven imagery; functional near-infrared spectroscopy; psychophysiology; polysomnography; sleep