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

Study Overview
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Brief Summary
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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).

Official Title
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The Nightmare Catcher: Modulating Dreams With Targeted Memory Reactivation

Conditions
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Nightmares, REM-Sleep Type

Intervention / Treatment
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* Behavioral: Imagery Rehearsal Therapy and Targeted memory reactivation during REM sleep
* Behavioral: Imagery Rehearsal Therapy


Participation Criteria
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Eligibility Criteria
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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.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: TMR group<br>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<br>* 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.<br>|
| Active Comparator: Control group<br>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<br>* These patients will receive the classic treatment of Imagery Rehearsal Therapy (IRT) for nightmares without any association with a sound.<br>|

What is the study measuring?
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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 |