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Hansen M, Simon KR, He X, Steele N, Thomas ML, Noble KG, Merz EC. Socioeconomic factors, sleep timing and duration, and amygdala resting-state functional connectivity in children. Front Psychiatry 2024; 15:1373546. [PMID: 38840942 PMCID: PMC11150855 DOI: 10.3389/fpsyt.2024.1373546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/08/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Reduced sleep health has been consistently linked with increased negative emotion in children. While sleep characteristics have been associated with neural function in adults and adolescents, much less is known about these associations in children while considering socioeconomic context. In this study, we examined the associations among socioeconomic factors, sleep duration and timing, and resting-state functional connectivity (rsFC) of the amygdala in children. Methods Participants were typically-developing 5- to 9-year-olds from socioeconomically diverse families (61% female; N = 94). Parents reported on children's weekday and weekend bedtimes and wake-up times, which were used to compute sleep duration and midpoint. Analyses focused on amygdala-anterior cingulate cortex (ACC) connectivity followed by amygdala-whole brain connectivity. Results Lower family income-to-needs ratio and parental education were significantly associated with later weekday and weekend sleep timing and shorter weekday sleep duration. Shorter weekday sleep duration was associated with decreased amygdala-ACC and amygdala-insula connectivity. Later weekend sleep midpoint was associated with decreased amygdala-paracingulate cortex and amygdala-postcentral gyrus connectivity. Socioeconomic factors were indirectly associated with connectivity in these circuits via sleep duration and timing. Discussion These results suggest that socioeconomic disadvantage may interfere with both sleep duration and timing, in turn possibly altering amygdala connectivity in emotion processing and regulation circuits in children. Effective strategies supporting family economic conditions may have benefits for sleep health and brain development in children.
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Affiliation(s)
- Melissa Hansen
- Department of Psychology, Colorado State University, Fort Collins, CO, United States
| | - Katrina R. Simon
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Xiaofu He
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Nick Steele
- Molecular, Cellular and Integrative Neuroscience, Colorado State University, Fort Collins, CO, United States
| | - Michael L. Thomas
- Department of Psychology, Colorado State University, Fort Collins, CO, United States
| | - Kimberly G. Noble
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States
| | - Emily C. Merz
- Department of Psychology, Colorado State University, Fort Collins, CO, United States
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Matsui M, Ishii K, Suzuki K, Togashi K. Chronotype and emotional/behavioral problems mediate the association between leisure screen time and academic achievement in children. Chronobiol Int 2024; 41:513-520. [PMID: 38380819 DOI: 10.1080/07420528.2024.2320231] [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: 09/21/2023] [Accepted: 02/12/2024] [Indexed: 02/22/2024]
Abstract
Leisure screen time is associated with poor academic achievement; however, the mechanism underlying this relationship is unclear. Chronotypes and emotional/behavioral problems may be linked to this association. This study aimed to examine the associations between leisure screen time, chronotype, emotional/behavioral problems, and academic achievement using mediation analysis. A total of 113 children aged 9-12 years participated in this study. All participants were assessed for leisure screen time, chronotype, emotional/behavioral problems, and academic achievement. Leisure screen time was evaluated using a self-reported questionnaire. Chronotypes were measured using The Japanese Children's Chronotype Questionnaire, and the morningness/eveningness (M/E) score was calculated. Emotional/behavioral problems were assessed using The Japanese Strengths and Difficulties Questionnaire, and the total difficulties score (TDS) was calculated. Academic achievement was assessed by the homeroom teacher for each of the seven school subjects. Partial correlation analysis adjusted for grade, sex, and sleep duration indicated that leisure screen time was associated with M/E scores and academic achievement (p < 0.05). There was a positive association between M/E score and TDS (p < 0.05) and a negative association between TDS and academic achievement (p < 0.05). A mediation analysis adjusted for grade, sex, and sleep duration was performed. There was a significant total effect of leisure screen time on academic achievement (p < 0.05). Additionally, the M/E score and TDS significantly mediated the association between leisure screen time and academic achievement (p < 0.05). Our findings suggest that the serial path between chronotype and emotional/behavioral problems weakly but significantly mediates the association of leisure screen time with academic achievement.
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Affiliation(s)
- Masahiro Matsui
- Institute of Health and Sports Science & Medicine, Juntendo University, Chiba, Japan
- Institute of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan
| | - Kaori Ishii
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Koya Suzuki
- Institute of Health and Sports Science & Medicine, Juntendo University, Chiba, Japan
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Cheung FTW, Li X, Hui TK, Chan NY, Chan JW, Wing YK, Li SX. Circadian preference and mental health outcomes in youth: A systematic review and meta-analysis. Sleep Med Rev 2023; 72:101851. [PMID: 37793219 DOI: 10.1016/j.smrv.2023.101851] [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: 01/25/2023] [Revised: 07/10/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023]
Abstract
Youth is a vulnerable developmental period associated with an increased preference for eveningness and risk for developing psychopathology. Growing evidence suggests a link between eveningness and poorer mental health outcomes, but the findings in the current literature are inconsistent, and a comprehensive synthesis of evidence in this area remains lacking. This meta-analysis aimed to 1) synthesise the existing evidence on the association between circadian preference and mental health outcomes in youths and 2) explore potential sleep-related factors that may moderate the relationship between circadian preference and mental health outcomes. A systematic search of five electronic databases resulted in 81 observational studies included in the review. Eveningness was found to be significantly associated with general mental health (r = 0.20), mood-related disturbances (r = 0.17), and anxiety problems (r = 0.13). The qualitative review also identified that eveningness was associated with greater risks for psychotic symptoms and maladaptive eating behaviours. These findings highlighted the need to consider circadian preference in the clinical management of youth mental health problems. Further research is needed to examine the efficacy of a circadian-focused intervention in the context of youth mental health.
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Affiliation(s)
- Forrest Tin Wai Cheung
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong.
| | - Xiao Li
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong
| | - Tsz Kwan Hui
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong
| | - Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Joey Wy Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Shirley Xin Li
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong.
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Friesen E, Sopp MR, Cordi MJ, Rasch B, Michael T. Sleep-Directed Hypnosis Improves Subjective Sleep Quality but not Extinction Memory After Exposure to Analog Trauma. COGNITIVE THERAPY AND RESEARCH 2023. [DOI: 10.1007/s10608-022-10345-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Abstract
Background
Evidence-based treatments of posttraumatic stress disorder (PTSD) aim to promote fear extinction learning. Post-learning sleep, particularly slow wave sleep (SWS), promotes memory consolidation and recall. Thus, boosting SWS might strengthen extinction recall. The current study investigated whether sleep-directed hypnosis designed to increase SWS and sleep quality improves extinction recall and reduces analog PTSD symptoms.
Method
In two subsamples (remote/laboratory), 211 healthy individuals underwent fear conditioning with a traumatic film clip. On the next evening, they underwent extinction training. Thereafter, the experimental group received sleep-directed hypnosis, whereas the control group listened to a control text. Extinction recall and generalization and film-related intrusions and rumination were assessed on the following morning.
Results
Subjective sleep quality declined following exposure to an aversive film. No group differences were found in SWS though exploratory analyses indicated less rapid eye movement sleep after hypnosis. After hypnosis, the experimental group reported improved sleep quality, whereas the control group showed a further deterioration. Hypnosis had no effects on extinction retention and generalization nor on analog intrusions and rumination.
Conclusion
The current results indicate that sleep-directed hypnosis may be beneficial for improving subjective sleep quality after trauma but not for enhancing extinction memory and reducing analog PTSD symptoms.
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Abstract
Sleep plays a crucial role in the consolidation of memories, including those for fear acquisition and extinction training. This chapter reviews findings from studies testing this relationship in laboratory, naturalistic, and clinical settings. While evidence is mixed, several studies in humans have linked fear and extinction recall/retention to both rapid eye-movement and slow wave sleep. Sleep appears to further aid in the processing of both simulated and actual trauma and improves psychotherapeutic treatment outcomes in those with anxiety and trauma- and stressor-related disorders. This chapter concludes with a discussion of the current challenges facing sleep and emotional memory research in addition to suggestions for improving future research.
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Affiliation(s)
- Ryan Bottary
- Department of Psychology and Neuroscience, Boston College, Chestnut Hill, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Laura D Straus
- Department of Research, San Francisco VA Health Care System, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Edward F Pace-Schott
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA.
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA.
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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: 4.0] [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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Lucifora C, Grasso GM, Nitsche MA, D'Italia G, Sortino M, Salehinejad MA, Falzone A, Avenanti A, Vicario CM. Enhanced fear acquisition in individuals with evening chronotype. A virtual reality fear conditioning/extinction study. J Affect Disord 2022; 311:344-352. [PMID: 35561887 DOI: 10.1016/j.jad.2022.05.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/09/2022] [Accepted: 05/05/2022] [Indexed: 11/18/2022]
Abstract
Circadian rhythms have received increasing attention within the context of mental disorders. Evening chronotype has been associated with enhanced risk to develop anxiety and post-traumatic stress disorder (PTSD). The classical fear conditioning paradigm is a powerful tool to reveal key mechanisms of anxiety and PTSD. We used this paradigm to study the neurocognitive basis of the association between chronotype and fear responses in healthy humans. 20 participants with evening chronotype and 20 controls (i.e., intermediate chronotype) completed a 2-day Pavlovian fear learning and extinction virtual reality task. Participants received fear conditioning, and extinction learning on day 1. Extinction memory recall was tested on day 2. To address interactions between chronotype and time of day of the fear conditioning, and extinction performance, half of the participants were tested in the morning, and the other half in the evening. Skin conductance response (SCR) and subjective fear ratings were measured as primary outcomes. Chronotype was established via the morningness-eveningness questionnaire (MEQ). We found an overall higher SCR for fear acquisition in participants with the evening chronotype profile, compared to controls. Moreover, the higher the MEQ scores -indicative of less eveningness - the lower the SCR was. No effects of chronotype were found for extinction and extinction recall. The higher vulnerability of the evening chronotype for anxiety and related disorders may thus be explained by enhanced fear acquisition of this group.
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Affiliation(s)
- Chiara Lucifora
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, 98121 Messina, Italy
| | - Giorgio M Grasso
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, 98121 Messina, Italy
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Center for Working Environment and Human Factors, Ardeystr. 67, 44139 Dortmund, Germany
| | - Giovanni D'Italia
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, 98121 Messina, Italy
| | - Mauro Sortino
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, 98121 Messina, Italy
| | - Mohammad A Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Center for Working Environment and Human Factors, Ardeystr. 67, 44139 Dortmund, Germany
| | - Alessandra Falzone
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, 98121 Messina, Italy
| | - Alessio Avenanti
- Centro Studi e Ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia, Alma Mater Studiorum - Università di Bologna, Campus di Cesena, 47521 Cesena, Italy; Centro de Investigación en Neuropsicología y Neurociencias Cognitivas, Universidad Católica Del Maule, 346000 Talca, Chile
| | - Carmelo M Vicario
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, 98121 Messina, Italy.
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Dutcher CD, Dowd SM, Zalta AK, Taylor DJ, Rosenfield D, Perrone A, Otto MW, Pollack MH, Hofmann SG, Smits JAJ. Sleep quality and outcome of exposure therapy in adults with social anxiety disorder. Depress Anxiety 2021; 38:1182-1190. [PMID: 34010494 PMCID: PMC8560555 DOI: 10.1002/da.23167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 04/29/2021] [Accepted: 05/07/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Poor sleep is prevalent among individuals with social anxiety disorder (SAD) and may negatively affect exposure therapy outcomes. Poor sleep may impair memory and learning, and thus compromise fear extinction learning thought to take place in exposure therapy. We examined poor sleep as a predictor of exposure therapy outcomes for SAD and the moderating role of d-cycloserine (DCS) on this relationship. METHODS Participants were 152 individuals with a primary diagnosis of SAD. As part of a randomized clinical trial evaluating the efficacy of DCS for enhancing the effects of exposure therapy, they completed self-report baseline measure of sleep quality, and self-report sleep diaries assessing sleep duration (total sleep time [TST]) and sleep quality the nights before and after treatment sessions. RESULTS Poorer baseline sleep quality was significantly associated with slower improvement over time and worse symptom outcomes at the end of treatment and follow-up after controlling for baseline symptoms of depression and social anxiety. Greater TST the night before treatment predicted lower SAD symptoms at the next session, after controlling for symptoms at the previous session. There was no relation between prior or subsequent night sleep quality on symptoms at the next session. No associations were moderated by DCS. CONCLUSIONS We replicated and extended findings indicating that poor sleep quality is associated with poorer exposure therapy outcomes for SAD. Assessing for sleep difficulties before treatment initiation and incorporating sleep interventions into treatment may enhance exposure therapy outcomes for SAD.
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Affiliation(s)
- Christina D. Dutcher
- Institute for Mental Health Research and Department of Psychology, The University of Texas at Austin, Austin, USA
| | - Sheila M. Dowd
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, USA
| | - Alyson K. Zalta
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, USA
- Department of Psychological Science, University of California, Irvine, USA
| | - Daniel J. Taylor
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, USA
| | - Alexander Perrone
- Institute for Mental Health Research and Department of Psychology, The University of Texas at Austin, Austin, USA
| | - Michael W. Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
| | - Mark H. Pollack
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, USA
| | - Stefan G. Hofmann
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
| | - Jasper A. J. Smits
- Institute for Mental Health Research and Department of Psychology, The University of Texas at Austin, Austin, USA
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Zhou L, Zhang H, Luo Z, Liu X, Yang L, Hu H, Wang Y, Wang C, Wang F. Abnormal night sleep duration and inappropriate sleep initiation time are associated with elevated anxiety symptoms in Chinese rural adults: the Henan Rural Cohort. Psychiatry Res 2020; 291:113232. [PMID: 32574900 DOI: 10.1016/j.psychres.2020.113232] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 06/10/2020] [Accepted: 06/13/2020] [Indexed: 12/20/2022]
Abstract
Sleep problems have been demonstrated to cause mental symptoms, such as anxiety. However, research on the association of the night sleep duration and sleep initiation time on anxiety symptoms in rural China is still lacking. The current study, therefore, explored the independent and combined association of the night sleep duration and sleep initiation time on anxiety symptoms. This study included 28, 054 participants from the Henan Rural Cohort. Sleep was measured using the Pittsburgh Sleep Quality Index (PSQI). Anxiety was assessed by the two-item Generalized Anxiety Disorder scale (GAD-2). Multivariable logistic regression models and restricted cubic spline with anxiety symptoms as a dependent variable were fitted. Among the participants in this study, 11, 209 (39.96%) were males, and 16,845 (60.04%) were females, 1574 (5.61%) had anxiety symptoms. Both shorter and longer night sleep duration were significantly related to elevated prevalence of anxiety symptoms. Extreme sleep initiation time was also significantly associated with elevated anxiety symptoms. Additionally, night sleep duration and sleep initiation time had a combined effect on the prevalent anxiety symptoms. In conclusion, there was a dose-response association of night sleep duration and sleep initiation time with anxiety among Chinese rural population. Moreover, they might jointly increase the odds of prevalent anxiety.
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Affiliation(s)
- Li Zhou
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, PR. China
| | - Haiqing Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhicheng Luo
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Liuye Yang
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, PR. China
| | - Haiyuan Hu
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, PR. China
| | - Yan Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
| | - Fang Wang
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, PR. China.
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Exposure therapy vs lifestyle intervention to reduce food cue reactivity and binge eating in obesity: A pilot study. J Behav Ther Exp Psychiatry 2020; 67:101453. [PMID: 30732912 DOI: 10.1016/j.jbtep.2019.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/18/2018] [Accepted: 01/17/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Learning models of overeating predict that exposure therapy is effective in reducing food cue reactivity and overeating. This pilot study tested an eight-session exposure therapy aimed at inhibitory learning vs. an active control condition aimed at lifestyle improvement for obesity (treatment-as-usual). Main outcomes are snacking behavior, eating psychopathology, food cue reactivity, and weight loss. Change in overeating expectancies was assessed as mediator for outcomes, and the associations between habituation of eating desires and outcomes were investigated in the exposure condition. Sleep quality was investigated as moderator for outcomes. METHODS 45 overweight women were randomly assigned to the exposure intervention or control condition. The main outcomes, overeating expectancies and sleep quality were re-assessed at post-treatment and three-month follow-up. Habituation of eating desires was measured during exposure sessions. RESULTS Compared to the control intervention, exposure led to a significantly stronger reduction in snacking behavior of exposed foods, though this effect did not generalize to non-exposed foods, and stronger binge eating frequency. The exposure condition lost significantly more weight at post-treatment and follow-up than the lifestyle condition. Changes of expectancies mediated the effect of condition on kcal consumption of exposed foods, while habituation during exposure was not related to better treatment outcome. Sleep quality did not moderate the effect of condition on treatment outcome. LIMITATIONS Small sample size and limited follow-up period. CONCLUSIONS This short exposure therapy reduced snacking behavior, binge eating and weight more than a lifestyle intervention and is therefore a recommendable intervention for obesity and overeating disorders.
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Social Jetlag is Independently Associated with Chronotype and Poor Memory for Extinguished Fear. EXPERIMENTAL RESULTS 2020. [DOI: 10.1017/exp.2020.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AbstractSocial jetlag (SJ) occurs when sleep-timing irregularities from social or occupational demands conflict with endogenous sleep–wake rhythms. SJ is associated with evening chronotype and poor mental health, but mechanisms supporting this link remain unknown. Impaired ability to retrieve extinction memory is an emotion regulatory deficit observed in some psychiatric illnesses. Thus, SJ-dependent extinction memory deficits may provide a mechanism for poor mental health. To test this, healthy male college students completed 7–9 nights of actigraphy, sleep questionnaires, and a fear conditioning and extinction protocol. As expected, greater SJ, but not total sleep time discrepancy, was associated with poorer extinction memory. Unexpectedly, greater SJ was associated with a tendency toward morning rather than evening chronotype. These findings suggest that deficient extinction memory represents a potential mechanism linking SJ to psychopathology and that SJ is particularly problematic for college students with a greater tendency toward a morning chronotype.
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Davidson P, Pace-Schott E. The role of sleep in fear learning and memory. Curr Opin Psychol 2019; 34:32-36. [PMID: 31568938 DOI: 10.1016/j.copsyc.2019.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/06/2019] [Accepted: 08/15/2019] [Indexed: 12/14/2022]
Abstract
During the last 10 years, a large body of studies have used fear conditioning paradigms to study the role of sleep in the consolidation of fear and safety learning. This line of research could allow us to answer if it is adaptive or not to sleep in the aftermath of a negative experience, and if sleep has a role in consolidating extinction learning. This field has so far produced several contrasting findings. Thus, this review will not deliver many clear conclusions, but will instead be an attempt to summarize what we know at the moment, to describe the potential clinical applications of this research, and to discuss where to go from here.
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Affiliation(s)
- Per Davidson
- Department of Psychiatry, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA; Department of Psychiatry, Harvard Medical School, 149 13th Street, Charlestown, MA 02129, USA; Department of Psychology, Lund University, Box 213, 221 00, Lund, Sweden.
| | - Edward Pace-Schott
- Department of Psychiatry, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA; Department of Psychiatry, Harvard Medical School, 149 13th Street, Charlestown, MA 02129, USA
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Seo J, Moore KN, Gazecki S, Bottary RM, Milad MR, Song H, Pace-Schott EF. Delayed fear extinction in individuals with insomnia disorder. Sleep 2019; 41:5026048. [PMID: 29860407 DOI: 10.1093/sleep/zsy095] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Indexed: 11/13/2022] Open
Abstract
Study Objectives Insomnia increases the risk for anxiety disorders that are also associated with fear-extinction deficits. We compared activation of fear and extinction networks between insomnia disorder (ID) without comorbidity and good sleepers (GS). Methods Twenty-three ID participants age- and sex-matched to 23 GS participants completed 14 days of actigraphy and diaries, three nights of ambulatory polysomnography and a 2-day fear conditioning and extinction paradigm. Fear conditioning and extinction learning occurred on the first day, followed 24 hours later by extinction recall. Blood-oxygen-level-dependent functional magnetic resonance imaging (fMRI) signal and skin conductance responses (SCR) were recorded. Nineteen participants per group produced usable fMRI data. Beta weights from areas where activation differed between groups were regressed against sleep and psychophysiological measures. SCR was compared between groups at various stages of the paradigm. Results During fear conditioning, both ID (N = 19) and GS (N = 19) activated fear-related structures. Across extinction learning, ID (N = 19) demonstrated little change, whereas GS (N = 16) activated both fear and extinction-related areas, including the hippocampus, insula, dorsal anterior cingulate (dACC), and ventromedial prefrontal (vmPFC) cortices. During extinction recall, while GS (N = 17) demonstrated limited activation, ID (N = 16) activated regions similar to those previously activated in GS (vmPFC, dACC, insula). Sleep quality was predictive of activations seen at various stages of the paradigm. SCR data suggested ID were more physiologically reactive than GS. Conclusions Across extinction learning, GS but not ID activated both fear and extinction-related networks. At extinction recall, ID engaged similar regions whereas GS no longer did so. Individuals with ID may show a delayed acquisition of fear extinction memories.
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Affiliation(s)
- Jeehye Seo
- Department of Psychiatry, Massachusetts General Hospital, Charlestown MA.,Department of Psychiatry, Harvard Medical School, Charlestown, MA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
| | - Kylie N Moore
- Department of Psychiatry, Massachusetts General Hospital, Charlestown MA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
| | - Samuel Gazecki
- Department of Psychiatry, Massachusetts General Hospital, Charlestown MA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
| | - Ryan M Bottary
- Department of Psychiatry, Massachusetts General Hospital, Charlestown MA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
| | - Mohammed R Milad
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
| | - Huijin Song
- Institute of Biomedical Engineering Research, Kyungpook National University, Daegu, Korea
| | - Edward F Pace-Schott
- Department of Psychiatry, Massachusetts General Hospital, Charlestown MA.,Department of Psychiatry, Harvard Medical School, Charlestown, MA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA
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14
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Norbury R, Evans S. Time to think: Subjective sleep quality, trait anxiety and university start time. Psychiatry Res 2019; 271:214-219. [PMID: 30502557 DOI: 10.1016/j.psychres.2018.11.054] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/22/2018] [Accepted: 11/22/2018] [Indexed: 01/31/2023]
Abstract
Poor quality sleep is related to mental health and there is increasing interest in student wellbeing and mental health. The aim of the current study was to evaluate sleep quality, daytime dozing, anxiety proneness, chronotype and preferred start time in a sample of university students. A total of 546 university students (age range, 18-55) from two university located in South East England were included and completed an online survey. Participants' self-reported age, gender, year and field of study. Sleep quality, anxiety, daytime dozing, coffee/caffeine/tobacco use (coded as binary variables), preferred start time and chronotype were also recorded. Data were analysed using independent samples t-tests, chi-square, simple mediation-analyses and Analysis of Variance. Across the entire sample 46% percent of participants rated their sleep as fairly bad or very bad. Poor quality sleep was associated with significantly higher levels of anxiety which was not mediated by chronotype. Poor quality sleep is more prevalent in the first year of university and our sample endorsed a start time for university activities approximately 2 h later than currently timetabled. The current findings demonstrate that a large proportion of students are chronically sleep deprived, obtaining, on average, less than 7 h sleep per night on week days and this was more marked in first year students. In addition, we show that poor sleep is associated with increased anxiety. Based on the current evidence the authors suggest a review of current university timetabling and examination scheduling merits immediate consideration by policy makers and educators.
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Affiliation(s)
- Ray Norbury
- Department of Psychology, University of Roehampton, London, UK, SW15 4JD.
| | - Simon Evans
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK, GU2 7XH
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15
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Abstract
PURPOSE OF REVIEW Evening chronotype is increasingly recognized as a correlate of, and perhaps a contributor to, mental illness. The current review evaluates recent evidence for the association between chronotype and mental illness and putative mechanisms underlying the association, while highlighting methodological advances and areas of research that are relatively under-examined in the literature. RECENT FINDINGS While evening chronotype is most consistently associated with severity of mood disorder symptoms, emerging evidence implicates evening chronotype as a transdiagnostic correlate of substance use severity, anxiety symptoms, attentional difficulties, and maladaptive behaviors such as aggression. Longitudinal studies point to the possibility that evening chronotype precedes problematic substance use, depression, and anxiety. Neural processes related to reward and affective regulation may underlie associations between evening chronotype and illness. The literature on chronotype and mental illness has evolved to (1) include associations with a broader range of psychiatric symptom profiles; (2) explore underlying mechanisms; and (3) expand on earlier research using objective measures and more sophisticated study designs. In addition to further mechanistic research, additional work is needed to examine the stability and key subcomponents of the chronotype construct, as well as more attention to pediatric and special populations. This research is needed to clarify the chronotype-mental health relationship, and to identify how, when, and what aspects of chronotype can be targeted via therapeutic interventions.
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16
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Azad-Marzabadi E, Amiri S. Morningness-eveningness and emotion dysregulation incremental validity in predicting social anxiety dimensions. Int J Gen Med 2017; 10:275-279. [PMID: 28919804 PMCID: PMC5593450 DOI: 10.2147/ijgm.s144376] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study investigates the usefulness of morningness–eveningness and emotion dysregulation for better understanding of social anxiety dimensions. Specifically, associations between morningness–eveningness and incremental validity of emotion dysregulation as a predictor of social anxiety were examined. Data were obtained from a sample of normal students (N=510). Results of regression analyses showed that morningness was a significant predictor of social anxiety variables. Dimensions of emotion dysregulation had multiple associations with facets from social anxiety. Emotion dysregulation was found to be a positive predictor of social anxiety. The results expand the understanding of social anxiety and indicate how the domains of morningness–eveningness and emotion regulation could explain social anxiety in a normal population.
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Affiliation(s)
| | - Sohrab Amiri
- Faculty of Literature and Humanities, Urmia University, Urmia, Iran
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17
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Baranger DAA, Margolis S, Hariri AR, Bogdan R. An earlier time of scan is associated with greater threat-related amygdala reactivity. Soc Cogn Affect Neurosci 2017; 12:1272-1283. [PMID: 28379578 PMCID: PMC5597858 DOI: 10.1093/scan/nsx057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/25/2017] [Accepted: 04/02/2017] [Indexed: 12/13/2022] Open
Abstract
Time-dependent variability in mood and anxiety suggest that related neural phenotypes, such as threat-related amygdala reactivity, may also follow a diurnal pattern. Here, using data from 1,043 young adult volunteers, we found that threat-related amygdala reactivity was negatively coupled with time of day, an effect which was stronger in the left hemisphere (β = -0.1083, p-fdr = 0.0012). This effect was moderated by subjective sleep quality (β = -0.0715, p-fdr = 0.0387); participants who reported average and poor sleep quality had relatively increased left amygdala reactivity in the morning. Bootstrapped simulations suggest that similar cross-sectional samples with at least 300 participants would be able to detect associations between amygdala reactivity and time of scan. In control analyses, we found no associations between time and V1 activation. Our results provide initial evidence that threat-related amygdala reactivity may vary diurnally, and that this effect is potentiated among individuals with average to low sleep quality. More broadly, our results suggest that considering time of scan in study design or modeling time of scan in analyses, as well as collecting additional measures of circadian variation, may be useful for understanding threat-related neural phenotypes and their associations with behavior, such as fear conditioning, mood and anxiety symptoms, and related phenotypes.
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Affiliation(s)
- David A. A. Baranger
- BRAIN Laboratory, Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
- Division of Biology and Biomedical Sciences, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Seth Margolis
- BRAIN Laboratory, Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Ahmad R. Hariri
- Laboratory of NeuroGenetics, Department of Psychology and Neuroscience, Duke University, Durham, NC 27708, USA
| | - Ryan Bogdan
- BRAIN Laboratory, Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
- Division of Biology and Biomedical Sciences, Washington University in St. Louis, St. Louis, MO 63110, USA
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18
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Pace-Schott EF, Zimmerman JP, Bottary RM, Lee EG, Milad MR, Camprodon JA. Resting state functional connectivity in primary insomnia, generalized anxiety disorder and controls. Psychiatry Res 2017; 265:26-34. [PMID: 28500965 PMCID: PMC5505504 DOI: 10.1016/j.pscychresns.2017.05.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/05/2017] [Accepted: 05/07/2017] [Indexed: 11/17/2022]
Abstract
Sleep abnormalities are extremely common in anxiety disorders and may contribute to their development and persistence. Their shared pathophysiological mechanisms could thus serve as biomarkers or targets for novel therapeutics. Individuals with Primary Insomnia were age- and sex-matched to controls and to persons with Generalized Anxiety Disorder. All underwent fMRI resting-state scans at 3-T. In Primary Insomnia and controls, sleep was recorded for 2 weeks using diaries and actigraphy. All participants completed state-anxiety and neuroticism inventories. Whole-brain connectivity of 6 fear- and extinction-related seeds were compared between the 3 groups using ANOVA. The only significant between-group main effect was seen for connectivity between the left amygdala seed and a bilateral cluster in the rostral anterior cingulate cortex. The latter is believed to exert top-down control over amygdala activity and their interaction may thus constitute an emotion regulatory circuit. This connectivity was significantly greatest in controls while Primary Insomnia was intermediate between that of controls and Generalized Anxiety Disorder. Across Primary Insomnia and control subjects, mean connectivity decreased with poorer sleep. Across all 3 groups, connectivity decreased with greater neuroticism and pre-scan anxiety. Decreased top-down control of the amygdala may increase risk of developing an anxiety disorder with preexisting Primary Insomnia.
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Affiliation(s)
- Edward F Pace-Schott
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; MGH/HST Martinos Center for Biomedical Imaging, Charlestown, MA, USA.
| | - Jared P Zimmerman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; MGH/HST Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Ryan M Bottary
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; MGH/HST Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Erik G Lee
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; MGH/HST Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Mohammed R Milad
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; MGH/HST Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Joan A Camprodon
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA; MGH/HST Martinos Center for Biomedical Imaging, Charlestown, MA, USA
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19
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Cremone A, de Jong DM, Kurdziel LBF, Desrochers P, Sayer A, LeBourgeois MK, Spencer RMC, McDermott JM. Sleep Tight, Act Right: Negative Affect, Sleep and Behavior Problems During Early Childhood. Child Dev 2017; 89:e42-e59. [PMID: 28129449 DOI: 10.1111/cdev.12717] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Temperamental negative affect and insufficient sleep have been independently associated with behavior problems during early childhood. However, it is unknown whether these factors interact to contribute to behavioral difficulties in young children. The current study examined the interactions between temperamental negative affect and both sleep onset time and sleep midpoint, assessed by actigraphy, in predicting externalizing and internalizing behaviors in a sample of 117 children (34-69 months of age). Children with high temperamental negative affect and either later sleep onset time or later sleep midpoint were more likely to exhibit externalizing and internalizing behaviors. These results emphasize the association between temperamental negative affect and behavioral difficulties, particularly for children with insufficient sleep.
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20
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Müller MJ, Olschinski C, Kundermann B, Cabanel N. Patterns of self-reported depressive symptoms in relation to morningness-eveningness in inpatients with a depressive disorder. Psychiatry Res 2016; 239:163-8. [PMID: 27082274 DOI: 10.1016/j.psychres.2016.03.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/16/2016] [Accepted: 03/07/2016] [Indexed: 01/22/2023]
Abstract
The stable and persisting preference for activities in the late evening (i.e. eveningness) is associated with a higher risk for depression, suicidality, and non-remission in major depression. The present study investigated symptom patterns in hospitalized patients with depressive syndromes in relation to morningness-eveningness (chronotypes). Depressive symptoms (Beck Depression Inventory [BDI-II]) and chronotype (German version of the Morningness-Eveningness Questionnaire [D-MEQ]) were assessed after admission and before discharge in inpatients with mainly major depression. Group differences of BDI-II single items and three BDI-II factors (cognitive, affective, somatic) between patients divided at the D-MEQ sample median into "morning preference" (MP) and "evening preference" (EP) were calculated. Data from 64 consecutively admitted patients (31MP/33EP) were analyzed. Both groups (MP/EP) were comparable regarding age, sex, diagnosis, length of stay, and subjective sleep quality, BDI-II scores were significantly higher in EP than in MP at admission. At admission and discharge, cognitive symptoms were significantly more pronounced in EP vs. MP; non-significant differences between EP and MP were found for affective and somatic symptoms. The results underline the importance of the trait-like chronotype for severity and symptomatology in patients with depressive disorders. The patients' chronotype should be taken into account in diagnostics and treatment of depressive disorders.
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Affiliation(s)
- Matthias Johannes Müller
- Vitos Clinical Centre for Psychiatry and Psychotherapy Giessen-Marburg, Germany; Faculty of Medicine, University of Giessen, Giessen, Germany.
| | | | - Bernd Kundermann
- Vitos Clinical Centre for Psychiatry and Psychotherapy Giessen-Marburg, Germany
| | - Nicole Cabanel
- Vitos Clinical Centre for Psychiatry and Psychotherapy Giessen-Marburg, Germany
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21
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Zuj DV, Palmer MA, Hsu CMK, Nicholson EL, Cushing PJ, Gray KE, Felmingham KL. IMPAIRED FEAR EXTINCTION ASSOCIATED WITH PTSD INCREASES WITH HOURS-SINCE-WAKING. Depress Anxiety 2016; 33:203-10. [PMID: 26744059 DOI: 10.1002/da.22463] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/14/2015] [Accepted: 12/06/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Prior research has demonstrated that time-of-day may play an important role in the extinction of conditioned fear, with extinction better learned earlier in the day rather than later. Impaired fear extinction memory is widely considered a key mechanism of posttraumatic stress disorder (PTSD). The relationship between fear extinction and PTSD symptoms may be moderated by hours-since-waking. METHOD In the present experiment, we examined whether hours-since-waking would moderate fear extinction learning ability in a clinical PTSD sample (n = 15), compared to trauma-exposed (n = 33) and nonexposed controls (n = 22). Participants completed a standardized differential fear conditioning and extinction paradigm, providing skin conductance response measures to quantify conditioned responding. RESULTS Mixed-model analysis of variance revealed a PTSD-specific impairment in extinction learning ability in the late extinction phase. A moderation analysis showed that hours-since-waking was a significant moderator of the relationship between impaired late extinction and PTSD symptoms. Specifically, we found that participants with higher PTSD symptoms demonstrated poorer fear extinction learning ability as they were awake for longer. CONCLUSIONS The results of the current study add to a growing literature indicating deficits in fear extinction learning in PTSD samples, compared to trauma-exposed and nonexposed controls. These results support previous findings that fear extinction is impaired later in the day, and extends this to a clinical sample, suggesting that exposure-therapy may be optimized by scheduling sessions in the morning.
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Affiliation(s)
- Daniel V Zuj
- Division of Psychology, School of Medicine, University of Tasmania, Australia
| | - Matthew A Palmer
- Division of Psychology, School of Medicine, University of Tasmania, Australia
| | - Chia-Ming K Hsu
- Division of Psychology, School of Medicine, University of Tasmania, Australia
| | - Emma L Nicholson
- Division of Psychology, School of Medicine, University of Tasmania, Australia
| | - Pippa J Cushing
- Division of Psychology, School of Medicine, University of Tasmania, Australia
| | - Kate E Gray
- Division of Psychology, School of Medicine, University of Tasmania, Australia
| | - Kim L Felmingham
- Division of Psychology, School of Medicine, University of Tasmania, Australia
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22
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Pace-Schott EF. Analog Flashbacks. Sleep 2015; 38:997-9. [PMID: 26085293 DOI: 10.5665/sleep.4792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 05/26/2015] [Indexed: 12/12/2022] Open
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23
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Pace-Schott EF, Germain A, Milad MR. Sleep and REM sleep disturbance in the pathophysiology of PTSD: the role of extinction memory. BIOLOGY OF MOOD & ANXIETY DISORDERS 2015; 5:3. [PMID: 26034578 PMCID: PMC4450835 DOI: 10.1186/s13587-015-0018-9] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/12/2015] [Indexed: 01/04/2023]
Abstract
Post-traumatic stress disorder (PTSD) is accompanied by disturbed sleep and an impaired ability to learn and remember extinction of conditioned fear. Following a traumatic event, the full spectrum of PTSD symptoms typically requires several months to develop. During this time, sleep disturbances such as insomnia, nightmares, and fragmented rapid eye movement sleep predict later development of PTSD symptoms. Only a minority of individuals exposed to trauma go on to develop PTSD. We hypothesize that sleep disturbance resulting from an acute trauma, or predating the traumatic experience, may contribute to the etiology of PTSD. Because symptoms can worsen over time, we suggest that continued sleep disturbances can also maintain and exacerbate PTSD. Sleep disturbance may result in failure of extinction memory to persist and generalize, and we suggest that this constitutes one, non-exclusive mechanism by which poor sleep contributes to the development and perpetuation of PTSD. Also reviewed are neuroendocrine systems that show abnormalities in PTSD, and in which stress responses and sleep disturbance potentially produce synergistic effects that interfere with extinction learning and memory. Preliminary evidence that insomnia alone can disrupt sleep-dependent emotional processes including consolidation of extinction memory is also discussed. We suggest that optimizing sleep quality following trauma, and even strategically timing sleep to strengthen extinction memories therapeutically instantiated during exposure therapy, may allow sleep itself to be recruited in the treatment of PTSD and other trauma and stress-related disorders.
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Affiliation(s)
- Edward F. Pace-Schott
- />Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital—East, CNY 149 13th Street Room 2624, Charlestown, MA 02129 USA
| | - Anne Germain
- />Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA USA
| | - Mohammed R. Milad
- />Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital—East, CNY 149 13th Street Room 2624, Charlestown, MA 02129 USA
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