Consolidation/reconsolidation therapies for the prevention and treatment of PTSD and re-experiencing: a systematic review and meta-analysis

Reconsolidation of Traumatic Memories in the Treatment of Complex Post-traumatic Stress Disorder (CPTSD): A Case Study

This case study explores the memory reconsolidation-based technique of reconsolidation of traumatic memories (RTM) to address complex post-traumatic stress disorder (CPTSD). Using the framework of CPTSD and the components of International Trauma Questionnaire (ITQ), several presenting symptoms and the history of childhood trauma (adverse childhood experiences assessment) were assessed. The individual, based on the trauma-informed care approach, went through a total of eight sessions after the initial consultation that included RTM on index trauma events, reframing, and self-regulation techniques. CPTSD and several internalizing symptoms were measured before and after the intervention. The findings suggest that memory reconsolidation-based RTM protocol, coupled with the constructs of CPTSD using ITQ and index trauma, could provide benefits for individuals with symptoms from prolonged exposure to trauma during childhood.

Reducing intrusive memories and promoting posttraumatic growth with Traveler: A randomized controlled study

Over recent decades, serious games have become a promising intervention approach for addressing psychological problems by providing users with computerized, engaging, and interactive experiences. An innovative serious game, Traveler, has been developed specifically as an intervention tool for managing posttraumatic responses immediately after trauma. The game incorporates the principle of visuospatial interference, the core elements of Tetris, such as spatial displacement and mental rotation, and the critical phases of eye movement desensitization and reprocessing. To test the intervention efficacy and feasibility of Traveler, we conducted a randomized controlled trial involving 105 young adults. Participants were randomly assigned into three groups: a wait-list control group, a group undergoing five-session written exposure therapy, or a group engaging in one session of Traveler gameplay. Outcome measures included intrusive memories (i.e. vividness of traumatic images, disgust at traumatic images, flashback frequency, and flashback impact) and posttraumatic growth measured by the Posttraumatic Growth Inventory. Traveler significantly outperformed the control and written exposure therapy groups in reducing intrusive memories and enhancing posttraumatic growth, with effects persisting at a 30-day follow-up. Thus, Traveler offers a promising brief and early intervention technique for addressing posttraumatic responses. Yet, its clinical applicability requires further investigation.

A systematic review and meta-analysis of experimental methods for modulating intrusive memories following lab-analogue trauma exposure in non-clinical populations

Experiencing trauma leads to intrusive memories (IMs), a hallmark symptom of post-traumatic stress disorder (PTSD), which also occurs transdiagnostically. Understanding why IMs increase or decrease is pivotal in developing interventions to support mental health. In this preregistered meta-analysis (PROSPERO: CRD42021224835), we included 134 articles (131 techniques, 606 effect sizes and 12,074 non-clinical participants) to investigate how experimental techniques alter IM frequency, intrusion-related distress and symptoms arising from lab-analogue trauma exposure. Eligible articles were identified by searching eight databases until 12 December 2023. To test potential publication biases, we employed methods including Egger's test and three-parameter selection models. We employed three-level multilevel modelling and meta-regressions to examine whether and how experimental techniques would modulate IM frequency and associated outcomes. Results showed that techniques (behavioural, pharmacological, neuromodulation) significantly reduced intrusion frequency (g = 0.16, 95% confidence interval [0.09, 0.23]). Notably, techniques aimed to reduce IMs also ameliorated intrusion-related distress and symptoms, while techniques that increased IMs exacerbated these related outcomes, thus highlighting IM's centrality in PTSD-like symptoms. Techniques tapping into mental imagery processing (for example, trauma reminder followed by playing Tetris) reduced intrusions when administered immediately after, or at a delayed time after trauma. Although our meta-analysis is limited to symptoms induced by lab-analogue trauma exposure, some lab-based results have now generalized to real-world trauma and IMs, highlighting the promising utility of lab-analogue trauma paradigms for intervention development.

How to distinguish promotion, prevention and treatment trials in public mental health? Study protocol for the development of the VErona-LUgano Tool (VELUT)

INTRODUCTION

Promoting mental health, preventing and treating mental disorders are critically important in public health, and many randomised controlled trials (RCTs) evaluate intervention strategies for these objectives. However, distinguishing promotion from prevention and from treatment RCTs is challenging. A tool to place studies along the promotion-to-treatment continuum in mental health research does not exist, leaving it to researchers and policymakers to decide on how to classify individual RCTs, which hinders evidence synthesis.

METHODS AND ANALYSIS

We present a protocol for the development of a new tool to assist researchers in distinguishing RCTs along the promotion-to-treatment continuum. We will establish a Tool Development Group, and use the Population, Intervention, Comparison and Outcome framework to define constructs. We will generate, define, categorise and reduce the items in the tool using qualitative methods, including cognitive interviews and a Delphi exercise. Psychometric evaluation-including unidimensionality, local independence, monotonicity and item homogeneity-will include data collection, scoring, internal consistency checks and factor analysis of the tool's indicators for available RCTs. We will use standard Cohen's kappa statistics to assess the reliability of the tool.

ETHICS AND DISSEMINATION

This study involves data collection from the already published literature. However, this protocol has been approved by the ethics committee of the Università della Svizzera Italiana (CE 2024 04). The results of the present project will be disseminated in peer-reviewed journals and at international and national scientific meetings. Training materials for the application of the tool will also be developed and disseminated to the scientific community. The tool and all related implementation materials will be published on a website and will be freely accessible to the public.

Impact of healthcare interventions on distress following acute musculoskeletal/orthopaedic injury: a scoping review of systematic reviews

BACKGROUND

Musculoskeletal injuries can cause distress, and distress is associated with delayed recovery. Numerous interventions have been developed to facilitate recovery from injury, and several systematic reviews evaluate the efficacy of these interventions for reducing psychological distress.

OBJECTIVES

This scoping review aims to map the synthesised evidence for the relationship between treatment interventions and distress-related outcomes following acute injury. The objectives were (1) to describe the types of interventions that have been evaluated in relation to distress-related outcomes following accidental injury, (2) to examine the scope of distress-related outcomes that have been measured in relation to these interventions and (3) to explore the range of clinical professions that deliver these interventions.

DESIGN

We searched nine electronic databases and grey literature (to 21 April 2022). We included any systematic review reporting on the relationship between interventions delivered in the time following injury and distress-related outcomes. Data relevant to the specific objectives of this scoping review were extracted and described using narrative synthesis.

RESULTS

From 8412 systematic reviews imported for screening, 8266 unique records were screened. 179 were selected for full-text review. 84 systematic reviews were included in the study. Interventional types were pharmacological, psychological, exercise based, physical/manual therapies, virtual reality based, multimodal and workplace based. Interventions were delivered digitally, face to face and using virtual reality by a variety of healthcare professionals, including doctors, nurses, psychologists and physiotherapists. The most frequently reported distress-related variables included anxiety, depression, post-traumatic stress disorder diagnosis.

CONCLUSION

A wide range of interventions may help to mitigate distress following acute accidental musculoskeletal or orthopaedic injury. Even interventions that were not designed to reduce distress were found to improve distress-related outcomes. In view of the important role of distress in recovery from injury, it is recommended that distress-related variables are measured as core outcomes in the evaluation of treatments for acute injuries.

Treatment Approaches for Posttraumatic Stress Disorder Derived From Basic Research on Fear Extinction

This brief review article will describe treatment approaches for posttraumatic stress disorder (PTSD) based on findings from basic research. The focus of this review will be fear conditioning and extinction models, which provide a translational model of PTSD that can help translate basic research in nonhuman animals through well-controlled trials confirming the efficacy of treatment approaches in humans with PTSD such as prolonged exposure therapy. Specific cognitive aspects of fear extinction processes, including consolidation and reconsolidation, are reviewed along with behavioral and pharmacological treatment strategies based on basic research in these areas including attempts to prevent the development of PTSD as well as the treatment of chronic PTSD. Pharmacological, behavioral, and device-based augmentation strategies of PTSD treatment based in basic science findings are reviewed, including those that disrupt noradrenergic receptor processes, medications that act on NMDA receptors, physical exercise, cannabinoids, estradiol, dexamethasone, yohimbine, losartan, dopamine, and MDMA, along with the evidence for their efficacy in human clinical samples. While fear extinction provides an exciting translational opportunity to improve PTSD based on basic science findings, we review limitations and challenges of the extant literature as well as future directions.

Associations Between Perceived Threats and Firearm Behaviors Among U.S. Adults

INTRODUCTION

The number of U.S. adults who own and carry a firearm for self-defense is rising. Research has established that owning or carrying a firearm increases the risk of injury and death for firearm owners and the people in their lives. This study sought to better understand this paradox by estimating associations of perceived specific and diffuse threats with firearm behaviors among U.S. adults.

METHODS

The authors used data from the 2023 National Firearm Attitudes and Behaviors Study, a nationally representative cross-sectional survey of U.S. adults. Binary and ordinal logistic regression estimated associations of perceived specific (fear of attack in the community, fear of someone breaking into the home) and diffuse threats (belief in a dangerous world) with firearm ownership and carriage frequency, overall and stratified by gender. Adjusted models controlled for violence exposures and demographic characteristics. The authors conducted analyses in 2024.

RESULTS

Among all U.S. adults, the perceived specific threat of someone breaking into the home was associated with firearm ownership (AOR: 1.09 [0.98, 1.23]). Among firearm-owning adults, the diffuse threat of belief in a dangerous world was associated with firearm carriage frequency (1.11 [0.98, 1.25]). Both the associations persisted among men (AORs = 1.27 [1.05-1.52] and 1.15 [1.01-1.31], respectively), but analyses found no associations between perceived threats and firearm behaviors among women.

CONCLUSIONS

Perceived threats are associated with firearm behaviors among U.S. men, even after accounting for the actual violence they report experiencing or witnessing.

The future of psychological treatments: The Marburg Declaration

Although psychological treatments are broadly recognized as evidence-based interventions for various mental disorders, challenges remain. For example, a substantial proportion of patients receiving such treatments do not fully recover, and many obstacles hinder the dissemination, implementation, and training of psychological treatments. These problems require those in our field to rethink some of our basic models of mental disorders and their treatments, and question how research and practice in clinical psychology should progress. To answer these questions, a group of experts of clinical psychology convened at a Think-Tank in Marburg, Germany, in August 2022 to review the evidence and analyze barriers for current and future developments. After this event, an overview of the current state-of-the-art was drafted and suggestions for improvements and specific recommendations for research and practice were integrated. Recommendations arising from our meeting cover further improving psychological interventions through translational approaches, improving clinical research methodology, bridging the gap between more nomothetic (group-oriented) studies and idiographic (person-centered) decisions, using network approaches in addition to selecting single mechanisms to embrace the complexity of clinical reality, making use of scalable digital options for assessments and interventions, improving the training and education of future psychotherapists, and accepting the societal responsibilities that clinical psychology has in improving national and global health care. The objective of the Marburg Declaration is to stimulate a significant change regarding our understanding of mental disorders and their treatments, with the aim to trigger a new era of evidence-based psychological interventions.

Psychological intervention in women victims of childhood sexual abuse: a randomized controlled clinical trial comparing EMDR psychotherapy and trauma-focused cognitive behavioral therapy

Introduction

Childhood sexual abuse persists as a painful societal reality, necessitating responses from institutions and healthcare professionals to prevent and address its severe long-term consequences in victims. This study implements an intervention comprising two psychotherapeutic approaches recommended by the WHO and international clinical guidelines for addressing short-, medium-, and long-term posttraumatic symptomatology: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR). Both approaches are adapted from group formats for implementation in small online groups via Zoom.

Methods

The impact of both therapeutic approaches on trauma improvement was assessed in a sample of 19 women who were victims of childhood sexual abuse through a Randomized Clinical Trial comparing EMDR Psychotherapy and Trauma-Focused Cognitive Behavioral Therapy after a baseline period. Intra and inter comparison were made using statistics appropriate to the sample.

Results

Both therapeutic approaches significantly reduced symptomatology across various evaluated variables, suggesting their efficacy in improving the quality of life for these individuals. Following CBT-FT treatment, patients exhibited enhanced emotional regulation, reduced reexperiencing, and avoidance. The EMDR group, utilizing the G-TEP group protocol, significantly improved dissociation, along with other crucial clinical variables and the perception of quality of life.

Discussion

Although the limitations of this study must be taken into account due to the size of the sample and the lack of long-term follow-up, the results align with existing scientific literature, underscoring the benefits of trauma-focused psychological treatments. The online group format appears promising for enhancing the accessibility of psychological treatment for these women. Furthermore, the differential outcomes of each treatment support recent research advocating for the inclusion of both approaches for individuals with trauma-related symptomatology.

Ethics and dissemination

The study has been approved by the Ethics Committee of the Valencian International University (VIU) (Valencia, Spain) (Ref. CEID2021_07). The results will be submitted for publication in peer-reviewed journals and disseminated to the scientific community.

Clinical trial registration

https://clinicaltrials.gov/ct2/show/NCT04813224, identifier NCT04813224.

Hitting the Rewind Button: Imagining Analogue Trauma Memories in Reverse Reduces Distressing Intrusions

Background

Intrusive re-experiencing of trauma is a core symptom of posttraumatic stress disorder. Intrusive re-experiencing could potentially be reduced by 'rewinding', a new treatment approach assumed to take advantage of reconsolidation-updating by mentally replaying trauma fast-backward.

Methods

The present analogue study was the first to investigate 'rewinding' in a controlled laboratory setting. First, 115 healthy women watched a highly aversive film and were instructed to report film-related intrusions during the following week. Twenty-four hours after film-viewing, participants reporting at least one intrusion (N = 81) were randomly allocated to an intervention (fast-backward, or fast-forward as active control condition) or a passive control condition. Intervention groups reactivated their trauma memory, followed by mentally replaying the aversive film either fast-backward or fast-forward repeatedly.

Results

Results indicate that replaying trauma fast-backward reduced intrusion load (intrusion frequency weighted for intrusion distress) compared to the passive group, whereas replaying fast-forward did not. No above-threshold differences between fast-backward and fast-forward emerged.

Conclusion

Present findings strengthen the view that 'rewinding' could be a promising intervention to reduce intrusions.

Evaluating the effects of single, multiple, and delayed systemic rapamycin injections to contextual fear reconsolidation: Implications for the neurobiology of memory and the treatment of PTSD-like re-experiencing

The mechanistic target of rapamycin (mTOR) kinase is known to mediate the formation and persistence of aversive memories. Rapamycin, an mTOR inhibitor, administered around the time of reactivation blocks retrieval-induced mTOR activity and de novo protein synthesis in the brains of rodents, while correspondingly diminishing subsequent fear memory. The goal of the current experiments was to further explore rapamycin's effects on fear memory persistence. First, we examined whether mTOR blockade at different time-points after reactivation attenuates subsequent contextual fear memory. We show that rapamycin treatment 3 or 12 h post-reactivation disrupts memory persistence. Second, we examined whether consecutive days of reactivation paired with rapamycin had additive effects over a single pairing at disrupting a contextual fear memory. We show that additional reactivation-rapamycin pairings exacerbates the reconsolidation impairment. Finally, we examined if impaired reconsolidation of a contextual fear memory from rapamycin treatment had any after-effects on learning and recalling a new fear association. We show that rapamycin-impaired reconsolidation does not affect new learning or recall and protects against fear generalization. Our findings improve our understanding of mTOR- dependent fear memory processes, as well as provide insight into potentially novel treatment options for stress-related psychopathologies such as posttraumatic stress disorder.

The effectiveness of two novel approaches to prevent intrusions: A pilot study comparing Tetris_dualtask and imagery rescripting to control

BACKGROUND AND OBJECTIVES

Post-traumatic stress disorder (PTSD) is a global health problem. Although effective treatments for it exist, early interventions that prevent PTSD from developing are lacking. The aim of this pilot analogue trauma study was to compare the effects of two potential early intervention strategies, namely Tetris_dualtask and imagery rescripting (IR) to a no-intervention control group on intrusion frequency and the vividness and emotionality of aversive film memory.

METHODS

Sixty healthy students were subjected to the trauma film paradigm and randomly allocated to either: Tetris_dualtask, IR or no-intervention. Main outcomes were the number of film-related intrusions at one week and vividness and emotionality ratings of the most aversive film memory. Secondary outcomes were PTSD-like symptoms, intrusion intensity, and explicit film memory.

RESULTS

The Tetris_dualtask group reported significant fewer intrusions compared to the no-intervention group; whereas the IR group did not. No effect was found on vividness and emotionality ratings, PTSD-like symptoms, intrusion intensity, and explicit memory.

LIMITATIONS

The sample size was small, and analogue trauma in healthy individuals was examined, thus generalizability may be limited. Also, to increase comparability between interventions, the duration of Tetris_dualtask and IR was standardized. As a result, the IR intervention was shorter compared to other studies, which might have decreased its efficacy.

CONCLUSIONS

The results of this pilot study suggest that playing Tetris during retrieval of traumatic images, might hold potential as an early intervention strategy to reduce intrusions in the early aftermath of trauma and adversity. However, future large-scale replication research is needed.

Developing a Brief Cognitive Task Intervention to Reduce Long-Standing Intrusive Memories of Trauma: A Feasibility Study With Remote Delivery for Women in Iceland

Background

There is emerging evidence that a brief cognitive task intervention may reduce the frequency of intrusive memories, even long-standing memories of older trauma. However, evaluations to date have involved in-person researcher contact. We investigated the feasibility and acceptability of remote delivery to women (n = 12) in Iceland who had experienced trauma on average two decades earlier.

Method

Participants monitored intrusive memories in a daily diary for one week (i.e., baseline phase), completed (at least) two guided, remote intervention sessions (e.g., via secure video platform), and were encouraged to continue to use the intervention self-guided.

Results

Eight participants completed the primary outcome and reported fewer intrusive memories in Week 5 (M = 6.98, SD = 5.73) compared to baseline (M = 25.98, SD = 29.39) - a 68% reduction. Intrusions decreased at each subsequent time point; at 3-months (n = 7) there was a 91% reduction compared to baseline. Other psychological symptoms reduced and functioning improved. Importantly, participant ratings and qualitative feedback support feasibility and acceptability.

Conclusion

Findings suggest the feasibility of remote delivery of the brief imagery-competing task intervention by non-specialists (who were not mental health professionals) and hold promise for developing psychotherapeutic innovations supporting women with intrusive memories even decades after trauma.

Using a Novel Gameplay Intervention to Target Intrusive Memories After Work-Related Trauma: Iterative Qualitative Analysis of Intensive Care Unit Staff Experiences

BACKGROUND

Many intensive care unit (ICU) staff experience intrusive memories following work-related traumatic events, which can lead to long-term mental health outcomes and impact work functioning. There is a need for interventions that target intrusive memories in this population; however, factors such as mental health stigma and difficulty in fitting interventions into busy schedules can pose barriers. The Brief Gameplay Intervention For National Health Service Intensive Care Unit Staff Affected By COVID-19 Trauma (GAINS) study tested a brief, digital imagery-competing task intervention (including computer gameplay) with the aim of reducing the recurrence of intrusive memories, which holds promise for overcoming some of these barriers.

OBJECTIVE

This substudy aims to explore barriers and facilitators to the uptake and practical use of the intervention by ICU staff, along with its acceptability, and iteratively explore the impact of intervention optimizations to further refine the intervention.

METHODS

The GAINS study is a randomized controlled trial comparing access to a brief digital imagery-competing task intervention for 4 weeks with usual care followed by delayed access to the intervention. The participants were ICU staff who worked during the COVID-19 pandemic and experienced intrusive memories. All participants were sent a questionnaire at 4 weeks to gather data about intervention acceptability. Nested within the randomized controlled trial, a subset of 16 participants was interviewed, and data were analyzed using thematic analysis drawing from a framework approach.

RESULTS

Both quantitative and qualitative data indicated high acceptability of the intervention. Intervention use data show that, on average, staff were able to target approximately 73% (3.64/4.88) of their intrusive memories and engaged with the Tetris component for the full 20 minutes per session. Overall, on the acceptability questionnaire, staff found the intervention easy to use, helpful, and highly acceptable. The interviews generated four themes: approach to the intervention, positives of the intervention, negatives of the intervention, and improvements and optimizations. Findings highlighted barriers that ICU staff experienced: stigma, feeling weak for seeking help, not wanting colleagues to know they were struggling, and skepticism. However, they provided suggestions on how barriers could be overcome and discussed the advantages of the intervention when compared with other treatments. Although participants described many positive aspects of the intervention, such as being easy to use, enjoyable, and leading to a reduction in the frequency or intensity of intrusive memories, they also raised practical issues for implementation.

CONCLUSIONS

The intervention has the potential to overcome stigma and reduce the frequency of intrusive memories after traumatic events among ICU staff. Further refinement is needed to improve the adoption and reach of this intervention. A limitation is that we could not interview the National Health Service staff who were unable or unwilling to take part in the trial.

Artemisinin reduces PTSD-like symptoms, improves synaptic plasticity, and inhibits apoptosis in rats subjected to single prolonged stress

Post-Traumatic Stress Disorder (PTSD) is a chronic mental disorder characterized by symptoms of panic and anxiety, depression, impaired cognitive functioning, and difficulty in social interactions. While the effect of the traditional Chinese medicine artemisinin (AR) on PTSD is unknown, its therapeutic benefits have been demonstrated by studies on models of multiple neurological disorders. This study aimed to extend such findings by investigating the effects of AR administration on a rat model of PTSD induced by a regimen of single prolonged stress (SPS). After rats were subjected to the SPS protocol, AR was administered and its impact on PTSD-like behaviors was evaluated. In the present study, rats were subjected to a multitude of behavioral tests to evaluate behaviors related to anxiety, memory function, and social interactions. The expression of hippocampal synaptic plasticity-related proteins was detected using Western blot and immunofluorescence. The ultrastructure of synapses was observed under transmission electron microscopy. The apoptosis of hippocampal neurons was examined with Western blot, TUNEL staining, and HE staining. The results showed that AR administration alleviated the PTSD-like phenotypes in SPS rats, including behavior indicative of anxiety, cognitive deficits, and diminished sociability. AR administration was further observed to improve synaptic plasticity and inhibit neuronal apoptosis in SPS rats. These findings suggest that administering AR after the onset of severe traumatic events may alleviate anxiety, cognitive deficits, and impaired social interaction, improve synaptic plasticity, and diminish neuronal apoptosis. Hence, the present study provides evidence for AR's potential as a multi-target agent in the treatment of PTSD.

Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review

This narrative state-of-the-art review paper describes the progress in the understanding and treatment of Posttraumatic Stress Disorder (PTSD). Over the last four decades, the scientific landscape has matured, with many interdisciplinary contributions to understanding its diagnosis, etiology, and epidemiology. Advances in genetics, neurobiology, stress pathophysiology, and brain imaging have made it apparent that chronic PTSD is a systemic disorder with high allostatic load. The current state of PTSD treatment includes a wide variety of pharmacological and psychotherapeutic approaches, of which many are evidence-based. However, the myriad challenges inherent in the disorder, such as individual and systemic barriers to good treatment outcome, comorbidity, emotional dysregulation, suicidality, dissociation, substance use, and trauma-related guilt and shame, often render treatment response suboptimal. These challenges are discussed as drivers for emerging novel treatment approaches, including early interventions in the Golden Hours, pharmacological and psychotherapeutic interventions, medication augmentation interventions, the use of psychedelics, as well as interventions targeting the brain and nervous system. All of this aims to improve symptom relief and clinical outcomes. Finally, a phase orientation to treatment is recognized as a tool to strategize treatment of the disorder, and position interventions in step with the progression of the pathophysiology. Revisions to guidelines and systems of care will be needed to incorporate innovative treatments as evidence emerges and they become mainstream. This generation is well-positioned to address the devastating and often chronic disabling impact of traumatic stress events through holistic, cutting-edge clinical efforts and interdisciplinary research.

Cellular mechanisms of contextual fear memory reconsolidation: Role of hippocampal SFKs, TrkB receptors and GluN2B-containing NMDA receptors

Memories are stored into long-term representations through a process that depends on protein synthesis. However, a consolidated memory is not static and inflexible and can be reactivated under certain circumstances, the retrieval is able to reactivate memories and destabilize them engaging a process of restabilization known as reconsolidation. Although the molecular mechanisms that mediate fear memory reconsolidation are not entirely known, so here we investigated the molecular mechanisms in the hippocampus involved in contextual fear conditioning memory (CFC) reconsolidation in male Wistar rats. We demonstrated that the blockade of Src family kinases (SFKs), GluN2B-containing NMDA receptors and TrkB receptors (TrkBR) in the CA1 region of the hippocampus immediately after the reactivation session impaired contextual fear memory reconsolidation. These impairments were blocked by the neurotrophin BDNF and the NMDAR agonist, D-Serine. Considering that the study of the link between synaptic proteins is crucial for understanding memory processes, targeting the reconsolidation process may provide new ways of disrupting maladaptive memories, such as those seen in post-traumatic stress disorder. Here we provide new insights into the cellular mechanisms involved in contextual fear memory reconsolidation, demonstrating that SFKs, GluN2B-containing NMDAR, and TrkBR are necessary for the reconsolidation process. Our findings suggest a link between BDNF and SFKs and GluN2B-containing NMDAR as well as a link between NMDAR and SFKs and TrkBR in fear memory reconsolidation. These preliminary pharmacological findings provide new evidence of the mechanisms involved in the reconsolidation of fear memory and have the potential to contribute to the development of treatments for psychiatric disorders involving maladaptive memories.

Hippocampal CaMKII inhibition induces reactivation-dependent amnesia for extinction memory and causes fear relapse

Hippocampal GluN2B subunit-containing NMDAR (GluN2B-NMDAR) activation during recall destabilizes fear extinction memory, which must undergo brain-derived neurotrophic factor (BDNF)-dependent reconsolidation to persist. Ca2+/calmodulin-dependent protein kinase II (CaMKII) is a Ser/Thr protein kinase essential for hippocampus-dependent memory processing that acts downstream GluN2B-NMDAR and controls BDNF expression, but its participation in fear extinction memory reconsolidation has not yet been studied. Using a combination of pharmacological and behavioral tools, we found that in adult male Wistar rats, intra dorsal-CA1 administration of the CaMKII inhibitors autocamtide-2-related inhibitory peptide (AIP) and KN-93, but not of their inactive analogs scrambled AIP and KN-92, after fear extinction memory recall impaired extinction and caused GluN2B-NMDAR-dependent recovery of fear. Our results indicate that hippocampal CaMKII is necessary for fear extinction reconsolidation, and suggest that modulation of its activity around the time of recall controls the inhibition that extinction exerts on learned fear.

The hippocampal FTO-BDNF-TrkB pathway is required for novel object recognition memory reconsolidation in mice

Memory reconsolidation refers to the process by which the consolidated memory was restored after reactivation (RA). Memory trace becomes labile after reactivation and inhibition of memory reconsolidation may disrupt or update the original memory trace, which provided a new strategy for the treatment of several psychiatric diseases, such as drug addiction and post-traumatic stress disorder. Fat mass and obesity-associated gene (FTO) is a novel demethylase of N6-methyladenosine (m6A) and it has been intensively involved in learning and memory. However, the role of FTO in memory reconsolidation has not been determined. In the present study, the function of FTO in memory reconsolidation was investigated in the novel object recognition (NOR) model in mice. The results showed that RA of NOR memory increased hippocampal FTO expression in a time-dependent manner, while FTO inhibitor meclofenamic acid (MA) injected immediately, but not 6 h after RA disrupted NOR memory reconsolidation. MA downregulated BDNF expression during NOR memory reconsolidation in the hippocampus, while the TrkB agonist 7,8-Dihydroxyflavone (7,8-DHF) reversed the disruptive effects of MA on NOR memory reconsolidation. Furthermore, overexpression of FTO increased BDNF expression via decreasing mRNA m6A in HT22 cells. Taken together, these results indicate that FTO may up-regulate the BDNF-TrkB pathway to promote NOR memory reconsolidation through m6A modification.

A brief treatment for veterans with PTSD: an open-label case-series study

Introduction

Despite the positive outcomes observed in numerous individuals undergoing trauma-focused psychotherapy for PTSD, veterans with this condition experience notably diminished advantages from such therapeutic interventions in comparison to non-military populations.

Methods

In a preliminary study we investigated the efficacy of an innovative treatment approach in a small sample of veterans (n = 7). Recognizing that accessing and targeting trauma memory in veterans with PTSD may be more challenging compared to other patient populations, we employed unique and personalized retrieval cues that engaged multiple senses and were connected to the context of their trauma. This was followed by a session focused on memory reconsolidation, which incorporated both psychological techniques (i.e., imagery rescripting) and a pharmacological component (i.e., 40 mg of propranolol).

Results

The findings from this small-scale case series cautiously indicate that this brief intervention, typically consisting of only one or two treatment sessions, shows promise in producing significant effects on symptoms of PTSD, distress and quality of life.This is particularly noteworthy given the complex symptomatology experienced by the veterans in this study.

Conclusion

To summarize, there are grounds for optimism regarding this brief treatment of combat-related PTSD. It appears that the potential for positive outcomes is far greater than commonly believed, as demonstrated by the encouraging results of this pilot study.

Single-session visuospatial task procedure to prevent childbirth-related posttraumatic stress disorder: a multicentre double-blind randomised controlled trial

Preventive evidence-based interventions for childbirth-related posttraumatic stress disorder (CB-PTSD) are lacking. Yet, 18.5% of women develop CB-PTSD symptoms following an unplanned caesarean section (UCS). This two-arm, multicentre, double-blind superiority trial tested the efficacy of an early single-session intervention including a visuospatial task on the prevention of maternal CB-PTSD symptoms. The intervention was delivered by trained maternity clinicians. Shortly after UCS, women were included if they gave birth to a live baby, provided consent, and perceived their childbirth as traumatic. Participants were randomly assigned to the intervention or attention-placebo group (allocation ratio 1:1). Assessments were done at birth, six weeks, and six months postpartum. Group differences in maternal CB-PTSD symptoms at six weeks (primary outcomes) and six months postpartum (secondary outcomes) were assessed with the self-report PTSD Checklist for DSM-5 (PCL-5) and by blinded research assessors with the Clinician-administered PTSD scale for DSM-5 (CAPS-5). Analysis was by intention-to-treat. The trial was prospectively registered (ClinicalTrials.gov, NCT03576586). Of the 2068 women assessed for eligibility, 166 were eligible and 146 were randomly assigned to the intervention (n = 74) or attention-placebo control group (n = 72). For the PCL-5, at six weeks, a marginally significant intervention effect was found on the total PCL-5 PTSD symptom count (β = -0.43, S.E. = 0.23, z = -1.88, p < 0.06), and on the intrusions (β = -0.73, S.E. = 0.38, z = -1.94, p < 0.0525) and arousal (β = -0.55, S.E. = 0.29, z = -1.92, p < 0.0552) clusters. At six months, a significant intervention effect on the total PCL-5 PTSD symptom count (β = -0.65, S.E. = 0.32, z = -2.04, p = 0.041, 95%CI[-1.27, -0.03]), on alterations in cognition and mood (β = -0.85, S.E. = 0.27, z = -3.15, p = 0.0016) and arousal (β = -0.56, S.E. = 0.26, z = -2.19, p < 0.0289, 95%CI[-1.07, -0.06]) clusters appeared. No group differences on the CAPS-5 emerged. Results provide evidence that this brief, single-session intervention carried out by trained clinicians can prevent the development of CB-PTSD symptoms up to six months postpartum.

To sleep or not to sleep, that is the question: A systematic review and meta-analysis on the effect of post-trauma sleep on intrusive memories of analog trauma

Distressing intrusive memories of a traumatic event are one of the hallmark symptoms of posttraumatic stress disorder. Thus, it is crucial to identify early interventions that prevent the occurrence of intrusive memories. Both, sleep and sleep deprivation have been discussed as such interventions, yet previous studies yielded contradicting effects. Our systematic review aims at evaluating existing evidence by means of traditional and individual participant data (IPD) meta-analyses to overcome power issues of sleep research. Until May 16th, 2022, six databases were searched for experimental analog studies examining the effect of post-trauma sleep versus wakefulness on intrusive memories. Nine studies were included in our traditional meta-analysis (8 in the IPD meta-analysis). Our analysis provided evidence for a small effect favoring sleep over wakefulness, log-ROM = 0.25, p < .001, suggesting that sleep is associated with a lower number of intrusions but unrelated to the occurrence of any versus no intrusions. We found no evidence for an effect of sleep on intrusion distress. Heterogeneity was low and certainty of evidence for our primary analysis was moderate. Our findings suggest that post-trauma sleep has the potential to be protective by reducing intrusion frequency. More research is needed to determine the impact following real-world trauma and the potential clinical significance.

Treating intrusive memories after trauma in healthcare workers: a Bayesian adaptive randomised trial developing an imagery-competing task intervention

Intensive care unit (ICU) staff continue to face recurrent work-related traumatic events throughout the COVID-19 pandemic. Intrusive memories (IMs) of such traumatic events comprise sensory image-based memories. Harnessing research on preventing IMs with a novel behavioural intervention on the day of trauma, here we take critical next steps in developing this approach as a treatment for ICU staff who are already experiencing IMs days, weeks, or months post-trauma. To address the urgent need to develop novel mental health interventions, we used Bayesian statistical approaches to optimise a brief imagery-competing task intervention to reduce the number of IMs. We evaluated a digitised version of the intervention for remote, scalable delivery. We conducted a two-arm, parallel-group, randomised, adaptive Bayesian optimisation trial. Eligible participants worked clinically in a UK NHS ICU during the pandemic, experienced at least one work-related traumatic event, and at least three IMs in the week prior to recruitment. Participants were randomised to receive immediate or delayed (after 4 weeks) access to the intervention. Primary outcome was the number of IMs of trauma during week 4, controlling for baseline week. Analyses were conducted on an intention-to-treat basis as a between-group comparison. Prior to final analysis, sequential Bayesian analyses were conducted (n = 20, 23, 29, 37, 41, 45) to inform early stopping of the trial prior to the planned maximum recruitment (n = 150). Final analysis (n = 75) showed strong evidence for a positive treatment effect (Bayes factor, BF = 1.25 × 106): the immediate arm reported fewer IMs (median = 1, IQR = 0-3) than the delayed arm (median = 10, IQR = 6-16.5). With further digital enhancements, the intervention (n = 28) also showed a positive treatment effect (BF = 7.31). Sequential Bayesian analyses provided evidence for reducing IMs of work-related trauma for healthcare workers. This methodology also allowed us to rule out negative effects early, reduced the planned maximum sample size, and allowed evaluation of enhancements. Trial Registration NCT04992390 ( www.clinicaltrials.gov ).

Role of hippocampal Wnt signaling pathways on contextual fear memory reconsolidation

Memories already consolidated when reactivated return to a labile state and can be modified, this process is known as reconsolidation. It is known the Wnt signaling pathways can modulate hippocampal synaptic plasticity as well as learning and memory. Yet, Wnt signaling pathways interact with NMDA (N-methyl-D-aspartate) receptors. However, whether canonical Wnt/β-catenin and non-canonical Wnt/Ca2+ signaling pathways are required in the CA1 region of hippocampus for contextual fear memory reconsolidation remains unclear. So, here we verified that the inhibition of canonical Wnt/β-catenin pathway with DKK1 (Dickkopf-1) into CA1 impaired the reconsolidation of contextual fear conditioning (CFC) memory when administered immediately and 2h after reactivation session but not 6h later, while the inhibition of non-canonical Wnt/Ca²⁺ signaling pathway with SFRP1 (Secreted frizzled-related protein-1) into CA1 immediately after reactivation session had no effect. Moreover, the impairment induced by DKK1 was blocked by the administration of the agonist of the NMDA receptors glycine site, D-Serine, immediately and 2h after reactivation session. We found that hippocampal canonical Wnt/β-catenin is necessary to the reconsolidation of CFC memory at least two hours after reactivation, while non-canonical Wnt/Ca²⁺ signaling pathway is not involved in this process and, that there is a link between Wnt/β-catenin signaling pathway and NMDA receptors. In view of this, this study provides new evidence regarding the neural mechanisms underlying contextual fear memory reconsolidation and contributes to provide a new possible target for the treatment of fear related disorders.

Relations Between Posttraumatic Stress Disorder Symptoms and Positive Memory Characteristics Among Women Reporting Intimate Partner Violence: A Micro-Longitudinal Study

Evidence links posttraumatic stress disorder (PTSD) symptoms to positive autobiographical memory characteristics. To extend this research, we uniquely utilized micro-longitudinal data to examine (1) the trajectory of PTSD symptom count across 30 days; and (2) if more vividness and accessibility of retrieved positive memories at the daily level predicted decreases in the trajectory of PTSD symptom count across 30 days. The current study was a secondary data analysis of a larger study. The sample included 74 women who reported physical or sexual victimization in the past 30 days by their current male partner and reported the use of alcohol and/or drugs during that time (M_age = 39.68 years; 37.80% with diagnostic PTSD; 43.2% White; 37.8% Black or African American). They completed thrice daily measures of PTSD symptoms and positive memory characteristics (vividness and accessibility) across 30 days. Results of the random effects longitudinal multilevel model indicated that, on average, the relation between PTSD symptom count and positive memory vividness was positive and statistically significant (0.19, 95% Confidence Interval [CI] [0.2, 0.35]); and the relation between PTSD symptom count and positive memory accessibility was positive and statistically significant (0.31, 95% CI [0.15, 0.47]). The relationship between PTSD symptom count and positive memory vividness/accessibility (i.e., slopes) varied significantly across participants, with a wide range of positive and negative regression coefficients. Future research needs to investigate why and how positive memory vividness and accessibility may relate to trajectories of PTSD symptoms over time, with potential clinical implications for positive memory interventions addressing PTSD.

Tackling childbirth-related intrusive memories with a single-session behavioural intervention involving a visuospatial task: protocol for a single-blind, waitlist-controlled randomised trial

INTRODUCTION

Approximately 12.3% of mothers experience childbirth-related post-traumatic stress symptoms (CB-PTSS). However, evidence-based interventions to treat CB-PTSS are lacking. Intrusive memories (IM), a key CB-PTSS, are distressing and can trigger other PTSS by reliving the traumatic event. Emerging evidence shows that a behavioural intervention involving a visuospatial task (BI-VT) can reduce the number of IM and PTSS, supposedly by interfering with the reconsolidation of the trauma memory. This study aims to test the efficacy of a single-session BI-VT targeting IM to reduce the number of childbirth-related (CB-)IM and PTSS, in comparison to a waitlist control group (WCG).

METHODS AND ANALYSIS

In this multicentre, single-blind, randomised controlled trial being undertaken at one regional and one university hospital in Switzerland, 60 participants will be allocated to the Immediate Intervention Group (IIG), receiving the immediate intervention on day 15, and 60 participants to the WCG receiving the delayed intervention on day 30. All participants will report their CB-IM during the 2 weeks preimmediate and postimmediate intervention in diaries. The IIG will additionally report their CB-IM over weeks 5 and 6 postimmediate intervention. Self-report questionnaires will assess CB-PTSS at 2 weeks preimmediate and postimmediate intervention in both groups, and at 6 weeks postimmediate intervention in the IIG. A feedback questionnaire will evaluate the intervention acceptability. The primary outcome will be group differences in the number of CB-IM between the 2 weeks preimmediate and postimmediate intervention. Secondary outcomes will be CB-PTSS at 2 and 6 weeks postimmediate intervention, the number of CB-IM at weeks 5 and 6 postimmediate intervention, and intervention acceptability.

ETHICS AND DISSEMINATION

Ethical approval was granted by the Human Research Ethics Committee of the Canton of Vaud (study number 202200652). Participants will provide an informed consent before study participation. Results will be presented in peer-reviewed journals and at conferences.

TRIAL REGISTRATION NUMBER

NCT05381155.

On making (and turning adaptive to) maladaptive aversive memories in laboratory rodents

Fear conditioning and avoidance tasks usually elicit adaptive aversive memories. Traumatic memories are more intense, generalized, inflexible, and resistant to attenuation via extinction- and reconsolidation-based strategies. Inducing and assessing these dysfunctional, maladaptive features in the laboratory are crucial to interrogating posttraumatic stress disorder's neurobiology and exploring innovative treatments. Here we analyze over 350 studies addressing this question in adult rats and mice. There is a growing interest in modeling several qualitative and quantitative memory changes by exposing already stressed animals to freezing- and avoidance-related tests or using a relatively high aversive training magnitude. Other options combine aversive/fearful tasks with post-acquisition or post-retrieval administration of one or more drugs provoking neurochemical or epigenetic alterations reported in the trauma aftermath. It is potentially instructive to integrate these procedures and incorporate the measurement of autonomic and endocrine parameters. Factors to consider when defining the organismic and procedural variables, partially neglected aspects (sex-dependent differences and recent vs. remote data comparison) and suggestions for future research (identifying reliable individual risk and treatment-response predictors) are discussed.

A systematic review and meta-analysis of the effect of cognitive interventions to prevent intrusive memories using the trauma film paradigm

There is an unmet need for effective early interventions that can relieve initial trauma symptoms and reduce symptoms of posttraumatic stress disorder (PTSD). We evaluated the efficacy of cognitive interventions compared to control in reducing intrusion frequency and PTSD symptoms in healthy individuals using the trauma film paradigm, in which participants view a film with aversive content as an experimental analogue of trauma exposure. A systematic literature search identified 41 experiments of different cognitive interventions targeting intrusions. In the meta-analysis, the pooled effect size of 52 comparisons comparing cognitive interventions to no-intervention controls on intrusions was moderate (g = -0.46, 95% CI [-0.61 to -0.32], p < .001). The pooled effect size of 16 comparisons on PTSD symptoms was also moderate (g = -0.31, 95% CI [-0.46 to -0.17], p < .001). Both visuospatial interference and imagery rescripting tasks were associated with significantly fewer intrusions than controls, whereas verbal interference and meta-cognitive processing tasks showed nonsignificant effect sizes. Interventions administered after viewing the trauma film showed significantly fewer intrusions than controls, whereas interventions administered during film viewing did not. No experiments had low risk of bias (ROB), 37 experiments had some concerns of ROB, while the remaining four experiments had high ROB. To the best of our knowledge, this is the first meta-analysis investigating the efficacy of cognitive interventions targeting intrusions in non-clinical samples. Results seem to be in favour of visuospatial interference tasks rather than verbal tasks. More research is needed to develop an evidence base on the efficacy of various cognitive interventions and test their clinical translation to reduce intrusive memories of real trauma.

The effect of sleep on intrusive memories in daily life: a systematic review and meta-analysis of trauma film experiments

STUDY OBJECTIVES

To synthesize the literature on the effect of sleep versus wake on the frequency and distress of intrusive memories in everyday life after watching film clips with distressing content as a proxy for traumatic experiences.

METHODS

We conducted a systematic review by searching PubMed and PsychInfo. The last search was conducted on January 31, 2022. We included experimental studies comparing sleep and wake groups on intrusions using ecological diary methods, whereas studies lacking a wake control condition or relying solely on intrusion-triggering tasks or retrospective questionnaires were excluded. Meta-analyses were performed to evaluate the results. Risks of biases were assessed following the Cochrane guidelines.

RESULTS

Across 7 effect sizes from 6 independent studies, sleep (n = 192), as compared to wake (n = 175), significantly reduced the number of intrusive memories (Hedges' g = -0.26, p = .04, 95% CI [-0.50, -0.01]), but not the distress associated with them (Hedges' g = -0.14, p = .25, 95% CI [-0.38, 0.10]).

CONCLUSIONS

Although the results suggest that sleep reduces the number of intrusions, there is a strong need for high-powered pre-registered studies to confirm this effect. Risks of biases in the reviewed work concern the selection of the reported results, measurement of the outcome, and failure to adhere to the intervention. Limitations with the current meta-analysis include the small number of studies, which comprised only English-language articles, and the fact that it was not pre-registered.

Chronic stress boosts systemic inflammation and compromises antiviral innate immunity in Carassius gibel

It is generally considered that stress causes decreased immune function and render fish vulnerable to infection and diseases. However, the molecular mechanisms between stress responses and susceptibility to infections, especially viral diseases, in fish remain unknown. Understanding and monitoring the biological consequences and mechanisms underlying stress responses in fish may contribute to the improvement of animal welfare and production efficiency. In this study, long-term exposure to a variety of stressors, including chasing, overcrowding, restraint stress, and air exposure mimicking chronic stresses, in aquaculture practices was conducted in Carassius gibel to investigate the consequences of chronic stress on inflammation and antiviral capability. With the continuation of stimulation, experimental fish gradually became insensitive to the stress of net chasing and feeding with the accompaniment of upregulated gene expressed in the HPI axis and elevated levels of stress hormones. As expected, stress-induced hyperglycaemia with a decrease in the insulin signaling pathway and altered gene expression in glycolysis and gluconeogenesis, suggesting the disturbance of glycometabolism. Importantly, a link between intestinal homoeostasis and systemic low-grade inflammation in stressed C. gibel was observed, implying crosstalk among the brain, intestine, and other organs. Furthermore, the compromised antiviral capability with impaired antiviral innate immunity in stressed fish was confirmed by RNA sequencing and infection with Cyprinid herpesvirus 2 (CyHV-2), promoting the understanding of enhanced susceptibility to viral infection in stressed fish.

Attachment processes in posttraumatic stress disorder: A review of mechanisms to advance theories and treatments

Current conceptualisations of posttraumatic stress disorder (PTSD) are driven by biological, learning, and cognitive models that have shaped current treatments of the disorder. The strong influence of these models has resulted in a relative neglect of social mechanisms that can influence traumatic stress. There is abundant evidence from experimental, observational, and clinical studies that social factors can moderate many of the mechanisms articulated in prevailing models of PTSD. In this review it is proposed that attachment theory provides a useful framework to complement existing models of PTSD because it provides explanatory value for social factors can interact with biological, learning, and cognitive processes that shape traumatic stress response. The review provides an overview of attachment theory in the context of traumatic stress, outlines the evidence for how attachment factors can moderate stress responses and PTSD, and considers how harnessing attachment processes may augment recovery from and treatment of PTSD. This review emphasizes that rather than conceptualizing attachment theory as an independent theory of traumatic stress, there is much to gain by integrating attachment mechanisms into existing models of PTSD to accommodate the interactions between cognitive, biological, and attachment processes.

Transforming experiences: Neurobiology of memory updating/editing

Long-term memory is achieved through a consolidation process where structural and molecular changes integrate information into a stable memory. However, environmental conditions constantly change, and organisms must adapt their behavior by updating their memories, providing dynamic flexibility for adaptive responses. Consequently, novel stimulation/experiences can be integrated during memory retrieval; where consolidated memories are updated by a dynamic process after the appearance of a prediction error or by the exposure to new information, generating edited memories. This review will discuss the neurobiological systems involved in memory updating including recognition memory and emotional memories. In this regard, we will review the salient and emotional experiences that promote the gradual shifting from displeasure to pleasure (or vice versa), leading to hedonic or aversive responses, throughout memory updating. Finally, we will discuss evidence regarding memory updating and its potential clinical implication in drug addiction, phobias, and post-traumatic stress disorder.

Memory Sins in Applied Settings: What Kind of Progress?

Over two decades ago, I proposed that memory errors could be classified into seven basic categories or sins (Schacter, 1999, 2001), comprising three sins of omission (transience, absentmindedness, and blocking) and four sins of commission (misattribution, suggestibility, bias, and persistence). In the past two decades, much has been learned about the nature and basis of the memory sins. Here, I assess the extent of progress that has been made during that time regarding applied implications of five of the sins: transience, absentmindedness, misattribution, suggestibility, and persistence. The manifestations of these sins have been examined in a variety of applied settings, including educational, clinical, legal, and technological domains. I argue that considerable progress has been made in characterizing the impact of memory sins in each domain, identify gaps in and limitations of our current knowledge, and briefly consider how these developments bear on broad questions regarding the reliability of human memory.

Trauma and Remembering: From Neuronal Circuits to Molecules

Individuals with posttraumatic stress disorder (PTSD) experience intrusions of vivid traumatic memories, heightened arousal, and display avoidance behavior. Disorders in identity, emotion regulation, and interpersonal relationships are also common. The cornerstone of PTSD is altered learning, memory, and remembering, regulated by a complex neuronal and molecular network. We propose that the essential feature of successful treatment is the modification of engrams in their unstable state during retrieval. During psychedelic psychotherapy, engrams may show a pronounced instability, which enhances modification. In this narrative review, we outline the clinical characteristics of PTSD, its multifaceted neuroanatomy, and the molecular pathways that regulate memory destabilization and reconsolidation. We propose that psychedelics, acting by serotonin-glutamate interactions, destabilize trauma-related engrams and open the door to change them during psychotherapy.

Amentoflavone impairs the reconsolidated fear memories through inhibition of ERK pathway

Post-traumatic stress disorder (PTSD) is a pathological fear memory-related disease. The persistence of pathological fearful memories is one of the most characteristic symptoms of PTSD. However, this can be eliminated by intervening in reconsolidation. Inflammation is intimately involved in the pathophysiologic progression of PTSD. Amentoflavone (AF) has anti-inflammatory effects. However, the effect of AF on fear memory reconsolidation remains unclear. In the present series of experiments, the CFC paradigm of rats were constructed. This was followed by AF administration immediately after exposure to the conditioning chamber to observe the maintenance of fear memory. Finally, a Western blot for the amygdala was used to explore the possible molecular biological mechanisms of AF affecting animal behavior. The findings suggest that re-exposure to the conditioning chamber for retrieval of CFC memory followed by immediate intragastric AF administration in rats attenuated the fear response for at least 14 days. In addition, the Western blot results show that the CFC memory intervention effect of AF administration during the reconsolidation phase may be related to the ERK signaling pathway inhibition. In general, the administration of AF in the reconsolidation phase to inhibit neuroinflammation can block the reconsolidation process and disrupt fear memory retention in the long term, at least in part through ERK pathway.

A Public Health Perspective of Post-Traumatic Stress Disorder

Trauma exposure is one of the most important and prevalent risk factors for mental and physical ill-health. Prolonged or excessive stress exposure increases the risk of a wide variety of mental and physical symptoms, resulting in a condition known as post-traumatic stress disorder (PTSD). The diagnosis might be challenging due to the complex pathophysiology and co-existence with other mental disorders. The prime factor for PTSD development is exposure to a stressor, which variably, along with peritraumatic conditions, affects disease progression and severity. Additionally, many factors are thought to influence the response to the stressor, and hence reshape the natural history and course of the disease. With sufficient knowledge about the disease, preventive and intervenient methods can be implemented to improve the quality of life of the patients and to limit both the medical and economic burden of the disease. This literature review provides a highlight of up-to-date literature on traumatic stress, with a focus on causes or triggers of stress, factors that influence response to stress, disease burden, and the application of the social-ecological public health model of disease prevention. In addition, it addresses therapeutic aspects, ethnic differences in traumatic stress, and future perspectives, including potential biomarkers.

Post-traumatic stress disorder: clinical and translational neuroscience from cells to circuits

Post-traumatic stress disorder (PTSD) is a maladaptive and debilitating psychiatric disorder, characterized by re-experiencing, avoidance, negative emotions and thoughts, and hyperarousal in the months and years following exposure to severe trauma. PTSD has a prevalence of approximately 6-8% in the general population, although this can increase to 25% among groups who have experienced severe psychological trauma, such as combat veterans, refugees and victims of assault. The risk of developing PTSD in the aftermath of severe trauma is determined by multiple factors, including genetics - at least 30-40% of the risk of PTSD is heritable - and past history, for example, prior adult and childhood trauma. Many of the primary symptoms of PTSD, including hyperarousal and sleep dysregulation, are increasingly understood through translational neuroscience. In addition, a large amount of evidence suggests that PTSD can be viewed, at least in part, as a disorder that involves dysregulation of normal fear processes. The neural circuitry underlying fear and threat-related behaviour and learning in mammals, including the amygdala-hippocampus-medial prefrontal cortex circuit, is among the most well-understood in behavioural neuroscience. Furthermore, the study of threat-responding and its underlying circuitry has led to rapid progress in understanding learning and memory processes. By combining molecular-genetic approaches with a translational, mechanistic knowledge of fear circuitry, transformational advances in the conceptual framework, diagnosis and treatment of PTSD are possible. In this Review, we describe the clinical features and current treatments for PTSD, examine the neurobiology of symptom domains, highlight genomic advances and discuss translational approaches to understanding mechanisms and identifying new treatments and interventions for this devastating syndrome.