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Schäfer SK, Lüder CC, Porcheret K, Hu X, Margraf J, Michael T, Holmes EA, Werner GG, Wilhelm I, Woud ML, Zeng S, Friesen E, Haim-Nachum S, Lass-Hennemann J, Lieb K, Kunzler AM, Wirth BE, Sopp MR. 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. Behav Res Ther 2023; 167:104359. [PMID: 37422952 DOI: 10.1016/j.brat.2023.104359] [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: 12/23/2022] [Revised: 06/05/2023] [Accepted: 06/18/2023] [Indexed: 07/11/2023]
Abstract
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.
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Affiliation(s)
- Sarah K Schäfer
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany; Leibniz Institute for Resilience Research (LIR), Mainz, Germany; Technische Universität Braunschweig, Department of Clinical Psychology, Psychotherapy and Psychodiagnostics, Brunswick, Germany.
| | - Charina C Lüder
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany.
| | - Kate Porcheret
- Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Xiaoqing Hu
- Department of Psychology, The University of Hong Kong, Jockey Club Tower, Centennial Campus, Hong Kong, China; The State Key Laboratory of Brian and Cognitive Sciences, The University of Hong Kong, Jockey Club Tower, Centennial Campus, Hong Kong, China; HKU-Shenzhen Institute of Research and Innovation, Shenzhen, China.
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany; DZPG (German Center for Mental Health), Germany.
| | - Tanja Michael
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany.
| | - Emily A Holmes
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, Uppsala University, Uppsala, Sweden.
| | - Gabriela G Werner
- Department of Clinical Psychology & Psychotherapy, LMU Munich, Munich, Germany.
| | - Ines Wilhelm
- Division of Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland; Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany.
| | - Marcella L Woud
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany.
| | - Shengzi Zeng
- Department of Psychology, The University of Hong Kong, Jockey Club Tower, Centennial Campus, Hong Kong, China.
| | - Edith Friesen
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany.
| | - Shilat Haim-Nachum
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.
| | - Johanna Lass-Hennemann
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany.
| | - Klaus Lieb
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany; Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Angela M Kunzler
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany; Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Benedikt E Wirth
- Divison of Cognition & Action, Department of Psychology, Saarland University, Saarbrücken, Germany; Department of Cognitive Assistants, German Research Center for Artificial Intelligence (DFKI), Saarbrücken, Germany.
| | - M Roxanne Sopp
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany.
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Gao J, Zhang L, Zhu J, Guo Z, Lin M, Bai L, Zheng P, Liu W, Huang J, Liu Z. Prefrontal Cortex Hemodynamics and Functional Connectivity Changes during Performance Working Memory Tasks in Older Adults with Sleep Disorders. Brain Sci 2023; 13:brainsci13030497. [PMID: 36979307 PMCID: PMC10046575 DOI: 10.3390/brainsci13030497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/04/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Objective: Older adults with sleep disorders (SDs) show impaired working memory abilities, and working memory processes are closely related to the prefrontal cortex (PFC). However, the neural mechanism of working memory impairment in older adults with SD remains unclear. This study aimed to investigate changes in PFC function among older adults with SD when carrying out the N-back task by functional near-infrared spectroscopy (fNIRS). Method: A total of 37 older adults with SDs were enrolled in this study and matched with 37 healthy older adults by gender, age, and years of education. Changes in PFC function were observed by fNIRS when carrying out the N-back task. Results: The accuracy on the 0-back and 2-back tasks in the SD group was significantly lower than that in the healthy controls (HC) group. The oxygenated hemoglobin (oxy-Hb) concentration of channel 8 which located in the dorsolateral prefrontal cortex (DLPFC) was significantly reduced in the SD group during the 2-back task, and the channel-to-channel connectivity between the PFC subregions was significantly decreased. Conclusions: These results suggest that patients with sleep disorders have a weak performance of working memory; indeed, the activation and functional connectivity in the prefrontal subregions were reduced in this study. This may provide new evidence for working memory impairment and brain function changes in elderly SDs.
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Affiliation(s)
- Jiahui Gao
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Lin Zhang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Jingfang Zhu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Zhenxing Guo
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Miaoran Lin
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Linxin Bai
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Peiyun Zheng
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Weilin Liu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Jia Huang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Zhizhen Liu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
- Correspondence:
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Massazza A, Joffe H, Parrott E, Brewin CR. Remembering the earthquake: intrusive memories of disaster in a rural Italian community. Eur J Psychotraumatol 2022; 13:2068909. [PMID: 35572391 PMCID: PMC9103703 DOI: 10.1080/20008198.2022.2068909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Disasters can have long-lasting impacts on mental health. Intrusive memories have been found to be common and persistent in the aftermath of earthquakes. OBJECTIVE To explore, using diaries, intrusive memories' presence, content, characteristics, and relationship with probable post-traumatic stress disorder (PTSD) in a small rural community exposed to mass destruction and loss of life. METHODS Survivors of the 2016-2017 Central Italy earthquakes (N = 104) were first interviewed to investigate the presence of intrusive memories of the disaster. Those that reported intrusive memories were subsequently asked to complete a 7-day paper-and-pen diary tracking their spontaneous memories of the earthquake events. RESULTS Twenty months after the earthquakes, 49% (n = 51) of the sample reported having experienced intrusive memories post-earthquake and 38% (n = 39) reported at least one intrusive memory in their diaries. Memories were rated as being distressing, vivid, and experienced as a mixture of images and thoughts. The content of intrusive memories generally focused on sensations and experiences during the earthquake. Other common categories of content were the material environment and physical objects as well as human loss & death. Several memories had a social focus. A minority of memories contained more positive content as well as content from before and after the earthquake. Some participants (28%) experienced repeated intrusive memories of the same content. Memories of participants with and without probable PTSD did not significantly differ on characteristics or content. CONCLUSIONS Intrusive memories can be common, distressing, and persistent occurrences following disasters, even in survivors not suffering from probable PTSD. HIGHLIGHTS Intrusive memories were common, distressing, and vivid more than 1-year post-disaster.They captured peri-earthquake sensations, material destruction, death, and social interactions.No difference in content or characteristics was found between participants with and without probable PTSD.
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Affiliation(s)
- Alessandro Massazza
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Helene Joffe
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Elinor Parrott
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Lau-Zhu A, Henson RN, Holmes EA. Selectively Interfering With Intrusive but Not Voluntary Memories of a Trauma Film: Accounting for the Role of Associative Memory. Clin Psychol Sci 2021; 9:1128-1143. [PMID: 34777922 PMCID: PMC8579330 DOI: 10.1177/2167702621998315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/01/2021] [Indexed: 11/16/2022]
Abstract
Intrusive memories of a traumatic event can be reduced by a subsequent interference procedure, seemingly sparing voluntary memory for that event. This selective-interference effect has potential therapeutic benefits (e.g., for emotional disorders) and legal importance (e.g., for witness testimony). However, the measurements of intrusive memory and voluntary memory typically differ in the role of associations between a cue and the emotional memory "hotspots." To test this, we asked participants to watch a traumatic film followed by either an interference procedure (reminder plus Tetris) or control procedure (reminder only). Measurement of intrusions (using a laboratory task) and voluntary memory (recognition for film stills) were crossed with the presence or absence of associative cues. The reminder-plus-Tetris group exhibited fewer intrusions despite comparable recognition memory, replicating the results of prior studies. Note that this selective interference did not appear to depend on associative cues. This involuntary versus voluntary memory dissociation for emotional material further supports separate-trace memory theories and has applied advantages.
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Affiliation(s)
- Alex Lau-Zhu
- Medical Research Council Cognition and Brain Sciences Unit, Department of Psychiatry, University of Cambridge
- Oxford Institute of Clinical Psychology Training and Research, Division of Medical Sciences, University of Oxford
- Centre for Psychiatry, Department of Brain Sciences, Imperial College London
- Oxford Health NHS Foundation Trust, Oxford, England
| | - Richard N. Henson
- Medical Research Council Cognition and Brain Sciences Unit, Department of Psychiatry, University of Cambridge
| | - Emily A. Holmes
- Medical Research Council Cognition and Brain Sciences Unit, Department of Psychiatry, University of Cambridge
- Department of Psychology, Uppsala University
- Department for Clinical Neuroscience, Karolinska Institutet
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Repantis D, Wermuth K, Tsamitros N, Danker-Hopfe H, Bublitz JC, Kühn S, Dresler M. REM sleep in acutely traumatized individuals and interventions for the secondary prevention of post-traumatic stress disorder. Eur J Psychotraumatol 2020; 11:1740492. [PMID: 32341766 PMCID: PMC7170365 DOI: 10.1080/20008198.2020.1740492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/26/2020] [Accepted: 03/03/2020] [Indexed: 01/04/2023] Open
Abstract
Increasing evidence supports a close link between REM sleep and the consolidation of emotionally toned memories such as traumatic experiences. In order to investigate the role of sleep for the development of symptoms related to traumatic experiences, beyond experimental models in the laboratory, sleep of acutely traumatised individuals may be examined on the first night after trauma. This might allow us to identify EEG variables predicting the development of posttraumatic stress disorder (PTSD) symptoms, and guide the way to novel sleep interventions to prevent PTSD. Based on our experience, patients' acceptance of polysomnography in the first hours after treatment in an emergency room poses obstacles to such a strategy. Wearable, self-applicable sleep recorders might be an option for the investigation of sleep in the aftermath of trauma. They would considerably decrease the perceived burden for patients and thus increase the likelihood of successful patient recruitment. As one potential sleep intervention, sleep deprivation directly after trauma has been suggested to reduce the consolidation of traumatic memories and hence act as a secondary preventive measure. However, experimental data from sleep deprivation studies in healthy volunteers with the trauma film paradigm have been inconclusive regarding the beneficial or detrimental effects of sleep on traumatic memory processing. Depending on further insights into the role of sleep in traumatic memory consolidation through observational and experimental studies, several options for therapeutic sleep interventions are conceivable: besides behavioural sleep deprivation, selective REM sleep suppression or enhancement by a pharmacological intervention into the serotonergic, noradrenergic or cholinergic systems might provide novel therapeutic options. While REM-modulating drugs have been used with some success for the prevention of PTSD after trauma, they have never been tried before the first night of sleep. In conclusion, more experimental and observational research is needed before sleep interventions are performed in actual trauma victims.
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Affiliation(s)
- Dimitris Repantis
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
| | - Katharina Wermuth
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nikolaos Tsamitros
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Heidi Danker-Hopfe
- Competence Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Christoph Bublitz
- Faculty of Law, Universität Hamburg, Hamburg, Germany.,Centre for Interdisciplinary Research (ZiF), Bielefeld, Germany
| | - Simone Kühn
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Martin Dresler
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
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