Psychophysiological and Functional Near-Infrared Spectroscopic Brain Imaging of Trauma Memory and Posttraumatic Nightmare Memory Using Script-Driven Imagery in Individuals with PTSD

Augustus Kram Mendelsohn, BA

Massachusetts General Hospital
Psychophysiological and Functional Near-Infrared Spectroscopic Brain Imaging of Trauma Memory and Posttraumatic Nightmare Memory Using Script-Driven Imagery in Individuals with PTSD

Scientific Abstract

Background: Repetitive, trauma-related nightmares are a common symptom of PTSD. A first-line treatment for PTSD, Prolonged Exposure (PE) therapy, produces fear-extinction via repeated imaginal exposure to details of the patient’s memory of their worst trauma. Relevant traumatic events may have occurred in the distant past and their memories become distorted. Posttraumatic nightmares may be more recent, salient, and better able to induce extinction learning. This study compares physiological responses during memory of a trauma to those during memory of the trauma-related nightmare.

Methods: Subjects who have experienced a traumatic event resulting in frequent trauma-related nightmares write an account of the initial trauma. This is used to create 2, 30-sec trauma scripts using standardized procedures. Subjects complete 14 days of actigraphy, sleep diaries, record narratives of any nightmares and complete 2+ nights of ambulatory polysomnography. A nightmare closely related to a subject’s trauma is used to create 2, 30-sec trauma-nightmare scripts. Subjects then complete 2 standardized Script-Driven Imagery (SDI) sessions. In one session, they listen to and vividly imagine their 2 trauma scripts interspersed with 2 neutral scripts. During the other, they perform the same protocol but with 2 trauma- nightmare scripts. The 2 SDI sessions are 1h apart and their order is counterbalanced. During each SDI session, skin conductance, heart rate, and facial electromyography are recorded. Functional activity of the lateral prefrontal cortex is simultaneously recorded, using near-infrared spectroscopy, by the NINscan system. Data are synchronized across all recordings. We hypothesize that the strength of physiological responses to trauma-nightmare SDI will equal or exceed those to trauma-memory SDI.

Results: Data collection began in fall 2020; 4 subjects have now completed the study.

Conclusion: Data will determine if imagined trauma-nightmares can evoke similar or greater physiological and CNS responses than recollected content from the initial trauma. This study will provide proof-of-concept for recording these responses during PE to identify biomarkers of treatment response.

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research Areas

Authors

Augustus Kram Mendelsohn, BA, Vladimir Ivkovic, PhD, Elizabeth P. Fortier, Quan Zhang, PhD, Gary Strangman, Phd, Natasha Lasko, PhD, Scott P. Orr, PhD, Suzanne Pineles, PhD, Edward F. Pace-Schott PhD

Principal Investigator

Edward F. Pace-Schott, PhD