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Sleep enhances exposure therapy

Published online by Cambridge University Press:  10 July 2013

B. Kleim ,
F. H. Wilhelm ,
L. Temp ,
J. Margraf ,
B. K. Wiederhold  and
B. Rasch
B. Kleim*
Affiliation:
Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
F. H. Wilhelm
Affiliation:
Department of Clinical Psychology, Psychotherapy, and Health Psychology, University of Salzburg, Salzburg, Austria
L. Temp
Affiliation:
University of Basel, Basel, Switzerland
J. Margraf
Affiliation:
Center for the Study and Treatment of Mental Health, Department of Clinical Psychology, Ruhr-University Bochum, Germany
B. K. Wiederhold
Affiliation:
Virtual Reality Medical Center, San Diego, CA, USA Virtual Reality Medical Center, Brussels, Belgium
B. Rasch
Affiliation:
Department of Biopsychology, University of Zurich, Zurich, Switzerland
*
* Address for correspondence: B. Kleim, Ph.D., Department of Clinical Psychology and Psychotherapy, University of Zurich, Binzmühlestrasse 14, Box 26, CH-8050 Zurich, Switzerland. (Email: b.kleim@psychologie.uzh.ch)
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Abstract

Background

Sleep benefits memory consolidation. Here, we tested the beneficial effect of sleep on memory consolidation following exposure psychotherapy of phobic anxiety.

Method

A total of 40 individuals afflicted with spider phobia according to DSM-IV underwent a one-session virtual reality exposure treatment and either slept for 90 min or stayed awake afterwards.

Results

Sleep following exposure therapy compared with wakefulness led to better reductions in self-reported fear (p = 0.045, d = 0.47) and catastrophic spider-related cognitions (p = 0.026, d = 0.53) during approaching a live spider, both tested after 1 week. Both reductions were associated with greater percentages of stage 2 sleep.

Conclusions

Our results indicate that sleep following successful psychotherapy, such as exposure therapy, improves therapeutic effectiveness, possibly by strengthening new non-fearful memory traces established during therapy. These findings offer an important non-invasive alternative to recent attempts to facilitate therapeutic memory extinction and consolidation processes with pharmacological or behavioral interventions.

Keywords

Electroencephalographyemotional learningexposure therapymemory consolidationphobiasleep

Information

Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 7 , May 2014 , pp. 1511 - 1519
Copyright
Copyright © Cambridge University Press 2013 

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References

Anderer, P, Moreau, A, Woertz, M, Ross, M, Gruber, G, Parapatics, S, Loretz, E, Heller, E, Schmidt, A, Boeck, M, Moser, D, Kloesch, G, Saletu, B, Saletu-Zyhlarz, GM, Danker-Hopfe, H, Zeitlhofer, J, Dorffner, G (2010). Computer-assisted sleep classification according to the standard of the American Academy of Sleep Medicine: validation study of the AASM version of the Somnolyzer 24 × 7. Neuropsychobiology 62, 250–264.Google Scholar
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, revised. American Psychiatric Association: Washington, DC.Google Scholar
Arntz, A, Lavy, E, Van den Berg, G, Van Rijsoort, S (1993). Negative beliefs of spider phobics: a psychometric evaluation of the Spider Phobia Beliefs Questionnaire. Advances in Behaviour Research and Therapy 15, 257–277.Google Scholar
Baran, B, Pace-Schott, EF, Ericson, C, Spencer, RMC (2012). Processing of emotional reactivity and emotional memory over sleep. Journal of Neuroscience 32, 1035–1042.Google Scholar
Beck, AT, Steer, RA (1987). Beck Depression Inventory: Manual. Psychological Corporation: San Antonio, TX.Google Scholar
Buysse, DJ, Reynolds, CF, Monk, TH, Berman, SR, Kupfer, DJ (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research 28, 193–213.CrossRefGoogle ScholarPubMed
Choy, Y, Fyer, AJ, Lipsitz, JD (2007). Treatment of specific phobia in adults. Clinical Psychology Review 27, 266–286.Google Scholar
Craske, MG, Mystkowski, JL (2006). Exposure therapy and extinction: clinical studies. In Fear and Learning: Basic Science to Clinical Application (ed. Craske, D. H. M. G. and Vansteenwegen, D.), pp. 217–234. American Psychological Association: Washington, DC.Google Scholar
De Quervain, DJF, Bentz, D, Michael, T, Bolt, OC, Wiederhold, BK, Margraf, J, Wilhelm, FH (2011). Glucocorticoids enhance extinction-based psychotherapy. Proceedings of the National Academy of Sciences USA 108, 6621–6625.Google Scholar
Diekelmann, S, Biggel, S, Rasch, B, Born, J (2012). Offline consolidation of memory varies with time in slow wave sleep and can be accelerated by cuing memory reactivations. Neurobiology of Learning and Memory 98, 103–111.CrossRefGoogle ScholarPubMed
Diekelmann, S, Born, J (2010). The memory function of sleep. Nature Reviews Neuroscience 11, 114–126.Google Scholar
Diekelmann, S, Wilhelm, I, Born, J (2009). The whats and whens of sleep-dependent memory consolidation. Sleep Medicine Review 13, 309–321.Google Scholar
Emmelkamp, PM, Bruynzeel, M, Drost, L, van der Mast, CA (2001). Virtual reality treatment in acrophobia: a comparison with exposure in vivo . Cyberpsychology and Behavior 4, 335–339.CrossRefGoogle ScholarPubMed
Horne, JA, Ostberg, O (1976). A self-assessment questionnaire to determine morningness–eveningness in human circadian rhythms. International Journal of Chronobiology 4, 97–110.Google ScholarPubMed
Hussaini, SA, Bogusch, L, Landgraf, T, Menzel, R (2009). Sleep deprivation affects extinction but not acquisition memory in honeybees. Learning and Memory 16, 698–705.Google Scholar
Johns, MW (1994). Sleepiness in different situations measured by the Epworth Sleepiness Scale. Sleep 17, 703–710.Google Scholar
Lahl, O, Wispel, C, Willigens, B, Pietrowsky, R (2008). An ultra short episode of sleep is sufficient to promote declarative memory performance. Journal of Sleep Research 17, 3–10.CrossRefGoogle ScholarPubMed
Magee, WJ, Eaton, WW, Wittchen, HU, McGonagle, KA, Kessler, RC (1996). Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Archives of General Psychiatry 53, 159–168.CrossRefGoogle ScholarPubMed
McNally, RJ (2007). Mechanisms of exposure therapy: how neuroscience can improve psychological treatments of anxiety disorders. Clinical Psychology Review 27, 750–759.Google Scholar
Mednick, S, Nakayama, K, Stickgold, R (2003). Sleep-dependent learning: a nap is as good as a night. Nature Neuroscience 6, 697–698.Google Scholar
Mölle, M, Born, J (2011). Slow oscillations orchestrating fast oscillations and memory consolidation. Progress in Brain Research 193, 93–110.Google Scholar
Mystkowski, JL, Craske, MG, Echiverri, AM (2002). Treatment context and return of fear in spider phobia. Behavior Therapy 33, 399–416.Google Scholar
Mystkowski, JL, Craske, MG, Echiverri, AM, Labus, JS (2006). Mental reinstatement of context and return of fear in spider-fearful participants. Behavior Therapy 37, 49–60.CrossRefGoogle ScholarPubMed
Nishida, M, Pearsall, J, Buckner, RL, Walker, MP (2009). REM sleep, prefrontal theta, and the consolidation of human emotional memory. Cerebral Cortex 19, 1158–1166.CrossRefGoogle ScholarPubMed
Norton, PJ, Price, EC (2007). A meta-analytic review of adult cognitive–behavioral treatment outcome across the anxiety disorders. Journal of Nervous and Mental Disease 195, 521–531.Google Scholar
Ost, LG (1996). One-session group treatment of spider phobia. Behavior Research and Therapy 34, 707–715.Google Scholar
Ost, LG, Brandberg, M, Alm, T (1997). One versus five sessions of exposure in the treatment of flying phobia. Behavior Research and Therapy 35, 987–996.Google Scholar
Pace-Schott, E, Verga, PW, Bennett, TS, Spencer, RM (2012). Sleep promoted consolidation and generalizaton of extinction learning in simulated exposure therapy for spider fear. Journal of Psychiatric Research 46, 1036–1044.Google Scholar
Pace-Schott, EF, Milad, MR, Orr, SP, Rauch, SL, Stickgold, R, Pitman, RK (2009). Sleep promotes generalization of extinction of conditioned fear. Sleep 32, 19–26.Google Scholar
Pace-Schott, EF, Shepherd, E, Spencer, RM, Marcello, M, Tucker, M, Propper, RE, Stickgold, R (2011). Napping promotes inter-session habituation to emotional stimuli. Neurobiology of Learning and Memory 95, 24–36.Google Scholar
Payne, JD, Stickgold, R, Swanberg, K, Kensinger, EA (2008). Sleep preferentially enhances memory for emotional components of scenes. Psychological Science 19, 781–788.Google Scholar
Powers, MB, Emmelkamp, PM (2008). Virtual reality exposure therapy for anxiety disorders: a meta-analysis. Journal of Anxiety Disorders 22, 561–569.Google Scholar
Price, M, Mehta, N, Tone, EB, Anderson, PL (2011). Does engagement with exposure yield better outcomes? Components of presence as a predictor of treatment response for virtual reality exposure therapy for social phobia. Journal of Anxiety Disorders 25, 763–770.Google Scholar
Rasch, B, Buchel, C, Gais, S, Born, J (2007). Odor cues during slow-wave sleep prompt declarative memory consolidation. Science 315, 1426–1429.CrossRefGoogle ScholarPubMed
Ressler, KJ, Rothbaum, BO, Tannenbaum, L, Anderson, P, Graap, K, Zimand, E, Hodges, L, Davis, M (2004). Cognitive enhancers as adjuncts to psychotherapy: use of d-cycloserine in phobic individuals to facilitate extinction of fear. Archives of General Psychiatry 61, 1136–1144.Google Scholar
Ruhmland, M, Margraf, J (2001). Effectiveness of psychological therapies for specific phobia and obssessive–compulsive disorder: disorder-specific meta-analyses. Verhaltenstherapie 11, 12.Google Scholar
Scheuchenpflug, R (2001). Measuring presence in virtual environments. In HCI International (ed. Smith, M. J., Salvendy, G. and Kasdorf, M. R.), pp. 56–58. Lawrence Erlbaum: Mahwah, NJ.Google Scholar
Schneider, S, Margraf, J (2006). Diagnostic Interview for Mental Disorders (DIPS). Springer: Berlin.Google Scholar
Silvestri, AJ, Root, DH (2008). Effects of REM deprivation and an NMDA agonist on the extinction of conditioned fear. Physiology and Behavior 93, 274–281.Google Scholar
Silvestri, R, Pace-Schott, EF, Gersh, T, Stickgold, R, Salzman, C, Hobson, JA (2001). Effects of fluvoxamine and paroxetine on sleep structure in normal subjects: a home-based Nightcap evaluation during drug administration and withdrawal. Journal of Clinical Psychiatry 62, 642–652.Google Scholar
Smith, CT, Aubrey, JB, Peters, KR (2004). Different roles for REM and stage 2 sleep in motor learning: a proposed model. Psychologica Belgica 44, 81–104.Google Scholar
Spoormaker, VI, Schröter, MS, Andrade, KC, Dresler, M, Kiem, SA, Goya-Maldonado, R, Wetter, TC, Holsboer, F, Sämann, PG, Czisch, M (2011). Effects of rapid eye movement sleep deprivation on fear extinction recall and prediction error signaling. Human Brain Mapping 33, 2362–2376.Google Scholar
Spoormaker, VI, Sturm, A, Andrade, KC, Schroter, MS, Goya-Maldonado, R, Holsboer, F, Wetter, TC, Samann, PG, Czisch, M (2010). The neural correlates and temporal sequence of the relationship between shock exposure, disturbed sleep and impaired consolidation of fear extinction. Journal of Psychiatric Research 44, 1121–1128.Google Scholar
Stickgold, R (2009). How do I remember? Let me count the ways. Sleep Medicine Review 13, 305–308.Google Scholar
Suppiger, A, In-Albon, T, Herren, C, Bader, K, Schneider, S, Margraf, J (2008). Reliabilität des Diagnostischen Interviews bei psychischen Störungen (DIPS für DSM-IV-TR). [Reliability of the Diagnostic Interview for Mental Disorders (DIPS for DSM-IV-TR).]. Verhaltenstherapie 18, 237–244.Google Scholar
van der Helm, E, Gujar, N, Nishida, M, Walker, MP (2011 a). Sleep-dependent facilitation of episodic memory details. PLoS ONE 6, e27421.Google Scholar
van der Helm, E, Walker, MP (2011). Sleep and emotional memory processing. Sleep Medicine Clinics 6, 31–43.Google Scholar
van der Helm, E, Yao, J, Dutt, S, Rao, V, Saletin, JM, Walker, MP (2011 b). REM sleep depotentiates amygdala activity to previous emotional experiences. Current Biology 21, 2029–2032.Google Scholar
Wagner, U, Gais, S, Born, J (2001). Emotional memory formation is enhanced across sleep intervals with high amounts of rapid eye movement sleep. Learning and Memory 8, 112–119.Google Scholar
Wagner, U, Hallschmid, M, Rasch, B, Born, J (2006). Brief sleep after learning keeps emotional memories alive for years. Biological Psychiatry 60, 788–790.Google Scholar
Walker, MP (2008). Sleep-dependent memory processing. Harvard Review of Psychiatry 16, 287–298.Google Scholar
Walker, MP (2009). The role of sleep in cognition and emotion. Annals of New York Academy of Science 1156, 168–197.Google Scholar
Walker, MP, Brakefield, T, Morgan, A, Hobson, JA, Stickgold, R (2002). Practice with sleep makes perfect: sleep-dependent motor skill learning. Neuron 35, 205–211.Google Scholar
Walker, MP, Brakefield, T, Seidman, J, Morgan, A, Hobson, JA, Stickgold, R (2003). Sleep and the time course of motor skill learning. Learning and Memory 10, 275–284.Google Scholar
Walker, MP, van der Helm, E (2009). Overnight therapy? The role of sleep in emotional brain processing. Psychological Bulletin 135, 731–748.CrossRefGoogle ScholarPubMed
Wamsley, EJ, Stickgold, R (2010). Dreaming and offline memory processing. Current Biology 20, R1010–R1013.CrossRefGoogle ScholarPubMed
Wertz, AT, Wright, KP, Ronda, J M, Czeisler, CA (2006). Effects of sleep inertia on cognition. Journal of the American Medical Association 295, 163–164.Google Scholar
Wolpe, J, Lazarus, AA (1966). Behavior Therapy Techniques. Pergamon Press: Oxford.Google Scholar