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Sleep enhances exposure therapy

Published online by Cambridge University Press:  10 July 2013

B. Kleim*
Department of Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
F. H. Wilhelm
Department of Clinical Psychology, Psychotherapy, and Health Psychology, University of Salzburg, Salzburg, Austria
L. Temp
University of Basel, Basel, Switzerland
J. Margraf
Center for the Study and Treatment of Mental Health, Department of Clinical Psychology, Ruhr-University Bochum, Germany
B. K. Wiederhold
Virtual Reality Medical Center, San Diego, CA, USA Virtual Reality Medical Center, Brussels, Belgium
B. Rasch
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:



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


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.


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.


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.

Original Articles
Copyright © Cambridge University Press 2013 

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