Clinical and neurophysiological effects of imagery rehearsal therapy and targeted memory reactivation in post-traumatic stress disorder
Océane Lüthi, Vincent Rochas, Audrey Theux, Alice Clerget, Laurence Bayer, Lampros Perogamvros
Research Square October 14, 2026 preprint DOI: 10.21203/rs.3.rs-11359503/v1 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial |
|---|---|
| Sample size | 36 |
| Population | Adults diagnosed with post-traumatic stress disorder |
| Interventions | Imagery Rehearsal Therapy Targeted Memory Reactivation |
| Duration | Three weekly Imagery Rehearsal Therapy sessions, with polysomnographic recordings before and after the intervention |
| Topics | PTSD |
| Key findings | Imagery Rehearsal Therapy significantly improved PTSD symptoms, insomnia severity, nightmare frequency and distress, and depressive symptoms in adults with PTSD. Combining it with Targeted Memory Reactivation added no further benefit on these outcomes, though it was associated with additional posterior sleep-related neural changes during REM sleep. Baseline sleep recordings in trauma-exposed patients suggested cortical hyperarousal relative to healthy individuals. |
Abstract
Abstract Post-traumatic stress disorder is frequently associated with post-traumatic nightmares, which may be related to cortical hyperarousal. Imagery Rehearsal Therapy is the first-line treatment for nightmares. Targeted Memory Reactivation, which reactivates specific memories during sleep to enhance memory consolidation, has been shown to enhance the effects of Imagery Rehearsal Therapy in idiopathic nightmares. This study investigated the efficacy of Imagery Rehearsal Therapy for traumatic nightmares and broader post-traumatic stress disorder symptoms, and whether these effects could be enhanced by Targeted Memory Reactivation. Thirty-six adults diagnosed with post-traumatic stress disorder received either Imagery Rehearsal Therapy alone (n = 17) or Imagery Rehearsal Therapy combined with Targeted Memory Reactivation (n = 19). Participants completed three weekly Imagery Rehearsal Therapy sessions and underwent polysomnographic recordings before and after the intervention. In the combined treatment group, a sensory cue associated with the positive therapy scenario was presented during sessions and reactivated nightly during rapid eye movement sleep at home using a sleep headband. Imagery Rehearsal Therapy significantly improved post-traumatic stress disorder symptoms and associated outcomes, including insomnia severity, nightmare frequency/distress, and depressive symptoms. No additional benefit of Targeted Memory Reactivation was observed. Compared to healthy individuals, trauma-exposed patients showed baseline polysomnographic alterations suggestive of cortical hyperarousal, including increased frontocentral beta activity during non-rapid eye movement sleep and reduced frontal delta activity during rapid eye movement sleep. Following treatment, beta activity decreased, while Targeted Memory Reactivation was associated with additional posterior sleep-related neural changes during rapid eye movement sleep, in regions previously implicated in dream experience.