Preferential Improvement of Trauma-Related Distressing Dreams Following Traumatic Memory Reactivation in Severe PTSD: A Secondary Analysis of a Randomized Placebo-Controlled Trial.

Abstract

Trauma-related distressing dreams are among the most frequent and persistent symptoms of posttraumatic stress disorder (PTSD). Propranolol has been proposed to modulate the reconsolidation of reactivated emotional memories through beta-adrenergic blockade, providing a rationale for its combination with traumatic memory reactivation procedures (TMRP). In this exploratory post hoc secondary analysis of the REDUCTRAUMA2 randomized double-blind placebo-controlled trial, we examined changes in distressing dreams severity during and after TMRP administered under propranolol or placebo in 66 patients with PTSD. Distressing dreams were assessed using item 2 of the PTSD Checklist-Specific (PCL-S). Distressing dreams severity decreased markedly following the intervention in the whole cohort, with large within-subject effects maintained up to 3 months. No significant differences were observed between propranolol and placebo. In the overall cohort, distressing dreams improved preferentially compared with the remaining PTSD symptoms at one-week and one-month follow-up. Subgroup analyses showed that this preferential improvement was sustained across all follow-up assessments in participants with severe PTSD at baseline, whereas no preferential effect was observed in the non-severe subgroup. Distribution-free RIDIT analyses yielded convergent findings. These exploratory findings suggest that trauma-related distressing dreams may represent a particularly treatment-responsive symptom dimension in PTSD, especially among patients with more severe symptomatology. No additional benefit of propranolol over placebo was observed; however, in the absence of a non-reactivation control condition, the specific contribution of TMRP to the observed improvement cannot be determined. Prospective studies using dedicated nightmare measures and appropriate control conditions are needed to confirm these findings. Trail Registration: ClinicalTrials.gov identifier: NCT01713556.