Autonomic and fronto-cortical correlates of script-driven imagery of trauma-related nightmares compared with such imagery of index trauma in PTSD using ambulatory physiological and fNIRS recordings.

创伤相关噩梦(TRN)是创伤后应激障碍的标志性再体验症状 对于患有创伤后应激障碍(PTSD)的人来说，这是一种严重的、再创伤性的痛苦来源。拟议的研究将 调查这种噩梦是否可能成为长时间暴露在想象中的目标 治疗(PE)，创伤后应激障碍的一线治疗。学习和记忆恐惧的消退是神经认知 体育的基础和在体育过程中增加的生理唤醒可以帮助消除学习。因此，体育 使用TRNS可能会改善治疗结果，因为噩梦的即时性和突发性更强 相对于时间上更遥远的创伤事件。我们的研究小组开发了标准化的脚本- 驱动成像(SDI)程序，通过该程序，由回忆引起的心理生理唤醒程度 可以评估引发创伤后症状的创伤事件(指数创伤)。我们队有 还开发了一种新型的可移动设备NINcan，它可以记录皮肤电导(SC)、面部 肌电图仪(EMG)和心电图仪(ECG)与同步功能近红外线 额叶外侧皮质(LPFC)的光谱成像(FNIRS)。LPFC包括以下地区 PTSD患者在SDI期间激活和/或去激活，包括右额下回(RIFG)， 在抑制不想要的行为和认知方面起着重要作用并表现出减少的区域 创伤后应激障碍患者的抑制性表现。在包括建立结构化临床评估的筛查之后 创伤后应激障碍的诊断和自我报告每周至少2个TRN，合格的参与者将记录 他们的食指创伤。然后，他们将完成为期两周的睡眠日记和手腕动作，并在四个晚上 动态多导睡眠图(PSG)，在此期间，他们将在带有时间戳的数字记录器上录音， 任何由噩梦引起的唤醒之后的详细噩梦报告。具有足够长度的TRN报告， 将选择与创伤指数的清晰度和相似性，并将与创伤指数报告一起重新 作为SDI的剧本录制。只有生成了适合SDI的TRN(N=40)的参与者才会接受 在佩戴NINcan的同时，在一天内进行2次SDI会话。一个剧本将从他们的脊柱创伤中衍生出来 另一种来自他们的TRN，其顺序将在参与者之间平衡。 心理生理反应和fNIRS LPFC激活将在使用2个初级脚本的脚本之间进行比较 观察指标：(1)结合SC、EMG和ECG的经验证的典型心理生理学变量； (2)与脚本相关的RIFC激活。我们假设TRN的两个激活都将大于 关于索引创伤的脚本。探索性目标将包括(1)检查睡眠阶段和 夜间噩梦睡醒前睡眠的脑电特征 使用PSG，以及(2)结合PSG和fNIRS使用NINScan记录与创伤相关的噩梦 睡眠实验室记录了5个人在家中监测期间最频繁的噩梦。

Trauma-related nightmares (TRNs) are a hallmark re-experiencing symptom of Posttraumatic Stress Disorder (PTSD) and a severe, re-traumatizing source of distress to those with this condition. Proposed research will investigate whether such nightmares might serve as targets for imaginal exposure during prolonged exposure therapy (PE), a first-line treatment for PTSD. Learning and memory of fear extinction are the neurocognitive underpinnings of PE and increased physiological arousal during PE can aid in extinction learning. Thus, PE using TRNs might enhance treatment outcomes because of the greater immediacy and salience of nightmares relative to the more temporally distant traumatic event. Our research group has developed standardized script- driven imagery (SDI) procedures whereby the degree of psychophysiological arousal induced by recollection of the traumatic event that precipitated posttraumatic symptoms (index trauma) can be assessed. Our team has also developed a novel ambulatory device, the NINscan, that can record skin conductance (SC), facial electromyography (EMG) and electrocardiography (ECG) along with simultaneous functional near-infrared spectroscopic (fNIRS) imaging of the lateral prefrontal cortex (LPFC). The LPFC encompasses regions that activate and/or deactivate during SDI in persons with PTSD and includes the right inferior frontal gyrus (rIFG), an area that plays an important role in inhibiting unwanted behavior and cognition and shows reduced inhibitory performance in PTSD. Following screenings that include a structured clinical evaluation establishing PTSD diagnosis and self-report of a least 2 TRNs per week, qualified participants will record an account of their index trauma. They will then complete 2 weeks of sleep diaries and wrist actigraphy with 4 nights of ambulatory polysomnography (PSG), during which they will audio-record, on a time-stamped digital recorder, a detailed nightmare report following any nightmare-induced awakening. A TRN report having sufficient length, clarity and resemblance to the index trauma will be selected and, along with the index-trauma report, will be re- recorded as a script for SDI. Only participants who generated a TRN suitable for SDI (N=40) will then undergo 2 SDI sessions on a single day while wearing the NINscan. One script will be derived from their index trauma and the other from their TRN, the order of which will be counterbalanced across participants. Psychophysiological response and fNIRS LPFC activation will be compared between scripts using 2 primary outcome measures: (1) a validated canonical psychophysiological variable combining SC, EMG and ECG, and (2) script-related activation of the rIFC. We hypothesize that both activations will be greater for the TRN than for the index-trauma script. Exploratory aims will include (1) examination of the sleep stage and electroencephalographic characteristics of sleep preceding awakenings when a nightmare occurred on a night with PSG, and (2) combined PSG and fNIRS recording of trauma-related nightmares using the NINscan in the sleep laboratory in 5 individuals who recorded the most frequent nightmares during home monitoring.