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.

创伤相关的噩梦（TRN）是创伤后应激障碍的标志性症状 （创伤后应激障碍）和一个严重的，再创伤的痛苦来源，这些条件。拟议的研究将 调查这些噩梦是否可以作为长时间暴露的想象暴露的目标 治疗（PE），PTSD的一线治疗。恐惧消退的学习和记忆是神经认知过程 体育运动的基础和体育运动期间增加的生理唤起可以帮助消退学习。因此，PE 使用TRN可能会提高治疗效果，因为噩梦的即时性和显著性更强 相对于时间上更遥远的创伤事件而言我们的研究小组开发了标准化的脚本- 驱动的意象（SDI）程序，即由回忆引起的心理生理唤醒的程度， 可以评估促成创伤后症状（指示创伤）的创伤事件。我们的团队已被 我还开发了一种新型的移动设备，NIN扫描，可以记录皮肤电导（SC），面部 肌电描记术（EMG）和心电图（ECG）沿着与同时的功能性近红外 光谱（fNIRS）成像的外侧前额叶皮层（LPFC）。LPFC包括以下地区： 在患有PTSD的人的SDI期间激活和/或失活，并且包括右额下回（rIFG）， 一个在抑制不必要的行为和认知方面起重要作用的区域， PTSD中的抑制表现。包括结构化临床评价的筛选后， PTSD诊断和自我报告每周至少2个TRN，合格的参与者将记录一个帐户， 他们的创伤指数然后，他们将完成2周的睡眠日记和腕动记录， 动态多导睡眠图（PSG），在此期间，他们将在带时间戳的数字记录器上录音， 在噩梦惊醒后的详细噩梦报告。具有足够长度的TRN报告， 将选择与索引创伤清晰度和相似性，并与索引创伤报告一起沿着重新 录制成SDI的脚本。然后，仅生成适合SDI的TRN的受试者（N=40）将接受 在佩戴NINscan的一天内进行2次SDI会话。其中一个剧本将来自他们的索引创伤 另一个来自他们的TRN，其顺序将在参与者之间平衡。 将使用2种主要方法比较脚本之间的心理生理反应和fNIRS LPFC激活 结果测量：（1）结合SC、EMG和ECG的经验证的典型心理生理变量，以及 (2)rIFC的脚本相关激活。我们假设，这两个激活将是更大的TRN比 创伤治疗脚本探索性目的将包括（1）检查睡眠阶段， 夜间噩梦发生时睡眠觉醒前的脑电图特征 （2）使用NIN扫描联合PSG和fNIRS记录创伤相关噩梦， 睡眠实验室在5个人谁记录了最频繁的噩梦在家庭监测。

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.