Sleep enhances exposure therapy

Abstract

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

1120 Effects of Post-Exposure Naps on Change in Autonomic Arousal to A social Challenge Across Exposure Therapy for Social Anxiety

“…Exposure therapy provides learning situations where new therapeutic extinction memory traces are formed that then need to be consolidated and integrated with pre-existing memories and experiences (Kleim et al, 2014 shown. However, in the wake group, responses to the new spider were actually stronger than to the original spider video in Session 1 when it was first shown (sensitization).…”

“…Another study of sleep following exposure therapy for spider phobia suggested that sleep improved therapeutic effectiveness (Kleim et al, 2014). This study tested the effectiveness of sleep following virtual reality exposure therapy on extinction memory consolidation.…”

Letter to the Editor: Simply avoiding reactivating fear memory after exposure therapy may help to consolidate fear extinction memory – a reply

“…In the recent study of Kleim et al (2014), going to sleep immediately after exposure increased the efficacy of the treatment of spider phobia, compared to staying awake after a session. The authors explain this effect by the benefits of sleep on memory consolidation found in earlier studies.…”

“…Therefore, if exposure is followed by sleep, the spider non-fearful memories will be better reactivated when competing with spider fearful memories. Kleim et al (2014) used a 90 min-long documentary about European cities for the awake condition. We can assume that this documentary contains some cues associated with spiders, as spiders can be found in most modern homes.…”

“…The study of Kleim et al (2014) emphasizes that, to ensure that the next 6 h needed for memory consolidation will not be disturbed by exposure to phobic cues (and reactivate the fear), behaviour therapists must enquire about post-exposure session activities of treated patients.…”