The role of prediction error in a behavioral memory reconsolidation intervention for the treatment of posttraumatic stress symptoms: Original proposal and update due to the COVID-19 global pandemic

ABSTRACT

A failure to naturally resolve posttraumatic stress symptoms (PTSS) following exposure to a traumatic event is associated with costly and debilitating consequences. Interventions for PTSS are successful for only 40%-70% of patients, and treatment drop-out and symptom relapse are common. Recent research targeting memory reconsolidation mechanisms to augment the memory may provide important information regarding possible paradigms for improving the efficacy of trauma-focused interventions. This research indicates that the use of prediction error during a memory activation cue may result in memory destabilization allowing for the destabilized memory to be updated. Considering that PTSS are inherently memory-dependent, an intervention targeting memory reconsolidation mechanisms may be especially relevant for the treatment of these symptoms. The current study was designed to translate the memory reconsolidation literature for clinical application in the treatment of PTSS. Participants were assigned to either the Intervention or the Control conditions. Psychophysiological arousal, as well as change in overall symptoms, intrusion symptoms specifically, and subjective distress were assessed one week later. Although initially designed as a randomized trial of a behavioral intervention targeting memory reconsolidation mechanism, the onset of the COVID-19 pandemic prevented the completion of planned data collection, and the study was discontinued with only five participants' data collected in full. Three participants were in the Intervention condition;two were in the Control condition. As such, this data was examined as a case series to explore the potential efficacy of the paradigm. Results of the case series were mixed, suggesting that the Intervention condition, but not the Control condition, may have been successful at diminishing the spontaneous recovery of psychophysiological responding for some individuals (n = 2), but that the effect is likely not clinically meaningful. The role of case series in treatment design is discussed as are limitations of the current design and future directions. A proposal for a future iteration of this study is presented. (PsycInfo Database Record (c) 2022 APA, all rights reserved)