Journal Digest: IRT; Motivational Therapy; Mental Health Apps; and More

Using sounds to activate positive memories during sleep may boost the effectiveness of a daytime therapy for nightmare disorder called image rehearsal therapy (IRT).

“Nightmare disorder is characterized by dreams with strong negative emotions occurring during rapid eye movement (REM) sleep,” wrote a team of researchers from the University of Geneva in Switzerland. IRT is a cognitive-behavioral technique in which a person recalls a nightmare during the daytime but changes the narrative to make it more positive.

The researchers wanted to know if targeted memory reactivation—a technique used to manipulate memory processing through the application of cues during sleep—might lead to better outcomes in patients receiving IRT. They enrolled 36 adults with nightmare disorder to receive one IRT therapy session; while the participants were reframing their nightmare, half of the adults were exposed to a sound while the other half were not. Over the next two weeks, all the participants wore a special wireless headband to bed that monitored their brain rhythms. When all participants reached REM sleep, they were exposed to the same sound that half of the participants heard during IRT.

At baseline, participants in both groups reported an average of about three nightmares per week. After two weeks, the adults who received memory reactivation alongside IRT reported an average of 0.19 nightmares per week compared with 1.02 nightmares per week among adults who received IRT only. In sleep diaries, the adults who received memory reactivation also reported more joy rather than fear about their dreams overall. These positive effects were maintained at a three-month follow-up assessment.

The investigators suggested that targeted memory activation could have applications beyond nightmare disorder as people with such conditions as mood disorders, anxiety, and posttraumatic stress disorder are also known to experience sleep problems. The study was published in Current Biology.

Motivational therapy can help adults become more engaged with advance care planning, a process by which patients plan for periods when their illness may inhibit decision-making capacity. The findings were published in JAMA Internal Medicine.

Researchers at Yale School of Medicine and colleagues recruited 483 veterans aged 55 years and older from the Connecticut VA Health System. These participants were assigned to one of four groups:

The researchers then compared how far participants in each group progressed after six months across four stages of advance care planning: communicating their views on quality versus quantity of life with someone trusted, assigning a health care agent, completing a living will, and submitting documents to their electronic health record.

Overall, participants in the MI and MET groups were statistically more likely to proceed further in care planning than those in the usual care group, whereas those receiving printed feedback only were not. The predicted probabilities of completing all four activities were 5.7% for the usual care group, 10.0% for the computer feedback group, 15.8% for the MI group, and 17.7% for the MET group.

“These findings suggest the importance of clinical interaction for advance care planning engagement,” the researchers wrote.

While the number of mental health apps has boomed in recent years, few of them address the needs of people with schizophrenia or other psychotic illness, according to an analysis in Schizophrenia.

Investigators at Beth Israel Deaconess Medical Center and colleagues conducted a review of research articles and mobile app marketplaces to evaluate schizophrenia apps.

The investigators identified 60 unique experimental psychosis apps in the medical literature. Of these, half provided symptom monitoring as their only function; only three of these apps offered symptom monitoring, therapeutic tools (like cognitive training exercises), and psychoeducation. Twenty-nine of the apps were available to download, but 20 of them required a special code or credentials.

The search for schizophrenia apps using the keywords “schizophrenia” or “psychosis” in the U.S. Apple and Google Play app stores uncovered 537 commercial apps. The researchers determined that only 25 of these apps were specific to psychosis. (Most were either not related to psychosis at all or supported general mental wellness.) Of the 25 psychosis-related apps, 19 were inaccessible, required an access code to work, or offered stigmatizing or dangerous information like “it’s all in your head.” The six appropriate and accessible apps were primarily focused on psychoeducation but, on average, had not been updated for about three years.

“While there is room to improve accessibility of research apps, our results suggest this work is necessary as the current marketplace offerings are concerning,” the investigators wrote. “While advanced apps are being studied, there is a clear need to provide simple but up-to-date apps directly on the Apple and Android marketplaces so that people with schizophrenia can at least benefit from higher quality psychoeducation.” ■