Abstract
Translational research highlights the potential of novel 'memory consolidation/reconsolidation therapies' to treat re-experiencing symptoms and post-traumatic stress disorder (PTSD). This systematic review and meta-analysis assessed the efficacy of so-called memory consolidation/reconsolidation therapies in randomised controlled trials (RCTs) for prevention and treatment of PTSD and symptoms of re-experiencing in children and adults (PROSPERO: CRD42020171167). RCTs were identified and rated for risk of bias. Available data was pooled to calculate risk ratios (RR) for PTSD prevalence and standardised mean differences (SMD) for PTSD/re-experiencing severity. Twenty-five RCTs met inclusion criteria (16 prevention and nine treatment trials). The methodology of most studies had a significant risk of bias. We found a large effect of reconsolidation interventions in the treatment of PTSD (11 studies, n = 372, SMD: −1.42 (−2.25 to −0.58), and a smaller positive effect of consolidation interventions in the prevention of PTSD (12 studies, n = 2821, RR: 0.67 (0.50 to 0.90). Only three protocols (hydrocortisone for PTSD prevention, Reconsolidation of Traumatic Memories (RTM) for treatment of PTSD symptoms and cognitive task memory interference procedure with memory reactivation (MR) for intrusive memories) were superior to control. There is some emerging evidence of consolidation and reconsolidation therapies in the prevention and treatment of PTSD and intrusive memories specifically. Translational research should strictly adhere to protocols/procedures describing precise reconsolidation conditions (e.g. MR) to both increase the likelihood of positive findings and more confidently interpret negative findings of putative reconsolidation agents.
Highlights
Scientific advances over the previous 20 years have demonstrated that, contrary to previous thinking, memories are highly malleable and that this may have applications for therapeutic innovation [1, 2]
The updated search contained 3188 papers. With both attempting to draw on consolidation/ examined the full text of 48 papers and 25 of these met the reconsolidation theory to alter a memory within a certain inclusion criteria
CMTR was superior to control in preventing intrusive memories in three RCTs. This meta-analysis assessed the efficacy of so-called, consolidation/reconsolidation therapy RCTs in the prevention and treatment of posttraumatic stress disorder (PTSD), PTSD symptoms and intrusive symptoms
Summary
Scientific advances over the previous 20 years have demonstrated that, contrary to previous thinking, memories are highly malleable and that this may have applications for therapeutic innovation [1, 2]. Basic scientific research into the neurobiology of memory formation (initial memory consolidation) and memory reconsolidation (for older memories) suggests a hypothetical process whereby memory is retrieved and altered [3, 4]. Translational clinical studies have aimed to utilise such basic scientific advances in memory modification mechanisms (consolidation and reconsolidation) to prevent and treat psychopathology— the re-experiencing of distressing traumatic memories and posttraumatic stress disorder (PTSD) [1, 5,6,7,8]. In 2000, Nader et al [3] ‘s seminal paper demonstrated that neuroplasticity and protein synthesis are required for the consolidation of new emotional memories and when already consolidated fear memories are retrieved. The hypothesis suggests that once retrieved (e.g. via memory reactivation (MR)), new protein synthesis can alter old memories, and reform them without their previous emotional salience via reconsolidation update mechanisms. Anisomycin is toxic in humans, but the work provides insights into the mobilisation and adaptation of emotional memories as a treatment after trauma [10, 11]
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