Controlling Nightmares with Imagery Rehearsal Therapy
Recurrent nightmares are common in patients with post-traumatic stress disorder (PTSD), but rarely are nightmares treated directly. These researchers randomized 168 women with chronic nightmares and DSM-IIIR-diagnosed PTSD to receive imagery rehearsal therapy (IRT) or to be placed on a wait list (control group). Of the participants, 79 percent were receiving concurrent psychotherapeutic or pharmacologic treatment.
Initially, the IRT sessions (two 3-hour group sessions a week apart plus 1 hour of follow-up 3 weeks later) provided participants with information about nightmares associated with traumatic experiences. Participants were taught methods of developing pleasant imagery and drawing on old nightmare images to slowly create a new dream, which they were instructed to rehearse 5 to 20 minutes per day. Standardized interviews and self-reports conducted 3 and 6 months afterwards showed that the treatment significantly decreased the weekly incidence of nights with nightmares and the weekly number of nightmares per week. Treatment also was associated with improved sleep and fewer PTSD symptoms compared with the wait-list status. Improvement in these measures was not associated with any concomitant treatment.
Comment: Although the use of wait-listed participants as controls may have exaggerated the differences between groups, the effectiveness of this intervention in both reducing bothersome nightmares and improving other PTSD symptoms is remarkable. Decreased PTSD symptoms, however, could also be related to improved sleep. The effectiveness of this therapy may have implications for psychotherapeutic techniques that rely on dream interpretation: The content of nightmares -- and dreams -- apparently can be manipulated and changed by continual rehearsal.
Published in Journal Watch Psychiatry September 5, 2001
Krakow B et al. Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: A randomized controlled trial. JAMA 2001 Aug 1 286 537-545.
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