Status of Imagery Rehearsal Therapy and Other Interventions for Nightmare Treatment in PTSD.
Current Psychiatry Reports November 1, 2025 Christine J So, Courtney J Bolstad, Katherine E Miller
Nightmares that persist after trauma often require targeted treatment, as trauma-focused therapies for PTSD may not fully resolve them. Imagery rehearsal therapy and the medication prazosin remain the most supported interventions, though results vary across studies. New consensus guidelines have produced Cognitive Behavioral Therapy for Nightmares, which combines rescripting, exposure, and sleep strategies. Emerging approaches such as digital self-management, brief coaching, lucid dreaming, and targeted memory reactivation show promise. Integrated treatments that sequence nightmare care with PTSD or insomnia therapies may improve outcomes, but evidence is mixed. The field needs standardized CBT-based approaches, consistent outcome measurement, and research on mechanisms and sequencing to optimize and expand access to nightmare treatment.