Chronic nightmares arise from an interaction between elevated hyperarousal and impaired fear extinction, facilitated by trait affect distress from traumatic experiences, early childhood adversity, trait susceptibility, elevated thought suppression, and potentially sleep-disordered breathing. Treatment options target nightmare meaning, chronic repetition, or maladaptive beliefs. The paper reviews epidemiological findings, aetiology models for traumatized and non-traumatized individuals, and evidence-based interventions, noting gaps in healthcare provider knowledge and delivery. Future perspectives for nightmare treatment and aetiology research are outlined.
Nightmares affect most healthy adults and many clinical populations, especially trauma survivors. Over the past decade, treatments for post-traumatic nightmares have advanced. The medication prazosin shows strong clinical effects with few side effects. Among psychological approaches, imagery rehearsal therapy has the most research support due to its proven effectiveness. This review covers these treatments and suggests directions for future research.
Chronic nightmares affect 5% to 8% of the general population and many trauma survivors. They may be a primary sleep disorder rather than just a symptom of psychiatric illness, so directly treating nightmares is a feasible approach. Imagery rehearsal therapy (IRT) has the strongest empirical support. This cognitive-imagery treatment is delivered over four roughly two-hour sessions. The article presents the main points and rationale for each session and suggests dismantling protocols to identify active ingredients of IRT, enabling flexible applications tailored to patients' needs.
A cognitive-behavioral method called imagery rehearsal significantly reduced nightmare frequency in chronic nightmare sufferers over an eighteen-month follow-up. Sixty-eight percent of subjects decreased their nightmares below the criteria for chronic nightmare disorder. Sleep quality and daytime anxiety also improved significantly. These findings suggest that nightmares may be considered a primary sleep disorder in some chronic sufferers.