Journal of Sleep Research
January 29, 2019
Annika Gieselmann, Malik Ait Aoudia, Michelle Carr et al.
192 citations
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.
Journal of Sleep Research
June 1, 2021
Jaap Lancee, Marieke Effting, Anna E Kunze
Telephone-guided imagery rehearsal therapy for nightmares, delivered by postgraduate students, produced large improvements in nightmare frequency, nightmare distress, and insomnia severity compared with a wait-list condition. 70 adults with nightmare disorder were randomized to three treatment sessions over 5 weeks or to a wait list. Effects were sustained at 3- and 6-month follow-up. No significant effects were found on nights with nightmares per week, anxiety, or depression. The treatment effect was mediated by increased mastery at mid-treatment, supporting mastery's mechanistic role in imagery rehearsal therapy. The findings indicate that imagery rehearsal therapy can be effectively delivered in a guided self-help format with minimal therapist training, improving scalability and cost-effectiveness.
Sleep Medicine Reviews
April 1, 2020
Dilan E Yücel, Arnold A P Van Emmerik, Camille Souama et al.
A meta-analysis of 15 studies (N = 1,078) compared prazosin and imagery rehearsal therapy (IRT) for posttraumatic nightmares. Prazosin showed moderate to large effects on nightmare frequency, posttraumatic stress symptoms, and sleep quality, while IRT showed small to moderate effects. No significant differences were found between the two treatments on any outcome. The authors conclude that downgrading the recommendation for prazosin may be premature, as aggregated results show efficacy of both treatments.
Behavior therapy
September 1, 2019
Anna E Kunze, Jaap Lancee, Nexhmedin Morina et al.
Imagery rescripting and imaginal exposure are both effective treatments for nightmare disorder, but they work through different underlying mechanisms. In a randomized wait-list controlled trial with 104 participants, enhanced mastery or self-efficacy regarding nightmare content mediated the therapeutic effects of imagery rescripting. In contrast, increased tolerability of negative emotions elicited by nightmares mediated the effects of imaginal exposure. Although both treatments produce similar therapeutic outcomes, they appear to engage distinct psychological processes.
Journal of Clinical Psychology
January 1, 2017
Annette van Schagen, Jaap Lancee, Marijke Swart et al.
Among 498 patients with diverse moderate-to-severe psychiatric disorders, those who also had nightmare disorder showed higher levels of psychopathology and personality pathology than those without nightmare disorder, with small effect sizes. No significant differences were found in coping strategies between the two groups. The findings suggest that nightmare disorder is linked to greater symptom severity in psychiatric patients.
The Journal of Clinical Psychiatry
September 1, 2015
Annette van Schagen, Jaap Lancee, Izaäk W De Groot et al.
Imagery rehearsal therapy (IRT) reduces nightmare frequency, nightmare distress, and general psychiatric symptoms in patients with a range of psychiatric disorders. In a trial of 90 patients, those who received six individual IRT sessions added to their usual treatment showed moderate improvements compared with those receiving treatment as usual alone. The benefits were largely sustained three months later. IRT involves patients changing the script of a nightmare into a new dream and practicing it during the day.
Journal of Sleep Research
September 1, 2011
Jaap Lancee, Victor I. Spoormaker, Jan Van den Bout
Two cognitive-behavioural self-help interventions for nightmares, imagery rehearsal and exposure, produced effects that were almost completely sustained 42 weeks after treatment ended. The initial improvements in nightmare measures persisted with effect sizes between 0.50 and 0.70. No differences in effectiveness were found between the two interventions. These long-term results suggest that nightmares can be effectively treated with targeted self-help approaches, and an internet-delivered intervention may serve as a good first step in a stepped-care model.
Psychotherapy and Psychosomatics
January 1, 2010
Jaap Lancee, Victor I. Spoormaker, Jan Van den Bout
Imagery rehearsal therapy (IRT) and exposure to nightmare imagery, delivered as self-help treatments over six weeks, both reduce nightmare frequency and distress, improve subjective sleep quality, and lessen anxiety (after IRT) and depression (after exposure) compared to a waiting list. Keeping a nightmare diary (recording) also helps, though less so. IRT reduces nightmare frequency more than recording alone, while exposure reduces distress more. IRT produces faster reductions in diary-reported nightmares. The findings suggest that exposure to nightmare imagery may be the key therapeutic ingredient, with cognitive restructuring adding immediate benefits.