Post-traumatic nightmares can resist standard PTSD treatments. A systematic review of 26 studies found that the drug Prazosin had a large effect on reducing these nightmares (effect size g = 1.30), while cognitive and behavioral therapies had a moderate effect (g = 0.55). Both approaches also lessened general PTSD symptoms and improved sleep. The findings support using either Prazosin or nightmare-focused therapies for treatment-resistant nightmares in adults with PTSD.
For two individuals with PTSD, adding imagery rehearsal therapy (IRT) to trauma-focused cognitive behavioral therapy (CBT) was feasible and showed promise. After three IRT sessions for one participant and five for the other, both experienced slight decreases in sleep difficulties and PTSD symptom intensity. One participant had a significant reduction in distress from post-traumatic nightmares. The results suggest combining IRT with CBT for PTSD is possible and warrants further study.
Up to 71% of trauma victims with PTSD experience frequent nightmares, versus 2–5% of the general population. In 71 individuals with PTSD receiving 20 weekly sessions of cognitive behavior therapy, the presence of nightmares did not reduce the therapy's overall effectiveness. Specific CBT components did reduce nightmare frequency and distress. After treatment, most participants no longer met PTSD criteria, though some still had nightmares.