An expert consensus panel reviewed treatment manuals for cognitive behavioral therapies for nightmares (CBT-N) tested in randomized clinical trials with adults. The panel developed guidelines for standardized implementation and terminology of CBT-N, addressing patient symptom presentations appropriate for treatment and components such as session length, relaxation training, stimulus control, sleep efficiency training, sleep hygiene, nightmare exposure, nightmare rescripting, and imagery rehearsal of rescripted dreams. The recommendations aim to clarify confusion caused by unstandardized nomenclature and implementation nuances, and are intended to be revised as new research evidence emerges.
A modified version of exposure, relaxation, and rescripting therapy (ERRT-B) reduced nightmare frequency and severity in seven trauma-exposed individuals with bipolar disorder who had experienced frequent posttrauma nightmares for an average of 16 years. After five weeks of treatment, large improvements were seen in nightmare frequency, nightmare severity, and PTSD symptoms, with six participants reporting no nightmares at the three-month follow-up. Improvements in depression, global sleep quality, and insomnia severity were mixed. The findings suggest ERRT-B may be clinically useful for treating trauma-related nightmares in people with bipolar disorder and warrant further research.
Trauma victims often have sleep problems like nightmares, which are linked to other distress symptoms. Efforts to treat trauma-related nightmares have grown, moving from mostly case studies to controlled trials. The most empirically supported treatment is imagery rehearsal therapy (IRT), which includes relaxation, limited exposure to nightmare content, rewriting the nightmare, and rehearsing the new version. This article describes a modified IRT that adds an enhanced exposure component, trauma themes, and sleep habit changes. A case study and case series were completed on this variant, and a randomized clinical trial is currently underway. Guidelines for application with clients are provided.