Imagery Rehearsal Therapy (IRT) is associated with reduced nightmare severity and depressive, anxiety and suicidal symptoms in adults with Major Depressive Episode.
Julia Maruani, Nathan Martins, Emmanuelle Clerici, Michel Lejoyeux, Pierre A Geoffroy
International journal of clinical and health psychology : IJCHP 2026 DOI: 10.1016/j.ijchp.2025.100658 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Non-randomized controlled study Peer reviewed |
|---|---|
| Sample size | 53 |
| Population | Adults diagnosed with both major depressive episode and nightmare disorder (DSM-5-TR criteria) |
| Interventions | Imagery rehearsal therapy Sleep education therapy |
| Duration | Four-week intervention, with a four-week waitlist before IRT for the control group |
| Topics | Anxiety Dreaming |
| Keywords | Controlled study Suicidal ideation |
| Key points | Imagery rehearsal therapy is associated with greater reductions in nightmare severity, depressive symptoms, anxiety, and suicidal ideation compared to sleep education therapy in patients with major depressive episodes. |
Abstract
Nightmare Disorder characterized by recurrent dysphoric dreams is strongly associated with major depressive episodes (MDE) and suicidal risk. Imagery rehearsal therapy (IRT) is the standard treatment for nightmares, but its effectiveness in individuals with MDE remain understudied. This study evaluated whether IRT is associated with greater improvement in nightmare symptoms compared to sleep education therapy (SET) in patients with MDE. In this non-randomized controlled study, 53 adults diagnosed with both MDE and Nightmare Disorder (DSM-5-TR criteria) received either four weekly group-based IRT sessions (n = 28) or a single SET session during the baseline interview, followed by a four-week waitlist before IRT (n = 25). Outcomes included the Nightmare Severity Index (NSI), depressive symptoms (QIDS-SR16 and HAD-D), anxiety symptoms (HAD-A and GAD-7) and suicidal ideation (item 12 of the QIDS-SR16). Treatment effects were assessed through change scores and pre- and post-intervention comparisons. IRT was significantly associated with greater reductions in nightmare severity (p < 0.001) with improvements observed across NSI subscales: frequency (p = 0.010), emotional (p = 0.003), diurnal (p = 0.017), and nocturnal impacts (p = 0.002). Associations were also found between IRT and reductions in depressive (ΔHAD-D p < 0.001, ΔQIDS-SR16 p = 0.028), anxiety (ΔHAD-A and ΔGAD-7 p < 0.001) and suicidal symptoms (p = 0.002). Treatment-resistant depression predicted greater improvements in the emotional impact of nightmares (p = 0.007), while nightmare frequency was associated with reduced benefit (p = 0.008). IRT is associated with meaningful reductions in nightmare severity, depressive symptoms, anxiety, and suicidal ideation in individuals with MDE. These findings support the integration of IRT in treatment plans for this high-risk population.
Comparable studies
Other non-randomized and open-label trials on dreaming, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| A combined group treatment for nightmares and insomnia in combat veterans: A pilot study Combat veterans with PTSD | 2009 | Open clinical trial | n = 10 |
| Cognitions in Sleep: Lucid Dreaming as an Intervention for Nightmares in Patients With Posttraumatic Stress Disorder. Patients suffering from posttraumatic stress disorder (PTSD) | 2020 | Pre-post intervention study | |
| Managing Insomnia Using Lucid Dreaming Training: A Pilot Study. Adults with Insomnia Disorder | 2021 | Open-label trial | n = 48 |
| Dream content and political ideology. U.S. adults who identified as members of the political right or political left (28 per... | 2002 | Pilot study | n = 56 |
| Imagery rehearsal therapy for the treatment of nightmares in individuals with borderline personality disorder – A pilot study Individuals with borderline personality disorder | 2024 | Between-subjects design, pilot study | n = 44 |
Citations in the library
Cited by 3
- Nightmares matter: rethinking suicide risk assessment and intervention in depression Sleep April 8, 2026
- Nightmare-focused interventions and suicide prevention: clarifying the role of imagery rehearsal therapy and prazosin Sleep May 29, 2026
- Nightmare disorder and depression: Exploring a neglected clinical association. Journal of Psychiatric Research August 1, 2026
Cites 10
- A new neurocognitive theory of dreams. Dreaming March 1, 2001
- The nightmare severity index (NSI): A short new multidimensional tool for assessing nightmares. Journal of Sleep Research May 1, 2024
- Bad Dreams and Nightmares Preceding Suicidal Behaviors. The Journal of Clinical Psychiatry November 23, 2022
- Nightmares in Patients with Major Depressive Disorder, Bipolar Disorder, and Psychotic Disorders: A Systematic Review. Journal of Clinical Medicine December 9, 2020
- Treatment of Nightmares in Psychiatric Inpatients With Imagery Rehearsal Therapy: An Open Trial and Case Series. Behavioral Sleep Medicine 2019
and 5 more in the library