Status of Imagery Rehearsal Therapy and Other Interventions for Nightmare Treatment in PTSD.
Christine J So, Courtney J Bolstad, Katherine E Miller
Current Psychiatry Reports November 1, 2025 DOI: 10.1007/s11920-025-01639-z (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Population | Trauma-exposed adult populations |
| Topics | PTSD Dreaming |
| Keywords | Imagery rehearsal Nightmares |
| Key findings | Imagery rehearsal therapy and prazosin remain the most supported treatments for nightmares in trauma-exposed adults, though results vary across studies. |
Abstract
We review the recent published literature on nightmare-focused interventions, including imagery rehearsal therapy, for trauma-exposed adult populations. Imagery rehearsal therapy (IRT) and prazosin remain the most supported treatments, though results vary across studies. New consensus guidelines have led to Cognitive Behavioral Therapy for Nightmares (CBT-N), which integrates rescripting, exposure, and sleep strategies. Digital self-management, brief coaching-support, and tools like lucid dreaming or targeted memory reactivation show promise. Integrated and sequenced approaches with PTSD or insomnia treatments may improve outcomes, though evidence remains mixed. While trauma-focused treatments reduce PTSD symptoms, nightmares may persist without targeted care. Standardized CBT-based approaches, consistent outcome measurement, and studies on mechanisms and sequencing are needed to optimize and expand access to nightmare treatment.