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.
Comparable studies
Other narrative reviews on PTSD, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Psychedelic Psychiatry's Brave New World. | 2020 | Review | |
| Reviewing the Potential of Psychedelics for the Treatment of PTSD | 2020 | Review | |
| Novel psychopharmacological therapies for psychiatric disorders: psilocybin and MDMA. | 2016 | Review | |
| MDMA-assisted psychotherapy for PTSD: Are memory reconsolidation and fear extinction underlying mechanisms? | 2018 | Review | |
| Clinical applications of hallucinogens: A review. | 2016 | Review |
Citations in the library
Cites 18
- The effectiveness of lucid dreaming therapy in patients with nightmares: A systematic review. L'Encephale October 1, 2023
- An Expert Consensus Statement for Implementing Cognitive Behavioral Therapy for Nightmares in Adults Behavioral Sleep Medicine January 15, 2025
- The Effectiveness of Imagery Rescripting Interventions for Military Veterans With Nightmares and Sleep Disturbances: A Systematic Review and Meta‐Analysis Clinical Psychology & Psychotherapy July 1, 2024
- Digital Cognitive Behavioral Therapy-Based Treatment for Insomnia, Nightmares, and Posttraumatic Stress Disorder Symptoms in Survivors of Wildfires: Pilot Randomized Feasibility Trial. JMIR human factors March 14, 2025
- Endorsement of: "Position paper for the treatment of nightmare disorder in adults: An American Academy of Sleep Medicine position paper" by the World Sleep Society. Sleep Medicine January 2, 2025
and 13 more in the library