Efficacy of imagery rehearsal therapy in the treatment of traumatic nightmares in youth with complex post-traumatic stress disorder.

Background: Traumatic nightmares are a core feature in adolescents with complex PTSD (CPTSD) exposed to early and repeated trauma, maintaining hyperactivity and dysregulation. Despite their prevalence and functional impact, targeted treatments for youth remain scarce. Imagery rehearsal therapy (IRT) is a brief cognitive-behavioral intervention effective in adults, but evidence in adolescents with CPTSD is limited.

Methods: This study assessed the feasibility and preliminary effectiveness of four sessions of IRT adapted for young participants (14-25 years) with CPTSD. Thirty-nine participants presenting ICD-11 criteria for CPTSD were recruited after at least 3 months of psychiatric follow-up. They received IRT and completed pre- and post-intervention self-report measures of nightmare frequency and distress (NDQ-13), sleep quality (PSQI, ISI), PTSD symptoms (CPTS-RI, CPC, PCL-5), anxiety, depression, and quality of life.

Results: All participants reported severe traumatic nightmares, mainly linked to repeated sexual (75%) and physical (65%) violence. After four IRT sessions, nightmare frequency per week decreased (5.7 vs. 2.8, p = 0.011) as did the distress rate on the visual analogue scale between 0 and 10 (7.7 vs. 4.4, p = 0.004). Sleep improved (PSQI 9.1 vs. 13.3, p = 0.007; ISI 12.2 vs. 17.9, p = 0.005), and quality of sleep (6.8 vs. 4.4, p = 0.01) and of life increased (6.8 vs. 4.7, p = 0.014), while anxiety and depressive symptomatology remained stable.

Conclusion: IRT appears feasible and promising in this population and was associated with reduced nightmare frequency and distress, along with improved sleep and quality of life. These results highlight its potential as a safe and easily disseminable intervention, also suitable for vulnerable or low-resource populations. Current knowledge/study

Rationale: Traumatic nightmares are highly prevalent and impairing in adolescents with complex PTSD (CPTSD), yet developmentally adapted treatments remain scarce. Imagery Rehearsal Therapy is effective in adults, but evidence in youth exposed to early and repeated trauma is limited. Study impact: This study suggests that a brief, four-session IRT protocol is feasible and may reduce nightmare frequency and distress in adolescents and young adults with CPTSD. The findings support IRT as a safe and scalable intervention that may help improve sleep and functioning in vulnerable or low-resource populations.