Imagery Rescripting and Imaginal Exposure in Nightmare Disorder Compared to Positive Imagery: A Randomized Controlled Trial.
Carolin Schmid, Kathrin Hansen, Tana Kröner-Borowik, Regina Steil
Psychotherapy and Psychosomatics 2021 DOI: 10.1159/000512757 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 96 |
| Population | Patients with nightmare disorder (idiopathic nightmares) from an outpatient clinic |
| Interventions | Imagery rescripting Imaginal exposure Positive imagery |
| Duration | Single individual treatment session and 4 weeks of practice at home |
| Topics | Dreaming |
| Keywords | Cognitive behavior therapy Irt Imagery rescripting Nightmares Sleep disorder |
| Key findings | All three interventions—imagery rescripting, imaginal exposure, and positive imagery—similarly reduced nightmare distress and frequency, with no differential treatment effects. |
Abstract
Both imagery rescripting and imaginal exposure have been proven to be effective in the treatment of chronic nightmares when compared to a waitlist condition. Little is known about their comparative efficacy and their efficacy compared to an active control. The aims of this study were to compare the two treatments to one another and to positive imagery as an active control, and to explore covariates of the treatment effect. In this single-blinded randomized controlled trial, 96 patients with nightmare disorder (idiopathic nightmares) from an outpatient clinic were randomly assigned to a single individual treatment session of rescripting, exposure, or positive imagery and 4 weeks of practice at home. The primary outcome was nightmare distress, and the secondary outcomes were nightmare frequency, nightmare effects, self-efficacy, and general psychopathology. Nightmare distress was reduced in all groups (imagery rescripting: Cohen's d = -1.04, imaginal exposure: d = -0.68, positive imagery: d = -0.57), as were nightmare frequency, nightmare effects, and psychopathology. Self-efficacy was enhanced. No differential treatment effects were found on any primary or secondary measure. Treatment gains were not associated with demographic or disorder characteristics, baseline values, treatment credibility, or the number of practice sessions. Even short nightmare treatments are effective regardless of personal characteristics, and different interventions produce similar results. Future research should aim to clarify the mechanisms of action. Health care should make more use of these powerful and easy-to-administer nightmare treatments.
Comparable studies
Other randomized controlled trials on dreaming, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Efficacy of a Cognitive‐Behavioral Treatment for Insomnia and Nightmares in Afghanistan and Iraq Veterans With PTSD Combat veterans of Operation Enduring Freedom and/or Operation Iraqi Freedom (mean age... | 2013 | Randomized controlled trial | n = 40 |
| Lucid Dreaming Treatment for Nightmares: A Pilot Study Chronic nightmare sufferers | 2006 | Randomized controlled trial | n = 23 |
| Testing the involvement of the prefrontal cortex in lucid dreaming: A tDCS study Participants spending three consecutive nights in a sleep laboratory | 2013 | Randomized controlled trial | n = 19 |
| Pre-sleep treatment with galantamine stimulates lucid dreaming: A double-blind, placebo-controlled, crossover study Adults with high dream recall and an interest in lucid dreaming | 2018 | Randomized crossover trial | n = 121 |
| Studies with lucid dreaming as add-on therapy to Gestalt therapy Adults with nightmares (ICD-10: F51.5) at least twice a week | 2015 | Randomized controlled trial | n = 32 |
Citations in the library
Cited by 5
- An Expert Consensus Statement for Implementing Cognitive Behavioral Therapy for Nightmares in Adults Behavioral Sleep Medicine January 15, 2025
- The nightmare severity index (NSI): A short new multidimensional tool for assessing nightmares. Journal of Sleep Research May 1, 2024
- Imagery rescripting as a short intervention for symptoms associated with mental images in clinical disorders: A systematic review and meta-analysis. Journal of Psychiatric Research October 2023
- Associations between frequent nightmares, nightmare distress and depressive symptoms in adolescent psychiatric patients. Sleep Medicine March 1, 2023
- A randomized sham-controlled clinical trial of a novel wearable intervention for trauma-related nightmares in military veterans. Journal of Clinical Sleep Medicine February 1, 2023
Cites 23
- The relationship of nightmare frequency and nightmare distress to well‐being Journal of Sleep Research May 26, 2004
- Aetiology and treatment of nightmare disorder: State of the art and future perspectives Journal of Sleep Research January 29, 2019
- Nightmares: Knowledge and attitudes in health care providers and nightmare sufferers Journal of Public Health and Epidemiology July 31, 2014
- Comparative efficacy of imagery rehearsal therapy and prazosin in the treatment of trauma-related nightmares in adults: A meta-analysis of randomized controlled trials. Sleep Medicine Reviews April 1, 2020
- Mediators of Change in Imagery Rescripting and Imaginal Exposure for Nightmares: Evidence From a Randomized Wait-List Controlled Trial. Behavior Therapy September 1, 2019
and 18 more in the library