Self-exposure treatment of recurrent nightmares: waiting-list-controlled trial and 4-year follow-up.

Adults with nightmare disorder who attended an outpatient clinic showed no improvement in nightmares and associated symptoms during a 3-month waiting-list period. After receiving a self-exposure manual and following it for 4 weeks, they experienced marked reductions in nightmares, anxiety, depression, hostility, and somatic symptoms. These improvements were maintained over a 4-year follow-up. All 10 participants completed the therapy and follow-up without dropouts. A matched control group without psychiatric disorders had fewer nightmares and symptoms at the start.

Study at a glance

Abstract

In open and randomized controlled trials self-exposure therapy reduced the frequency of nightmares but follow-up ceased at 7 months post-entry. Ten adults who attended an outpatient clinic and had DSM-IV nightmare disorder were put on a 3-month waiting-list. After 3 months they were given a self-exposure manual and were asked to follow its instructions for 4 weeks and were then followed up for 4 years. They were rated at 0, 3, 4, 5, 7, 10, 16, 28 and 52 months. At month 0 only, a matched control group of 10 subjects from the same clinic who had no axis I or II disorder was also rated. At month 0, the nightmare sufferers had more nightmares, anxiety, depression, hostility and somatic symptoms than the matched control group. All 10 nightmare sufferers completed the 3-month waiting-list, 4-week self-exposure therapy and 4-year follow-up without any dropouts. The recurrent nightmares and most associated symptoms did not improve while on the waiting-list but improved markedly after self-exposure therapy and remained improved over the 4-year follow-up. Adults' recurrent nightmares and associated symptoms failed to improve over a 3-month waiting-list period but reduced greatly after subsequent self-exposure therapy with minimal therapist contact over 1 month, and these gains continued over the next 4 years.