Imagery rehearsal therapy for the treatment of nightmares in individuals with borderline personality disorder – A pilot study
Clara Sayk, Nicole Koch, Janine Stierand, Felix Timpe, Hong‐Viet V. Ngo, Ines Wilhelm, Klaus Junghanns
Journal of Psychiatric Research December 28, 2024 DOI: 10.1016/j.jpsychires.2024.12.044 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Between-subjects design, pilot study Randomized Peer reviewed |
|---|---|
| Sample size | 44 |
| Population | Individuals with borderline personality disorder |
| Intervention | Imagery rehearsal therapy |
| Duration | Eight sessions of group-IRT as an add-on to inpatient treatment |
| Topics | Dreaming |
| Keywords | Borderline personality disorder Clinical psychology Psychotherapist Psychoanalysis |
| Citations | 6 |
| Key points | Imagery rehearsal therapy improved nightmare symptoms and reduced intrusions, hyperarousal, and anxiety in individuals with borderline personality disorder compared to matched controls. |
Abstract
Insomnia and nightmares are present in up to 45 % of individuals with borderline personality disorder (BPD) and can contribute to challenges with emotion regulation, low sleep quality, dream anxiety, increased arousal and self-control. Despite their prevalence, nightmares are usually not addressed in classical BPD treatment. Imagery rehearsal therapy (IRT) is considered first in line treatment for nightmares, however, there are no studies to date that investigate its effects in individuals with BPD. Here we investigated a) whether IRT can be used to treat nightmares in individuals with BPD and b) whether there is an additional benefit of the intervention on symptoms associated with BPD. In a between-subjects design, 22 individuals with BPD completed eight sessions of group-IRT as an add-on to their inpatient treatment and were compared to 22 gender and age matched control participants regarding nightmares, trauma, depression and anxiety symptoms. Nightmare symptoms improved significantly during the intervention as indicated by subjective ratings. Moreover, participants in the IRT group showed a more pronounced decrease in intrusions, hyperarousal and anxiety compared to the control group. This pilot study gives a first glimpse into the feasibility and benefits of imagery rehearsal therapy in individuals with BPD. Our findings suggest that IRT may not only help treat nightmare symptoms but also reduce anxiety and trauma symptoms in BPD. Future studies should include randomized controlled trials of IRT in individuals with BPD with larger sample sizes and polysomnography in both groups.
Comparable studies
Other non-randomized and open-label trials on dreaming, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| A combined group treatment for nightmares and insomnia in combat veterans: A pilot study Combat veterans with PTSD | 2009 | Open clinical trial | n = 10 |
| Cognitions in Sleep: Lucid Dreaming as an Intervention for Nightmares in Patients With Posttraumatic Stress Disorder. Patients suffering from posttraumatic stress disorder (PTSD) | 2020 | Pre-post intervention study | |
| Managing Insomnia Using Lucid Dreaming Training: A Pilot Study. Adults with Insomnia Disorder | 2021 | Open-label trial | n = 48 |
| Dream content and political ideology. U.S. adults who identified as members of the political right or political left (28 per... | 2002 | Pilot study | n = 56 |
| Does training increase NREM dream recall? A pilot study High dream recallers | 2013 | Pilot study |
Citations in the library
Cited by 2
- Efficacy of imagery rehearsal therapy in the treatment of traumatic nightmares in youth with complex post-traumatic stress disorder. Journal of Clinical Sleep Medicine June 17, 2026
- When the mind reprocesses the night: A clinical case study on eye movement desensitization and reprocessing therapy for idiopathic nightmare disorder Sleep Research June 2, 2026
Cites 11
- Aetiology and treatment of nightmare disorder: State of the art and future perspectives Journal of Sleep Research January 29, 2019
- Nightmares and bad dreams in patients with borderline personality disorder: Fantasy as a coping skill? The European Journal of Psychiatry March 1, 2010
- Drawing your way out: Imagery rehearsal based art therapy (IR-AT) for post-traumatic nightmares in borderline personality disorder. Journal of Clinical Psychology May 1, 2024
- Cortical hyperarousal in individuals with frequent nightmares. Journal of Sleep Research April 1, 2024
- 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
and 6 more in the library