Treating posttraumatic nightmares in trauma-affected refugees: An investigation of outcome predictors of imagery rehearsal therapy.
Ola Hornmoen, Jessica Carlsson, Jesper Dammeyer, Annette van Schagen, Hinuga Sandahl
Journal of Psychiatric Research 2026 DOI: 10.1016/j.jpsychires.2025.10.049 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Pragmatic randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 62 |
| Population | Trauma-affected refugees who started imagery rehearsal therapy (IRT) as an add-on to treatment as usual |
| Intervention | Imagery rehearsal therapy |
| Topics | Dreaming |
| Keywords | Nightmare-focused therapy Nightmares Psychotherapy Refugees Sleep disturbances |
| Key findings | Higher baseline symptom severity predicted greater improvement across outcomes, while low motivation and low cognitive functioning were associated with less treatment response. |
Abstract
A recent randomized controlled trial (RCT) did not find an effect of imagery rehearsal therapy (IRT) for nightmares as an add-on to treatment as usual in a sample of trauma-affected refugees. However, certain factors may have accounted for substantial variations in treatment outcomes. This study aimed to test whether symptom severity, cognitive functioning, use of an interpreter, motivation for psychotherapy, chronicity of posttraumatic stress disorder (PTSD), and variables relating to treatment participation predicted outcome for refugees receiving IRT as an add-on to treatment as usual. Data were derived from a pragmatic RCT, and those randomized to and who started IRT were included (N = 62). Outcome variables were pre-to post-treatment changes in sleep quality, nightmare severity, and PTSD symptoms. Multiple regression analyses revealed that higher baseline scores (more symptoms) were associated with treatment improvement across all outcome measures (βs = 0.32, 0.45, 0.44, ps = 0.007, 0.003, <0.001, respectively), while high motivation for psychotherapy predicted improvement in sleep quality (β = 0.28, p = .035) and PTSD symptoms (β = 0.28, p = .008). Additionally, lower cognitive functioning and use of an interpreter were associated with less treatment response on PTSD symptoms (β = -0.38, p = .002) and sleep quality (β = -0.28, p = .034), respectively. Findings indicate that low motivation and low cognitive functioning may represent modifiable barriers to refugees' ability to respond to IRT. The small sample may have affected the results, and future studies should use larger samples to improve reliability and generalizability.
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
Cites 8
- Imagery Rehearsal Therapy for trauma-affected refugees – A case series Research at the University of Copenhagen January 7, 2021
- 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
- Predictors of treatment noninitiation, dropout, and response for cognitive behavioral therapy for trauma nightmares. Psychological Trauma: Theory, Research, Practice and Policy July 19, 2018
- Treatment of sleep disturbances in trauma-affected refugees: Study protocol for a randomised controlled trial. Trials November 6, 2017
- Verbal memory functioning moderates psychotherapy treatment response for PTSD-Related nightmares. Behaviour Research and Therapy April 2017
and 3 more in the library