Comparative efficacy of imagery rehearsal therapy and prazosin in the treatment of trauma-related nightmares in adults: A meta-analysis of randomized controlled trials.
Dilan E Yücel, Arnold A P Van Emmerik, Camille Souama, Jaap Lancee
Sleep Medicine Reviews April 1, 2020 DOI: 10.1016/j.smrv.2019.101248 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Meta-analysis Randomized Peer reviewed |
|---|---|
| Sample size | 1,078 |
| Population | Participants with posttraumatic nightmares |
| Interventions | Prazosin Imagery rehearsal therapy |
| Topics | PTSD Dreaming |
| Keywords | Imagery rehearsal therapy Meta-analysis Posttraumatic nightmares Prazosin |
| Key findings | Both prazosin and imagery rehearsal therapy are effective for posttraumatic nightmares, with no significant difference between them. |
Abstract
Pharmacological treatment with prazosin and psychological treatment with imagery rehearsal therapy (IRT) are the two main treatments of posttraumatic nightmares. The American Academy of Sleep Medicine task force recently listed IRT as the recommended treatment for trauma-related nightmares and changed the recommendation of prazosin to 'may be used'. This new recommendation was based on a single prazosin trial and not on a meta-analytic review of all available trials. The current meta-analysis aims to fill this gap in the literature. Eight studies on IRT and seven studies on prazosin (N = 1.078) were analyzed based on the random effects model. Relative to control groups, prazosin had a moderate to large effect on nightmare frequency (g = 0.61), posttraumatic stress symptoms (g = 0.81), and sleep quality (g = 0.85). IRT showed small to moderate effects on nightmare frequency (g = 0.51), posttraumatic symptoms (g = 0.31), and sleep quality (g = 0.51). No significant differences in effect were observed between prazosin and IRT on any of these outcomes (all p's > 0.10). It is concluded that downgrading the recommendation of prazosin may be a premature decision and that the aggregated results in this meta-analysis clearly show efficacy of both treatments.
Comparable studies
Other systematic reviews and meta-analyses on dreaming, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Dreaming as mind wandering: evidence from functional neuroimaging and first-person content reports. | 2013 | Systematic review with meta-analytic comparison | |
| Lucid dreaming incidence: A quality effects meta-analysis of 50 years of research | 2016 | Meta-analysis | |
| The effectiveness of lucid dreaming therapy in patients with nightmares: A systematic review. Adults with chronic and recurring nightmares | 2023 | Systematic review | |
| The relationships between insomnia, nightmares, and dreams: A systematic review Individuals without a concomitant psychopathology, including those with insomnia or... | 2024 | Systematic review | |
| Psychosocial treatments for nightmares in adults and children: a systematic review | 2023 | Systematic review |
Citations in the library
Cited by 26
- Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review. Current Neuropharmacology 2024
- Longitudinal associations of nightmare frequency and nightmare distress with suicidal behavior in adolescents: mediating role of depressive symptoms Sleep July 2, 2020
- An Expert Consensus Statement for Implementing Cognitive Behavioral Therapy for Nightmares in Adults Behavioral Sleep Medicine January 15, 2025
- Imagery rehearsal therapy for the treatment of nightmares in individuals with borderline personality disorder – A pilot study Journal of Psychiatric Research December 28, 2024
- Interest in telephone nightmare counselling in patients with sleep-related breathing disorders Somnologie: Schlafforschung und Schlafmedizin August 3, 2020
and 21 more in the library
Cites 15
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- Mediators of Change in Imagery Rescripting and Imaginal Exposure for Nightmares: Evidence From a Randomized Wait-List Controlled Trial. Behavior Therapy September 1, 2019
- Self-efficacy as a Mechanism of Action of Imagery Rehearsal Therapy's Effectiveness: An Exploratory Mediation Analysis. The Journal of Nervous and Mental Disease October 1, 2018
- Position Paper for the Treatment of Nightmare Disorder in Adults: An American Academy of Sleep Medicine Position Paper. Journal of Clinical Sleep Medicine June 15, 2018
- Imagery rehearsal therapy in addition to treatment as usual for patients with diverse psychiatric diagnoses suffering from nightmares: a randomized controlled trial. The Journal of Clinical Psychiatry September 1, 2015
and 10 more in the library