Management of Post-Traumatic Nightmares: a Review of Pharmacologic and Nonpharmacologic Treatments Since 2013.
Scott H Waltman, David Shearer, Bret A Moore
Current Psychiatry Reports October 11, 2018 DOI: 10.1007/s11920-018-0971-2 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Topics | PTSD Dreaming |
| Keywords | Imagery rehearsal therapy Nightmares Prazosin Trauma nightmare Traumatic |
| Key findings | Prazosin is no longer considered a first-line pharmacological intervention for post-traumatic nightmares by the AASM and VA/DoD, while imagery rescripting therapy and exposure, relaxation, and rescripting therapy remain preferred non-pharmacological treatments. |
Abstract
Post-traumatic nightmares (PTN) are a common and enduring problem for individuals with post-traumatic stress disorder (PTSD) and other clinical presentations. PTN cause significant distress, are associated with large costs, and are an independent risk factor for suicide. Pharmacological and non-pharmacological treatment options for PTN exist. A previous review in this journal demonstrated that Prazosin, an alpha blocker, was a preferred pharmacological treatment for PTN and imagery rescripting therapy (IRT) was a preferred non-pharmacological treatment. Since that time, new and important research findings create the need for an updated review. Based on the results of a recent study in the New England Journal of Medicine, Prazosin has been downgraded by both the American Academy of Sleep Medicine (AASM) and the Veterans Health Administration/Department of Defense (VA/DoD) for PTN. In Canada, Nabilone, a synthetic cannabinoid, appears to be promising. Few recent studies have been published on non-pharmacological interventions for PTN; however, recent data is available with regard to using IRT on an inpatient setting, with German combat veterans, and through the use of virtual technology. Recent evidence supports the use of exposure, relaxation, and rescripting therapy (ERRT) with children and individuals with comorbid bipolar disorder and PTN. Prazosin is no longer considered a first-line pharmacological intervention for PTN by AASM and VA/DoD. However, in the absence of a suitable alternative, it will likely remain the preferred option of prescribers. IRT and ERRT remain preferred non-pharmacological treatments of PTN. Combining cognitive behavior therapy for insomnia (CBT-I) with IRT or ERRT may lead to improved outcomes.
Comparable studies
Other narrative reviews on dreaming, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| The cognitive neuroscience of lucid dreaming | 2019 | Review | |
| Sleep and dreaming are for important matters | 2013 | Review | |
| Nightmare Disorder and Isolated Sleep Paralysis | 2020 | Review | |
| My Dream, My Rules: Can Lucid Dreaming Treat Nightmares? | 2019 | Review | |
| Dream Recall: State or Trait Variable? Part I: Model, Theories, Methodology and Trait Factors | 1996 | Review |
Citations in the library
Cited by 11
- The Effectiveness of Imagery Rescripting Interventions for Military Veterans With Nightmares and Sleep Disturbances: A Systematic Review and Meta‐Analysis Clinical Psychology & Psychotherapy July 1, 2024
- 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
- 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
- The nightmare severity index (NSI): A short new multidimensional tool for assessing nightmares. Journal of Sleep Research May 1, 2024
- Changes in dreams - the development of a dream-transformation scale in psychoanalyses with chronically depressed, early traumatized patients The Scandinavian Psychoanalytic Review July 3, 2023
and 6 more in the library
Cites 19
- Efficacy of a Cognitive‐Behavioral Treatment for Insomnia and Nightmares in Afghanistan and Iraq Veterans With PTSD Journal of Clinical Psychology April 29, 2013
- An Ambulatory Polysomnography Study of the Post-traumatic Nightmares of Post-traumatic Stress Disorder Sleep November 21, 2017
- Treatment of Nightmares in Psychiatric Inpatients With Imagery Rehearsal Therapy: An Open Trial and Case Series. Behavioral Sleep Medicine 2019
- 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
- Pilot Study: Brief Posttrauma Nightmare Treatment for Persons With Bipolar Disorder Dreaming June 1, 2018
and 14 more in the library