Comparative meta-analysis of prazosin and imagery rehearsal therapy for nightmare frequency, sleep quality, and posttraumatic stress.
Gilbert Seda, Maria M Sanchez-Ortuno, Carolyn H Welsh, Ann C Halbower, Jack D Edinger
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine January 15, 2015 DOI: 10.5664/jcsm.4354 (opens in new tab) via PubMed
Summary
AI-generated from the abstractPrazosin and imagery rehearsal therapy (IRT) show comparable short-term effects on nightmares, sleep quality, and posttraumatic stress symptoms, each producing moderate improvements. Combining IRT with cognitive behavior therapy for insomnia yields greater sleep quality gains than prazosin, IRT alone, or IRT plus another psychological intervention. Effect sizes did not differ significantly between pharmacological and psychological treatments for nightmare frequency, sleep quality, or posttraumatic stress symptoms. More randomized trials with long-term follow-up are needed.
Study at a glance
| Characteristics | Meta-analysis Randomized Peer reviewed |
|---|---|
| Interventions | Prazosin Imagery rehearsal therapy |
| Keywords | Cognitive behavior therapy Imagery rehearsal therapy Insomnia Nightmares Posttraumatic stress disorder |
| Key finding | Prazosin and imagery rehearsal therapy produce comparable acute effects for nightmares, but adding cognitive behavior therapy for insomnia to IRT enhances sleep quality and posttraumatic stress symptoms more than prazosin or IRT alone. |
Abstract
In this meta-analysis, we compare the short-term efficacy of prazosin vs. IRT on nightmares, sleep quality, and posttraumatic stress symptoms (PTSS). Reference databases were searched for randomized controlled trials using IRT or prazosin for nightmares, sleep disturbance, and/or PTSS. Effect sizes were calculated by subtracting the mean posttest score in the control group from the mean posttest score in the treatment group, and dividing the result by the pooled standard deviation of both groups. Mixed effects models were performed to evaluate effects of treatment characteristics, as well as sample characteristics (veteran vs. civilian) on treatment efficacy. Four studies used prazosin, 10 used IRT alone or in combination with another psychological treatment, and 1 included a group receiving prazosin and another group receiving IRT. Overall effect sizes of both treatments were of moderate magnitude for nightmare frequency, sleep quality, and PTSS (p < 0.01). Effect size was not significantly different with type of treatment (psychological vs. pharmacological) on nightmare frequency (p = 0.79), sleep quality (p = 0.65), or PTSS, (p = 0.52). IRT combined with CBT for insomnia showed more improvement in sleep quality compared to prazosin (p = 0.03), IRT alone (p = 0.03), or IRT combined with another psychological intervention, (p < 0.01). Although IRT interventions and prazosin yield comparable acute effects for the treatment of nightmares, adding CBT for insomnia to IRT seems to enhance treatment outcomes pertaining to sleep quality and PTSS. More randomized clinical trials with long-term follow-up are warranted. A commentary on this article appears in this issue on page 9.