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 January 15, 2015 DOI: 10.5664/jcsm.4354 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Meta-analysis Randomized Peer reviewed |
|---|---|
| Interventions | Prazosin Imagery rehearsal therapy |
| Topics | Dreaming |
| Keywords | Cognitive behavior therapy Imagery rehearsal therapy Insomnia Nightmares Posttraumatic stress disorder Prazosin |
| Key findings | 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.
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 21
- Aetiology and treatment of nightmare disorder: State of the art and future perspectives Journal of Sleep Research January 29, 2019
- 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
- Dreams and nightmares: Clinical aspects, management, and links to psychiatric disorders L'Encephale April 9, 2026
- Nightmare Relief: Implementing Imagery Rehearsal Therapy in Counseling Journal of Mental Health Counseling April 1, 2025
- Measurement of Nightmare Experience, and its Application in Research and Treatment of Psychiatric Disorders Journal of Psychiatry 2017
and 16 more in the library
Cites 11
- Efficacy of a Cognitive‐Behavioral Treatment for Insomnia and Nightmares in Afghanistan and Iraq Veterans With PTSD Journal of Clinical Psychology April 29, 2013
- A Meta-analysis of Imagery Rehearsal for Post-trauma Nightmares: Effects on Nightmare Frequency, Sleep Quality, and Posttraumatic Stress Clinical Psychology Review June 30, 2012
- Effectiveness of a manualized imagery rehearsal therapy for patients suffering from nightmare disorders with and without a comorbidity of depression or PTSD. Behaviour Research and Therapy May 30, 2012
- Physiological predictors of response to exposure, relaxation, and rescripting therapy for chronic nightmares in a randomized clinical trial. Journal of Clinical Sleep Medicine December 1, 2011
- Expanding Self-Help Imagery Rehearsal Therapy for Nightmares With Sleep Hygiene and Lucid Dreaming: A Waiting-List Controlled Trial November 30, 2010
and 6 more in the library