Combat-related PTSD nightmares and imagery rehearsal: nightmare characteristics and relation to treatment outcome.
Gerlinde C. Harb, Richard Thompson, Richard J Ross, Joan M Cook
Journal of Traumatic Stress October 1, 2012 DOI: 10.1002/jts.21748 (opens in new tab) via PubMed
Summary
AI-generated from the abstractThe nightmares of 48 male U.S. Vietnam war veterans with combat-related PTSD were predominantly replays of actual combat events involving death, violence, and fear for one's life. In Imagery Rehearsal therapy, rescripted dreams that addressed or resolved the nightmare theme were linked to reduced sleep disturbance, but including violent details in the rescripted dream predicted poorer treatment outcome in nightmare frequency (B = 5.69, SE = 1.14). Experiencing olfactory sensations in nightmares, a possible marker of nightmare intensity, also predicted poorer treatment response (B = 2.95, SE = 1.06). The therapy may be most effective when rescripted dreams resolve the nightmare theme and exclude violent content.
Study at a glance
| Characteristics | Observational cohort Peer reviewed |
|---|---|
| Sample size | 48 |
| Population | Male U.S. Vietnam war veterans with combat-related PTSD |
| Intervention | Imagery Rehearsal therapy |
| Key finding | Rescripted dreams that resolved the nightmare theme were associated with reduced sleep disturbance, while violent details in the rescripted dream and olfactory sensations in nightmares predicted poorer treatment outcome. |
Abstract
The characteristics of nightmares of 48 male U.S. Vietnam war veterans with combat-related posttraumatic stress disorder (PTSD), as well as revised dream scripts developed in the course of Imagery Rehearsal therapy, were examined in relation to pretreatment symptomatology and treatment outcome. Features, content, and themes of nightmares and rescripted dreams were coded by 2 independent raters. Nightmares were replete with scenes of death and violence and were predominantly replays of actual combat events in which the veteran was under attack and feared for his life. Although addressing or resolving the nightmare theme with rescripting was associated with a reduction in sleep disturbance, references to violence in the rescripted dream were related to poorer treatment outcome in nightmare frequency; B = 5.69 (SE = 1.14). The experience of olfactory sensations in nightmares, a possible index of nightmare intensity, was also related to poorer treatment response; B = 2.95 (SE = 1.06). Imagery rehearsal for individuals with severe, chronic PTSD and fairly replicative nightmares may be most effective when the rescripted dream incorporates a resolution of the nightmare theme and excludes violent details.