Clinical management of chronic nightmares: imagery rehearsal therapy.

Chronic nightmares affect 5% to 8% of the general population and many trauma survivors. They may be a primary sleep disorder rather than just a symptom of psychiatric illness, so directly treating nightmares is a feasible approach. Imagery rehearsal therapy (IRT) has the strongest empirical support. This cognitive-imagery treatment is delivered over four roughly two-hour sessions. The article presents the main points and rationale for each session and suggests dismantling protocols to identify active ingredients of IRT, enabling flexible applications tailored to patients' needs.

Study at a glance

Abstract

Problems with nightmares are reported by a sizable proportion of individuals with a history of trauma and by approximately 5% to 8% of the general population. Chronic nightmares may represent a primary sleep disorder rather than a symptom of a psychiatric disorder, and direct targeting of nightmares is a feasible clinical approach to the problem. Of the treatments proposed, imagery rehearsal therapy (IRT) has received the most empirical support. An up-to-date account of this cognitive-imagery approach shows how to treat nightmares during 4 roughly 2-hr sessions. The main points covered in each therapy session and their underlying rationale are presented. Dismantling protocols are suggested to discern active ingredients of IRT and to develop flexible applications based on patients' needs.