Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: a randomized controlled trial.
Barry Krakow, Michael Hollifield, L Johnston, Mary P. Koss, R Schrader, Teddy D. Warner, D Tandberg, J Lauriello, L McBride, L Cutchen, D Cheng, S Emmons, Anne Germain, D Melendrez, D Sandoval, H Prince
JAMA August 1, 2001 DOI: 10.1001/jama.286.5.537 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 168 |
| Population | Women in New Mexico with PTSD and chronic nightmares; 95% had moderate-to-severe PTSD, 97% had experienced rape or other sexual assault |
| Intervention | Imagery rehearsal therapy |
| Duration | 3 sessions; 3- and 6-month follow-up |
| Topics | Dreaming PTSD |
| Key findings | Imagery rehearsal therapy significantly reduced nightmare frequency, improved sleep quality, and decreased PTSD symptom severity compared to a wait-list control group. |
Abstract
Chronic nightmares occur frequently in patients with posttraumatic stress disorder (PTSD) but are not usually a primary target of treatment. To determine if treating chronic nightmares with imagery rehearsal therapy (IRT) reduces the frequency of disturbing dreams, improves sleep quality, and decreases PTSD symptom severity. Randomized controlled trial conducted from 1995 to 1999 among 168 women in New Mexico; 95% had moderate-to-severe PTSD, 97% had experienced rape or other sexual assault, 77% reported life-threatening sexual assault, and 58% reported repeated exposure to sexual abuse in childhood or adolescence. Participants were randomized to receive treatment (n = 88) or to the wait-list control group (n = 80). The treatment group received IRT in 3 sessions; controls received no additional intervention, but continued any ongoing treatment. Scores on the Nightmare Frequency Questionnaire (NFQ), Pittsburgh Sleep Quality Index (PSQI), PTSD Symptom Scale (PSS), and Clinician-Administered PTSD Scale (CAPS) at 3- and 6-month follow-up. A total of 114 participants completed follow-up at 3 and/or 6 months. Comparing baseline to follow-up (n = 97-114), treatment significantly reduced nights per week with nightmares (Cohen d = 1.24; P<.001) and number of nightmares per week (Cohen d = 0.85; P<.001) on the NFQ and improved sleep (on the PSQI, Cohen d = 0.67; P<.001) and PTSD symptoms (on the PSS, Cohen d = 1.00; P<.001 and on the CAPS, Cohen d = 1.53; P<.001). Control participants showed small, nonsignificant improvements for the same measures (mean Cohen d = 0.21). In a 3-point analysis (n = 66-77), improvements occurred in the treatment group at 3-month follow-up (treatment vs control group, Cohen d = 1.15 vs 0.07 for nights per week with nightmares; 0.95 vs -0.06 for nightmares per week; 0.77 vs 0.31 on the PSQI, and 1.06 vs 0.31 on the PSS) and were sustained without further intervention or contact between 3 and 6 months. An intent-to-treat analysis (n = 168) confirmed significant differences between treatment and control groups for nightmares, sleep, and PTSD (all P<.02) with moderate effect sizes for treatment (mean Cohen d = 0.60) and small effect sizes for controls (mean Cohen d = 0.14). Posttraumatic stress symptoms decreased by at least 1 level of clinical severity in 65% of the treatment group compared with symptoms worsening or not changing in 69% of controls (chi(2)(1) = 12.80; P<.001). Imagery rehearsal therapy is a brief, well-tolerated treatment that appears to decrease chronic nightmares, improve sleep quality, and decrease PTSD symptom severity.
Comparable studies
Other randomized controlled trials on PTSD, most cited first.
Citations in the library
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- Insomnia Symptoms, Nightmares, and Suicidal Ideation in a College Student Sample Sleep 2011
- Nightmare Prevalence, Nightmare Distress, and Self-Reported Psychological Disturbance Sleep 2002
- Aetiology and treatment of nightmare disorder: State of the art and future perspectives Journal of Sleep Research January 29, 2019
- Efficacy of a Cognitive‐Behavioral Treatment for Insomnia and Nightmares in Afghanistan and Iraq Veterans With PTSD Journal of Clinical Psychology April 29, 2013
- Lucid Dreaming Treatment for Nightmares: A Pilot Study Psychotherapy and Psychosomatics 2006
and 100 more in the library
Cites 3
- A controlled study of imagery rehearsal for chronic nightmares in sexual assault survivors with PTSD: a preliminary report. Journal of Traumatic Stress October 1, 2000
- Nightmares and schizotypy. Psychiatry 1998
- Imagery rehearsal treatment for chronic nightmares. Behaviour Research and Therapy September 1, 1995