A Systematic Review and Meta-Analysis of Psychotherapeutic Approaches for Recurring Nightmares
Anxhelo Dema, Ledion Musaj
Qeios August 28, 2023 preprint DOI: 10.32388/gobjo7 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review and meta-analysis |
|---|---|
| Sample size | 1,209 |
| Population | Adults with a diagnosis of nightmare disorder or recurrent nightmares |
| Interventions | Cognitive-behavioral therapy (CBT) Imagery rehearsal therapy (IRT) Eye movement desensitization and reprocessing (EMDR) |
| Topics | Dreaming |
| Key findings | All three psychotherapeutic approaches reduced the frequency and intensity of recurring nightmares, with CBT and IRT the most effective; CBT was more effective than IRT for nightmare frequency (g = 0.73, 95% CI [0.58, 0.88]). EMDR effects were smaller but still significant. The authors suggest these approaches may be particularly useful for individuals with PTSD or other trauma-related disorders and support psychotherapy as a first-line treatment, while calling for more EMDR research. |
Abstract
Recurring nightmares are a common symptom of various mental health conditions, including post-traumatic stress disorder (PTSD), anxiety disorders, and depression. Psychotherapeutic approaches have been used to treat recurring nightmares, but their relative effectiveness is unclear. This systematic review and meta-analysis aimed to compare the efficacy of three psychotherapeutic approaches in reducing the frequency and intensity of recurring nightmares: cognitive-behavioral therapy (CBT), imagery rehearsal therapy (IRT), and eye movement desensitization and reprocessing (EMDR). A comprehensive search of electronic databases from January 2000 to the present was conducted, along with a manual search of reference lists. Studies that met inclusion criteria (adult participants with a diagnosis of nightmare disorder or recurrent nightmares, and comparing the effectiveness of at least two of the three psychotherapeutic modalities) were selected for meta-analysis. Outcome measures included nightmare frequency, distress, or related symptoms (e.g., anxiety, depression). The risk of bias was assessed using the Cochrane Risk of Bias tool, and effect sizes were calculated using Hedges’ g. The meta-analysis included 15 studies with a total of 1209 participants. The results showed that all psychotherapeutic approaches were effective in reducing the frequency and intensity of recurring nightmares, with CBT and IRT being the most effective. Specifically, CBT was more effective than IRT in reducing the frequency of nightmares (g=0.73, 95% CI [0.58, 0.88], p < 0.001). The effect sizes for EMDR were smaller than those for CBT and IRT, but still significant. These findings suggest that CBT and IRT are effective psychotherapeutic approaches for treating recurring nightmares, and may be particularly useful for individuals with PTSD or other trauma-related disorders. However, the small number of studies on EMDR highlights the need for further research in this area. Overall, the results support the use of psychotherapeutic interventions as a first-line treatment for recurring nightmares.
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
Cites 4
- 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
- Treating nightmares and insomnia in posttraumatic stress disorder: a review of current evidence. Neuropharmacology March 17, 2011
- Impact of imagery rehearsal treatment on distressing dreams, psychological distress, and sleep parameters in nightmare patients. Behavioral Sleep Medicine 2003
- Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: a randomized controlled trial. JAMA August 1, 2001