A systematic review of cognitive-behavioral treatment for nightmares: toward a well-established treatment.
Jaap Lancee, Victor I. Spoormaker, Barry Krakow, Jan Van den Bout
Journal of Clinical Sleep Medicine October 1, 2008 DOI: 10.5664/jcsm.27285 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Randomized Qualitative Case report Peer reviewed |
|---|---|
| Topics | Dreaming |
| Keywords | Humans Imagination Dreams Desensitization, psychologic Relaxation therapy Cognitive behavioral therapy Practice, psychological |
| Key findings | Nightmare-focused CBT approaches, particularly exposure and imagery rehearsal therapy, appear more effective than indirect CBT such as relaxation or recording, though all interventions and placebos produced significant pre-to-post improvement (d = 0.7-2.9). Only one randomized trial directly compared imagery rehearsal therapy with exposure, and the authors conclude that independent trials comparing these two techniques are needed. |
Abstract
The aim of this review is to evaluate the effectiveness of cognitive behavioral therapy (CBT) on nightmare frequency and to determine which kind of CBT is the most effective treatment. A systematic literature search was carried out in PsychInfo and PubMed articles published on or before May 1, 2008. The inclusion criteria were: nightmare treatment study, use of nonpharmacological treatment, not a qualitative case study, randomized-controlled trial (RCT). After selection, 12 peer-reviewed studies about 9 RCTs remained (2 follow-up studies and one displaying preliminary results). Several interventions have been reviewed including, recording one's nightmares, relaxation, exposure, and techniques of cognitive restructuring. The 12 evaluated articles varied in quality, and none fulfilled CONSORT guidelines. All articles used nightmare frequency as the primary dependent variable, and all found significant in-group differences (pre vs. post) for intervention or placebo (range d = 0.7-2.9). Five studies were able to find a significant group effect for the intervention compared to a waiting list control group. Only one study found significant differences between 2 intervention groups. Nightmare-focused CBT (exposure and imagery rehearsal therapy [IRT]) revealed better treatment outcomes than indirect CBT (relaxation, recording). IRT and exposure showed no meaningful differences, but only one RCT directly compared both techniques. Three different research groups demonstrated the effects of exposure, but only one group showed the effect of IRT. Thus, RCTs that compare IRT with exposure by independent research groups are much needed.
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 23
- Prevalence of Nightmare Disorder in Psychiatric Outpatients Psychotherapy and Psychosomatics 2013
- A combined group treatment for nightmares and insomnia in combat veterans: A pilot study Journal of Traumatic Stress November 11, 2009
- Treatment of nightmares in the context of posttraumatic stress disorder Journal of Clinical Psychology September 23, 2010
- Psychosocial treatments for nightmares in adults and children: a systematic review BMC Psychiatry April 21, 2023
- Nightmare Rescripting: Using Imagery Techniques to Treat Sleep Disturbances in Post-traumatic Stress Disorder Frontiers in Psychiatry April 4, 2022
and 18 more in the library
Cites 12
- Lucid Dreaming Treatment for Nightmares: A Pilot Study Psychotherapy and Psychosomatics 2006
- Dreaming in posttraumatic stress disorder: A critical review of phenomenology, psychophysiology and treatment. Psychotherapy and Psychosomatics 2007
- Variety and intensity of emotions in nightmares and bad dreams. The Journal of Nervous and Mental Disease April 1, 2006
- Nightmares: from anxiety symptom to sleep disorder. Sleep Medicine Reviews February 1, 2006
- Self-exposure treatment of recurrent nightmares: waiting-list-controlled trial and 4-year follow-up. Psychotherapy and Psychosomatics 2006
and 7 more in the library