Physiological predictors of response to exposure, relaxation, and rescripting therapy for chronic nightmares in a randomized clinical trial.
Joanne L. Davis, Jamie L Rhudy, Kristi E. Pruiksma, Patricia Byrd, Amy E. Williams, Klanci M McCabe, Emily J Bartley
Journal of Clinical Sleep Medicine December 1, 2011 DOI: 10.5664/jcsm.1466 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 47 |
| Population | Trauma-exposed individuals with nightmares |
| Interventions | Exposure relaxation |
| Duration | 6-month follow-up |
| Topics | Dreaming |
| Keywords | Humans Chronic disease Electroencephalography Treatment outcome Relaxation Risk assessment Follow-up studies Dreams Stress disorders, post-traumatic Neuropsychological tests Reference values Middle aged Female Young adult Sleep wake disorders Cognitive behavioral therapy Imagery, psychotherapy Nightmares Posttraumatic stress disorder Sleep quality Physiological assessment |
| Key findings | ERRT produced improvements relative to a waitlist control at one week post-treatment, and at six-month follow-up the authors report significant improvements in nightmare frequency and severity, PTSD symptoms, depression, sleep quality and quantity, physical health symptoms, anger, dissociation, tension-reduction behaviors, and quality of life. Treatment-related decreases in heart rate, skin conductance, and corrugator activity during nightmare imagery correlated with improvements in sleep, nightmare and PTSD severity, fear of sleep, and physical health. |
Abstract
Study
Objectives: Evidence supports the use of cognitive behavioral therapies for nightmares in trauma-exposed individuals. This randomized clinical trial replicated a study of exposure, relaxation, and rescripting therapy(ERRT) and extended prior research by including broad measures of mental health difficulties, self-reported physical health problems, and quality of life. Additionally, physiological correlates of treatment-related change assessed from a script-driven imagery paradigm were examined.
Methods: Forty-seven individuals were randomized to treatment or waitlist control.
Results: The treatment group demonstrated improvements relative to the control group at the one-week post-treatment assessment. At the 6-month follow-up assessment, significant improvements were found for frequency and severity of nightmares, posttraumatic stress disorder symptoms, depression, sleep quality and quantity, physical health symptoms, anger, dissociation, and tension reduction behaviors. Participants also reported improved quality of life. Treatment-related decreases in heart rate to nightmare imagery were correlated with improvements in sleep quality and quantity; treatment-related decreases in skin conductance to nightmare imagery were correlated with improvements in nightmare severity, posttraumatic stress disorder symptom severity, sleep quality, and fear of sleep; and treatment-related decreases in corrugator activity to nightmare imagery were correlated with improved physical health.
Conclusions: Findings provide additional support for the use of ERRT in treating nightmares and related difficulties and improving sleep.
Comparable studies
Other randomized controlled trials on dreaming, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Efficacy of a Cognitive‐Behavioral Treatment for Insomnia and Nightmares in Afghanistan and Iraq Veterans With PTSD Combat veterans of Operation Enduring Freedom and/or Operation Iraqi Freedom (mean age... | 2013 | Randomized controlled trial | n = 40 |
| Lucid Dreaming Treatment for Nightmares: A Pilot Study Chronic nightmare sufferers | 2006 | Randomized controlled trial | n = 23 |
| Testing the involvement of the prefrontal cortex in lucid dreaming: A tDCS study Participants spending three consecutive nights in a sleep laboratory | 2013 | Randomized controlled trial | n = 19 |
| Pre-sleep treatment with galantamine stimulates lucid dreaming: A double-blind, placebo-controlled, crossover study Adults with high dream recall and an interest in lucid dreaming | 2018 | Randomized crossover trial | n = 121 |
| Studies with lucid dreaming as add-on therapy to Gestalt therapy Adults with nightmares (ICD-10: F51.5) at least twice a week | 2015 | Randomized controlled trial | n = 32 |
Citations in the library
Cited by 26
- Nightmares in Patients with Psychosis: The Relation with Sleep, Psychotic, Affective, and Cognitive Symptoms The Canadian Journal of Psychiatry August 1, 2015
- Psychosocial treatments for nightmares in adults and children: a systematic review BMC Psychiatry April 21, 2023
- An Expert Consensus Statement for Implementing Cognitive Behavioral Therapy for Nightmares in Adults Behavioral Sleep Medicine January 15, 2025
- Survival, Attachment, and Healing: An Evolutionary Lens on Interventions for Trauma-Related Dissociation Psychology Research and Behavior Management June 1, 2024
- The Impact of Cognitive-Behavioral Therapies for Nightmares and Prazosin on the Reduction of Post-Traumatic Nightmares, Sleep, and PTSD Symptoms: A Systematic Review and Meta- Analysis of Randomized and Non‐Randomized Studies InTech eBooks November 2, 2016
and 21 more in the library
Cites 4
- Imagery rehearsal for posttraumatic nightmares: A randomized controlled trial Journal of Traumatic Stress October 1, 2010
- Imagery rehearsal in the treatment of posttraumatic nightmares in Australian veterans with chronic combat-related PTSD: 12-month follow-up data. Journal of Traumatic Stress October 1, 2003
- Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: a randomized controlled trial. JAMA August 1, 2001
- Evaluation of dream content in combat-related PTSD. Journal of Traumatic Stress October 1, 1999