Cognitive‐behavioral treatment for chronic nightmares in trauma‐exposed persons: assessing physiological reactions to nightmare‐related fear

Abstract

Cognitive-behavioral treatments (CBTs) that target nightmares are efficacious for ameliorating self-reported sleep problems and psychological distress. However, it is important to determine whether these treatments influence objective markers of nightmare-related fear, because fear and concomitant physiological responses could promote nightmare chronicity and sleep disturbance. This randomized, controlled study (N=40) assessed physiological (skin conductance, heart rate, facial electromyogram) and subjective (displeasure, fear, anger, sadness, arousal) reactions to personally relevant nightmare imagery intended to evoke nightmare-related fear. Physiological assessments were conducted at pretreatment as well as 1-week, 3-months, and 6-months posttreatment. Results of mixed effects analysis of variance models suggested treatment reduced physiological and subjective reactions to nightmare imagery, gains that were generally maintained at the 6-month follow-up. Potential implications are discussed.

Physiological Predictors of Response to Exposure, Relaxation, and Rescripting Therapy for Chronic Nightmares in a Randomized Clinical Trial

“…Moreover, our confidence in the integrity of the signal is bolstered by our findings that facial EMG reliably increases in response to the nightmare script and these increases are significantly reduced by treatment. 32 Therefore, we do not believe aliasing played a significant role in signal degradation in the current study.…”

“…A previous study indicated that nightmare sufferers exhibited heightened physiological responses to nightmare imagery 3 and that these physiological reactions were significantly reduced by ERRT relative to the control group that showed no change in physiological reactivity to nightmare imagery. 32 Rhudy et al 32 argued that physiological reactivity to nightmare imagery may index activation of the fear network associated with the nightmare, 37 and that engaging this fear network may be essential for processing emotional material to decrease fear and anxiety 37 and improve nightmares and sleep disturbance. 38 If true, then changes in physiological reactivity to nightmare imagery should covary with other indicators of treat- ological indices of sleep functioning (i.e., polysomnography or actigraphy) and an established measure of clinical significance.…”

“…32 What remains unknown, however, is the nature of the relationship between the reduction in these physiological reactions and other measures of treatment outcome. Specifically, it is currently unclear whether changes in physiological defensive reactivity covary with changes in nightmare frequency and severity, mental health, or physical health.…”

Cognitive-behavioral therapy for sleep disturbances in treating posttraumatic stress disorder symptoms: A meta-analysis of randomized controlled trials

“…It includes sleep hygiene, psychoeducation on sleep and nightmares, exposure to nightmares, nightmares tracking and rescripting (Davis, 2009). Randomized controlled trials demonstrated that ERRT is efficacious in improving PTSD symptoms (Davis & Wright, 2007;Rhudy et al, 2010). This underscores the promising prospect that effective treatments for sleep disturbances may help improve daytime PTSD symptoms and overall functioning, in addition to improving sleep.…”

“…In particular, cognitive behavioral treatments, including CBT for insomnia (CBT-I), imagery rehearsal therapy (IRT) and exposure, rescripting and relaxation therapy (ERRT), are the most commonly identified and empirically sound approaches that directly tackle sleep disturbances, including insomnia (Morin et al, 2006) and chronic nightmares (Casement & Swanson, 2012;Rhudy et al, 2010). CBT-I typically entails psychoeducation on sleep hygiene, sleep restriction, stimulus control, and cognitive therapy (Morin & Barlow, 1993).…”