Imagery Rehearsal Therapy for Chronic Nightmares in Sexual Assault Survivors With Posttraumatic Stress Disorder

Krakow, Barry; Hollifield, Michael; Johnston, Lisa G.; Koss, Mary P.; Schrader, Ron; Warner, Teddy D.; Tandberg, Dan; Lauriello, John; McBride, Leslie G.; Cutchen, Lisa; Cheng, Diana; Emmons, Shawn; Germain, Anne; Melendrez, Dominic; Sandoval, Diane; Prince, Holly

doi:10.1001/jama.286.5.537

Cited by 492 publications

(404 citation statements)

References 43 publications

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“…Table 1 presents descriptive characteristics for each study included in the meta-analysis, ordered by publication year. Of these, there are 4 pharmacological trials including prazosin, [24][25][26][27] 10 studies including IRT, either alone or combined with another form of psychological intervention, [28][29][30][31][32][33][34][35][36][37] and one study comprising both IRT and prazosin interventions administered to 2 groups randomly assigned to these treatments. 38 All studies were published between 2000 and 2013.…”

Section: Description Of Studiesmentioning

confidence: 99%

Comparative Meta-Analysis of Prazosin and Imagery Rehearsal Therapy for Nightmare Frequency, Sleep Quality, and Posttraumatic Stress

Seda

Sánchez-Ortuño

Welsh

et al. 2015

Journal of Clinical Sleep Medicine

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Study Objective:In this meta-analysis, we compare the shortterm effi cacy of prazosin vs. IRT on nightmares, sleep quality, and posttraumatic stress symptoms (PTSS). Methods: Reference databases were searched for randomized controlled trials using IRT or prazosin for nightmares, sleep disturbance, and/or PTSS. Effect sizes were calculated by subtracting the mean posttest score in the control group from the mean posttest score in the treatment group, and dividing the result by the pooled standard deviation of both groups. Mixed effects models were performed to evaluate effects of treatment characteristics, as well as sample characteristics (veteran vs. civilian) on treatment effi cacy. Results: Four studies used prazosin, 10 used IRT alone or in combination with another psychological treatment, and 1 included a group receiving prazosin and another group receiving IRT. Overall effect sizes of both treatments were of moderate magnitude for nightmare frequency, sleep quality, and PTSS (p < 0.01). Effect size was not signifi cantly different with type of treatment (psychological vs. pharmacological However, when these frightening dreams occur in a recurrent fashion, the nightmare activity may constitute a disorder. In fact, nightmare disorder is listed in both the DSM-5 and in the ICSD-3 as a distinct disorder whose essential features are the presence of repeated negative dreams that lead to awakening, such that the individual becomes fully alert and aware of his or her surroundings. 2,3Nightmares can have an idiopathic origin or may occur after traumatic events. 4 Along with other sleep disturbances (e.g., insomnia and poor sleep quality), 5 nightmares are a typical symptom of posttraumatic stress disorder (PTSD). 6 Indeed, it has been estimated that around 70% of individuals with PTSD report posttraumatic nightmares. 7,8 Nonetheless, nightmares are not exclusive to PTSD, since they are also associated with anxiety and depression, among other mental health comorbidities. BRIEF SUMMARYCurrent Knowledge/Study Rationale: Imagery rehearsal therapy (IRT) and prazosin are both used for treatment of nightmares in posttraumatic stress. The main aim of this study was a comparative meta-analysis of each treatment on nightmare frequency, sleep quality, and posttraumatic stress disorder symptoms. Study Impact: IRT and prazosin had similar effects for nightmare frequency, sleep quality, and posttraumatic stress disorder symptoms; however, adding cognitive-behavior therapy for insomnia to IRT enhanced its effects for improving sleep quality as well as posttraumatic stress disorder symptoms.

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Section: Description Of Studiesmentioning

confidence: 99%

Comparative Meta-Analysis of Prazosin and Imagery Rehearsal Therapy for Nightmare Frequency, Sleep Quality, and Posttraumatic Stress

Seda

Sánchez-Ortuño

Welsh

et al. 2015

Journal of Clinical Sleep Medicine

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“…In terms of sleep, poor sleep quality is characteristic of PTSD, with sleep disturbance being the most frequently reported symptom of PTSD. [21][22][23] Moreover, self-reported poor sleep quality in PTSD appears to be minimally influenced by age, gender, and psychiatric comorbidity.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

The Mediating Effect of Sleep Quality on the Relationship between PTSD and Physical Activity

Talbot

Neylan

Metzler

et al. 2014

Journal of Clinical Sleep Medicine

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Study Objectives: Physical inactivity is linked to health outcomes such as obesity, diabetes, and psychiatric disorders. Sleep disturbance has been linked to the same adverse outcomes. We examine the infl uence of sleep on physical activity as a novel approach to understand these relationships. Specifi cally, our objective was to determine whether low sleep quality predicts low physical activity in posttraumatic stress disorder (PTSD), a disorder associated with sleep disturbance, physical inactivity, and poor health outcomes. Methods: We used data from the Mind Your Heart Study, a prospective cohort study of 736 outpatients recruited from two Department of Veterans Affairs (VA) medical centers. We assessed PTSD with the Clinician Administered PTSD Scale, sleep quality using an item from the Pittsburgh Sleep Quality Index, and physical activity by self-report at baseline and again one year later. Hierarchical multiple regression models and structural equation modeling were used to examine the relationships among PTSD, sleep, and physical activity. Results: Sleep quality but not PTSD status was prospectively associated with lower physical activity in a model adjusting for age, sex, apnea probability, depression, body mass index, and baseline physical activity (β = 0.129, SE = 0.072, p < 0.01). Structural equation modeling indicated that the results were consistent with sleep quality statistically mediating the relationship between PTSD status at baseline and physical activity one year later. Conclusions: Worse sleep quality predicts lower physical activity in PTSD, providing possible evidence for a behavioral pathway from disturbed sleep to poor physical health outcomes. Keywords: posttraumatic stress disorder, sleep quality, physical activity Citation: Talbot LS, Neylan TC, Metzler TJ, Cohen BE. The mediating effect of sleep quality on the relationship between PTSD and physical activity. J Clin Sleep Med 2014;10(7):795-801.

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“…Imagery rehearsal therapy (IRT) is a psychotherapy for nightmares that involves writing an altered version of a trauma-related nightmare and rehearsing the changed narrative [64]. Findings are mixed about the efficacy of IRT [65,66]. A recent meta-analysis demonstrated that IRT as compared to prazosin, an alpha-aderenergic blocker previously shown to be effective in reducing nightmares [64], produced equivalent reductions in nightmare frequency and associated sleep and trauma symptoms [67].…”

Section: Recent Treatment Studiesmentioning

confidence: 99%

Understanding Recent Insights in Sleep and Posttraumatic Stress Disorder from a Research Domain Criteria (RDoC) Framework

Kelly

Killgore

Haynes

2016

Curr Sleep Medicine Rep

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Posttraumatic stress disorder (PTSD) is associated with sleep disturbances, including insomnia, nightmares, sleep-disordered breathing, and REM abnormalities. Recent studies have expanded our knowledge of the neurobiology of trauma and sleep. In addition, intervention research has provided valuable information about how sleep treatments affect PTSD symptoms and how PTSD treatments affect sleep symptoms. This review of recent literature aims to move away from the categorical approach that currently dominates our conceptualization of trauma response and sleep disorders. Possible mechanisms of both trauma and sleep disturbance are posed within the framework put forth by the National Institute of Mental Health's (NIMH) Research Domain Criteria (RDoC) project. By examining domains of dysfunction that cut across disorders, RDoC may guide future research and treatment of the maladaptive neurobiological and behavioral correlates of both trauma and sleep disturbances.

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Imagery Rehearsal Therapy for Chronic Nightmares in Sexual Assault Survivors With Posttraumatic Stress Disorder

Abstract: Imagery rehearsal therapy is a brief, well-tolerated treatment that appears to decrease chronic nightmares, improve sleep quality, and decrease PTSD symptom severity.

Cited by 492 publications

References 43 publications

Comparative Meta-Analysis of Prazosin and Imagery Rehearsal Therapy for Nightmare Frequency, Sleep Quality, and Posttraumatic Stress

Comparative Meta-Analysis of Prazosin and Imagery Rehearsal Therapy for Nightmare Frequency, Sleep Quality, and Posttraumatic Stress

The Mediating Effect of Sleep Quality on the Relationship between PTSD and Physical Activity

Understanding Recent Insights in Sleep and Posttraumatic Stress Disorder from a Research Domain Criteria (RDoC) Framework

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