Randomized clinical trial for treatment of chronic nightmares in trauma‐exposed adults

Abstract

Nightmares and sleep disturbance are fundamental concerns for victims of trauma. This study examined the efficacy of a manualized cognitive-behavioral treatment (CBT) for chronic nightmares in trauma-exposed individuals via a randomized clinical trial. Participants were randomly assigned to a treatment group or wait-list control group, with 27 participants completing the treatment. At the 6-month follow-up assessment, 84% of treated participants reported an absence of nightmares in the previous week. Significant decreases were also reported in symptoms of depression and posttraumatic stress, fear of sleep, and number of sleep problems, while sleep quality and quantity improved. The present study adds to the growing literature indicating this brief CBT as a first-line treatment for trauma-exposed individuals with chronic nightmares.

Treatment of sleep disturbances in posttraumatic stress disorder: A review

“…The most common explanation for its efficacy is that it promotes mastery of the content and images of the nightmare. Though instructions for IR vary widely, the general message that most protocols appear to convey is that patients should select a change to their target nightmare that decreases the negative content or changes the negative ending of the dream (Davis and Wright [55], Gehrman and Harb [48], Nappi et al [52]), though there are protocols that specifically do not provide guidance on how to change the nightmare (Moore and Krakow [56]). "Mastery of the nightmare" is not a clearly defined construct, but appears to include two components: the recognition of an alternative ending for the nightmare that contains fewer negative connotations about the patient or the world in general, and a decrease in distress related to the nightmare.…”

“…As noted previously, some protocols focus on specific trauma-related themes that are identified in the nightmares or emphasized in traumafocused treatments (Davis and Wright [55], Swanson et al [61]). The imagery rescripting and rehearsal procedures used to treat nightmares share some similarities with imagery rescripting and reprocessing treatments for trauma-related intrusive memories, and imagery rescripting and reprocessing is generally viewed as an imagerybased cognitive therapy (Grunert et al [62], Smucker and Niederee [63]).…”

“…In a randomized clinical trial of exposure, relaxation, and rescripting therapy (ERRT), which includes stimulus control, progressive muscle relaxation, and IR encouraging participants "to utilize relevant themes" (p. 127) when changing nightmares, Davis and Wright [55] reported significant improvements in nightmare frequency and severity as well as in PTSD symptom severity in a sample of trauma survivors with nightmares, 66 percent of whom met diagnostic criteria for PTSD. However, Davis and Wright [55] found no improvements in total sleep time or measures of sleep quality.…”

“…In a randomized clinical trial of exposure, relaxation, and rescripting therapy (ERRT), which includes stimulus control, progressive muscle relaxation, and IR encouraging participants "to utilize relevant themes" (p. 127) when changing nightmares, Davis and Wright [55] reported significant improvements in nightmare frequency and severity as well as in PTSD symptom severity in a sample of trauma survivors with nightmares, 66 percent of whom met diagnostic criteria for PTSD. However, Davis and Wright [55] found no improvements in total sleep time or measures of sleep quality. Krakow et al [50] provided combined IRT and CBTI, including stimulus control, sleep restriction, and sleep hygiene components, to a group of 62 violent crime survivors with PTSD and found improvements in sleep quality and nightmare frequency, along with decreases in PTSD symptoms.…”

“…Long et al [74] found that six sessions of group IR combined with a session of exposure to the original nightmare resulted in improvements from pretreatment to posttreatment in nightmare frequency, sleep quantity, and PTSD symptoms in a sample of 37 veterans with PTSD. The treatment package added a week of exposure to the original unchanged nightmare account (writing the most distressing and/or frequent nightmare and reading it several times until anxiety decreases) and an extra week of rehearsal of the rescripted account, as well as additional unspecified "cognitive-behavior skills for sleep management" (p. 533), to the ERRT protocol of Davis and Wright [55].…”