Treatment of combat‐related nightmares using imagery rehearsal: A pilot study

Abstract

Posttraumatic nightmares are a hallmark of PTSD and distinct from general nightmares as they are often repetitive and faithful representations of the traumatic event. This paper presents data from a pilot study that examined the use of Imagery Rehearsal in treating combat-related nightmares of 12 Vietnam veterans with PTSD. Three treatment groups, comprising 4 veterans in each, completed standardised treatment across 6 sessions. Treatment effects were investigated using nightmare diaries and established instruments, including the IES-R, BDI, BAI, and SCL-90-R. The data demonstrate significant reductions in nightmares targeted, and improvements in PTSD and comorbid symptomatology. The paper recommends that, on the basis of the promising preliminary data, a randomised control trial be established to assess imagery ability and attitude toward nightmares.

Dreaming in Posttraumatic Stress Disorder: A Critical Review of Phenomenology, Psychophysiology and Treatment

“…Roughly one third of participants in the third study suffered from PTSD, a further 30% showed mild posttraumatic stress symptoms [110]. It is remarkable that in these three and also in two other uncontrolled studies [111, 112] subjects reported not only a reduction in nightmare frequency but also in PTSD symptoms beyond distressing dreams. In the study by Neidhardt et al [113] 10 subjects received IRT after a nightmare-recording phase of 1 month.…”

Treatment of sleep disturbances in posttraumatic stress disorder: A review

“…Both studies reported reduced frequency of nightmares, improved sleep quality, and decreased levels of PTSD symptoms. Forbes et al provided six 90-minute individual sessions of IR, which was presented to participants as including their making "changes that promote mastery or control" [51] (p. 436) to their nightmares, to a sample of 12 Vietnam veterans with PTSD. This IR intervention resulted in decreases in the frequency of the target nightmare, PTSD symptom severity, and depression.…”

“…The treatment, provided in group or individual format, was associated with decreases in nightmare frequency and PTSD symptoms, as well as a significant decrease on one measure of insomnia severity. Lu et al [53] provided group IR based on the Forbes et al [51] protocol to a sample of 17 male veterans and found no posttreatment effects on nightmares or PTSD symptoms. However, total nights with trauma-related nightmares decreased at 3-and 6-month follow-up points compared with pretreatment, and PTSD symptoms decreased at the 3-month follow-up in the intent-to-treat sample.…”

“…However, total nights with trauma-related nightmares decreased at 3-and 6-month follow-up points compared with pretreatment, and PTSD symptoms decreased at the 3-month follow-up in the intent-to-treat sample. A large RCT compared IR, based on the treatment protocol used by Forbes et al [51], to education and relaxation alone in a sample of 124 Vietnam veterans with chronic, severe PTSD. No differences between treatment and control groups were found in the intent-to-treat analysis in nightmare frequency, sleep quality, or PTSD symptoms (Cook et al [54]).…”

“…The Standards of Practice Committee of the American Academy of Sleep Medicine gave a Level A rating to "imagery rehearsal therapy," which appeared to include protocols by Krakow and colleagues (e.g., Krakow et al [64]) as well as Forbes et al [51] for the treatment of nightmare disorder (Aurora et al [65]), and noted that "IRT appears to be effective in the management of nightmares exhibited in patients with PTSD as well as idiopathic nightmares" (p. 395). In published studies, IR protocols tend to be associated with improvements in nightmare frequency and intensity as well as PTSD symptoms.…”