RECENT REPORT BY THE US Committee for Refugees estimates there are 14.9 million refugees and 22 million internally displaced persons in the world. 1 Most have experienced significant trauma, including torture, 2-4 as evidenced by prevalence studies in clinics and nonrepresentative community samples. [5][6][7][8][9][10][11][12] Health problems of refugees have also been documented. Clinical research demonstrates a high prevalence of posttraumatic stress and depression symptoms, 6,10,[13][14][15] and community studies using self-rated scales [2][3][4]8,10,16 and structured diagnostic interviews 9,17-19 have found wide variation in the prevalence of the symptoms of posttraumatic stress (4%-86%) and depression (5%-31%). Refugees experience multiple symptoms, 4,5,[20][21][22][23][24][25][26] perhaps due to the many types of insults experienced, 4,6,20,23,24,27,28 yet the significance of these symptoms is not clear since many are not characteristic of posttraumatic stress disorder (PTSD), depression, or other defined disorders. [29][30][31][32][33][34][35] A few community studies Author Affiliations are listed at the end of this article.

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

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Imagery-rehearsal therapy for chronic nightmares was assessed in a randomized, controlled study of sexual assault survivors with posttraumatic stress disorder (PTSD). Nightmares, sleep quality, and PTSD were assessed at baseline for 169 women, who were randomized into two groups: treatment (n = 87) and wait-list control (n = 82). Treatment consisted of two 3-hr sessions and one 1-hr session conducted over 5 weeks. Of 169 participants, 91 women (Treatment, n = 43, Control, n = 48) completed a 3-month follow-up and 78 did not. At follow-up, nightmare frequency and PTSD severity decreased and sleep quality improved in the treatment group with small to minimal changes in the control group. Treatment effects were moderate to high (Cohen's d ranged from 0.57 to 1.26). Notwithstanding the large dropout rate, imagery-rehearsal therapy is an effective treatment for chronic nightmares in sexual assault survivors with PTSD and is associated with improvement in sleep quality and decreases in PTSD severity.