Effectiveness of Imagery Rehearsal Therapy for the Treatment of Combat-Related Nightmares in Veterans

Imagery rehearsal for posttraumatic nightmares: A randomized controlled trial

“…Perhaps those veterans were therefore able to better benefit as they had already received trauma-focused treatment. In a chart review of veterans offered imagery rehearsal, those who completed a full course of PTSD treatment in the past year were more likely to engage in imagery rehearsal, suggesting such veterans may be more amenable to treatment, particularly if nightmares have persisted despite prior PTSD treatment (Nappi et al, 2010).…”

“…In addition, examination of significant clinical change indicated that very few patients in either imagery rehearsal or sleep and nightmare management had meaningful long-term improvement. Given two positive clinical trials indicating the efficacy of imagery rehearsal delivered in group format in other traumatized populations Krakow et al, 2001) and positive findings from uncontrolled pilots of imagery rehearsal with veterans (Forbes et al, 2001;Harb et al, 2009;Lu et al, 2009;Moore & Krakow, 2007;Nappi et al, 2010), an explanation for these non-significant findings was sought. Even though there are certain similarities between this trial and the other two controlled trials of imagery rehearsal Krakow et al, 2001), there are several important distinctions, namely in the choice of comparison conditions, the nature of the patient samples, and the particulars of the respective treatment strategies.…”

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.…”

“…This IR intervention resulted in decreases in the frequency of the target nightmare, PTSD symptom severity, and depression. Nappi et al retrospectively examined records of veterans who completed five sessions of IR in which "therapists guided veterans in writing a highly detailed, vivid, and creative alternative ending [to the target nightmare] that did not elicit negative affect or include distressing content from the target nightmare" [52] (p. 239). 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.…”

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

“…New Treatments for Both Insomnia and Nightmares in PTSD Previous studies have evaluated group modalities for individuals with PTSD experiencing insomnia and/or nightmares with positive results for both sleep and trauma-related symptoms [82,83]. More recently, Haynes and colleagues developed and tested Cognitive Behavioral Social Rhythm Therapy (CBSRT) in veterans with moderate to severe comorbid insomnia, MDD, and PTSD [84].…”