Imagery rescripting and exposure group treatment of posttraumatic nightmares in Veterans with PTSD

Abstract

This study details results of an open trial of a group psychological treatment for Veterans with posttraumatic stress disorder (PTSD) and chronic posttraumatic nightmares called "Imagery Rescripting and Exposure Therapy" (IRET). IRET is a variant of a successful imagery rescripting treatment for civilian trauma-related nightmares that was modified to address the needs of the Veteran population. Thirty-seven male U.S. Veterans with PTSD and nightmares attended 6 multicomponent group sessions. Findings indicated that the intervention significantly reduced frequency of nightmares and PTSD severity, as well as increased hours of sleep. Unlike the few open trials examining treatment of nightmares in Veterans, effect sizes in this study were similar to those that have been found in the civilian randomized controlled trial. These preliminary findings suggest that a nightmares treatment can be adapted to successfully reduce distress associated with combat Veterans' chronic nightmares. Clinical and research implications are discussed.

Imagery rescripting: Is incorporation of the most aversive scenes necessary?

“…As ImRs taps on negative memories or fantasies, it has been mostly studied in the context of post-traumatic stress disorder (PTSD). Several clinical studies have indicated that incorporating ImRs during treatment can help to reduce PTSD symptoms such as feelings of anger, guilt and hostility (Arntz, Tiesema, & Kindt, 2007), fear and nightmares (Long et al, 2011) and the vividness and frequency of involuntary intrusions (Hackmann, 2011). Additionally, other psychopathological problems involving negative affect also seem to benefit from ImRs such as depression, social phobia, simple phobia, borderline personality disorder and other personality disorders (see for a review Arntz, 2012).…”

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

“…Previous work has demonstrated effectiveness of combined nightmare rescripting and emotional processing for both nightmare frequency and PTSD symptom severity in both civilian [74] and veteran populations [75]. Exposure, relaxation, and rescripting therapy (ERRT) incorporates IRT techniques with sleep and trauma-related psychoeducation, relaxation training and problem-focused coping skills, and exposure (focusing on trauma-related nightmares, identifying themes, and verbal rehearsal in session).…”

Physician Health and Wellness

“…The use of mindfulness and guided imagery is also gaining acceptance in the military to reduce stress and enhance performance. 59,60 One of the few available randomized controlled clinical trials in physician burnout intervention demonstrated substantial decrease of rates of depersonalization, emotional exhaustion, and overall burnout in the treatment group and resulted in improved sense of meaning and engagement in work in 74 practicing internal medicine physicians who attended 9 months of biweekly facilitated discussion groups that incorporated elements of mindfulness, reflection, shared experience, and small group learning. 15 More research is needed to identify programs that will best serve the needs of pediatricians at various stages of training and practice.…”