Randomized controlled trials of psychological and pharmacological treatments for nightmares: A meta-analysis

Augedal, Aslak Wøien; Hansen, Kenneth Schøld; Kronhaug, Christian Robstad; Harvey, Allison G.; Pallesen, Ståle

doi:10.1016/j.smrv.2012.06.001

Cited by 83 publications

(81 citation statements)

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“…These findings are in accordance with and extend the results provided by a recent meta-analysis comparing psychological and pharmacological treatments for nightmares. 20 Nonetheless, since the RCTs including IRT showed considerable variation regarding the components of the treatment protocol (e.g., some studies combined IRT with CBT for insomnia or with other type of psychological intervention), our subsequent contrast analyses suggest that the subgroup of studies combining IRT with CBT for insomnia performed significantly better at improving overall sleep quality than did studies using prazosin, studies using IRT alone, and studies using IRT combined with other form of psychological intervention. Values are based on mixed effects models.…”

Section: Discussionmentioning

confidence: 81%

“…18,19 After the publication of this influential review paper, a few meta-analyses have been conducted to quantitatively summarize the results of studies testing the treatments for nightmares. [20][21][22] With respect to psychological approaches for the treatment of nightmares, an important aspect noted in those meta-analyses is that treatment protocols using IRT often combine this therapy with another form of psychological intervention. In this line, the meta-analysis conducted by Casement et al showed that adding cognitive-behavioral treatment for insomnia (CBT-I), although not being superior to IRT alone for reducing nightmare frequency, did result in greater improvement in other parameters of sleep disturbance, such as sleep quality.…”

Section: S C I E N T I F I C I N V E S T I G At I O N Smentioning

confidence: 99%

“…including only randomized clinical trials, RCTs) by Augedal et al showed that multicomponent treatments are not superior than IRT alone at reducing nightmare frequency. 20 However, unlike the Casement meta-analysis, Augedal's study did not compare treatment effects on other relevant outcomes that are often included in such studies, such as sleep quality or symptoms of PTSD. Of interest, the Augedal meta-analysis was the only one comparing the effect sizes of studies employing one of the two best-supported treatments for nightmares, IRT and prazosin, concluding that both the psychological and the pharmacological approach were reasonably effective and comparable, both showing medium effect sizes.…”

Section: S C I E N T I F I C I N V E S T I G At I O N Smentioning

confidence: 99%

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Comparative Meta-Analysis of Prazosin and Imagery Rehearsal Therapy for Nightmare Frequency, Sleep Quality, and Posttraumatic Stress

Seda

Sánchez-Ortuño

Welsh

et al. 2015

Journal of Clinical Sleep Medicine

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Study Objective:In this meta-analysis, we compare the shortterm effi cacy of prazosin vs. IRT on nightmares, sleep quality, and posttraumatic stress symptoms (PTSS). Methods: Reference databases were searched for randomized controlled trials using IRT or prazosin for nightmares, sleep disturbance, and/or PTSS. Effect sizes were calculated by subtracting the mean posttest score in the control group from the mean posttest score in the treatment group, and dividing the result by the pooled standard deviation of both groups. Mixed effects models were performed to evaluate effects of treatment characteristics, as well as sample characteristics (veteran vs. civilian) on treatment effi cacy. Results: Four studies used prazosin, 10 used IRT alone or in combination with another psychological treatment, and 1 included a group receiving prazosin and another group receiving IRT. Overall effect sizes of both treatments were of moderate magnitude for nightmare frequency, sleep quality, and PTSS (p < 0.01). Effect size was not signifi cantly different with type of treatment (psychological vs. pharmacological However, when these frightening dreams occur in a recurrent fashion, the nightmare activity may constitute a disorder. In fact, nightmare disorder is listed in both the DSM-5 and in the ICSD-3 as a distinct disorder whose essential features are the presence of repeated negative dreams that lead to awakening, such that the individual becomes fully alert and aware of his or her surroundings. 2,3Nightmares can have an idiopathic origin or may occur after traumatic events. 4 Along with other sleep disturbances (e.g., insomnia and poor sleep quality), 5 nightmares are a typical symptom of posttraumatic stress disorder (PTSD). 6 Indeed, it has been estimated that around 70% of individuals with PTSD report posttraumatic nightmares. 7,8 Nonetheless, nightmares are not exclusive to PTSD, since they are also associated with anxiety and depression, among other mental health comorbidities. BRIEF SUMMARYCurrent Knowledge/Study Rationale: Imagery rehearsal therapy (IRT) and prazosin are both used for treatment of nightmares in posttraumatic stress. The main aim of this study was a comparative meta-analysis of each treatment on nightmare frequency, sleep quality, and posttraumatic stress disorder symptoms. Study Impact: IRT and prazosin had similar effects for nightmare frequency, sleep quality, and posttraumatic stress disorder symptoms; however, adding cognitive-behavior therapy for insomnia to IRT enhanced its effects for improving sleep quality as well as posttraumatic stress disorder symptoms.

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Section: Discussionmentioning

confidence: 81%

Section: S C I E N T I F I C I N V E S T I G At I O N Smentioning

confidence: 99%

Section: S C I E N T I F I C I N V E S T I G At I O N Smentioning

confidence: 99%

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Comparative Meta-Analysis of Prazosin and Imagery Rehearsal Therapy for Nightmare Frequency, Sleep Quality, and Posttraumatic Stress

Seda

Sánchez-Ortuño

Welsh

et al. 2015

Journal of Clinical Sleep Medicine

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“…4 The etiology of nightmares is best explained by a disposition-stress model 5 and effective treatment strategies, like Imagery Rehearsal Therapy, are available. 6 Nightmares are also of special importance in a clinical context because nightmares are an independent predictor of suicidal ideation and suicide.…”

Section: Introductionmentioning

confidence: 99%

“…[26][27][28] Clinicians, whether they are working in sleep medicine or other areas of professional health care, should be encouraged to ask specifically about nightmare frequency and nightmare distress, and they should be informed about effective therapeutic approaches like imagery rehearsal. 6,29,30 …”

mentioning

confidence: 99%

Interest in Information about Nightmares in Patients with Sleep Disorders

Schredl

Dehmlow

Schmitt

2016

Journal of Clinical Sleep Medicine

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Study Objectives: Despite the considerable prevalence of the nightmare disorder and its burden on the patient, nightmares are underdiagnosed and undertreated, even in sleep centers. Methods: A total of 1,125 patients in a sleep center undergoing routine diagnostic procedures for their sleep disorders completed a questionnaire about nightmares. Results: About 20% of the sample indicated an interest in more information about nightmare etiology and nightmare therapy-even patients who had never sought professional help previously. Conclusions: From a clinical viewpoint, health care professionals should be encouraged to ask about nightmares and, as a first step, internet-based selfhelp programs should be implemented for this patient group. Keywords: nightmare disorder, imagery rehearsal therapy Citation: Schredl M, Dehmlow L, Schmitt J. Interest in information about nightmares in patients with sleep disorders. J Clin Sleep Med 2016;12(7):973-977. I NTRO DUCTI O NNightmares are defined as extended, extremely dysphoric, and well-remembered dreams that usually involve threat to survival, security, or physical integrity.1 Nightmares are experienced occasionally by many persons during their lifetime, 2 i.e., for the clinical context, it is important to differentiate between nightmares that occur rarely and the presence of a nightmare disorder (which includes the criteria that nightmares cause clinically significant distress and/or impairment in social, occupational, or other important areas of functioning).1 The nightmare disorder prevalence in the general population is estimated to be about 5%, 3 and about 30% in a patient group with various mental disorders. 4 The etiology of nightmares is best explained by a disposition-stress model 5 and effective treatment strategies, like Imagery Rehearsal Therapy, are available.6 Nightmares are also of special importance in a clinical context because nightmares are an independent predictor of suicidal ideation and suicide. 7-9Despite the considerable prevalence of the nightmare disorder 3 and its burden on the patient, 10 nightmares have been rarely diagnosed and treated, even in sleep clinics: Krakow reported that 16.3% of sleep-disordered patients (n = 718) also have a salient nightmare condition that normally would not have been diagnosed if they had not specifically asked for it as part of this research project.11 Comparable results were reported by Schredl et al., 12 who found that 13.4% of the patients undergoing diagnostic procedures for various reasons in a sleep laboratory (n = 4,001) reported nightmares at least once a week, whereas a diagnosis of a nightmare disorder was given to only 1.6% of the sample. On the other hand, nightmare sufferers also rarely seek help for their problem on their own initiative. [13][14][15][16] In an online study of nightmare sufferers (n = 335), only 29.6% of the respondents reported that they had asked a health care provider for help.13 Even lower figures were reported for persons of a representative sample having nightmares at least once...

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