The Effects of an Internet-Based Imagery Rehearsal Intervention: A Randomized Controlled Trial

Abstract

Background: Nightmares are extremely dysphoric dreams, which are prevalent and associated with psychological strain. This study investigated (a) the efficacy of an internet-based imagery rehearsal therapy (IRT), (b) the role of imagery rescription, and (c) the role of guidance during internet-based IRT. Methods: A total of 127 patients suffering from mainly idiopathic nightmares were randomly assigned to 1 of 2 IRT internet-based groups (guided IRT; unguided IRT) or to 1 of 2 active control groups (frequency control group; narrative control group). Results: IRT was more effective than a nightmare frequency control condition with respect to nightmare frequency and nightmare distress. Compared to the narrative control group, IRT was only superior in improving nightmare distress but not in nightmare frequency because the narrative control group also improved regarding nightmare frequency. Guidance by a nightmare coach did not affect efficacy, compliance, or dropout. Conclusion: Internet-based IRT seems to be an effective treatment even when offered with minimal guidance by a nightmare coach. Describing the nightmare narrative in detail already decreased nightmare frequency. However, with regard to inducing decreases in nightmare frequency and nightmare distress, IRT was superior to the narrative control group. The results are discussed with reference to the mastery hypothesis.

Online Self-Help as an Add-On to Inpatient Psychotherapy: Efficacy of a New Blended Treatment Approach

“…Our findings raise the issue of whether the effectiveness of a blended care approach could be further enhanced by integrating it more into the inpatient program. Furthermore, since the effect of guidance on the efficacy of internet-based interventions is still controversially discussed [56], our study would have benefitted from a subgroup of participants with therapeutic guidance to explore the effect of therapeutic interventions. Finally, we are aware that we compared treatment packages with multiple effective ingredients [57] and that we could not control how Deprexis was supported by the different members of the staff.…”

Aetiology and treatment of nightmare disorder: State of the art and future perspectives

“…Because IRT is most often offered in a multicomponent treatment package, specific treatment mechanisms are difficult to identify: nightmare modification rarely occurs without any exposure to the aversive nightmare content (Lancee, Van Den Bout, & Spoormaker, ) and most treatment manuals also include psycho‐education, the keeping of sleep diaries, relaxation exercises and imagination techniques taken from the treatment of PTSD. Attempts to identify such treatment components have demonstrated that the simple recording of nightmares in a diary decreases nightmare frequency and nightmare distress (Lancee et al., ; Neidhardt, Krakow, Kellner, & Pathak, ); nonetheless, IRT as an adjunct therapy outperformed a comparison treatment that also included diaries (Gieselmann et al., ; Van Schagen et al., ). On the other hand, keeping detailed narrative sleep diaries was as effective as IRT (with the diaries) in decreasing nightmare frequency, whereas IRT outperformed detailed diaries in reducing nightmare distress.…”

“…In the attempt to improve access to treatment, low‐threshold interventions such as telephone counselling (Schredl et al., ), Internet‐based applications and self‐help approaches (Gieselmann et al., ; Lancee et al., ) should be further developed and offered to the general public. There is an abundance of evidence that Internet‐based treatment is effective, with effect sizes comparable to those of face‐to‐face treatments; such novel approaches may help with disseminating, simplifying and, perhaps, increasing the effects of treatments (Andersson, Cuijpers, Carlbring, Riper, & Hedman, ; Cuijpers, Kleiboer, Karyotaki, & Riper, ).…”

“…The most frequently used distress instrument, the NDQ (Belicki, 1992), demonstrates that nightmare distress is more strongly associated with other mental health complaints, including anxiety and depression, than is nightmare frequency. Furthermore, the relationship between nightmare frequency and well-being is mediated by NDQ-assessed nightmare distress (Blagrove et al, 2004) and nightmare-specific treatment reduces both nightmare frequency and nightmare distress, whereas non-specific treatment only reduces nightmare frequency (Gieselmann, Böckermann, Sorbi, & Pietrowsky, 2017;Van Schagen, Lancee, De Groot, Spoormaker, & Van Den Bout, 2015). Against this background, many authors conclude that the distress caused by the nightmares is more relevant to mental health than is the sheer number of nightmares (Belicki, 1992;Blagrove et al, 2004;Gieselmann et al, 2017;Levin & Fireman, 2002;Van Schagen et al, 2015).…”

“…Internet-based self-help (Gieselmann et al, 2017). However, the majority of nightmare sufferers do not seek professional help.…”