Nightmare Therapy for Nightmares

Overseen By Jill M Clark, MBA

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: kathleen mcnamara

Disqualifiers: Under 18, Non-military, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 7

Duration: 6 weeks

156 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new, quick therapy for recurring nightmares called Nightmare Rescripting and Rehearsal Therapy (NRRT). It aims to equip primary care doctors with a simple, non-drug treatment that takes just ten minutes. Participants will receive either this new therapy with sleep tips or only the sleep tips, and researchers will compare the frequency and distress of their nightmares. The trial seeks individuals who experience frequent disturbing dreams (at least three times a month) and can receive care at Nellis Air Force Base. As an unphased trial, it offers a unique opportunity to contribute to developing innovative, non-drug treatments for nightmares.

Will I have to stop taking my current medications?

You will need to stop taking any over-the-counter or prescription medications that you use to improve sleep during the study.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that Imagery Rehearsal Therapy (IRT), similar to Nightmare Rescripting and Rehearsal Therapy (NRRT), is generally easy for patients to handle. Studies have found that IRT significantly reduces the frequency of nightmares. Some participants also experienced improvements in anxiety and trauma symptoms.

Overall, imagery techniques like those in NRRT appear safe for most people. Studies have reported no serious side effects from these therapies. This suggests that NRRT might be a safe option for reducing nightmares without medication. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Unlike the standard treatments for nightmares, which often involve medication or lengthy therapy sessions, Nightmare Rescripting and Rehearsal offers a quick, 10-minute intervention combined with sleep hygiene practices. This approach is unique because it empowers individuals to actively reshape their nightmares by rescripting the story and rehearsing a new, less distressing version. Researchers are excited because this method not only promises rapid results but also focuses on giving individuals practical tools to change their nightmare experiences, potentially reducing the need for medication.

What evidence suggests that Nightmare Rescripting and Rehearsal Therapy is effective for treating recurring nightmares?

Research shows that Imagery Rehearsal Therapy (IRT) can greatly reduce the frequency of nightmares and improve sleep quality. Studies have found that IRT helps make dreams less negative and gives individuals a sense of control. A review of multiple studies found that IRT significantly reduces nightmares and improves PTSD symptoms. Imagery Rescripting, a similar method, also effectively lowers the frequency and distress of nightmares. In this trial, participants will receive either the standard of care or a combination of the standard of care and Nightmare Rescripting and Rehearsal Therapy (NRRT), a shorter version that might effectively treat recurring nightmares. ^{1 2 4 6 7}

Are You a Good Fit for This Trial?

This trial is for adults aged 18+ who have recurring nightmares at least three times a month and are receiving care at Nellis Air Force Base. Participants must also score at least 15 on specific nightmare distress and frequency tools to qualify.

Inclusion Criteria

I have had disturbing dreams at least three times a month for the last month.

You must have nightmares, but they can't be too severe. You need to score at least 15 out of 52 on a questionnaire about your nightmares.

You must be able to receive medical care at a military base called Nellis Air Force Base to participate in this study.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

1 visit (in-person)

Treatment

Participants receive Nightmare Rescripting and Rehearsal Therapy (NRRT) and sleep hygiene education

6 weeks

4 visits (in-person)

Follow-up

Participants are monitored for changes in nightmare distress and frequency, as well as secondary outcomes like PTSD, depression, and anxiety

4 weeks

2 visits (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Nightmare Rescripting and Rehearsal
• standard of care

Trial Overview The study tests 'Nightmare Rescripting and Rehearsal Therapy' (NRRT), a brief intervention by non-mental health professionals in primary care, against standard sleep hygiene education. The impact on nightmare distress and frequency will be measured over six weeks.

How Is the Trial Designed?

Group I: Intervention + Standard of care Experimental Treatment 2 Interventions

Nightmare Rescripting and Rehearsal: a 10 minute intervention for Primary Care plus Sleep Hygiene handout.

Group II: Standard of care Active Control 1 Intervention

Standard of Care Sleep Hygiene handout alone.

Who Is Running the Clinical Trial?

kathleen mcnamara

Lead Sponsor

Trials

1

Recruited

160+

David Moss

Lead Sponsor

Trials

6

Recruited

830+

Published Research Related to This Trial

A modified treatment called Exposure, Relaxation, and Rescripting Therapy, which builds on imagery rehearsal techniques, showed promise in reducing the frequency and severity of nightmares in a case series of 4 participants (1 male and 3 females).

Three out of the four participants also experienced reductions in posttraumatic stress and depression symptoms, along with improvements in sleep quality and quantity, suggesting that this approach may be beneficial for individuals with trauma-related nightmares.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Case series utilizing exposure, relaxation, and rescripting therapy: impact on nightmares, sleep quality, and psychological distress. Davis, JL., Wright, DC.[2019]

Imagery Rehearsal Therapy effectively reduced nightmare frequency and anxiety in participants, particularly benefiting those who primarily suffered from nightmares, as shown in a study with 69 participants across different groups.

While all groups experienced a decrease in nightmare frequency, PTSD patients had the highest initial anxiety levels and showed the least reduction in anxiety during treatment, indicating that they may require additional support beyond this therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of a manualized imagery rehearsal therapy for patients suffering from nightmare disorders with and without a comorbidity of depression or PTSD. Thünker, J., Pietrowsky, R.[2019]

In a study of 58 chronic nightmare sufferers, those who received cognitive-behavioral therapy (imagery rehearsal) experienced significant reductions in nightmare frequency, with an average decrease of 2 nightmares per week and 4 nightmares overall after treatment.

The treatment group also reported improved sleep quality, indicating that addressing nightmares can lead to better overall sleep, supporting the idea that nightmares can be treated effectively as a primary sleep disorder.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Imagery rehearsal treatment for chronic nightmares. Krakow, B., Kellner, R., Pathak, D., et al.[2019]

Chronic nightmares affect a significant number of trauma survivors and about 5% to 8% of the general population, indicating that they may be a primary sleep disorder rather than just a symptom of other psychiatric issues.

Imagery Rehearsal Therapy (IRT) is the most supported treatment for nightmares, involving four 2-hour sessions that focus on cognitive-imagery techniques, with suggestions for dismantling protocols to tailor the therapy to individual patient needs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical management of chronic nightmares: imagery rehearsal therapy. Krakow, B., Zadra, A.[2019]

The dream reorganization approach, which combines systematic desensitization and guided rehearsal, effectively reduced recurrent nightmares in a 10-year-old boy, leading to a complete elimination of nightmares and nighttime disturbances.

This treatment method is based on established theories of dream construction and offers a promising new direction for addressing nightmares, highlighting the potential for cognitive-behavioral strategies in improving sleep-related issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment of recurrent nightmares by the dream reorganization approach. Palace, EM., Johnston, C.[2019]

Chronic nightmare sufferers who learned imagery rehearsal (N = 9) experienced a significant reduction in nightmare frequency and total distress 30 months after treatment, compared to those who only recorded their nightmares (N = 10).

Both treatment groups reported fewer nightmares at 3 and 30 months, but only the imagery rehearsal group showed a lasting decrease in distress, supporting the idea that nightmares can be treated as a primary sleep disorder rather than a symptom of other psychiatric issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Imagery rehearsal treatment of chronic nightmares: with a thirty month follow-up. Krakow, B., Kellner, R., Neidhardt, J., et al.[2019]

Imagery rehearsal therapy significantly reduced the frequency of nightmares in adolescent girls, with a 57% decrease in nights with nightmares and a 71% decrease in total nightmares per month after 3 months of treatment.

The therapy was conducted in a single 6-hour workshop and involved participants actively changing their nightmares into more positive scenarios, demonstrating its effectiveness in this specific population with a history of trauma.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment of chronic nightmares in adjudicated adolescent girls in a residential facility. Krakow, B., Sandoval, D., Schrader, R., et al.[2019]

Both imagery rehearsal and exposure interventions for nightmares showed sustained effectiveness over 42 weeks, with moderate effect sizes (d=0.50-0.70) in reducing nightmare frequency and severity.

The study involved 198 participants who completed a 6-week self-help intervention, indicating that internet-delivered therapies can be a viable first step in treating nightmares within a stepped-care model.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Long-term effectiveness of cognitive-behavioural self-help intervention for nightmares. Lancee, J., Spoormaker, VI., van den Bout, J.[2018]

Imagery rehearsal treatment (IRT) significantly reduced nightmare frequency and psychological distress in 12 chronic nightmare patients after just one session, with notable reductions in both retrospective and prospective nightmare reports.

The treatment led to a decrease in anxiety scores without causing major changes in sleep patterns, suggesting that while IRT effectively addresses nightmares and related distress, improvements in overall sleep quality may take longer to manifest.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of imagery rehearsal treatment on distressing dreams, psychological distress, and sleep parameters in nightmare patients. Germain, A., Nielsen, T.[2015]

In a randomized controlled trial with 104 patients suffering from nightmare disorder, both imagery rescripting (IR) and imaginal exposure (IE) significantly reduced nightmare frequency and distress compared to a wait-list control group.

The positive effects of both treatments were not only immediate but also sustained over 3- and 6-month follow-ups, suggesting that IR and IE are effective components of cognitive-behavioral therapies for nightmares.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of imagery rescripting and imaginal exposure for nightmares: A randomized wait-list controlled trial. Kunze, AE., Arntz, A., Morina, N., et al.[2019]

Pharmacological agents that influence neurotransmitters like norepinephrine, serotonin, and dopamine are strongly linked to the occurrence of nightmares in patients, indicating a clear relationship between medication and altered dreaming.

The study suggests that the biochemical mechanisms behind dreaming and nightmares are complex, with potential associations also found with medications affecting acetylcholine, GABA, histamine, and certain anesthetics, antipsychotics, and antiepileptics.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Drug induced nightmares--an etiology based review. Pagel, JF., Helfter, P.[2013]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9013762/

Nightmare Rescripting: Using Imagery Techniques to Treat ... The results showed that not only the new dreams produced with IRT were characterized by fewer negative elements, but that the subjects developed a greater sense ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4120639/

A Meta-analysis of Imagery Rehearsal for Post-trauma ... Results indicate that imagery rehearsal had large effects on nightmare frequency, sleep quality, and PTSD symptoms. These effects were sustained through 6 to 12 ...

3. clinicaltrials.gov clinicaltrials.gov/study/NCT04529070

NCT04529070 | Nightmare Rescripting and Rehearsal This study aims to test the efficacy of an abbreviated version of Imagery Rehearsal Therapy administered by non-mental health professionals in a Primary Care ...

4. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0005796717301225

Efficacy of imagery rescripting and imaginal exposure for ... Results showed that compared to WL, both interventions effectively reduced nightmare frequency (ΔdIR-WL = 0.74; ΔdIE-WL = 0.70) and distress (ΔdIR-WL = 0.98; Δd ...

5. bmcpsychiatry.biomedcentral.com bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-023-04703-1

Psychosocial treatments for nightmares in adults and children Of the remaining studies that assessed forms of image rehearsal or rescripting therapies, all but one showed significant reductions in nightmare ...

6. sciencedirect.com sciencedirect.com/science/article/pii/S0022395624007465

Imagery rehearsal therapy for the treatment of nightmares ... Our findings suggest that IRT may not only help treat nightmare symptoms but also reduce anxiety and trauma symptoms in BPD.

7. apa.org apa.org/monitor/2024/10/science-of-nightmares

Nightmares in adults: Symptoms, causes, and innovative, ... Nightmares can increase anxiety and distress and impair daytime functioning. Research shows they are also associated with an increased risk of suicide.