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

Trial Summary

What is the purpose of this trial?

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 setting. This treatment, to be called 'Nightmare Rescripting and Rehearsal Therapy' (NRRT) would arm Primary Care medical personnel with a nonpharmacologic, ten minute intervention for treating recurring nightmares. The study will provide sleep hygiene education to both the control and experiment groups, NRRT to the experiment group only, and compare their Nightmare Distress Questionnaire and Nightmare Frequency Tool at two (2), four (4), and six (6) week intervals.

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.

What data supports the effectiveness of the treatment Nightmare Rescripting and Rehearsal for nightmares?

Research shows that a similar treatment called imagery rehearsal, which involves changing and visualizing nightmares in a positive way, significantly reduces the frequency of nightmares and improves sleep quality. This suggests that Nightmare Rescripting and Rehearsal could also be effective in treating nightmares. ^{1 2 3 4 5}

Is Nightmare Therapy for Nightmares safe for humans?

Nightmare Therapy, including techniques like imagery rescripting and rehearsal, has been studied in various trials and is generally considered safe for humans. Participants in these studies reported improvements in nightmare frequency and sleep quality without significant safety concerns. ^{3 4 6 7 8}

How does the Nightmare Rescripting and Rehearsal treatment differ from other treatments for nightmares?

Nightmare Rescripting and Rehearsal is unique because it involves changing the storyline of a nightmare and repeatedly imagining the new, positive version, which is different from other treatments that may focus on exposure or relaxation techniques. This approach directly targets the nightmare content itself, rather than treating it as a symptom of another condition. ^{5 7 9 10 11}

Eligibility Criteria

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

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)

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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 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]

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]

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]

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]

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]

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]

References

1. United States pubmed.ncbi.nlm.nih.gov

Treatment of chronic nightmares in adjudicated adolescent girls in a residential facility. [2019]

2. England pubmed.ncbi.nlm.nih.gov

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

3. England pubmed.ncbi.nlm.nih.gov

Efficacy of imagery rescripting and imaginal exposure for nightmares: A randomized wait-list controlled trial. [2019]

4. England pubmed.ncbi.nlm.nih.gov

Imagery rehearsal treatment for chronic nightmares. [2019]

5. Netherlands pubmed.ncbi.nlm.nih.gov

Imagery rehearsal treatment of chronic nightmares: with a thirty month follow-up. [2019]

6. England pubmed.ncbi.nlm.nih.gov

Long-term effectiveness of cognitive-behavioural self-help intervention for nightmares. [2018]

7. England pubmed.ncbi.nlm.nih.gov

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

8. England pubmed.ncbi.nlm.nih.gov

Drug induced nightmares--an etiology based review. [2013]

9. England 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. [2019]

10. England pubmed.ncbi.nlm.nih.gov

Clinical management of chronic nightmares: imagery rehearsal therapy. [2019]

11. Netherlands pubmed.ncbi.nlm.nih.gov

Treatment of recurrent nightmares by the dream reorganization approach. [2019]