Image Rehearsal Therapy Improves Sleep, Reduces Victims' Nightmares.

2001 AUG 23 - (NewsRx Network) -- As few as three sessions of a dream- and sleep-oriented therapy called image rehearsal therapy (IRT) can substantially improve sleep while reducing the frequency of nightmares and the severity of posttraumatic stress disorder (PTSD) symptoms m women who have experienced sexual assault, study findings show.

Barry Krakow, MD, of the Sleep and Human Health Institute, Albuquerque, New Mexico, and colleagues studied 168 women, of whom 95% were diagnosed with moderate-to-severe PTSD: 97% had experienced rape or other sexual assault, 77% reported life-threatening sexual assault, and 58% reported repeated exposure to sexual abuse in childhood or adolescence. The women were divided into two groups: 88 received three sessions of IRT treatment and 80 continued any treatment they were already receiving but did not receive IRT (controls). Both groups completed questionnaires that rated sleep quality, frequency of nightmares, and severity of PTSD symptoms at three- and six-month follow-up.

A total of 114 participants completed follow-up at three and/or six months. The authors found that IRT substantially reduced nightmares, improved sleep quality and decreased PTSD symptom severity from moderately severe to moderate levels. Therapeutic effects occurred at three months follow-up and were maintained at six months in comparison with the control group, which showed on average small or no improvement at either follow-up (Journal of the American Medical Association, August 1, 2001;286:537-545).

Previous studies have indicated that 60% of people with PTSD may have frequent nightmares, but these nightmares are not the primary target of treatment, Krakow and team note. They state that the prevailing medical opinion is that nightmares occur secondary to the primary disorder, which precludes viewing nightmares as a distinctly treatable condition. Most treatment is focused on treating the symptoms of PTSD to reduce the occurrence of nightmares.

In this study, the IRT therapy consisted of three sessions provided in groups of four to eight women. In the first session the participants were encouraged to recognize that nightmares may be both trauma-induced and a learned behavior. Participants were then coached to practice pleasant imagery exercises. In the second session a week later, the women wrote about a single nightmare and were instructed to change the nightmare any way they wished and to write down the changed dream. They then rehearsed the "new dream" scenario for 10 to 15 minutes, and described the old nightmare and how they changed it in the written and rehearsal phase. Afterwards, they were asked to rehearse the new dream while awake for a least five to 20 minutes per day.

After three weeks, the group met again and discussed their progress, shared experiences, and asked questions about PTSD symptoms, nightmares, sleep, and discussed other ways IRT might be useful. Participants were mailed questionnaires at ...