Nightmares and Imagery Rehearsal Therapy

Maybe you’ve heard that if you have a recurring nightmare, you should try imagining a new version of the dream and rescripting a more pleasant ending. It’s a simple idea, but one that psychology researchers have elaborated into an entire method of therapy for people with chronic nightmares.

Most people experience nightmares from time to time, but some people – many with PTSD, for example – are plagued by dreams gone awry. For people whose quality of life is being affected by nightmares, one option for treatment is Imagery Rehearsal Therapy, or IRT. Among other things, IRT involves working with a therapist to reimagine recurring nightmares and shape these dreams into something more benign.

Much of the early research into IRT looked at the therapy as a treatment for nightmares in PTSD specifically, since nightmares are often a symptom of the disorder. A 2012 meta-review of thirteen studies came back with some promising results: IRT had a real effect on the frequency of nightmares, the quality of people’s sleep and the severity of PTSD symptoms. Even better, the benefits of therapy were still evident six months and a year later.

Since then, research has started to branch out, looking at whether IRT can be an effective treatment for people with other psychiatric disorders who experience chronic nightmares. A 2015 study, for instance, found that supplementing people’s regular psychiatric treatment with IRT did indeed take a lot of the edge off of those people’s bad dreams.

Most recently, a study done at the Menninger Clinic in Houston tried IRT on 20 inpatients who were being treated for various psychiatric disorders, ranging from anxiety disorders to personality disorders to substance use. By the time the therapy was done, the patients reported experiencing less frequent and less intense nightmares – and better sleep quality.

Of course, 20 people is a relatively small sample, and there’s still a lot that isn’t understood about why reimagining bad dreams can make a difference. Increasingly, though, it’s looking like IRT could be a helpful therapy not just for people with PTSD but for anyone whose dreams are repeatedly causing them problems at night.

Image: Flickr/Mateus Lunardi Dutra