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Therapeutic Management of Nightmares: Practice Guide for Imagery Rehearsal Therapy (IRT)

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Abstract

Purpose of Review

Nightmares, vivid and distressing dreams leading to arousal, can significantly impact sleep and daytime functioning. Nightmare disorder can occur with or without psychiatric disorders and with or without a traumatic event. Effective management of nightmares is crucial not only for nightmare disorder but also to prevent the worsening of psychiatric disorders or complications, such as suicide. This review explores the range of available treatments, encompassing both pharmacological and non-pharmacological, for nightmare disorders and trauma-associated nightmares.

Recent Findings

Different interventions have shown their safety and effectiveness in the therapeutic management of nightmares, such as imagery rehearsal therapy; exposure, relaxation, and rescripting therapy; lucid dreaming therapy; desensitization and exposure therapy; self-exposure therapy; and Prazosin.

Summary

Imagery rehearsal therapy (IRT) stands out with robust evidence supporting its effectiveness in nightmare disorder as well as in trauma-associated nightmares and should be considered as a first-line choice for therapeutic management of nightmares. This psychotherapeutic intervention employs cognitive and behavioral techniques and involves practicing mental imagery during daytime to modify the content of nightmares. This review summarizes the core principles of IRT and presents comprehensive guidelines for clinical practice.

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Abbreviations

AASM:

American Academy of Sleep Medicine

CAPS:

Clinician-Administered PTSD Scale

CBT:

Cognitive behavioral therapy

CBT-I:

Cognitive behavioral therapy for insomnia

CNS:

Central nervous system

DDNSI:

Disturbing Dreams and Nightmare Severity Index

DSM:

Diagnostic and statistical manual of mental disorders

EMDR:

Eye movement desensitization and reprocessing

ERRT:

Exposure, relaxation, and rescripting therapy

HNQ:

Hamburg Nightmare Questionnaire

ICSD:

International Classification of Sleep Disorders

IRT:

Imagery rehearsal therapy

LDT:

Lucid dreaming therapy

MADRE:

Mannheim Dream Questionnaire

NDIQ:

Nightmare Distress And Impact Questionnaire

NDQ:

Nightmare Distress Questionnaire

NFQ:

Nightmare Frequency Questionnaire

NES:

Nightmare Effects Survey

NREM sleep:

Non-rapid eye movement sleep

NSI:

Nightmare severity index

PSQI:

Pittsburgh Sleep Quality Index

PTSD:

Post-traumatic stress disorder

RCT:

Randomized controlled trial

REM sleep:

Rapid eye movement sleep

TRNS:

Trauma-Related Nightmare Survey

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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  1. Département de psychiatrie et d’addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat - Claude Bernard, 46 rue Henri Huchard, F-75018, Paris, France

    Alix Romier, Julia Maruani & Pierre A. Geoffroy

  2. Université Paris Cité, NeuroDiderot, Inserm, FHU I2-D2, F-75019, Paris, France

    Alix Romier, Julia Maruani & Pierre A. Geoffroy

  3. Centre ChronoS, GHU Paris - Psychiatry & Neurosciences, 1 rue Cabanis, 75014, Paris, France

    Emmanuelle Clerici, Emilie Stern, Julia Maruani & Pierre A. Geoffroy

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  1. Alix Romier
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Romier, A., Clerici, E., Stern, E. et al. Therapeutic Management of Nightmares: Practice Guide for Imagery Rehearsal Therapy (IRT). Curr Sleep Medicine Rep (2024). https://doi.org/10.1007/s40675-024-00287-8

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