Monday, November 9, 2009

Changing Nightmares: Imagery Rehearsal Therapy

“Your Health” columnist Kim Painter reports in USA Today that imagery rehearsal therapy is helping some people change their nightmares.

This method is just one form of
cognitive behavioral therapy. A variety of CBT techniques have been used to reduce nightmare frequency.

One method is to record your nightmares in a diary. Relaxation exercises also may be helpful. Exposure techniques involve “reliving” a nightmare in your imagination during the daytime.

Cognitive-restructuring techniques involve changing a nightmare. One technique is
lucid dreaming treatment; you change the nightmare as it occurs during sleep.

Imagery rehearsal therapy involves changing the nightmare while awake; you “rehearse” the new version in your mind during the day.

The first step is to write down a recent nightmare. Then you change the nightmare. Usually you change it to a more positive version.

You write down this new version. Then you rehearse it in your mind daily; you imagine the imagery of the changed nightmare.

In 2008 a
review in the Journal of Clinical Sleep Medicine noted that CBT has become the treatment of choice for nightmares. It reported that imagery rehearsal therapy and exposure are effective at reducing nightmares; the methods also reduce other sleep complaints and mental distress.

The authors noted that the drug prazosin also may be effective at reducing nightmares. But it appears that treatment requires ongoing use of the drug; nightmares may return after drug withdrawal.

One of the review’s co-authors was sleep specialist Dr. Barry Krakow. He is founder of the
Maimonides International Nightmare Treatment Center in Albuquerque, N.M.

In 1992 Krakow and colleagues at the University of New Mexico published a
study of imagery rehearsal therapy in the journal Sleep. They found that the therapy reduced nightmare frequency by 72 percent.

Nightmare rehearsal was first
reported as an effective treatment option in a 1978 case study. The method was adapted into an imagery rehearsal technique at the University of New Mexico; the first case studies were reported in 1991.

In June the Sleep Education Blog
reported that imagery rehearsal therapy also can be helpful for children with nightmares. Learn more about dreams and nightmares on Get help for nightmare disorder at an AASM-accredited sleep center near you.

Image by Cornelia Kopp

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