Psychological Therapy To Treat Recurring Nightmares

Surely, all humans have experienced a terrible nightmare at some point in our lives. They seem so real and are so emotionally intense that They can leave us dejected and affected, and even activate anxiety

Let us remember that nightmares are parasomnias related to the REM sleep phase, and it is common for the fear and/or anxiety reaction they produce to startle us and we wake up. They are considered a problem when they affect the subject’s routine and interfere with their daily life systematically over time, and are directly related to poor sleep quality.

When nightmares are especially recurrent, such as victims of trauma or people with severe depression or general anxiety, and constitute an obstacle to the individual’s normal functioning, it is advisable to take action on the matter through therapy. That is why it is good to go to a professional and receive a adequate psychological treatment to reduce the frequency of recurring nightmares and cope with them more adaptively.

Imaginal rehearsal therapy to treat chronic nightmares

This therapy was developed throughout the 90s by Krakow, Kellner, Pathak and Lambert, with the aim of treating typical chronic nightmares in patients with Post-Traumatic Stress Disorder. People who have experienced or visualized trauma often have recurring nightmares and poor sleep quality, and they tend to persist despite receiving treatment for PTSD. In this way, nightmares constitute one of the most difficult sources to eliminate or reduce in this type of disorder.

These authors emphasize that the nature of these experiences they suffer must be explained in detail to the person who suffers from chronic nightmares (e.g., they may be generated by having lived or experienced traumatic events, by having suffered high levels of anxiety and stress, due to having consumed certain substances, due to frequent alcohol consumption…); In short, a psychoeducation session is carried out with the patient. One of the striking characteristics of this therapy is that its sessions are long (approximately 3 hours).

They also highlight that It is very important to train the person’s imagination, since throughout the therapy we will proceed to perform imagination exercises of pleasant scenes, and the more quality the imagined scenes have, the better for the patient. Next, we are going to detail the steps to follow proposed by Krakow and collaborators:

Write one of the most recent nightmares

This first step consists of write in detail the most recent nightmare the person has had If there are several, which is very common in patients with PTSD, we would start with one of the least traumatic to apply the procedure to each of them separately. The authors recommend that the nightmare does not include per se a reproduction of the traumatic event, since it is not exposure therapy as such. However, this could be a limitation of the procedure unless there has previously been specialized treatment for PTSD focused on trauma.

Modify the elements of the nightmare as the person wants

The goal is for the person to create a different set of images, and to feel in control. This new “dream” has a much less negative connotation, since the person chooses to eliminate those elements that cause discomfort and replace them with more positive ones. The sensation of mastery over the original nightmare is sought, although the patient is not explicitly told that this will be the case

This procedure can also be applied in group therapy, and is really interesting: people share their nightmares and explain them to each other, then they modify the elements of the original nightmare and share them.

Imagination during the new dream session

It is a very simple exercise of imagination. The person is asked to relax and begin to imagine the new dream with all the details you have chosen to include in it You will be asked to provide sensory details to increase immersion in the imagined scene. This exercise can last approximately 10-15 minutes.

Activities between sessions: more imagination

Ideally, the person should put into practice the imagination exercise carried out within the session at home, between sessions. He will imagine the new scene, the dream he has chosen with the new elements, not the original nightmare. It would be good if you imagined this more positive scene for 10-20 minutes every day. In the event that there are several different nightmares, Every week you work with one of them, or two at most

In cases where the person’s imagination capacity is not very good, they are asked to imagine pleasant scenes that do not have to do with sleep at different times of the day, in order to train their imagination.

Adaptation of imaginal trial therapy

Thünker and Pietrowsky (2012) have adapted imaginal rehearsal therapy, combining it with relaxation training and imagination training. The entire process goes hand in hand with the patient completing a self-registration of nightmares, and The therapy usually lasts about 8 sessions

Another adaptation of the imaginal rehearsal procedure is the process of imaginal reworking of nightmares devised by Butler, Fennel and Hackmann (2008). This proposal is especially interesting because it includes reflection on the meaning of dreams, their history and their restructuring (verbal questioning). Furthermore, the evocation of the nightmare description is done in the present tense and out loud, which allows for greater emotional activation. The aim is for the patient to internalize more adaptive cognitions

Krakow, B., Kellner, R., Pathak, D., & Lambert, L. (1995). Imagery rehearsal treatment for nightmare chronics. Behavior Research and Therapy, 33, 837-843. Krakow, B. and Zadra, A. (2006). Clinical management of chronic nightmares: imagery rehearsal therapy. Behavioral Sleep Medicine, 4, 45-70