Rehearsal Therapy In Imagination: What Does It Consist Of And How Does It Work?
Nightmares are unpleasant dreams that cause high anxiety while they are experienced. This is a normal phenomenon and one that we have all experienced; However, when these become recurrent, we can talk about nightmare disorder
Imagination rehearsal therapy is an effective type of therapy to eliminate them In this article we will learn what this technique consists of, how it is applied, the three steps that comprise it and what the scientific evidence says about it. Furthermore, we will see what some authors think about the mechanism that explains its effectiveness.
Imagination rehearsal therapy is a type of therapy used to treat nightmares. Nightmares are terrifying dreams that we have all experienced at some point in our lives.
They appear especially in childhood and adolescence (to a lesser extent), and having them is not considered pathological; However, when their frequency is exaggerated, and when they cause clinically significant discomfort, it is considered a sleep disorder (nightmare disorder).
Thus, as a disorder, it is classified in the DSM-IV-TR and the DSM-5 (Diagnostic Manuals of Mental Disorders) as a sleep disorder. Nightmare disorder consists of the appearance of unpleasant and even terrifying dreams, which awaken the subject and leave a vivid memory (which gradually fades). All of this causes discomfort to the subject and/or interferes with his or her normal functioning.
Nightmares are a type of parasomnia, and occur in the second half of sleep, in the REM phase. For their part, parasomnias are sleep disturbances that occur during awakening, in the sleep-wake transition or while sleeping (specifically, in the REM phase).
In nightmare disorder, once the person wakes up, they regain their oriented and alert state.
Rehearsal therapy in imagination: characteristics
Imagery Rehearsal Therapy (IRT) It is considered the therapy of choice to treat nightmare disorder, or simply nightmares, especially in childhood (although it is useful at all ages). Imagination rehearsal therapy has been used for more than 10 years with war veterans and people who have suffered physical abuse, all of whom have recurring nightmares.
The effectiveness of this therapy has been investigated through different studies, and these show how it is an effective therapy to reduce and even eliminate nightmares. Additionally, other studies have compared the effectiveness of imagination trial therapy with the use of venlafaxine (antidepressant; selective serotonin and norepinephrine reuptake inhibitor) or prazosin (a drug used to treat hypertension), and have shown that The effectiveness of IRT and that of drugs is similar.
Imagination rehearsal therapy has the objective of having the patient rework the nightmare they have had, including a positive and pleasant ending; That is, he can modify it as he wants so that it is pleasant to him. In the end, the patient learns to “change” the content of his own nightmares, exercising control over them even while you sleep. But how do you achieve it?
Steps
Let’s take you through the four steps of imagination rehearsal therapy.
1. Write the nightmare
The first step that the patient must take is to write (and describe) the nightmare they have had ; Ideally, you should do it immediately after waking up, since as time goes by, you will forget it. If this is not possible, the ideal is to select a nightmare with the therapist and write it down.
It is recommended that you do it on paper and with natural light, or artificial light but with low intensity, right next to the bed. The use of a tablet or phone is not recommended, since the type of light that these devices emit is harmful in this case, and would interfere with the memory of the dream.
The second step of rehearsal therapy in imagination is to rework the nightmare, in rewriting it so that it ends up becoming a pleasant dream, or at least, with a happy ending. That is, the subject changes the nightmare to his liking, and describes the new version in detail. Later this new version will be discussed with the therapist.
To rewrite the nightmare, the use of imagination will be essential. It is not an easy step, since it requires practice and perseverance; The ultimate goal is for the subject to be able to include pleasing details, and to be imagined as vividly and realistically as possible.
3. Induce the intention to dream again
There are people who can have “lucid dreams”; That is, they can dream “being aware” that they are dreaming during the same dream. This means that they can even “intervene” within the dream, or influence it.
This ability to dream lucidly, however, is an ability that few people have. That is why most subjects will have to train and practice to achieve it, or at least to achieve a similar experience.
That is why, in the third step of imagination rehearsal therapy, the subject, before falling asleep, will try to influence the fact of having the nightmare again. To do this, he will apply three steps:
3.1. Repetition of a phrase
Just before falling asleep, the subject will say to himself: “If I start having the nightmare, or when I have it, I will be able to influence myself to have a much more pleasant dream” He has to repeat that phrase to himself as a kind of “mantra”, internalizing it in his head.
3.2. Imagine dream rewritten
In this case, the subject must imagine the pleasant dream that he rewrote through the nightmare, in great detail. This step can be repeated; The more the subject imagines the dream, the better.
The objective is for the subject to mentally review the sequence of the new images during wakefulness Ideally, you should spend between 5 and 20 minutes a day. On the other hand, it is recommended that you work with a maximum of 2 or 3 nightmares at a time.
3.3. Repeat step 1
The last part of the third step of Imagination Rehearsal Therapy is for the subject to repeat the initial phrase (from step 1), as many times as necessary.
4. Success + Repeat the process
The fourth and final step of imagination rehearsal therapy comes when it is possible to replace the nightmare with a pleasant dream (that is, dream it), or when you influence the course of the nightmare to change it for the better. That is, when success is achieved and therefore the nightmare disappears.
The last step, in turn, includes repeating the previous steps whenever necessary, when new nightmares appear.
On the other hand, the ideal is to try the technique for at least ten nights, to see the results obtained, the possible obstacles that appear, the resistance, improvements, etc.
Mechanism of action
Although imagination rehearsal therapy is considered an effective therapy, should continue to be investigated, since the studies carried out are single case reports and some controlled studies
Where there is controversy, however, is precisely determining the mechanism of action of the technique; That is, why is it effective? Two authors have given their opinion on this topic: Marks and Krakow.
Thus, while Marks proposes three key elements in imagination rehearsal therapy, which are exposure, abreaction (relief), and mastery (learning anxiety management skills), Krakow speaks of 1 essential element: the process of sleep modification (according to this author, it would be the element that would explain the effectiveness of the technique).
