flashpurp.gif (18939 bytes)Cognitive Behavioral Therapyflashpurp.gif (18939 bytes)

 

According to Krakow et. al.(2001) the targeted treatment of sleep problems is associated with improvement in distress. According to their study, crime victims with nightmare, insomnia, and PTSD who average thirteen years of chronicity demonstrated moderate to large improvement in their symptoms and psychiatric distress after receiving cognitive therapy treatment approaches. This treatment focused on 5 main approaches. First, it deemphasized exposure by avoiding discussion of trauma or traumatic content of nightmares. Secondly, the approach focuses on habitual components of disturbing dreams and sleeplessness. Thirdly, it provides no group psychotherapy. Fourthly, it offers minimal instruction for dealing with unpleasant imagery. Fifthly, there is an emphasis in relaxation. Lastly, it conveys no specific non-sleep-related instructions for managing posttraumatic stress, anxiety, or depressive symptoms.

Marks hypothesized the three therapeutic ingredients in the process of imagery rehearsal to be exposure, abreaction, and mastery. By gaining the sense of controllability over the nightmare help to modify the stimulus and response and the meaning of proposition in the trauma.

In one of Krakow et. al.’s studies they successfully reduced disturbing dreams and nightmare distress of a small sample of adolescent girls. These girls were in residential program because they had committed felonies, using imagery rehearsal therapy. Krakow et. al. (2001) combined several techniques. They used imagery rehearsal for treatment of nightmares (rehearsing images of a changed nightmare), a cognitive imagery approach that encourages the user to "change the nightmare any way you wish," rehearse the "new dream" while awake, and cognitive restructuring (to break the tie between nightmare and trauma). During the process the patients were encouraged not to discount past trauma but instead to consider that "nightmares that are trauma-induced may become habit-sustained." Patients were taught how to manage unpleasant imagery that may develop while they are practicing pleasant imagery or during imagery of "new dreams." This treatment was also followed insomnia treatment for 10 three-weekly sessions and are given a final instruction to change no more than one or more than one or two nightmares per week. At the 1-month follow up, the group meets to assess progress and clarify instructions and current strategies.

This is a very important evidence especially they claim that their participants might be a more difficult population to treat than other types of adolescents who suffer from disturbing dreams. Their participants suffered from moderate to sever distress potentially related to past sexual trauma, and nearly 40% met adult-scale criteria for PTSD. Compared to these conditions the rest of the chronic adolescent nightmare sufferers are less severely distressed who might benefit from imagery rehearsal treatment for disturbing dreams. However, this study is limited due its small sample size and lack of randomized psychometric instruments. Which might be a stretch to generalized the result of the study to the general population. Therefore in Krakow’s article he mentioned that imagery rehearsal therapy in adult samples did not significantly reduce daytime distress or improve sleep quality.

Forbes, et. al. (2001) did a follow up study to asses the efficacy of imagery rehearsal in reducing the frequency and intensity of targeted combat-related nightmares in a group of Vietnam veterans with PTSD. In the study the veterans were specifically instructed to write down and subsequent reading out of the nightmare to the group, which constitutes to the exposure and reabreaction component hypothesized by Marks. The mastery component of the this treatment is done by requiring to change the content of the nightmare to promote mastery over the content-threat, and in alterations in the meaning, importance and orientation to the nightmare. The key to succeed in this treatment is the use of imagery. Many studies including Forbes et. al. suggest that PTSD is associated awith a propensity to image, particularly where the posttraumatic symptom picture is characterized by nightmares and flashbacks. Therefore by incorporating a system to increase the imagery control as part of the therapeutic interventions it will help the treatment.

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Look at the different Types of Nightmares