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.

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

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

• Related article: "Nightmares and night terrors: differences and similarities"

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 quality of sleep, and they tend to persist despite having received treatment for PTSD. In this way, nightmares are one of the most difficult sources to eliminate or reduce in this type of disorder.

These authors emphasize that the person who suffers chronic nightmares should be explained in detail what is the nature of these experiences that he suffers (p. For example, they can be generated by having lived or experienced traumatic events, by having suffered high levels of anxiety and stress, from having consumed certain substances, from consuming alcohol frequently…); in short, a psychoeducation session is carried out with the patient. One of the striking characteristics of this therapy is that its sessions are of long duration (approximately 3 hours).

They also highlight that it is very important to train the imagination of the person, since throughout the therapy we will proceed to perform exercises of imagination 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 down the most recent nightmare the person has had in detail. If there are several, something 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 not include per se a replay of the traumatic event, as it is not an exposure therapy as such. However, this could be a limitation of the procedure unless specialized treatment for trauma-focused PTSD has previously existed.

• You may be interested: "Nightmares: what are they and why do they appear (causes)"

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 that they are 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 feeling of mastery over the original nightmare is sought, although the patient is not explicitly told that it will be like this.

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

Imagination during the session of the new dream

It is a very simple exercise in 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 performed within the session at her 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 each day. In the event that there are several different nightmares, each week you work with one of them, or a maximum of two.

In cases where the person's imagination capacity is not very good, they are asked to imagine scenes pleasant activities that have nothing to do with sleep at different times of the day, in order to train your imagination.

• Related article: "Types of psychological therapies"

Adaptation of imaginal trial therapy

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

There is 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). In addition, the evocation of the description of the nightmare is done in the present tense and out loud, which allows for greater emotional activation. It is intended that the patient internalize more adaptive cognitions.

Bibliographic references:

Krakow, B., Kellner, R., Pathak, D. and Lambert, L. (1995). Imagery rehearsal treatment for chronic nightmares. 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