Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: a randomized controlled trial.
Level 2 - randomized trial
Individual randomized controlled trial
PubMed 11476655 · doi:10.1001/jama.286.5.537
What was done
A randomized controlled trial evaluated imagery rehearsal therapy (IRT) in 168 women with posttraumatic stress disorder (PTSD) and chronic nightmares (95% moderate-to-severe PTSD, 97% sexual assault survivors). Participants were randomized to receive 3 sessions of IRT (n = 88) or to a wait-list control group continuing usual care (n = 80). Outcomes measured at 3- and 6-month follow-up included nightmare frequency (Nightmare Frequency Questionnaire), sleep quality (Pittsburgh Sleep Quality Index), and PTSD symptom severity (PTSD Symptom Scale and Clinician-Administered PTSD Scale).
What was found
A total of 114 participants completed follow-up at 3 and/or 6 months. In completer analyses (n = 97–114), IRT produced significant improvements from baseline in nightmare nights per week (Cohen d = 1.24, P < .001), nightmares per week (Cohen d = 0.85, P < .001), sleep quality (Cohen d = 0.67, P < .001), and PTSD symptoms on the PSS (Cohen d = 1.00, P < .001) and CAPS (Cohen d = 1.53, P < .001), whereas controls showed small, nonsignificant changes (mean Cohen d = 0.21). In intent-to-treat analyses (n = 168), IRT remained significantly superior to control for nightmares, sleep, and PTSD (all P < .02; mean Cohen d = 0.60 vs 0.14). PTSD symptoms decreased by at least one clinical severity level in 65% of the treatment group versus worsening or no change in 69% of controls (P < .001).
Why it matters
This trial demonstrates that a brief, 3-session cognitive-behavioral intervention targeting chronic nightmares can substantially reduce nightmare frequency and indirectly decrease overall PTSD severity in sexual assault survivors.
Limits
The control group was a wait-list design without an active comparator, meaning non-specific effects of therapist contact and expectancy were not controlled. There was substantial study dropout, with only 114 of 168 participants completing follow-up. The study population was restricted to female sexual assault survivors, which may limit generalizability to men or individuals with other trauma etiologies.
Cited by
- supports Rewriting the ending of a recurring nightmare and reading it repeatedly before sleep alters the dream's content over a period of 7 to 10 days.