A systematic review of cognitive-behavioral treatment for nightmares: toward a well-established treatment.
Level 1 - systematic review of randomized trials
Systematic review of randomized controlled trials
What was done
The authors conducted a systematic review searching PsychInfo and PubMed (through May 1, 2008) to evaluate nonpharmacological cognitive behavioral therapy (CBT) for nightmare frequency and compare different CBT approaches. Eligible studies were randomized controlled trials (RCTs) evaluating nightmare treatments. The review identified 12 peer-reviewed articles covering 9 RCTs (including 2 follow-up studies and 1 preliminary report) that evaluated recording nightmares, relaxation, exposure, and cognitive restructuring.
What was found
All evaluated studies used nightmare frequency as the primary dependent variable and found significant within-group reductions from pre- to post-treatment for intervention or placebo conditions (Cohen's d range = 0.7 to 2.9). Five studies showed significant intervention superiority over a waiting-list control group. Only one study detected a significant difference between two active interventions. Nightmare-focused CBT (exposure and imagery rehearsal therapy [IRT]) showed better outcomes than indirect CBT methods (recording, relaxation). There was no meaningful difference between IRT and exposure, but only one RCT directly compared them. Exposure was evaluated by three distinct research groups, whereas IRT was evaluated by only one research group.
Why it matters
Direct, nightmare-focused psychological interventions appear more efficacious than indirect behavioral approaches like relaxation or tracking alone for reducing nightmare frequency.
Limits
None of the included articles fulfilled CONSORT quality guidelines. The evidence base was small (9 RCTs), only five studies demonstrated superiority over waitlist controls, direct active-comparator trials were almost absent, and IRT findings originated from a single research group. Total participant numbers and adverse effects were not reported in the abstract.
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.