Imagery rehearsal therapy for PTSD-related nightmares

Abstract

Veterans with combat-related post-traumatic stress disorder (PTSD) experience high rates of chronic nightmares that contribute to emotional distress and sleep disturbance. This chapter presents Imagery Rehearsal Therapy (IRT), which has emerged as the leading non-pharmacologic treatment for nightmares, with a particular focus on its application to combat-related PTSD. The history and growth of IRT over the past 25 years is discussed. Hypothesized mechanisms of IRT are presented as they relate to the assumption that chronic nightmares are a learned behavior symptomatic of a malfunctioning imagery system. Elements of IRT are described, including treatment components (dream rescripting, imagery practice, homework, and self-monitoring), indications/contraindications for treatment, and treatment obstacles (avoidance, adherence, adverse effects). Additionally, treatment modifications consisting of IRT protocol variants, the application of IRT to special populations, and issues related to treatment duration, delivery, and format are discussed. The empirical support for IRT is reviewed, followed by indications for future research. Despite limited research examining the efficacy of IRT in veterans with combat-related PTSD, IRT has demonstrated good success across multiple settings and diverse populations. It is an inexpensive, flexible, short-term intervention that holds promise for ameliorating nightmares and related distress in combat veterans.