Sleep Care

Take Control of Your Nightmares: Image Rehearsal Therapy

For those suffering from repeated nightmares, time devoted to sleep becomes dreaded and stressful, instead of relaxing and refreshing. The normal dream-life that most people experience is instead of time of terror: sensations of falling, being chased or kidnapped, or being paralyzed and unable to respond to a threatening attack are common. Illnesses, vehicles going out of control, and natural disasters are other typical themes for repetitive nightmares. Fortunately, there are ways to reduce or even get rid of repetitive nightmares. One of these methods is Imagery Rehearsal Therapy (IRT), which is a form of Cognitive Behavioral Therapy. It has been particularly effective in helping those suffering from Post-Traumatic Stress Disorder (PTSD). In a study of veterans suffering from nightmares due to chronic combat-related PTSD, significant improvements in both nightmare intensity and frequency were observed twelve months post-treatment when IRT was used. Lay out the storyline The first step in changing the storyline of the nightmare is to determine exactly what the storyline is. Often, it is easy to recall very terrifying or scary elements of the dream—for example, a stranger who is chasing the dreamer. These are often the images that dominate the storyline and are vividly remembered, particularly in the case of repetitive nightmares, where the imagery is reinforced. However, there are other elements in the storyline—such as the setting, time of day, presence of other characters, etc.—that are can be important when rewriting what happens during the dream. Keeping a dream journal for at least a two week period prior to IRT can be a useful way to get down the different details of the dream. Part of this process can be developing a glossary of common and recurring symbols to figure out what elements of the dream should be focused on in therapy. Rewrite the nightmare, and then rehearse it Once the storyline for the nightmare is sufficiently laid out, the next steps in the IRT process are to

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rewrite the storyline and ending, and then rehearse it

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during the daytime before sleep. The goal of rewriting is to create an alternative, less distressing plot and outcome. This can be achieved by changing some of the elements, symbols, etc.—especially the ones perceived as particularly anxiety-producing. For example, imagine a person has the repeated nightmare that she’s being chased. Keeping a dream journal reveals the additional details that she’s being chased down a dark alley during a cold night by a big male stranger, who’s yelling her name while running behind her. She always wakes up just as he comes up from behind and grabs her. During IRT, she changes the storyline of the dream. Instead of a dark alley at night, she’s walking down the hallway of a large mall during the day. Rather than a big male stranger, she’s being chased by the friendly young store clerk who helped her check out at the store she just came from. He catches up to her to give her back the bag she accidentally left on the counter at the store. Rehearsing this new storyline for the dream several times throughout the day—and particularly close to when she gets ready to go to sleep—the repeated nightmare is changed from a stressful event to a pleasant dream.

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