Nightmares (cont.)
Nightmares and cultural differences
The interpretation of and significance given to nightmares varies tremendously by culture. While some cultures view nightmares as indicators of mental health problems, others view them as related to supernatural or spiritual phenomena. Clinicians should keep this in mind during their assessments of the impact that nightmares have on clients.
How are nightmares related to PTSD?
Nightmares are 1 of 17 possible symptoms of PTSD. One does not have to experience nightmares in order to have PTSD. However, nightmares are one of the most common of the "re-experiencing" symptoms of PTSD, seen in approximately 60% of individuals with PTSD. A recent study of nightmares in female sexual assault survivors found that a higher frequency of nightmares was related to increased severity of PTSD symptoms. Little is known about the typical frequency or duration of nightmares in individuals with PTSD.
Are there any effective treatments for nightmares?
Yes. There are both psychological treatments (involving changing thoughts and behaviors) and psychopharmacological treatments (involving medicine) that have been found to be effective in reducing nightmares.
Psychological treatment for nightmares
In recent years, Barry Krakow and his colleagues at the University of New Mexico have conducted numerous studies regarding a promising psychological treatment for nightmares. This research group found positive results in applying this treatment to individuals suffering from nightmares in the context of PTSD. Krakow and colleagues found that crime victims and sexual assault survivors with PTSD who received this treatment showed fewer nightmares and better sleep quality after three group-treatment sessions. Another group of researchers applied the treatment to Vietnam combat veterans and found similarly promising results in a small pilot study.
The treatment studied at the University of New Mexico is called "Imagery Rehearsal Therapy" and is classified as a cognitive-behavioral treatment. It does not involve the use of medications. In brief, the treatment involves helping the clients change the endings of their nightmares, while they are awake, so that the ending is no longer upsetting. The client is then instructed to rehearse the new, nonthreatening images associated with the changed dream. Imagery Rehearsal Therapy also typically involves other components designed to help clients with problems associated with nightmares, such as insomnia. For example, clients are taught basic strategies that may help them to improve the quality of their sleep, such as refraining from caffeine during the afternoon, having a consistent evening wind-down ritual, or refraining from watching TV in bed.
Psychologists who use cognitive-behavioral techniques may be familiar with Imagery Rehearsal Therapy, or may have access to research literature describing it.
Next: What are psychopharmacological treatments for nightmares? »
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