Imagination Trial Therapy: What Is It And How Does It Work?

Nightmares are unpleasant dreams that cause strong anxiety during the experience. It is a normal phenomenon that we have all experienced; but, when these become recurrent, we can speak of the nightmarish disorder.

Imagination testing therapy is a type of therapy that is effective in eliminating. In this article, we will know what this technique is, how it is applied, the three stages that make it up and what the scientific evidence says about it. In addition, we will see what some authors think of the mechanism that explains its efficiency.

Nightmares and nightmarish disorder

Imagination testing therapy is a type of therapy used to treat nightmares. Nightmares are terrifying dreams that we have all experienced at some point in our lives.

They appear mainly in childhood and adolescence (to a lesser extent), and having them is not considered pathological; however, when their frequency is exaggerated, and when they cause clinically significant discomfort, it is considered a sleep disorder. (Nightmarish disorder).

    Thus, as a disorder, it is classified in the DSM-IV-TR and DSM-5 (Diagnostic Manual of Mental Disorders) as a sleep disorder. The nightmarish disorder consists of the appearance of unpleasant or even terrifying dreams, which awaken the subject and leave a vivid memory (which fades). All this causes discomfort for the subject and / or interferes with his normal functioning.

    Nightmares are a type of parasomnia and occur in the second half of sleep, in the REM phase. For their part, parasomnias are sleep disorders that occur during wakefulness, during the sleep-wake transition or during sleep (in particular, in the REM phase).

    In Nightmare Disorder, once the person wakes up, they regain the oriented and alert state.

    Imagination testing therapy: features

    Repetitive imaging therapy (IRT) is considered the therapy of choice to treat nightmares or simply nightmares, Especially in childhood (although it is useful at all ages). Imagination Trial Therapy has been used for over 10 years among veterans and those who have experienced physical abuse, all with recurring nightmares.

    The effectiveness of this therapy has been studied through different studies, and these show how effective it is in reducing and even eliminating nightmares. In addition, other studies have compared the effectiveness of imaging test therapy with the use of venlafaxine (an antidepressant; selective serotonin and norepinephrine reuptake inhibitor) or prazosin (a drug used to treat hypertension) and have shown that the effectiveness of ESRD and that of the drug are similar.

    The Imagination Trial Therapy aims for the patient to rework the nightmare they have experienced, including a positive and pleasurable ending; that is, modify it as you wish so that you like it. In the end, the patient learns to “change” the content of his own nightmares., By exercising control over them even while sleeping. But how do you do this?


    Let’s examine this through the four stages of Imagination Therapy in the Imagination.

    1. Write the nightmare

    The first step the patient will need to do is write down (and describe) the nightmare they have experienced; the ideal is to do it immediately after waking up, because over time it is forgotten. If this is not possible, the ideal is to select a nightmare with the therapist and write it down.

    It is recommended to do this on paper and in natural, or artificial, but low light, right on the side of the bed. I do not recommend the use of the tablet or the phone, as the type of light emitted by these devices is harmful in this case and would interfere with the memory of sleep.

    2. Rewrite the nightmare

    The second step in Imagination Essay Therapy is to rework the nightmare, Rewriting it so that it ends up turning into a pleasant dream, or at least with a happy ending. In other words, the subject changes the nightmare to his liking and describes the new version in detail. Later, this new version will be discussed with the therapist.

    To rewrite the nightmare, the use of the imagination will be essential. This is not an easy step, as it requires practice and perseverance; the ultimate goal is for the subject to be able to include pleasing details and imagine it in the most vivid and realistic way possible.

    3. Induce the intention to dream again

    There are people who can have “lucid dreams”; that is, they can dream “while being aware” that they are dreaming during the same dream. This makes them able even to “intervene” in sleep, or influence it.

    This ability to lucid dream, however, is an ability that few people have. This is why most subjects will need to practice and practice to achieve this, or at least to perform a similar experiment.

    Therefore, in the third step of the imaginary therapeutic trial, the subject, before falling asleep, will try to influence having the nightmare again. To do this, three steps will be applied:

    3.1. Repeating a phrase

    Just before falling asleep, the subject will say to himself: “If I start to have the nightmare, or when I have it, I will be able to influence to have a much more pleasant dream”. He has to repeat this phrase like a sort of “mantra”, internalizing in his head.

    3.2. Imagine rewritten dreams

    In this case, the subject will have to imagine the pleasant dream he rewrote through the nightmare, with all the luxury of detail. This step can be repeated; the more the subject imagines the dream, the better.

    The goal is for the subject to mentally review the sequence of new images during the vigil.. Ideally, you should spend between 5 and 20 minutes per day. On the other hand, it is recommended to work with a maximum of 2 or 3 nightmares at a time.

    3.3. Repeat step 1

    The last part of the third step of Imagination Essay Therapy involves the subject repeating the initial sentence (from step 1) as many times as needed.

    4. Success + Repeat the process

    The fourth and final stage of imaging trial therapy arrives when you manage to replace the nightmare with a pleasant dream (i.e. dreaming it), Or when it comes to influencing the course of the nightmare to change it for the better. That is, when the success is achieved and therefore the nightmare disappears.

    The last step, in turn, is to repeat the previous steps whenever necessary, when new nightmares appear.

    On the other hand, the ideal is to try the technique for at least ten nights, to see the results obtained, any obstacles that appear, resistance, improvements, etc.

    Action mechanism

    Although trial imaging therapy is considered to be an effective therapy, should continue to investigate, as the studies conducted are single case reports and controlled studies.

    There is therefore controversy, however, as to the precise determination of the technique’s mechanism of action; that is, why is it effective? Two authors commented on this topic: Marks and Krakow.

    So while Marks raises three key elements of Imagination Essay Therapy, namely exposure, abreaction (relief) and mastery (learning anxiety management skills), Krakow speaks of a essential element: the process of sleep modification (according to this author, this would be the element that would explain the effectiveness of the technique).

    Bibliographical references:

    • American Psychiatric Association -APA- (2014). DSM-5. Diagnostic and Statistical Manual of Mental Disorders. Madrid: Panamericana.

    • Aurora, R., Zak, R., Auerbach et al. (2010). Guide to good practice for the treatment of nightmares in adults. Journal of Clinical Sleep Medicine, 6, 389-401.

    • Pérez, M., Fernández, JR,; Fernández, C. and Amic, I. (2010). Guide to effective psychological treatments I and II :. Madrid: Pyramid.

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