Psychological therapy to treat recurring nightmares

Surely all humans have experienced a terrible nightmare at some point in our lives. They look so real and are so emotionally intense that they can leave us depressed and affected, and even trigger anxiety.

Remember that nightmares are parasomnias related to the REM phase of sleep, and it’s common for the fear and / or anxiety response they produce to surprise us and wake us up. They are considered a problem when they affect the subject’s routine and interfere with their daily life in a systematic way over time, and are directly linked to poor quality of sleep.

When nightmares are particularly recurrent, as victims of trauma or people suffering from severe depression or generalized anxiety, and constitute an obstacle to the normal functioning of the individual, it is advisable to intervene in the matter by the therapy. This is why it is good to go to a professional and receive one appropriate psychological treatment to reduce the frequency of recurring nightmares and in a more adaptive way.

    Imaginary trial therapy to treat chronic nightmares

    This therapy was developed throughout the 1990s by Krakow, Kellner, Pathak and Lambert, With the aim of treating typical chronic nightmares in patients with post-traumatic stress disorder. People who have experienced or visualized trauma often have recurring nightmares and poor quality of sleep and tend to persist despite treatment for PTSD. Thus, nightmares are one of the most difficult foci to eliminate or reduce in this type of disorder.

    These authors insist that the person suffering from chronic nightmares should be informed in detail about the nature of these experiences (for example, they may be generated by having lived or experienced traumatic events, by having suffered from high levels of anxiety. and stress, having consumed certain substances, frequently consuming alcohol …); in short, a psychoeducational session is conducted with the patient. One of the striking characteristics of this therapy is that its sessions are long (approximately 3 hours).

    They also point out that it is very important to train the imagination of the personBecause throughout the therapy, imaginative pleasurable scenes will be performed, and the higher the quality of the imagined scenes, the better for the patient. Below, we will detail the steps proposed by Krakow and its collaborators:

    Write one of the most recent nightmares

    This first step consists of write down in detail the person’s most recent nightmare. If there are more than one, which is very common in PTSD patients, one should start with one of the least traumatic to apply the procedure to each of them separately. The authors recommend that the nightmare does not in itself include a reproduction of the traumatic event, as it is not exposure therapy as such. However, this could be a limitation of the procedure unless there has previously been specialized treatment for trauma-focused PTSD.

      Modify the elements of the nightmare as the person wants

      The goal is for the person to create a different set of images and to feel in control. This new “dream” has a much less negative connotation, as the person chooses to eliminate the elements that cause them discomfort and replace them with more positive ones. He seeks the feeling of mastery of the original nightmare, although the patient is not explicitly asked to do so.

      This procedure can also be applied in group therapy, being really interesting: people share their nightmares and explain them to each other, then modify the elements of the original nightmare and share them.

      Imagination in the new dream session

      It is a very simple exercise of the imagination. The person is asked to relax and start imagine the new dream with all the details you chose to include in it. You will be asked to give sensory details to increase the immersion in the imagined scene. This exercise can last about 10 to 15 minutes.

      Activities between sessions: more imagination

      Ideally, the person should practice the imaginative exercise performed during the home session, between sessions. He will imagine the new scene, the dream he chose with the new elements, not the original nightmare. It would be nice to imagine this scene more positive for 10-20 minutes every day. In case there are several different nightmares, each week you work with one of them, or at most two.

      In cases where the person’s imagination is not very good, they are asked to imagine pleasant scenes that have nothing to do with sleep at different times of the day, in order to train their imaginations.

        Adaptation of imaginal trial therapy

        Thünker and Pietrowsky (2012) adapted imaginary trial therapy, combining it with relaxation training and imagination training. The whole process goes hand in hand with the patient’s self-registration of nightmares, and therapy usually lasts about 8 sessions.

        Another procedural adaptation of the imaginal trial is the process of imaginal reworking of nightmares devised by Butler, Fennel and Hackmann (2008). This proposal is particularly interesting because it includes a reflection on the meaning of dreams, on their history and their restructuring (verbal questioning). In addition, the evocation of the description of the nightmare is performed in the present tense and aloud, allowing for greater emotional activation. The patient is expected to internalize more adaptive cognitions.

        Bibliographical references:

        Krakow, B., Kellner, R., Pathak, D. and Lambert, L. (1995). Image trial processing for chronic nightmares. Behavioral Research and Therapy, 33, 837-843. Krakow, B. and Zadra, A. (2006). Clinical management of chronic nightmares: imaging trial therapy. Behavioral sleep medicine, 4, 45-70

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