Psychological therapy to treat recurrent nightmares.

A psychotherapy proposal to reduce the frequency of recurring nightmares.

Surely, all humans have experienced at some point in our lives a terrible nightmare. They seem so real and are so intense on an emotional level that they can leave us feeling dejected and they can leave us dejected and affected, and even trigger anxiety..

Let us remember that nightmares are parasomnias related to the REM sleep phase, and it is common that the reaction of fear and/or anxiety that they produce startle us and we wake up. They are considered a problem when they affect the subject's routine and interfere with daily life systematically over time, and are directly related to poor sleep quality.

When nightmares are especially recurrent, as victims of some trauma or people with severe depression or generalized anxiety, and constitute an obstacle to the normal functioning of the individual, it is advisable to take action on the matter through therapy. That is why it is a good idea to go to a professional and receive an adequate psychological treatment to reduce the frequency of recurrent nightmares and to cope with them in a more adaptive way. in a more adaptive way.

Imaginal rehearsal therapy to treat chronic nightmares.

This therapy was developed throughout the 1990s by Krakow, Kellner, Pathak and Lambertwith the aim of treating chronic nightmares typical in patients with Post Traumatic Stress Disorder. People who have experienced or visualized trauma often have recurrent nightmares and poor sleep quality, and they tend to persist despite treatment for PTSD. Thus, nightmares constitute one of the most difficult foci to eliminate or reduce in this type of disorder.

These authors emphasize that the nature of these experiences should be explained in detail to the person suffering from chronic nightmares (e.g., they may be generated by having lived through or experienced traumatic events, by having suffered high levels of anxiety and stress, by having consumed certain substances, by frequent alcohol consumption...); in short, a psychoeducation session is held with the patient. One of the striking characteristics of this therapy is that its sessions are of long duration (approximately 3 hours).

They also emphasize that it is very important to train the person's imagination.The higher the quality of the imagined scenes, the better it will be for the patient. Next, we are going to detail the steps to follow that Krakow and collaborators propose:

Write down one of the most recent nightmares.

This first step consists of write down in detail the most recent nightmare the person has had.. If there are several, which is very common in patients with PTSD, start with one of the less traumatic ones and apply the procedure to each of them separately. The authors recommend that the nightmare should not include per se a reproduction of the traumatic event, since it is not an exposure therapy as such. However, this could be a limitation of the procedure unless there has been previous specialized trauma-focused PTSD treatment.

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 those elements that generate discomfort and replaces them with more positive ones. A sense of mastery over the original nightmare is sought, although the patient is not explicitly told that this will be the case..

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 during the new dream session

This is a very simple imagination exercise. The person is asked to relax and start imagining the new dream with all the details. imagine the new dream with all the details they have chosen to include in it.. He/she will be asked to give sensory details to increase the immersion in the imagined scene. This exercise can last approximately 10-15 minutes.

Activities between sessions: more imagination

Ideally, the person should practice the imagination exercise done within the session at home, between sessions. He will imagine the new scene, the dream he has chosen with the new elements, not the original nightmare. It would be good to imagine for 10-20 minutes each day such a more positive scene. In the case that there are several different nightmares, each week we work with one of them, or two at the most..

In the cases in which the capacity of imagination of the person is not very good, he is asked to imagine pleasant scenes that do not have to do with the dream in different moments of the day, in order to train his imagination.

Adapting imaginal rehearsal therapy.

Thünker and Pietrowsky (2012) have adapted imaginal rehearsal therapy, combining it with relaxation training and imagination training. The whole process goes hand in hand with the patient's completion of self-reporting of nightmares, and therapy usually lasts about 8 sessions.

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

Bibliographical references:

Krakow, B., Kellner, R., Pathak, D., & Lambert, L. (1995). Imagery rehearsal treatment for chronic nightmares. Behaviour Research and Therapy, 33, 837-843. Krakow, B. and Zadra, A. (2006). Clinical management of chronic nightmares: imagery rehearsal therapy. Behavioral Sleep Medicine, 4, 45-70