Imagery Rehearsal Therapy to Treat Nightmares With PTSD

Imagery Rehearsal Therapy to Treat Nightmares With PTSD PTSD Treatment Print Imagery Rehearsal Therapy to Treat Nightmares With PTSD By Matthew Tull, PhD twitter Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder. Learn about our editorial policy Matthew Tull, PhD Medically reviewed by Medically reviewed by Steven Gans, MD on August 05, 2016 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on June 26, 2019 Post-Traumatic Stress Disorder Overview Symptoms & Diagnosis Causes & Risk Factors Treatment Living With In Children Juanmonino / Getty Images Imagery rehearsal therapy (IRT) is a  cognitive-behavioral treatment  for reducing the number and intensity of nightmares among people with posttraumatic stress disorder (PTSD).  Nightmares or terrifying dreams are among the most common PTSD symptoms. IRT focuses directly on helping to make nightmares less intense for people with PTSD. If youve ever had a nightmare, you probably woke up just at the moment when it felt most frightening. Thats because, as you probably know, the intensity of a nightmare usually builds until the sleeper is too terrified to continue--and wakes up. In IRT treatment, youre helped to reimagine your nightmares with different, less frightening outcomes. The goal is to reprogram your nightmares to be less terrifying if and when they occur again. How Imagery Rehearsal Therapy Works In IRT, your therapist first provides you with background information on sleep and nightmares to set the scene for learning to manage them. Then, working with your therapist, you: Create detailed, nonfrightening endings for nightmares youve had repeatedlyWrite down and rehearse the nightmares with the new endingsLearn how to monitor your nightmares so you know how well your IRT treatment is working Often a person with PTSD has already thought about whether it might help to reimagine and defuse nightmares so theyre less frightening. That can help make starting IRT feel more comfortable and hopeful, but it isnt necessary for the technique to be successful. Could Imagery Rehearsal Therapy Itself Be Upsetting? Your therapist will likely ask you to begin your IRT with one or more of your less-frightening nightmares. Why? To build your confidence and help keep you from being frightened by the nightmares again as you bring them into your waking hours. The goal is not to trigger emotional responses. Instead, its to help you view your nightmares with as little emotion as possible. Typically the therapist will start the rehearsal process by saying something to help you stay calm, such as, Now well rehearse the dream--not the nightmare. Think of it as a crawl before you walk approach. How Long Does Imagery Rehearsal Therapy Last? Its important to be aware that IRT is not an open-ended therapy. It lasts for a specific length of time because its focused only on nightmares, which are just one symptom of PTSD. If you are having a number of PTSD symptoms, consider looking into more broad-based treatments, such as exposure therapy. Is Imagery Rehearsal Approach Right for You? You can work with IRT alone with your therapist or as part of group therapy. Although the usual goal of IRT is achieving less frightening endings to nightmares, different people with PTSD may have different ideas about what they want from it. For example, you may want to change an entire nightmare, or a large portion of it, while someone else wants to reimagine only a few small details. Your therapist will work with you to choose the IRT approach that best fits your needs. The 9 Best Online Therapy Programs