Imagery Rehearsal Therapy for Chronic Nightmares in Sexual Assault Survivors With Posttraumatic Stress Disorder: A Randomized Controlled Trial

CONTEXT Chronic nightmares occur frequently in patients with posttraumatic stress disorder (PTSD) but are not usually a primary target of treatment. OBJECTIVE To determine if treating chronic nightmares with imagery rehearsal therapy (IRT) reduces the frequency of disturbing dreams, improves sleep q...

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Bibliographic Details
Published in:JAMA : the journal of the American Medical Association 2001-08, Vol.286 (5), p.537-545
Main Authors: Krakow, Barry, Hollifield, Michael, Johnston, Lisa, Koss, Mary, Schrader, Ron, Warner, Teddy D, Tandberg, Dan, Lauriello, John, McBride, Leslie, Cutchen, Lisa, Cheng, Diana, Emmons, Shawn, Germain, Anne, Melendrez, Dominic, Sandoval, Diane, Prince, Holly
Format: Article
Language:English
Subjects:
Adult
Adult and adolescent clinical studies
Aged
Biological and medical sciences
Chronic Disease
Clinical trials
Cognitive Behavioral Therapy
Dreams
Female
Humans
Imagery (Psychotherapy)
Medical research
Medical sciences
Middle Aged
Miscellaneous
Post traumatic stress disorder
Prospective Studies
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Sex Offenses - psychology
Sickness Impact Profile
Sleep disorders
Sleep Wake Disorders - etiology
Sleep Wake Disorders - therapy
Stress Disorders, Post-Traumatic - complications
Stress Disorders, Post-Traumatic - therapy
Survivors - psychology
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Summary:CONTEXT Chronic nightmares occur frequently in patients with posttraumatic stress disorder (PTSD) but are not usually a primary target of treatment. OBJECTIVE To determine if treating chronic nightmares with imagery rehearsal therapy (IRT) reduces the frequency of disturbing dreams, improves sleep quality, and decreases PTSD symptom severity. DESIGN, SETTING, AND PARTICIPANTS Randomized controlled trial conducted from 1995 to 1999 among 168 women in New Mexico; 95% had moderate-to-severe PTSD, 97% had experienced rape or other sexual assault, 77% reported life-threatening sexual assault, and 58% reported repeated exposure to sexual abuse in childhood or adolescence. INTERVENTION Participants were randomized to receive treatment (n = 88) or to the wait-list control group (n = 80). The treatment group received IRT in 3 sessions; controls received no additional intervention, but continued any ongoing treatment. MAIN OUTCOME MEASURES Scores on the Nightmare Frequency Questionnaire (NFQ), Pittsburgh Sleep Quality Index (PSQI), PTSD Symptom Scale (PSS), and Clinician-Administered PTSD Scale (CAPS) at 3- and 6-month follow-up. RESULTS A total of 114 participants completed follow-up at 3 and/or 6 months. Comparing baseline to follow-up (n = 97-114), treatment significantly reduced nights per week with nightmares (Cohen d = 1.24; P
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.286.5.537