Psychological therapy to treat recurrent nightmares
Surely, all humans have experienced at some point in our lives a terrible nightmare. They seem so real and so emotionally intense that They can leave us downcast and affected, and even activate anxiety .
Remember that nightmares are parasomnias related to the REM sleep phase, and it is usual that the reaction of fear and / or anxiety that produce us startle us and we wake up. They are considered a problem when they affect the subject's routine and interfere in their daily life in a systematic way over time, and are directly related to the poor quality of sleep.
When nightmares are especially recurrent, as victims of trauma or people with severe depression or generalized anxiety, and are an obstacle to the normal functioning of the individual, it is advisable to take action on the matter through therapy. That's why it's good to go to a professional and receive a appropriate psychological treatment to reduce the frequency of recurrent nightmares and cope with them in a more adaptive way
- Related article: "Nightmares and night terrors: differences and similarities"
Imaginary trial therapy to treat chronic nightmares
This therapy was developed throughout the 90s by Krakow, Kellner, Pathak and Lambert , with the aim of treating typical chronic nightmares in patients with Posttraumatic Stress Disorder. People who have experienced or visualized trauma often have recurring nightmares and poor sleep quality, and tend to persist despite receiving treatment for PTSD. In this way, nightmares are one of the most difficult foci to eliminate or reduce in this type of disorder.
These authors emphasize that the person who suffers chronic nightmares should be explained in detail about the nature of these experiences that they suffer (eg, they can be generated by having lived or experienced traumatic events, having suffered high levels of anxiety and stress, for having consumed certain substances, for consuming alcohol frequently ...); In short, a psychoeducation session with the patient is carried out. One of the striking features of this therapy is that its sessions are long lasting (approximately, about 3 hours).
They also highlight that it is very important to train the imagination of the person , since throughout the therapy will proceed to perform imaginative exercises of pleasant scenes, and how much more quality the imagined scenes have, better for the patient. Next, we will detail the steps to follow proposed by Krakow and collaborators:
Write one of the most recent nightmares
This first step consists of write in detail the most recent nightmare the person has had . If there are several, something very common in patients with PTSD, one would start with one of the least traumatic to apply the procedure to each of them separately. The authors recommend that the nightmare does 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 previously been specialized treatment for trauma-focused PTSD.
- Maybe you're interested: "Nightmares: what they are and why they appear (causes)"
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 that they are in control. This new "dream" has a much less negative connotation, since the person chooses to eliminate those elements that generate discomfort and replace them with more positive ones. The feeling of dominance over the original nightmare is sought, although the patient is not explicitly told that it will be this way .
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 session of the new dream
It is a very simple exercise in imagination. The person is asked to relax and begin to imagine the new dream with all the details you have chosen to include in it . You will be asked to give sensory details to increase immersion in the imagined scene. This exercise can last approximately 10-15 minutes.
Activities between sessions: more imagination
The ideal is for the person to put into practice the exercise of imagination performed 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 if every day I imagined that positive scene for 10-20 minutes. In case there are several different nightmares, Each week we 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 do not have to do with the dream at different times of the day, in order to train their imagination.
- Related article: "Types of psychological therapies"
Adaptation of imaginal trial 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 completion of the patient's self-registration of nightmares, and The therapy usually lasts about 8 sessions.
There is another adaptation of the procedure of the imaginal trial is the process of imaginal reworking of nightmares devised by Butler, Fennel and Hackmann (2008). This proposal is especially interesting because it includes reflection on the meaning of dreams, their history and their restructuring (verbal questioning). In addition, the evocation of the description of the nightmare is done in the present and in a loud voice, which allows a greater emotional activation. It is intended that the patient interiorizes more adaptive cognitions.
Bibliographic references:
Krakow, B., Kellner, R., Pathak, D. and Lambert, L. (1995). Imagery rehearsal treatment for chronic nightmares. Behavior 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
