Cognitive-behavioral treatment of posttraumatic nightmares

Malik Ait Aoudia

Nightmares are reported by over 70% of adults with posttraumatic stress disorder (PTSD) and they are often resist classically recommended and administered therapies for PTSD such as Trauma Focused CBT and EMDR; as such, nightmares complicate the therapeutic management of patients suffering from PTSD, making for a substantial clinical challenge. However, new therapeutic perspectives, such as rehearsal imagery - currently proposed in the treatment of nightmares - offer real clinical opportunities to optimize and improve the quality of care in psychotraumatology. This lecture will address some clinical applications of cognitive-behavioral treatment centered on posttraumatic nightmares.

Beyond diathesis stress: Evidence for trait-like Environmental Sensitivity in nightmare sufferers

Michelle Carr

Prior research has placed nightmares and their associated negative outcomes within a diathesis-stress framework, suggesting that individuals who are more sensitive to stressors exhibit nightmares. However, Environmental Sensitivity frameworks propose that individual differences in sensitivity extend to positive contexts, as well, and may entail heightened sensory and cognitive processing of the environment. Our recent laboratory findings that nightmare sufferers have heightened semantic associativity, and report positive and vivid waking imagery, will be presented as evidence for trait-like Environmental Sensitivity in nightmare sufferers.

The potential of mobile health technology in the treatment of nightmares

Anne Germain, Bambang Parmanto, Wayan Pulantara, Robin Richardson, & Hassen Khan

Access to evidence-based nightmare treatment remains limited. With the increased awareness that nightmares are a treatable sleep disorder among patients and clinicians, mobile health (mHealth) technology can be leveraged to improve access and clinician’s resource allocation. This presentation will discuss preliminary work to highlight how mHealth tools can improve access and dissemination of evidence-based sleep treatments.

The case of nightmare distress

Annika Gieselmann, Max Böckermann, & Reinhard Pietrowsky

Nightmare distress is a key feature of a Nightmare Disorder. In this talk, we   want to summarize the current literature on nightmare distress with a special focus on the most Nightmare Distress Questionnaire (NDQ) by Belicki (1992) which is commonly utilized but confronted with a number of limitations, while an underlying theory is lacking. Against this background, nightmare distress was conceptualized multifactorially on the basis of Lazarus (1966)’ transactional stress model. According to the Questionnaire of Cognitive Appraisal on Nightmares (CAN), nightmares would be distressing if the individual feels his or her needs, motives, and well-being threatened (primary appraisal), while adequate coping skills are lacking (secondary appraisal).

Lucid Dreaming: How consciousness in dreams might be a useful technique for overcoming nightmares

Brigitte Holzinger

Lucid dreaming is being aware of dreaming while dreaming and being able to navigate the dream as well as to influence the story plot experienced. The results of two research projects "treating" nightmare sufferers with and without PTSD with lucid dreaming will be presented and discussed.

Treating nightmares using Imagery Rehearsal Treatment (IRT) in psychiatric inpatients: feasibility and active treatment mechanisms

Birgit Kleim & Thomas Mäder

The present study will attempt to investigate sleep problems and nightmares in the severely mentally ill, psychiatric inpatients, and test the effectiveness of IRT treatments in this population. A separate laboratory study will investigate in a more controlled environment moderators and active IRT treatment mechanisms, including EEG-based sleep characteristics. The project aims to evaluate, better understand and optimize the treatment of sleep problems and nightmares in psychiatric inpatients, as well as push forward the use of IRT in this population.

Nightmare treatment perls and possibilities

Barry Krakow

Nightmares, long thought to be a mysterious, deeply ingrained and uncontrollable psychological sleep behavior, have proven to be a mostly treatable condition using a simple cognitive-imagery technique (IRT). The consistently high potency of IRT in treating chronic nightmares has opened up new discussions on the meaning, purpose, and pathology of disturbing dreams and nightmares, and these points are often explored during patient encounters for IRT. Recent research indicates further therapeutic possibilities, spanning a wide spectrum from pharmacotherapy to sleep-disordered breathing treatments to resolve problematic nightmares. Nightmare therapeutics are emerging as vital healthcare resources for many afflicted individuals.

Imagery Rescripting and Imaginal Exposure for nightmares: efficacy and mechanisms of change

Anna E. Kunze, Arnoud Arntz, Nexhmedin Morina, Merel Kindt, & Jaap Lancee

Exposure-based and rescripting-based techniques both seem to be effective treatments for nightmares. However, there is an ongoing debate regarding the working mechanism of psychological treatments for chronic nightmares. It has been argued that IRT and exposure may work via different pathways, but the particular underlying mechanisms of these nightmare therapies to date remain largely unknown. In a randomized controlled trial, we aimed to investigate the efficacy of stripped-down IR and IE as stand-alone intervention techniques for the treatment of nightmares, and to explore mediators of their respective therapeutic effects.

Nightmare treatment as an adjunctive therapy for suicidal behavior

Michael Nadorff, Shea Golding, & Chris Drapeau

Previous work has shown that nightmares increase the risk of suicide, and the longer you have them the greater the risk. Researchers are just starting to explore whether treating nightmares may reduce suicide risk. In my talk, I will discuss the potential for these interventions, and precautions that should be taken with this sort of work.

Knowledge and attitudes in health care providers

Reinhard Pietrowsky & Johanna Thünker

Although nightmares are very common in the general population, knowledge about nightmares and its treatment seems to be rather low in nightmare sufferers as well as in health care providers. To substantiate this impression we performed a study in 213 health care providers and in 335 nightmare sufferers. The results display that all participants overestimated the prevalence of chronic nightmares. The great majority of nightmare sufferers did neither know any treatment for nightmares nor did they ask for professional help. Most nightmare sufferers asked General Practitioners for help, which mostly treated nightmares by drugs. Psychiatrists and psychotherapists were rarely asked for help by nightmare sufferers.

REM sleep instability and dreams in insomnia

Dieter Riemann

Our own work has shown that microarousals during sleep are increased in insomnia, especially in REM sleep. Furthermore, we observed a negative correlation between the amount of REM sleep and the misperception of sleep in patients with insomnia. Based on these observations we performed a Non REM and REM sleep awakening study in patients with insomnia and good sleeper controls. In short, the data analysis showed that REM sleep was perceived more frequently as awake compared to being asleep in insomniacs compared to good sleepers. Furthermore, dream content from REM sleep was more negative in insomniacs than in good sleepers. Summarizing, we think that REM sleep in insomnia is characterized by an increased frequency of microarousals leading in consequence to an altered perception of the dreaming process.

Treatment of sleep disturbances in trauma-affected refugees: a randomized controlled trial

Hinuga Sandahl, Poul Jennum, Lone Baandrup, & Jessica Carlsson Lohmann

The aim of this study is to examine sleep enhancing treatment in refugees with PTSD. In a randomised controlled trial sleep quality, sleep length and nightmares will be examined and related to changes in symptoms of PTSD and depression, quality of life and level of functioning.

The treatment of nightmares in adolescents suffering from chronic insomnia

Angelika Schlarb, Isabel Bihlmaier, & Jasmin Faber

Insomnia and nightmares in childhood and adolescence are common disorders with severe consequences on cognitive and emotional functioning. This study was carried out to evaluate short- and long-term effects of a CBT for children and adolescents. Participants were 112 children and 31 adolescents and their parents. The treatment was a multicomponent cognitive behavior therapy CBT designed for insomnia and nightmares in children and adolescents. Sleep behavior was assessed using subjective questionnaires and sleep diary, as well as the objective measure of wrist actigraphy. Children and adolescents with CBT had significantly greater improvements in subjective and objective sleep behavior after CBT compared to the WL-condition. Improvements persisted up to three-month, six-month and twelve-month follow-up assessments.

Coping behavior and help seeking in persons with nightmares

Michael Schredl

Several empirical studies of our research group investigated on the one hand, what kind of coping strategies persons with nightmares use and how beneficial these strategies are and, on the other hand, how often persons with nightmares, especially frequent nightmares (once per week or more often) seek professional help. The findings indicate that the percentage of help seeking is relatively low. Interestingly, offering telephone counseling would be acceptable for many nightmare patients.

Effects of a nightmare induction in healthy participants: an experimental approach

Regina Steil, Tana Kröner-Borowik, Stefanie Gosch, Kathrin Hansen, Benjamin Borowik, & Michael Schredl

Ironic control theory states suppressing unwanted thoughts can lead to their increased occurrence. We examined the influence of thought suppression on dreams in thirty healthy participants (good sleepers) over one week. Independent rating of dream diaries showed increased dreams related to suppressed targets and a tendency to have more distressing dreams in the suppression condition. Moreover, the data imply that thought suppression may lead to significantly increased general psychiatric symptoms.

Nightmares in psychiatric populations with comorbidities

Annette van Schagen

Nightmares are more prevalent in patients with diverse mental disorders in secondary mental healthcare. Also nightmares are associated with more severe psychopathology in this population. A randomized controlled trial of revealed that addition of imagery rehearsal therapy to treatment as usual is effective for reduction of nightmare frequency and nightmare distress as well as comorbid psychopathology.

Making sense of repetitions and variations in posttraumatic nightmares

Lutz Wittmann

Posttraumatic nightmares as a symptom of re-experiencing attract our attention mainly as a target for treatment. At the same time, however, they may carry valuable information which can help tailoring our treatment approach. This presentation illustrates different types of relevant information including the time point of repetitions, affect regulation in nightmares, changes in content, and relation to other sources of information.

To top

Responsible for the content: E-MailDr. Annika Gieselmann