1
|
Paquet C, Lenker KP, Calhoun SL, Bixler EO, Vgontzas AN, Fernandez-Mendoza J. Short-term stability and night-to-night variability of sleep parameters in nightmares comorbid with chronic insomnia Disorder across multiple nights of polysomnography. Sleep 2024; 47:zsae032. [PMID: 38300896 DOI: 10.1093/sleep/zsae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/07/2024] [Indexed: 02/03/2024] Open
Abstract
STUDY OBJECTIVES The purpose of this study was to examine the degree of short-term stability of polysomnographic (PSG) measured sleep parameters and the overall differences between individuals with comorbid nightmares and insomnia compared to those with chronic insomnia disorder alone or good sleeping controls across four nights in the sleep lab. METHODS A total of 142 good sleeping controls, 126 chronic insomnia alone, and 24 comorbid insomnia/nightmare participants underwent four consecutive nights of 8-hour PSG recordings. Outcomes included sleep continuity, architecture, and REM-related parameters across nights one through four. Intraclass correlation coefficients with mixed-effect variances and repeated-measure analysis of covariance were used, respectively, to determine short-term stability as well as between-participants and time-by-group interaction effects. RESULTS Wake after sleep onset and stage 1 showed "poor stability" in the comorbid insomnia/nightmare group compared to "moderate stability" in the good sleeping controls and chronic insomnia alone group. Significant between-group effects (all ps < .05) showed that the comorbid insomnia/nightmare group took longer to fall asleep and had a greater first-night-effect in stage 1 compared to good sleeping controls and chronic insomnia alone group; in addition, the comorbid insomnia/nightmare and insomnia alone groups slept shorter, with fewer awakenings and REM periods, compared to the good sleeping controls. CONCLUSIONS Nightmares are associated with abnormal sleep above and beyond REM disruption, as sleep continuity was the primary aspect in which poor stability and group differences emerged. The greater inability to fall asleep and instability of sleep fragmentation in those with comorbid insomnia/nightmares compared to chronic insomnia alone may be attributed to the impact of presleep anticipatory anxiety and nightmare-related distress itself. CLINICAL TRIAL INFORMATION The data analyzed in this study does not come from any current or previous clinical trials. Therefore, there is no clinical trial information to report.
Collapse
Affiliation(s)
- Caitlin Paquet
- Department of Psychiatry and Behavioral Health, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, USA
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristina P Lenker
- Department of Psychiatry and Behavioral Health, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, USA
| | - Susan L Calhoun
- Department of Psychiatry and Behavioral Health, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, USA
| | - Edward O Bixler
- Department of Psychiatry and Behavioral Health, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, USA
| | - Alexandros N Vgontzas
- Department of Psychiatry and Behavioral Health, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, USA
| | - Julio Fernandez-Mendoza
- Department of Psychiatry and Behavioral Health, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, USA
| |
Collapse
|
2
|
Wagner AM, Richards A, Chiros C, Thuras P, Parsons EC, Oien AD, Schenck CH, Irfan M. A Retrospective Pilot Study of Imagery Rehearsal Therapy Enhanced with Narrative Therapy Principles for the Treatment of Nightmares in US Military Veterans. Sleep Sci 2023; 16:e439-e445. [PMID: 38197021 PMCID: PMC10773522 DOI: 10.1055/s-0043-1776796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 02/14/2023] [Indexed: 01/11/2024] Open
Abstract
Introduction Chronic nightmares are a common and disabling feature of posttraumatic stress disorder (PTSD) for which broadly effective treatments are still lacking. While imagery rehearsal therapy (IRT) demonstrates benefits for patients with idiopathic nightmares and some patients with PTSD-related nightmares, research indicates it may be less beneficial for veterans. Narrative therapy (NT) is a form of psychotherapy which is client-centered and value-focused and has demonstrated benefits for PTSD patients. The application of NT principles to IRT may provide a valuable therapeutic approach for treatment in veterans. Objective To perform a retrospective chart review of veteran clients participating in a novel, brief intervention developed by the first author consisting of IRT enhanced with NT principles (N-IRT) for the treatment of nightmares. The primary outcomes were nightmare frequency and intensity, and the secondary outcome was the impact of the intervention on nightmare distress and coping, subjective sleep quality, and overall PTSD symptoms. Materials and Methods We conducted retrospective chart reviews for eight veterans referred to the first author for the treatment of nightmares, who completed N-IRT, including baseline and end-of-treatment measures. The protocol involved a single 60-minute NT-enhanced rescripting session and assigned homework to rehearse the revised dream script, and a follow-up evaluation 4 weeks later. The subjects completed a sleep and nightmare interview developed by the first author and the PTSD Checklist at baseline and after the intervention at the follow-up evaluation. Paired t -tests were conducted to test for pre-to-post differences. Results In the statistical analysis, we observed a statistically significant and clinically meaningful reduction in the frequency ( p = 0.04) and intensity of nightmares ( p = 0.001) from pretreatment to the 1-month follow-up. Measures of nightmare-associated emotional distress, the ability to cope with nightmares, sleep duration and sleep efficiency, as well as overall PTSD symptoms also demonstrated significant improvements. Conclusion These pilot data provide compelling preliminary evidence that a single-session IRT intervention modified with NT (N-IRT) is effective in reducing nightmare frequency and intensity, reducing nightmare distress, improving the act of coping with nightmares, and improving sleep quality and overall PTSD symptoms in veterans. Further investigation of this method with gold-standard clinical trial designs and larger sample sizes is indicated to confirm effectiveness and to better understand the possible mechanisms of treatment effect.
Collapse
Affiliation(s)
- Ann Marie Wagner
- Mental Health Services, Minneapolis Veteran's Affairs (VA) Health Care System, Minneapolis, MN, United States of America
| | - Anne Richards
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States of America
- Mental Health Services, San Francisco Veteran's Affairs (VA) Health Care System, San Francisco, CA, United States of America
| | - Christine Chiros
- Mental Health Services, Minneapolis Veteran's Affairs (VA) Health Care System, Minneapolis, MN, United States of America
| | - Paul Thuras
- Mental Health Services, Minneapolis Veteran's Affairs (VA) Health Care System, Minneapolis, MN, United States of America
| | - Elizabeth C. Parsons
- Pulmonary and Critical Care, Puget Sound Veteran's Affairs (VA) Health Care System, Seattle, WA, United States of America
- Division of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Angela D. Oien
- Pulmonary and Critical Care, Puget Sound Veteran's Affairs (VA) Health Care System, Seattle, WA, United States of America
| | - Carlos H. Schenck
- Department of Psychiatry, Minnesota Regional Sleep Disorders Center, Minneapolis, MN, United States of America
| | - Muna Irfan
- Pulmonary, Allergy, Critical Care and Sleep, Minneapolis Veteran's Affairs (VA) Health Care System, Minneapolis, MN, United States of America
- Department of Neurology, Medical School, University of Minnesota, Minneapolis, MN, United States of America
| |
Collapse
|
3
|
Gill P, Fraser E, Tran TTD, De Sena Collier G, Jago A, Losinno J, Ganci M. Psychosocial treatments for nightmares in adults and children: a systematic review. BMC Psychiatry 2023; 23:283. [PMID: 37085821 PMCID: PMC10122409 DOI: 10.1186/s12888-023-04703-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/21/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND As nightmares may be a risk factor for, or symptom of, multiple psychological disorders, some researchers suggest that nightmares should be screened, diagnosed, and treated. Treatments for nightmares include trauma-focused Cognitive Behavioural Therapy and Image Rehearsal Therapy, and pharmacological interventions such as prazosin and nitrazepam. As recent research has put into question our current understanding of treatment efficacy, there is a need to systematically review findings related to the effectiveness of nightmare treatments to inform best practice. The current review assessed the efficacy of psychosocial treatments of nightmare in all cohorts. METHODS A systematic search of four databases for peer reviewed journal articles from 2000 onwards produced 69 (35 RCTs, 34 non-RCTs) eligible articles that underwent narrative synthesis. RESULTS The results provide strong evidence for exposure and image rehearsal treatments for the reduction of nightmare frequency, severity, and distress, in civilian, military, idiopathic, and posttraumatic stress disorder (PTSD) cohorts. There is emerging evidence that self-guided and brief treatment modalities offer efficient and effective treatment options. There is an urgent need for clinical trials of treatment effectiveness in children. CONCLUSIONS The results suggest that treatments for nightmares are most effective when they facilitate a sense of control or mastery by directly targeting the nightmare content and/or the client's emotional responses to the nightmare content. TRIAL REGISTRATION A review protocol was registered with PROSPERO (CRD42020204861).
Collapse
Affiliation(s)
- Peter Gill
- Institute for Health and Sport, Victoria University Australia, Footscray Park, Ballarat Rd, Melbourne, VIC, Australia.
| | - Emily Fraser
- Institute for Health and Sport, Victoria University Australia, Footscray Park, Ballarat Rd, Melbourne, VIC, Australia
| | - Thong Thai Diep Tran
- Institute for Health and Sport, Victoria University Australia, Footscray Park, Ballarat Rd, Melbourne, VIC, Australia
| | - Gabriel De Sena Collier
- Institute for Health and Sport, Victoria University Australia, Footscray Park, Ballarat Rd, Melbourne, VIC, Australia
| | - Andrew Jago
- Institute for Health and Sport, Victoria University Australia, Footscray Park, Ballarat Rd, Melbourne, VIC, Australia
| | - Joe Losinno
- Institute for Health and Sport, Victoria University Australia, Footscray Park, Ballarat Rd, Melbourne, VIC, Australia
| | - Michael Ganci
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| |
Collapse
|
4
|
Schwartz S, Clerget A, Perogamvros L. Enhancing imagery rehearsal therapy for nightmares with targeted memory reactivation. Curr Biol 2022; 32:4808-4816.e4. [PMID: 36306786 DOI: 10.1016/j.cub.2022.09.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/14/2022] [Accepted: 09/15/2022] [Indexed: 11/21/2022]
Abstract
Nightmare disorder (ND) is characterized by dreams with strong negative emotions occurring during rapid eye movement (REM) sleep. ND is mainly treated by imagery rehearsal therapy (IRT), where the patients are asked to change the negative story line of their nightmare to a more positive one. We here used targeted memory reactivation (TMR) during REM sleep to strengthen IRT-related memories and accelerate remission of ND. Thirty-six patients with ND were asked to perform an initial IRT session and, while they generated a positive outcome of their nightmare, half of the patients were exposed to a sound (TMR group), while no such pairing took place for the other half (control group). During the next 2 weeks, all patients performed IRT every evening at home and were exposed to the sound during REM sleep with a wireless headband, which automatically detected sleep stages. The frequency of nightmares per week at 2 weeks was used as the primary outcome measure. We found that the TMR group had less frequent nightmares and more positive dream emotions than the control group after 2 weeks of IRT and a sustained decrease of nightmares after 3 months. By demonstrating the effectiveness of TMR during sleep to potentiate therapy, these results have clinical implications for the management of ND, with relevance to other psychiatric disorders too. Additionally, these findings show that TMR applied during REM sleep can modulate emotions in dreams.
Collapse
Affiliation(s)
- Sophie Schwartz
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland; Swiss Center for Affective Sciences, University of Geneva, 1202 Geneva, Switzerland
| | - Alice Clerget
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland
| | - Lampros Perogamvros
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland; Swiss Center for Affective Sciences, University of Geneva, 1202 Geneva, Switzerland; Center for Sleep Medicine, Geneva University Hospitals, 1225 Geneva, Switzerland; Department of Psychiatry, Geneva University Hospitals, 1225 Geneva, Switzerland.
| |
Collapse
|
5
|
Possemato K, Silander N, Bellete N, Emery JB, De Stefano L, Pigeon W. Characteristics of Posttraumatic Nightmares and Their Relationship to PTSD Severity Among Combat Veterans With PTSD and Hazardous Alcohol Use. J Nerv Ment Dis 2022; 210:223-226. [PMID: 35199661 PMCID: PMC8887778 DOI: 10.1097/nmd.0000000000001422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Although nightmares are known to predict the clinical course of posttraumatic stress disorder (PTSD), research on the relationship between specific nightmare characteristics and PTSD severity is sparse. This study conducted a secondary analysis to explore how five nightmare characteristics are cross-sectionally related to PTSD severity in 76 combat veterans with PTSD and at-risk alcohol use. Consistent with emotional processing theory, we hypothesized that more replicative, threatening, realistic, and easily recalled nightmares would be associated with more severe PTSD, whereas those with greater symbolism would predict lower PTSD severity. Nightmares narratives were audio-recorded and rated by multiple coders. Multiple analyses of variance explored the relationship between nightmare characteristics and PTSD clinical indicators. Most nightmares were realistic, easily recalled, and involved significant threat. Greater realism and replication were associated with greater PTSD severity. Realistic and replicative nightmares may be markers of more severe PTSD and may indicate that less emotional processing of the trauma has occurred.
Collapse
Affiliation(s)
- Kyle Possemato
- Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, NY
| | - Nina Silander
- Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, NY
| | - Nardos Bellete
- Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, NY
| | - J. Bronte Emery
- Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, NY
| | - Leigha De Stefano
- Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, NY
| | - Wilfred Pigeon
- Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, NY
- Center of Excellence for Suicide Prevention, Canandaigua Veterans Affairs Medical Center, Canandaigua, NY
- Sleep & Neurophysiology Research Laboratory, University of Rochester Medical Center, Rochester, NY
| |
Collapse
|
6
|
Chan NY, Au CT, Li SX, Wing YK. Sleep Complaints Among School Children. Sleep Med Clin 2022; 17:53-65. [PMID: 35216761 DOI: 10.1016/j.jsmc.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sleep complaints are common among children. These include both night-time and daytime symptoms, such as trouble falling asleep, problems in maintaining sleep, snoring, and unusual events during sleep and daytime functioning impairment. However, sleep complaints in children are often overlooked and undertreated in clinical practice. Untreated sleep problems may further impact on children's development and will persist into adulthood in some cases. This review summarizes the common sleep complaints and disorders in school children, and provides an overview of the epidemiology, clinical features, consequences, and treatment of the sleep problems.
Collapse
Affiliation(s)
- Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Chun Ting Au
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Shirley Xin Li
- Department of Psychology, The University of Hong Kong, Hong Kong SAR, China; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China.
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
| |
Collapse
|
7
|
Borghese F, Henckaerts P, Guy F, Perez Mayo C, Delplanque S, Schwartz S, Perogamvros L. Targeted Memory Reactivation During REM Sleep in Patients With Social Anxiety Disorder. Front Psychiatry 2022; 13:904704. [PMID: 35845468 PMCID: PMC9281560 DOI: 10.3389/fpsyt.2022.904704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Social anxiety disorder (SAD) is characterized by a significant amount of fear when confronted to social situations. Exposure therapy, which is based on fear extinction, does not often lead to full remission. Here, based on evidence showing that rapid eye movement (REM) sleep promotes the consolidation of extinction memory, we used targeted memory reactivation (TMR) during REM sleep to enhance extinction learning in SAD. METHODS Forty-eight subjects with SAD were randomly assigned to two groups: control or TMR group. All patients had two successive exposure therapy sessions in a virtual reality (VR) environment, where they were asked to give a public talk in front of a virtual jury. At the end of each session, and only in the TMR group (N = 24), a sound was paired to the positive feedback phase of therapy (i.e., approval of their performance), which represented the memory to be strengthened during REM sleep. All participants slept at home with a wearable headband device which automatically identified sleep stages and administered the sound during REM sleep. Participants' anxiety level was assessed using measures of parasympathetic (root mean square of successive differences between normal heartbeats, RMSSD) and sympathetic (non-specific skin conductance responses, ns-SCRs) activity, and subjective measures (Subjective Units of Distress Scale, SUDS), during the preparation phase of their talks before (T1) and after (T2) one full-night's sleep and after 1 week at home (T3). Participants also filled in a dream diary. RESULTS We observed an effect of time on subjective measures of anxiety (SUDS). We did not find any difference in the anxiety levels of the two groups after 1 week of TMR at home. Importantly, the longer the total duration of REM sleep and the more stimulations the TMR group had at home, the less anxious (increased RMSSD) these participants were. Finally, fear in dreams correlated positively with ns-SCRs and SUDS at T3 in the TMR group. CONCLUSION TMR during REM sleep did not significantly modulate the beneficial effect of therapy on subjective anxiety. Yet, our results support that REM sleep can contribute to extinction processes and substantiate strong links between emotions in dreams and waking stress levels in these patients.
Collapse
Affiliation(s)
- Francesca Borghese
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Pauline Henckaerts
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Fanny Guy
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Coral Perez Mayo
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sylvain Delplanque
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Sophie Schwartz
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland.,Human Neuroscience Platform, Fondation Campus Biotech Geneva, Geneva, Switzerland
| | - Lampros Perogamvros
- Department of Basic Neurosciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland.,Human Neuroscience Platform, Fondation Campus Biotech Geneva, Geneva, Switzerland.,Center for Sleep Medicine, Geneva University Hospitals, Geneva, Switzerland.,Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
8
|
Albanese M, Liotti M, Cornacchia L, Mancini F. Nightmare Rescripting: Using Imagery Techniques to Treat Sleep Disturbances in Post-traumatic Stress Disorder. Front Psychiatry 2022; 13:866144. [PMID: 35444578 PMCID: PMC9013762 DOI: 10.3389/fpsyt.2022.866144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
Besides affecting 8% of the general population, nightmares are one of the most frequent symptoms of traumatized individuals. This can be a significant factor in the treatment of post-traumatic disorders; indeed, several studies demonstrated its strong predictive and prognostic value. Sleep disorders, nightmares in particular, could be very distressing for individuals and need targeted interventions, especially if they are associated with a PTSD diagnosis. To date, the best technique for the treatment of traumatic sleep disturbances seems to be Imagery Rehearsal Therapy (IRT), an empirically supported method. Through a review of the literature on this matter, this article aims to outline the incidence and consequences of nightmares in PTSD, illustrate how IRT could prove useful in their treatment, and investigate its clinical applications.
Collapse
Affiliation(s)
- Marzia Albanese
- School of Cognitive Psychotherapy, Rome, Italy.,Crossing Dialogues Association, Rome, Italy
| | - Marianna Liotti
- School of Cognitive Psychotherapy, Rome, Italy.,Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | | | - Francesco Mancini
- School of Cognitive Psychotherapy, Rome, Italy.,Department of Human Sciences, Guglielmo Marconi University, Rome, Italy
| |
Collapse
|
9
|
Schmid C, Hansen K, Kröner-Borowik T, Steil R. Imagery Rescripting and Imaginal Exposure in Nightmare Disorder Compared to Positive Imagery: A Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:328-340. [PMID: 33477151 DOI: 10.1159/000512757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 11/02/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Both imagery rescripting and imaginal exposure have been proven to be effective in the treatment of chronic nightmares when compared to a waitlist condition. Little is known about their comparative efficacy and their efficacy compared to an active control. OBJECTIVE The aims of this study were to compare the two treatments to one another and to positive imagery as an active control, and to explore covariates of the treatment effect. METHODS In this single-blinded randomized controlled trial, 96 patients with nightmare disorder (idiopathic nightmares) from an outpatient clinic were randomly assigned to a single individual treatment session of rescripting, exposure, or positive imagery and 4 weeks of practice at home. The primary outcome was nightmare distress, and the secondary outcomes were nightmare frequency, nightmare effects, self-efficacy, and general psychopathology. RESULTS Nightmare distress was reduced in all groups (imagery rescripting: Cohen's d = -1.04, imaginal exposure: d = -0.68, positive imagery: d = -0.57), as were nightmare frequency, nightmare effects, and psychopathology. Self-efficacy was enhanced. No differential treatment effects were found on any primary or secondary measure. Treatment gains were not associated with demographic or disorder characteristics, baseline values, treatment credibility, or the number of practice sessions. CONCLUSIONS Even short nightmare treatments are effective regardless of personal characteristics, and different interventions produce similar results. Future research should aim to clarify the mechanisms of action. Health care should make more use of these powerful and easy-to-administer nightmare treatments.
Collapse
Affiliation(s)
- Carolin Schmid
- Department of Clinical Psychology, Goethe University, Frankfurt am Main, Germany,
| | - Kathrin Hansen
- Department of Clinical Psychology, Goethe University, Frankfurt am Main, Germany
| | - Tana Kröner-Borowik
- Department of Clinical Psychology, Goethe University, Frankfurt am Main, Germany
| | - Regina Steil
- Department of Clinical Psychology, Goethe University, Frankfurt am Main, Germany
| |
Collapse
|
10
|
Gazerani P. Nightmares in Migraine: A Focused Review. Behav Sci (Basel) 2021; 11:bs11090122. [PMID: 34562960 PMCID: PMC8471052 DOI: 10.3390/bs11090122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/21/2021] [Accepted: 09/01/2021] [Indexed: 11/24/2022] Open
Abstract
Nightmares usually occur during the sleep phase of rapid eye movement (REM) and are associated with some physical symptoms, including sweating, shortness of breath, and lower limb movements. Emotions of fear, anger, shame, and sadness may also accompany nightmares. These symptoms can occur during dreaming, upon awakening, or later when the dream experience is recollected. Nightmares may sporadically occur for everyone, but nightmare disorders are associated with features of impaired mental and physical health and require professional medical treatment. The occurrence of nightmares with several disorders has been reported in the literature, but in migraines it has only been investigated in a small number of studies. Considering the existing relationship between sleep disorders and migraine, the occurrence of nightmares in migraine can negatively affect this association and elevate the risk of depression and anxiety. This, in turn, further reduces the quality of life of affected individuals. Hence, expanding the knowledge on the link between nightmares and migraine, promoting an acceptable quantity and quality of sleep through pharmacological and nonpharmacological interventions in the management of nightmares in migraine, and further scientific investigation of the biopsychosocial mechanisms underlying the link, will be highly valuable for optimal care. This focused review, therefore, gives a brief overview of the current understanding of nightmares in migraine to highlight the open questions and value of further research. The ultimate goal is to contribute to timely recognition and sufficient action to offer beneficial outcomes for affected patients.
Collapse
Affiliation(s)
- Parisa Gazerani
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; or
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg E, Denmark
| |
Collapse
|
11
|
Marquis LP, Julien SH, Daneault V, Blanchette-Carrière C, Paquette T, Carr M, Soucy JP, Montplaisir J, Nielsen T. Local Neuronal Synchronization in Frequent Nightmare Recallers and Healthy Controls: A Resting-State Functional Magnetic Resonance Imaging Study. Front Neurosci 2021; 15:645255. [PMID: 33815047 PMCID: PMC8012764 DOI: 10.3389/fnins.2021.645255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/25/2021] [Indexed: 11/25/2022] Open
Abstract
Nightmares are highly dysphoric dreams that are well-remembered upon awakening. Frequent nightmares have been associated with psychopathology and emotional dysregulation, yet their neural mechanisms remain largely unknown. Our neurocognitive model posits that nightmares reflect dysfunction in a limbic-prefrontal circuit comprising medial prefrontal and anterior cingulate cortices, hippocampus, and amygdala. However, there is a paucity of studies that used brain imaging to directly test the neural correlates of nightmares. One such study compared the regional homogeneity (ReHo) of resting-state functional magnetic resonance imaging blood-oxygen level-dependent signals between frequent nightmare recallers and controls. The main results were greater regional homogeneity in the left anterior cingulate cortex and right inferior parietal lobule for the nightmare recallers than for the controls. In the present study, we aimed to document the ReHo correlates of frequent nightmares using several nightmare severity measures. We acquired resting-state functional magnetic resonance imaging data from 18 frequent nightmare recallers aged 18-35 (3 males and 15 females) and 18 age- and sex-matched controls, as well as retrospective and prospective disturbed dreaming frequency estimates and scores on the Nightmare Distress Questionnaire. While there were inconsistent results for our different analyses (group comparisons, correlational analyses for frequency estimates/Nightmare Distress scores), our results suggest that nightmares are associated with altered ReHo in frontal (medial prefrontal and inferior frontal), parietal, temporal and occipital regions, as well as some subcortical regions (thalamus). We also found a positive correlation between retrospective disturbed dreaming frequency estimates and ReHo values in the hippocampus. These findings are mostly in line with a recent SPECT study from our laboratory. Our results point to the possibility that a variety of regions, including but not limited to the limbic-prefrontal circuit of our neurocognitive model, contribute to nightmare formation.
Collapse
Affiliation(s)
- Louis-Philippe Marquis
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM – Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Sarah-Hélène Julien
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM – Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Véronique Daneault
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM – Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Cloé Blanchette-Carrière
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM – Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Tyna Paquette
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM – Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Michelle Carr
- Department of Psychiatry, Sleep & Neurophysiology Research Laboratory, University of Rochester Medical Center, Rochester, NY, United States
| | | | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM – Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montreal, QC, Canada
| | - Tore Nielsen
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM – Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montreal, QC, Canada
| |
Collapse
|
12
|
Reiter H, Humphreys L. Exposure, Relaxation, and Rescripting Therapy for Trauma-Related Nightmares With Psychiatric Inpatients: A Case Series. Clin Case Stud 2020. [DOI: 10.1177/1534650120953614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research has shown that posttraumatic stress disorder (PTSD) is a highly prevalent diagnosis for psychiatric patients, yet individualized care and treatment is limited in the inpatient acute care sector. Two case studies are presented which examine the use of Exposure, Relaxation, and Rescripting Therapy (ERRT) for chronic trauma-related nightmares, within a private acute care inpatient psychiatric hospital setting. ERRT is empirically supported with efficacy for veteran and civilian populations, however no research to date has been conducted with psychiatric inpatients. Two participants diagnosed with PTSD, suffering distressing trauma-related nightmares, completed ERRT over three sessions during their psychiatric hospital admission, with the aim of reducing the frequency and severity of nightmares and related psychological symptoms. PTSD, depression, sleep quality and quantity, and nightmare frequency and related distress, were measured pre-treatment, during treatment, and follow-up at one, 3 and 6 months. Only one participant reported ongoing nightmares by the third week of the intervention, with both participants reporting an absence of nightmares at the one and 3-month follow-ups, but mixed results by the 6-month follow-up. One participant also reported a reduction in PTSD symptoms and a mild improvement in depression. The results offer some preliminary support for the provision of ERRT for the treatment of trauma-related nightmares for psychiatric inpatients.
Collapse
Affiliation(s)
- Helen Reiter
- Charles Sturt University, Bathurst, New South Wales, Australia
| | | |
Collapse
|
13
|
Gieselmann A, Elberich N, Mathes J, Pietrowsky R. Nightmare distress revisited: Cognitive appraisal of nightmares according to Lazarus' transactional model of stress. J Behav Ther Exp Psychiatry 2020; 68:101517. [PMID: 31884305 DOI: 10.1016/j.jbtep.2019.101517] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 08/06/2019] [Accepted: 09/23/2019] [Indexed: 11/28/2022]
Abstract
Aim of the current research was to newly conceptualize nightmare distress. The special focus was on the appraisal of nightmare distress while applying a theory-driven approach based on Lazarus' transactional model of stress. It was argued that individuals feel the more distressed the more they feel threatened and harmed by their nightmares (primary appraisal according to Lazarus) and the more they lack of adequate coping skills to deal with the stressor (secondary appraisal). Based on these assumptions, the questionnaire of Cognitive Appraisal of Nightmares (CAN) was challenged empirically in two studies of patients who have experienced distressing nightmares using explorative and confirmative factor analyses (N = 504 and N = 402). Items and scales showed good psychometric properties and plausible correlations. The CAN sum score was more distinct from nightmare frequency than the frequently used Nightmare Distress Questionnaire (NDQ), underpinning that frequency and distress are both different approaches to what patients suffer from. The NDQ was particularly associated with acted out behaviors after a nightmare, while the CAN was particularly associated with physiological and emotional consequences of a nightmare. In order to obtain a multifactorial and theory-driven picture about how individuals appraise their nightmares, the CAN may be convenient.
Collapse
|
14
|
Lancee J, Effting M, Kunze AE. Telephone-guided imagery rehearsal therapy for nightmares: Efficacy and mediator of change. J Sleep Res 2020; 30:e13123. [PMID: 32567103 PMCID: PMC8244061 DOI: 10.1111/jsr.13123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 01/25/2023]
Abstract
The currently best‐supported psychological treatment for nightmares is imagery rehearsal therapy. The problem, however, is that not enough trained practitioners are available to offer this treatment. A possible solution is to conduct imagery rehearsal therapy in a guided self‐help format. In the current study, 70 participants with nightmares according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders were randomized to either telephone‐guided imagery rehearsal therapy (n = 36) or a wait‐list condition (n = 34). Participants in the imagery rehearsal therapy condition received three sessions over the course of 5 weeks. Every treatment session was followed by telephone support delivered by postgraduate students. Participants who received imagery rehearsal therapy showed larger improvements on nightmare frequency (d = 1.03; p < .05), nightmare distress (d = 0.75; p < .05) and insomnia severity (d = 1.12; p < .001) compared with the participants in the wait‐list condition. The effects were sustained at 3‐ and 6‐month follow‐up. No significant effects were observed on the number of nights with nightmares per week, anxiety and depression. In line with earlier reports, the treatment effect was mediated by the increase of mastery at mid‐treatment, underlining the mechanistic value of mastery in imagery rehearsal therapy. The present study demonstrates that it is possible to deliver imagery rehearsal therapy in a self‐help format supported by unexperienced therapists and with relatively little time investment. This opens possibilities in terms of cost‐effectiveness, scalability and dissemination of imagery rehearsal therapy in the treatment of nightmares.
Collapse
Affiliation(s)
- Jaap Lancee
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.,PsyQ Amsterdam, Amsterdam, The Netherlands
| | - Marieke Effting
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Anna E Kunze
- Department of Psychology, LMU Munich, Munich, Germany
| |
Collapse
|
15
|
Zhang Y, Ren R, Sanford LD, Tang X. Commentary on Yücel DE et al. Downgrading recommendation level of prazosin for treating trauma-related nightmares: Should decision be based on a single study? Sleep Med Rev 2020; 51:101285. [PMID: 32234660 DOI: 10.1016/j.smrv.2020.101285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 12/16/2019] [Indexed: 02/08/2023]
Affiliation(s)
- Ye Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Ren
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Larry D Sanford
- Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Department of Pathology and Anatomy, Eastern Virginia Medical School, USA.
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
16
|
de Macêdo TCF, Ferreira GH, de Almondes KM, Kirov R, Mota-Rolim SA. My Dream, My Rules: Can Lucid Dreaming Treat Nightmares? Front Psychol 2019; 10:2618. [PMID: 31849749 PMCID: PMC6902039 DOI: 10.3389/fpsyg.2019.02618] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/06/2019] [Indexed: 12/11/2022] Open
Abstract
Nightmares are defined as repeated occurrences of extremely dysphoric and well-remembered dreams that usually involve subjective threats to survival, security, or physical integrity. Generally, they occur during rapid eye movement sleep (REMS) and lead to awakenings with distress and insufficient overnight sleep. Nightmares may occur spontaneously (idiopathic) or as recurrent nightmares. Recurrent nightmares cause significant distress and impairment in occupational and social functioning, as have been commonly observed in post-traumatic stress disorder, depression and anxiety. By contrast, during lucid dreaming (LD), subjects get insight they are dreaming and may even control the content of their dreams. These features may open a way to help those who suffer from nightmare disorder through re-significations of the dream scene, i.e., knowing that they are dreaming and having control over their dream content. Thus, lucid dreamers might be able to render nightmares normal dreams, thereby assuring a restoring sleep. The aim of the present study is to review the existing literature of the use of LD as an auxiliary tool for treatment of nightmares. We conducted a careful literature search for eligible studies on the use of LD treatment for nightmares. We observed that whereas LD may be a feasible aid in the treatment of patients with nightmares through minimizing their frequency, intensity and psychological distress, the available literature is still scarce and does not provide consistent results. We conclude therefore that more research is clearly warranted for a better estimation of the effective conductance and therapeutic outcome of LD treatment in clinical practice.
Collapse
Affiliation(s)
| | | | - Katie Moraes de Almondes
- Department of Psychology, Postgraduate Program in Psychobiology, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Roumen Kirov
- Institute of Neurobiology, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Sérgio Arthuro Mota-Rolim
- Brain Institute, Physiology and Behavior Department, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, Brazil
| |
Collapse
|
17
|
Mediators of Change in Imagery Rescripting and Imaginal Exposure for Nightmares: Evidence From a Randomized Wait-List Controlled Trial. Behav Ther 2019; 50:978-993. [PMID: 31422852 DOI: 10.1016/j.beth.2019.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 03/11/2019] [Accepted: 03/15/2019] [Indexed: 11/21/2022]
Abstract
Imagery rescripting (IR) and imaginal exposure (IE) are two efficacious treatments for nightmare disorder, but their discrete underlying mechanism(s) remain largely unknown. We therefore examined mediators of the treatment effects of IR and IE in a randomized wait-list controlled trial (N = 104). Therapeutic outcomes were assessed at pre- and post-assessment, and mediator assessment took place in between treatment sessions to establish a temporal relationship between mediators and nightmare symptoms (i.e., frequency and distress). In line with the hypothesis, enhanced mastery (or self-efficacy) of the nightmare content mediated the therapeutic efficacy of IR. Furthermore, the treatment effects of IE were mediated by increased tolerability of the negative emotions elicited by nightmares. Even though IR and IE for nightmares seem to produce similar therapeutic effects, the results of this study suggest that IR and IE tap into different underlying processes.
Collapse
|
18
|
Jenkins D. Nightmare resolution: Where to begin, where to end? A commentary on "The mechanisms of action underlying the efficacy of psychological nightmare treatments: A systematic review and thematic analysis of discussed hypotheses". Sleep Med Rev 2019; 45:129-130. [PMID: 30982773 DOI: 10.1016/j.smrv.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/29/2019] [Indexed: 11/16/2022]
|
19
|
Gieselmann A, Ait Aoudia M, Carr M, Germain A, Gorzka R, Holzinger B, Kleim B, Krakow B, Kunze AE, Lancee J, Nadorff MR, Nielsen T, Riemann D, Sandahl H, Schlarb AA, Schmid C, Schredl M, Spoormaker VI, Steil R, van Schagen AM, Wittmann L, Zschoche M, Pietrowsky R. Aetiology and treatment of nightmare disorder: State of the art and future perspectives. J Sleep Res 2019; 28:e12820. [PMID: 30697860 PMCID: PMC6850667 DOI: 10.1111/jsr.12820] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/17/2018] [Accepted: 11/22/2018] [Indexed: 12/11/2022]
Abstract
This consensus paper provides an overview of the state of the art in research on the aetiology and treatment of nightmare disorder and outlines further perspectives on these issues. It presents a definition of nightmares and nightmare disorder followed by epidemiological findings, and then explains existing models of nightmare aetiology in traumatized and non‐traumatized individuals. Chronic nightmares develop through the interaction of elevated hyperarousal and impaired fear extinction. This interplay is assumed to be facilitated by trait affect distress elicited by traumatic experiences, early childhood adversity and trait susceptibility, as well as by elevated thought suppression and potentially sleep‐disordered breathing. Accordingly, different treatment options for nightmares focus on their meaning, on the chronic repetition of the nightmare or on maladaptive beliefs. Clinically, knowledge of healthcare providers about nightmare disorder and the delivery of evidence‐based interventions in the healthcare system is discussed. Based on these findings, we highlight some future perspectives and potential further developments of nightmare treatments and research into nightmare aetiology.
Collapse
Affiliation(s)
- Annika Gieselmann
- Department of Clinical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Malik Ait Aoudia
- Centre du Psychotrauma de l'Institut de Victimologie à Paris, Paris, France
| | - Michelle Carr
- Department of Psychology, Swansea University, Swansea, UK
| | - Anne Germain
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert Gorzka
- Central Institute for Mental Health, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | | | - Birgit Kleim
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zürich, Zürich, Switzerland
| | - Barry Krakow
- Maimonides Sleep Arts and Sciences, Ltd, Albuquerque, New Mexico, USA
| | - Anna E Kunze
- Department of Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Jaap Lancee
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Michael R Nadorff
- Department of Psychology, Mississippi State University, Mississippi State, Mississippi, USA
| | - Tore Nielsen
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Freiburg, Germany
| | - Hinuga Sandahl
- Competence Centre for Transcultural Psychiatry, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark
| | - Angelika A Schlarb
- Department of Psychology and Sports, Bielefeld University, Bielefeld, Germany
| | - Carolin Schmid
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Michael Schredl
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | | | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Annette M van Schagen
- Foundation Centrum '45, Partner in Arq Psychotrauma Expert Group, Oegstgeest, the Netherlands
| | - Lutz Wittmann
- International Psychoanalytic University Berlin, Berlin, Germany
| | - Maria Zschoche
- Department of Psychology and Sports, Bielefeld University, Bielefeld, Germany
| | - Reinhard Pietrowsky
- Department of Clinical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
20
|
Management of Post-Traumatic Nightmares: a Review of Pharmacologic and Nonpharmacologic Treatments Since 2013. Curr Psychiatry Rep 2018; 20:108. [PMID: 30306339 DOI: 10.1007/s11920-018-0971-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW Post-traumatic nightmares (PTN) are a common and enduring problem for individuals with post-traumatic stress disorder (PTSD) and other clinical presentations. PTN cause significant distress, are associated with large costs, and are an independent risk factor for suicide. Pharmacological and non-pharmacological treatment options for PTN exist. A previous review in this journal demonstrated that Prazosin, an alpha blocker, was a preferred pharmacological treatment for PTN and imagery rescripting therapy (IRT) was a preferred non-pharmacological treatment. Since that time, new and important research findings create the need for an updated review. RECENT FINDINGS Based on the results of a recent study in the New England Journal of Medicine, Prazosin has been downgraded by both the American Academy of Sleep Medicine (AASM) and the Veterans Health Administration/Department of Defense (VA/DoD) for PTN. In Canada, Nabilone, a synthetic cannabinoid, appears to be promising. Few recent studies have been published on non-pharmacological interventions for PTN; however, recent data is available with regard to using IRT on an inpatient setting, with German combat veterans, and through the use of virtual technology. Recent evidence supports the use of exposure, relaxation, and rescripting therapy (ERRT) with children and individuals with comorbid bipolar disorder and PTN. Prazosin is no longer considered a first-line pharmacological intervention for PTN by AASM and VA/DoD. However, in the absence of a suitable alternative, it will likely remain the preferred option of prescribers. IRT and ERRT remain preferred non-pharmacological treatments of PTN. Combining cognitive behavior therapy for insomnia (CBT-I) with IRT or ERRT may lead to improved outcomes.
Collapse
|