A Dream Come True: Using IRT to Combat Nightmares

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There’s nothing quite so bone-chilling as being startled awake by a horrific nightmare. For some people, especially those who have experienced trauma, this is an all-too-frequent occurrence and one that keeps them from getting restful sleep. Image Rehearsal Therapy (IRT), developed by Maimonides Post-Traumatic Stress Disorder (PTSD) Sleep Clinic founder Dr. Barry Krakow, is one way for post-traumatic nightmare sufferers to stop their chronic nightmares.

A Bad Night’s Sleep
According to Dr. Krakow, up to 25 percent of adults report having one or more nightmares per month. And while chronic nightmares are much more prevalent among those with trauma or mental illness, they also arise for approximately 8 percent of the general population, leading to insomnia and reduced sleep quality. Dr. Krakow says that among the myriad techniques out there, only IRT has been empirically proven to have an effect on controlling nightmares.

Dreaming as Learned Behavior
The theory behind IRT, a form of cognitive behavioral therapy (CBT), is that nightmares are a bad habit that can be broken. The first step in treatment, which is comprised of four approximately two-hour sessions that total eight to nine hours of therapy, encourages patients to think about the negative impact that nightmares have on their sleep. By doing so, the patients can recognize that nightmares, and the consequent sleep problems like insomnia, are a learned behavior that they can positively alter with the right techniques.

The second component of IRT teaches nightmare sufferers about the human imagery system, teaching that elements of their dreams correspond to traumas they may have experienced. In this process, which resembles lucid dreaming, the dreamers evaluate their own nightmares for information that may help them emotionally process their traumas. Image rehearsal therapists teach their patients that nightmares serve a survival function by motivating dreamers to alter their behavior or lifestyle to avoid harm and that, in their case, this survival mechanism needs to be placed back in balance.

Finally, once nightmare sufferers realize both the cause and effect of their dreams and realize that these components are within their own control, they begin to practice actively changing their dreams. With their therapists’ guidance, IRT patients select a dream that is disturbing to them (preferably one of lesser intensity, rather than a reenactment of the trauma that led to their nightmares), think of how they wish to change the dream, and then rehearse the new dream for a few minutes every day. Once patients have successfully altered a dream outcome in their sleep, they can begin selecting new nightmares to change every three to seven days, gradually working up to alter dreams of greater intensity.

According to Dr. Krakow, once patients have successfully completed IRT, they will have fewer nightmares, better sleep, and reduced stress during the day.

Will It Work for You?
While scholarly research devoted to alleviating chronic nightmares does not support Dr. Krakow’s claim that IRT is the only proven method for ridding nightmare sufferers of their bad dreams, there is a large body of peer-reviewed journal articles that affirm IRT is a viable alternative to other treatment methods like psychotherapy and medication. Since IRT is especially designed for individuals with PTSD-related chronic nightmares, it may not be as effective for those who suffer with the occasional idiopathic nightmare.

Don’t Lose Sleep Over Bad Dreams
Those interested in learning more about IRT or in finding a therapist in their area can visit the NationalCenterforPTSDwebsite. If you suffer from chronic nightmares and are willing to put in the time and effort for therapy, IRT may very well be your dream come true.


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