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Sleep and Combat-Related Post Traumatic Stress Disorder pp 303–309Cite as

Imagery Rehearsal Therapy for PTSD-Related Nightmares

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Abstract

Veterans with combat-related post-traumatic stress disorder (PTSD) experience high rates of chronic nightmares that contribute to emotional distress and sleep disturbance. This chapter presents Imagery Rehearsal Therapy (IRT), which has emerged as the leading non-pharmacologic treatment for nightmares, with a particular focus on its application to combat-related PTSD. The history and growth of IRT over the past 25 years is discussed. Hypothesized mechanisms of IRT are presented as they relate to the assumption that chronic nightmares are a learned behavior symptomatic of a malfunctioning imagery system. Elements of IRT are described, including treatment components (dream rescripting, imagery practice, homework, and self-monitoring), indications/contraindications for treatment, and treatment obstacles (avoidance, adherence, adverse effects). Additionally, treatment modifications consisting of IRT protocol variants, the application of IRT to special populations, and issues related to treatment duration, delivery, and format are discussed. The empirical support for IRT is reviewed, followed by indications for future research. Despite limited research examining the efficacy of IRT in veterans with combat-related PTSD, IRT has demonstrated good success across multiple settings and diverse populations. It is an inexpensive, flexible, short-term intervention that holds promise for ameliorating nightmares and related distress in combat veterans.

This material is the result of work supported with resources and the use of facilities at the VA Medical Center, Durham, NC. The contents do not represent the views of the Department of Veterans Affairs or the US Government.

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Author information

Authors and Affiliations

  1. Psychology Service, Durham Veterans Affairs Healthcare System, Durham, NC, USA

    Amanda J. Countryman & Melanie K. Leggett

  2. Pediatric Psychology Associates, Aventura, Durham, NC, USA

    Amanda J. Countryman

  3. Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA

    Melanie K. Leggett

Authors
  1. Amanda J. Countryman
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  2. Melanie K. Leggett
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Correspondence to Melanie K. Leggett .

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Editors and Affiliations

  1. Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands

    Eric Vermetten

  2. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

    Anne Germain

  3. University of California, San Francisco, California, USA

    Thomas C. Neylan

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Countryman, A.J., Leggett, M.K. (2018). Imagery Rehearsal Therapy for PTSD-Related Nightmares. In: Vermetten, E., Germain, A., Neylan, T. (eds) Sleep and Combat-Related Post Traumatic Stress Disorder. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-7148-0_26

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  • DOI: https://doi.org/10.1007/978-1-4939-7148-0_26

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