Psychotherapy Reduces PTSD-Related Nightmares

In people with posttraumatic stress disorder (PTSD), psychotherapies that lessen nightmares may fail to improve sleep, according to Leslie Swanson, Ph.D., a clinical lecturer in psychiatry at the University of Michigan School of Medicine.

She and colleagues combined effective nightmare therapies, such as imagery rehearsal and exposure, visualizing better dream outcomes, and relaxation techniques with cognitive-behavioral therapy for insomnia in a pilot study treating 10 male combat veterans with PTSD.

Nine of the veterans had served in the Vietnam War and one in the Gulf War. Many had had the same nightmare several times a week for decades. They met in three- or four-person groups led by doctoral-level clinical psychologists for 10 90-minute sessions.

Group leaders encouraged adherence to a regular sleep schedule and other healthy sleep practices. They also addressed misperceptions about sleep, aiming to improve the men's efficacy in managing their chronic sleep problems.

Following treatment, the men reported a 50 percent reduction in weekly nightmare frequency and distress. Most fell asleep faster and slept more solidly, although they continued to have clinically significant sleep problems, the researchers reported in the November 2009 Journal of Traumatic Stress.

The researchers hope to work with veterans from Iraq and Afghanistan experiencing nightmares and insomnia. “We hope early treatment will help prevent a chronic disorder,” Swanson said.