Treatment of Nightmares in Psychiatric Inpatients With Imagery Rehearsal Therapy: An Open Trial and Case Series

Objectives: This study sought to assess the utility of Imagery Rehearsal Therapy (IRT) for nightmares in an inpatient psychiatric setting. Although IRT enjoys a substantial evidence base for efficacy in various populations, data with psychiatric inpatients are lacking. Participants: Participants were 20 adult psychiatric inpatients (11 male, 9 female; mean age=43.4), in an extended stay psychiatric inpatient facility. All participants were diagnosed with multiple, treatment resistant, comorbid conditions, including mood disorders, anxiety disorders, personality disorders, and substance-related disorders. Patients with active psychosis or significant cognitive impairment were excluded. Methods: This was an open trial utilizing a case series design. In addition to routine hospital treatment that included psychotherapeutic and pharmacological interventions, participants received IRT over a span of 3 weeks in 4 small group sessions. Included were education about sleep and nightmares, instruction in writing new dream narratives and practicing guided imagery, and support via further consultation and trouble-shooting. Patients were referred by their psychiatrist or were self-referred, with approval from their treatment teams. Results: Results showed significant aggregate reductions in nightmare frequency and intensity, as well as improvement in sleep overall. Patients also improved on a variety of other symptom measures, including suicidal ideation. No adverse reactions were observed. The present report includes a sampling of individual case vignettes to illustrate variability in treatment response. Conclusions: This study provides preliminary evidence that IRT can be used safely and effectively in a hospital environment to benefit patients suffering from serious mental illnesses, often in the midst of significant life crises. It is not possible in this preliminary study to conclude that IRT specifically (as opposed to other aspects of hospital treatment) produced these outcomes. Larger, controlled trials are needed to establish a causal connection between IRT and nightmare reduction.