When Nightmares Won't Go Away
Nightmare therapy may put chronic nightmares to rest.
Changing Nightmare Scripts
The technique that Levy used, known as imagery rehearsal therapy (IRT), grew out of research conducted in the 1990s. It's been steadily gaining favor as a treatment for chronic nightmares since 2001 when a landmark study published in the Journal of the American Medical Association found that it not only curbed nightmares among victims of sexual assault but also reduced PTSD symptoms.
"Studies show that 70% to 80% of people who try IRT get significant relief," says Barry Krakow, MD, director of the Maimonides International Nightmare Treatment Center in Albuquerque, N.M. He's one of the researchers who worked on the JAMA study and the author of four books on sleep medicine, including Sound Sleep, Sound Mind.
IRT is surprisingly easy to learn and to use. The basic technique can often be mastered in a few hours; once learned, it's used for only a few minutes a day for a matter of days or weeks.
Krakow says it's possible to try IRT on your own, but he warns that people who suffer from PTSD or another psychological condition should attempt the technique only with the help of a doctor or therapist.
Working with a professional also makes sense for people who have trouble visualizing dream images while awake. "Some people have difficulty painting a picture in the mind's eye," Harris says. "But with help, they get good at priming the pump for imagery."
3 Steps to Nightmare Control
As described by Krakow and Harris, IRT is a three-step process:
- Jot down a brief description of a recent nightmare. If your most recent nightmare is too upsetting to think about, pick another.
- Think of a way to change the nightmare. Krakow declines to tell his patients what sort of change to make, encouraging them to rely on their intuition to make an appropriate change.
- Set aside a few minutes each day to imagine this altered version of the nightmare. Simply paint a mental picture of the altered version.
Some people with chronic nightmares, especially those who have suffered for years, find it hard to believe that a simple, essentially do-it-yourself technique could be effective.
Krakow says that when he explains IRT to his patients, "it's almost like they think the process is disrespecting them. They say, 'What do you mean I just write down a nightmare and change it and picture it in my mind? That's crazy.' It's almost like they think I'm saying, 'Change two dreams and call me in the morning.'"
Levy can't recall exactly what she thought when Harris told her about IRT. But she tried it and found that it worked. Her nightmare about the concentration camp? She re-imagined herself in a summer camp where she could walk about freely. And the bad dream about drowning? The deep water that threatened to swallow her up became shallow enough to stand up in.
Levy still has nightmares, but they occur much less frequently -- about once every six weeks or so. When they do occur, they are less upsetting.
"Just learning that there was something I could do about my nightmares really helped a lot," Levy says. "Getting help changed things for me significantly. I'm more rested and happier, and I'm able to be more active during the day."