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Nightmare Treatment

Here you will learn the value and expectations of treating nightmares as a result of traumatic experiences in your life.

Psychological Treatment

In recent years, Barry Krakow and his colleagues at the University of New Mexico have conducted numerous studies regarding a promising psychological treatment for nightmares. This research group found positive results in applying this treatment to individuals suffering from nightmares in the context of PTSD Krakow and colleagues found that crime victims and sexual assault survivors with PTSD who received this treatment showed fewer nightmares and better sleep quality after three group-treatment sessions. Another group of researchers applied the treatment to Vietnam combat veterans and found similarly promising results in a small pilot study.

The treatment studied at the University of New Mexico is called 'Imagery Rehearsal Therapy' and is classified as a cognitive-behavioral treatment. It does not involve the use of medications. In brief, the treatment involves helping the clients change the endings of their nightmares, while they are awake, so that the ending is no longer upsetting. The client is then instructed to rehearse the new, nonthreatening images associated with the changed dream. Imagery Rehearsal Therapy also typically involves other components designed to help clients with problems associated with nightmares, such as insomnia. For example, clients are taught basic strategies that may help them to improve the quality of their sleep, such as refraining from caffeine during the afternoon, having a consistent evening wind-down ritual, or refraining from watching TV in bed.

Psychologists who use cognitive-behavioral techniques may be familiar with Imagery Rehearsal Therapy, or may have access to research literature describing it. If you need help locating a cognitive-behavioral therapist in your area, try using the clinical referral directory of the Association for the Advancement of Behavior Therapy.

PTSD NIGHTMARE TREATMENT

Traumatic nightmares can also occur as one of the many symptoms of posttraumatic stress disorder (PTSD). Repetitive, intrusive nightmares following a trauma often contain symbolic themes that mirror the original trauma and relate to threat to life, threat of abandonment or death, or loss of identity. Although exploration of these themes in psychotherapy can promote improved personal adjustment, the nightmares may continue to persist despite any symbolic interpretation.

Therefore, traumatic nightmares need to be treated differently than other dreams. It’s not enough just to “know” intellectually the psychological reasons why you have these nightmares. An event is traumatic because it disrupts your previously secure—and illusory—sense of “self.” And so, to heal from a trauma, you must take the initiative to make conscious changes in your life to accommodate the traumatic shattering of your illusions about life and identity.

Systematic desensitization, for example, as part of a multidimensional treatment for PTSD, may be of special help in reducing traumatic reenactment. An even more effective way to “sow the seeds” of new ways of thinking and acting is Imagery Rehearsal Therapy.

Psychological Therapy

I know from personal experience that treating PTSD with professional psycho-therapy is extremely helpful. Although painful during therapy, by releasing suppressed traumatic memories during therapeutic discussion, over time, PTSD symptoms and nightmares deminish. Although painful at first, cognitive therapy will bring about relief. If one can experience tears relevent to specific traumatic experiences and memories, there is healing powder in them. One who suffers from traumatic experiences should seek therapy as soon as possible. Many PTSD symptoms can be prevented or avoided if treated early enough or immediately after the event. The most harmful thing for anyone to do is not seek professional treatment, especially for a prolonged period of years! If not treated for a sustained period, it is difficult to alleviate the PTSD symptoms.

Psychopharmacological Treatment

Researchers have also conducted studies of medications for the treatment of nightmares. However, it should be noted that the research findings in support of these treatments are more tentative than findings from studies of Imagery Rehearsal Therapy. Part of the reason for this is simply that fewer studies have been conducted with medications at this point in time. Also, the studies that have been conducted with medications have generally been small and have not included a comparison control group (that did not receive medication). This makes it difficult to know for sure whether the medication is responsible for reducing nightmares, or whether the patientís belief or confidence that the medication will work was responsible for the positive changes (a.k.a., a placebo effect).

Some medications that have been studied for treatment of PTSD-related nightmares and may be effective in reducing nightmares include Topiramate, Prazosin, Nefazodone, Trazodone, and Gabapentin. Because medications typically have side effects, many patients choose to try a behavioral treatment first. If that does not help improve their symptoms, they may choose to try medication. For suggestions about how to talk to your doctor about your PTSD-related nightmares and the possible use of medications for your symptoms, consult the fact sheet below.

What happens if nightmares are left untreated?

Nightmares can be a chronic mental health problem for some individuals, but it is not yet clear why they plague some people and not others. One thing that is clear is that nightmares are common in the early phases after a traumatic experience. However, research suggests that most people who have PTSD symptoms (including nightmares) just after a trauma will recover without treatment. This typically occurs by about the third month after a trauma. However, if PTSD symptoms (including nightmares) have not decreased substantially by about the third month, these symptoms can become chronic If you have been suffering from nightmares for more than 3 months, you are encouraged to contact a mental health professional and discuss with him or her the behavioral treatments described above.

You may also find many helpful professional psychiatric manuals concerning the diagnosis and treatment of PTSD online at http://www.psychiatryonline.com



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