What Is Dream Rehearsal Therapy for Nightmares?

Rewriting Bad Dream Endings Can Lead to Lasting Change

EB0386-001.jpg
A boy screams in terror in bed. Zigy Kaluzny/The Image Bank/Getty Images

Sometimes bad dreams are hard to shake. If you have recurrent bad dreams or nightmares, you may be interested in learning about one possible solution. It can sometimes be helpful to rewrite the endings of your bad dreams through a process called dream rehearsal therapy. What is dream rehearsal therapy? How can it be done? Learn more about dream (or imagery) rehearsal therapy and whether it might be helpful to you.

Recurrent Bad Dreams May Resolve with a Simple Intervention

Everyone has an occasional bad dream or nightmare. You might wake in a panic, sweaty and anxious. These may occur more frequently during stressful periods of life. They can be associated with anxiety and post-traumatic stress disorder (PTSD). If you experience recurrent bad dreams, these can be very upsetting and lead to disrupted sleep. Some people even develop insomnia, with fear about going to sleep. What can be done?

A surprisingly effective treatment for recurrent nightmares is called dream (or imagery) rehearsal therapy. It is a process by which your dreams can be altered by changing an unhappy ending into a more neutral or positive one. It is accomplished by repeatedly writing out or reviewing the content of the recurrent bad dream during the daytime. This can be done on paper, with a computer, or even just in your mind. Recreate the dream in as much detail as you can recall.

When it comes to the end, write in an alternative outcome that is more favorable.

Let’s explore a few examples of nightmares:

  • “I am in my house by myself at night and I hear a window pane shatter in the back bedroom. It sounds like someone is breaking into my home. I look for my phone to call the police, but I can’t find it. I have to get out of the house. I start to walk quietly towards the front door and I see a dark-clothed figure out of the corner of my eye. The intruder is after me! I run towards the door and I can hear him coming at me. I reach the door, but I can’t get it open. The lock is sticking and in moments the attacker is upon me. I scream out and try to fight him off. I then suddenly wake up, scared to death and drenched in sweat with my heart racing.”
  • “I am walking across my college campus. I realize that I am late for my next class. I pick up my pace and hurry into the building. When I finally arrive to the right room, I realize it is the day of the final examination. I haven’t studied. In fact, I haven’t done any of the required work or attended any of the previous classes. I won’t be able to pass the course. My grade point average will be destroyed, and I’ll never get the job I want after I graduate. I wake up feeling anxious.”

These are two very different scenarios, and you can think about your nightmares and identify their common themes. If a similar dream keeps recurring, it is ripe for changing with dream rehearsal therapy.

Once you have recognized the dream’s content, start by writing out the beginning of the dream. As you reach a critical decision point in the dream, begin to change the ending. In the first example, there are multiple points of potential intervention. Perhaps with a new ending I discover a cell phone in my pocket to summon help, manage to reach the door more quickly, remember to open the deadbolt, or pull a weapon that I can use against the intruder.

In the second example, maybe I grab the required work out of my backpack, realize the examination is simple for me and required no prior study, or remember that I had dropped the course at the start of the quarter and walk out of the room worry free. Each of these endings could be a more favorable outcome to the nightmares.

It is important that you practice rewriting or thinking through your new endings several times per day. This is the rehearsal. You might want to write it up to 5 times over the course of a day. You may want to spend a total of 5 to 20 minutes thinking through the new dream pattern. All you need to do is to repeatedly write, imagine, or visualize the better outcome. This practice reinforces an alternative pathway when your brain starts to recreate the dream scenario during sleep. Rather than experiencing the nightmare’s typical conclusion, you will develop the possibility for the less distressing resolution.

If you have nightmares that persist after attempting dream rehearsal therapy, consider speaking with a sleep specialist. There are certain treatments, including medications like Prazosin, that can prove helpful. If you have coexisting anxiety, PTSD, or other problems, treatment of these conditions may also be important. Some people additionally benefit from learning stress management skills, including relaxation training and scheduled worry time. No matter the cause, get the help you need to stop recurrent nightmares for good.

Sources:

Kellner R et al. “Changes in chronic nightmares after one session of desensitization or rehearsal of instructions.” Am J Psychiatry. 1992;149:659-663.

Krakow B et al. “Imagery Rehearsal Therapy for Chronic Nightmares in Sexual Assault Survivors With Posttraumatic Stress Disorder: A Randomized Controlled Trial.” JAMA. 2001;286(5):537-545.

Krakow BJ et al. “Imagery rehearsal treatment for chronic nightmares.”  Behav Res Ther. 1995;33:837-843.

Neidhardt EJ et al. “The beneficial effects of one treatment session and recording of nightmares on chronic nightmare sufferers.”  Sleep. 1992;15:470-473.

Continue Reading