Imagery Rehearsal

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Category: Allied Health Options

What is it?

Imagery rehearsal is a cognitive behavioural technique commonly used to treat post traumatic nightmares. It involves story line alteration of the nightmare in the waking state, followed by rehearsal of the new set of images.

How does it work?

The primary focus in imagery rehearsal is to help clients sleep better by teaching them how to eliminate disturbing dreams. By decreasing bad dreams and improving sleep quality, PTSD patients improve daytime energy which facilitates coping with other symptoms. If sleep problems are addressed, it might facilitate, enhance or maximise therapeutic outcomes. Specifically, imagery rehearsal impresses on clients that they can control their nightmares and hence these can be remedied or alleviated.

Is it effective?

Studies that examined the use of imagery rehearsal to treat post traumatic nightmares experienced by patients with PTSD include findings of short term reductions in chronic nightmares, as well as improved sleep quality and overall PTSD symptoms among sexual assault survivors. Similar resultss were demonstrated in another trial which involved Australian veterans with chronic combat-related PTSD. Positive long term results were likewise reported when a follow-up was conducted on this trial.

There is a growing evidence base to support the use of Imagery Rehearsal therapy to treat post traumatic nightmares. However, further trials which are of good quality are required before any definite conclusions on its effectiveness can be drawn.

Are there any disadvantages?

One of the studies reported patients who discontinued the therapy after experiencing increased negative imagery. Imagery rehearsal may be offered as part of, or in combination with, other interventions for PTSD.

Where do you get it?

Imagery rehearsal can only be administered by a registered mental health professional.

What are the evidence limitations?

The evidence taken from the recent studies mentioned above highlights a number of limitations, including that study participants were not diagnosed using DSM-IV criteria. There was a relatively large rate of non-completion for participants in one of the studies, which may also inflated treatment effects. In the other small study, influences such as life events, or other treatment potentially provided to the participants throughout duration of the trial were not considered in the analysis. Therefore this evidence should be interpreted with caution.

Recommendations

While the evidence base for this treatment is limited, the results are promising. More research is needed to strengthen current evidence and identify if imagery rehearsal is useful as a stand alone therapy or where used in conjunction with exposure.

Key References

Forbes, D, Phelps, A, McHugh, T 2001, ‘Treatment of combat-related nightmares using imagery rehearsal: A pilot study’, Journal of Traumatic Stress, vol. 14, no. 2, pp. 433-442.

Forbes, D, Phelps, A, McHugh, T, et al. 2001, ‘Imagery rehearsal in the treatment of post traumatic nightmares in Australian veterans with chronic combat-related PTSD: 12-month follow-up data’, Journal of Traumatic Stress, vol. 16, no. 5, pp. 509-513.

Krakow, B, Hollifield, M, Johnston, L, et al. 2000, ‘Imagery Rehearsal Therapy for chronic nightmares in sexual assault survivors with post traumatic stress disorder’, Journal of American Medical Association, vol. 286. No. 5, pp. 537-545.

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