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Rewrite the nightmare's ending
Nightmares and PTSD
In sleep research, a nightmare is a dream bad enough to wake the sleeper, usually scared. Recurring nightmares are common among veterans and others with PTSD, and they are one of the criteria for diagnosing it. A 1998 study found that 2 to 8 percent of adults have problematic nightmares, compared with 52 percent of Vietnam veterans.
Rewriting the ending
For someone with PTSD, the nightmare is the event that caused it, relived over and over every night. The therapy built for that takes the same approach as dream incubation: the person is trained to change how the dream ends, with the attacker fought off or the scene suddenly shifting to home and peace. The same method can be used by anyone with recurring bad dreams, and the person never has the nightmare again.
What nightmares cost
Frequent nightmares can bring sleep deprivation and can interfere with normal routines, jobs, and relationships.
Why do PTSD nightmares keep repeating?
In PTSD, the amygdala stays hyperactive while the prefrontal cortex does less to calm it, so reminders of the event keep triggering fear responses. Sleep researcher Matthew Walker of the University of California, Berkeley has proposed that REM sleep works as overnight therapy, replaying emotional memories while norepinephrine, the brain's stress chemical, is at its lowest, so the memory loses its sting. In PTSD that process is thought to fail, and the memory is replayed with its fear intact. The result is a dream that reruns the event instead of softening it.
Where did imagery rehearsal therapy come from?
Sleep physician Barry Krakow and colleagues developed imagery rehearsal therapy in the 1990s for people with chronic nightmares. A 2001 trial of theirs, published in the Journal of the American Medical Association, tested it in trauma survivors with PTSD and reported fewer nightmares afterward. The method rests on the observation that a recurring nightmare behaves like a script, and a script can be revised while awake. It has since been studied in veterans and in people with nightmare disorder.
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