Imagery Rescripting Helps Victims Cope With Experienced Injustice

In clinical psychology, imagery rescripting (ImRs) is a promising intervention to target negative emotional memories after victimization experiences. The present research tested the effects of ImRs in “minor” cases of experienced injustice. After imagining being the victim of an injustice, participants ( N = 272) were randomly assigned to one of four conditions in a univariate design (treatment: active ImRs, passive ImRs; control: pleasant imagery, imagery rehearsal). Dependent variables were positive and negative affect; mediator variables were justice-related satisfaction and empowerment. Both justice-related satisfaction and empowerment increased positive and decreased negative affect, but empowerment was higher in the active than in the passive ImRs condition (while justice-related satisfaction was increased by both ImRs conditions). These results suggest that ImRs can be beneficial even in minor victimization experiences and that these beneficial effects are mediated by both empowerment and justice-related satisfaction.

Conquering nightmares on the phone: one-session counseling using imagery rehearsal therapy

Background Since people with nightmares rarely seek help, low-threshold interventions and self-help methods are needed. Among different treatment approaches for nightmares, imagery rehearsal therapy (IRT) is the method of choice. Objective In the current study, the authors tested whether IRT is also effective when applied in a short version, within the scope of a single session of telephone counseling. Methods The nightmare frequency and nightmare distress of 28 participants was investigated before and 8 weeks after one session of telephone counseling. The 30-minute session included information on nightmare etiology as well as a short version of IRT. The session was followed by an 8‑week period of self-practice. Participants were either part of a student group or part of a group of patients from a sleep laboratory. Within-group and between-group differences were assessed. There was no control group. Results The intervention significantly reduced nightmare frequency and nightmare distress in the total sample and in both samples individually analyzed. Effect sizes were very high compared to those of waiting-list control groups of similar studies. Conclusion We were able to show that a one-session intervention can be enough to achieve significant relief from nightmares. As nightmares are underdiagnosed and undertreated, this approach might help to provide a low-threshold intervention for nightmare sufferers.

Imagery Rehearsal Based Art Therapy: Treatment of Post-traumatic Nightmares in Art Therapy

Imagery Rehearsal Therapy (IRT) is effective for trauma-related nightmares and is also a challenge to patients in finding access to their traumatic memories, because these are saved in non-verbal, visual, or audiovisual language. Art therapy (AT) is an experiential treatment that addresses images rather than words. This study investigates the possibility of an IRT-AT combination. Systematic literature review and field research was conducted, and the integration of theoretical and practice-based knowledge resulted in a framework for Imagery Rehearsal-based Art Therapy (IR-AT). The added value of AT in IRT appears to be more readily gaining access to traumatic experiences, living through feelings, and breaking through avoidance. Exposure and re-scripting take place more indirectly, experientially and sometimes in a playlike manner using art assignments and materials. In the artwork, imagination, play and fantasy offer creative space to stop the vicious circle of nightmares by changing theme, story line, ending, or any part of the dream into a more positive and acceptable one. IR-AT emerges as a promising method for treatment, and could be especially useful for patients who benefit least from verbal exposure techniques. This description of IR-AT offers a base for further research.

Alpträume

Das Manual bietet eine strukturierte Anleitung zur Behandlung von Patientinnen und Patienten, die unter häufigen und belastenden Alpträumen leiden. Die Alpträume können alleine auftreten, also ohne weitere komorbide psychische Störungen, oder im Kontext anderer psychischer Störungen, wie z. B. Depressionen, Angststörungen und vor allem der Posttraumatischen Belastungsstörung. Das Verfahren basiert auf der Imagery-Rehearsal-Therapie (IRT), die seit Jahren erfolgreich zur Behandlung von Alpträumen und Posttraumatischen Belastungsstörungen eingesetzt wird. Wesentliche Elemente dieses Therapieansatzes sind die Modifikation des Alptraums in einen nicht bedrohlichen Traum und die Imagination dieses neuen Traumverlaufs. Das Therapieprogramm umfasst acht einstündige Therapiesitzungen im Einzelsetting mit den Elementen Psychoedukation, Entspannung, Imagination und Alptraummodifikation. Die Alptraumtherapie kann für sich alleine durchgeführt oder auch als Zusatztherapie in eine weitere therapeutische Intervention integriert werden. Das Manual liefert eine praxisorientierte Beschreibung des therapeutischen Vorgehens. Das Programm wurde bereits erfolgreich an verschiedenen Patientengruppen durchgeführt und in seiner Wirksamkeit überprüft. Es führt zu einem deutlichen Rückgang der Alptraumhäufigkeit und der Belastung durch Alpträume. Die Neubearbeitung berücksichtigt neue Forschungserkenntnisse und enthält nun zudem ein Kapitel zur Behandlung von Alpträumen bei Kindern und Jugendlichen. Die im Buch erwähnten Arbeitsblätter und Audio-Dateien können nach erfolgter Registrierung von der Hogrefe Website heruntergeladen werden.

1222 Does Creativity & “Dose” Enhance Outcomes in Imagery Rehearsal Therapy? A Case of Successful IRT

Introduction Imagery Rehearsal Therapy (IRT) is an efficacious treatment for Nightmare Disorder. In IRT, patients practice pleasant guided imagery techniques, then use these skills to re-script recurring nightmares, which lowers the frequency and intensity of overall nightmare activity. However, the most efficacious methods and dosage of guided imagery and nightmare re-scripting is undetermined. Report of Case The patient was a 70-year-old male with Nightmare Disorder. Patient denied any precipitating event or trauma associated with nightmare onset. He has a longstanding history of depression and OSA (uses CPAP). He was taking Seroquel, which reduced severity of nightmares but not frequency. Trials of other medications for nightmares had failed (including prazosin, Depakote, and trazodone). Patient presented as highly distressed, exhibited distrust towards medical providers, and was skeptical about the effectiveness of IRT. Despite his skepticism, patient self-initiated very detailed and media-enhanced methods for pleasant guided imagery and nightmare re-scripting, including written narratives, voice recordings, and created a movie of his re-scripted nightmare with pictures set to music. He listened to the recordings 2-3x/day. Themes of nightmares included lack of mastery over problems; patient’s re-scripted dreams put him back in control of frightening scenarios. Nightmare logs at baseline showed sleep quality=1.9/5; average=2.0 nightmares/night; average intensity= 6.2/10. At week 15 of treatment, sleep quality=3/5; nightmares/night average=0.25; average intensity=6/10. Sleep disturbance also improved (ISI=18-moderately severe clinical insomnia to 11-subthreshold insomnia); mood was stable (PHQ=5-mild depression). Conclusion Previous studies have suggested that IRT increases patients’ sense of mastery or perceived self-efficacy over nightmares (Rousseau et al., 2018). Additionally, higher verbal memory in persons with trauma-related nightmares has been shown to improve nightmare frequency and severity in IRT (Scott et al., 2017). In this case study, self-efficacy may have been activated by the highly detailed and media-enhanced imagery the patient created. Further empirical research on the mechanisms for enhancing IRT is warranted.