Imagery Rehearsal Therapy: Principles and Practice

C 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 U N C O R R E Many clinicians in sleep medicine, psychiatry, and psychology remain unaware of the suffering and distress caused by chronic nightmares. This lack of awareness extends to the therapeutic tools that effectively reduce or eliminate the problem. Many nonpharmacologic techniques have been proposed to treat posttraumatic stress disorder (PTSD)–related or idiopathic nightmares, including hypnosis, lucid dreaming, eye movement desensitization and reprocessing, desensitization, and imagery rehearsal therapy (IRT). However, only desensitization and IRT have been the objects of controlled studies, and IRT has received the most empirical support. This article highlights key principles behind this technique and the practice methods used to apply it by presenting an abridged and updated version of an earlier work. Further resources are also available to readers interested in additional material on the clinical use of IRT. For those patients in whom IRT may be impractical or counterproductive, pharmacotherapy (eg, prazosin, a central a-1 adrenoreceptor blocker) may be a useful alternative therapeutic option for PTSD-related nightmares. Readers interested in pharmacologic approaches to nightmare treatment and the issue of drug-induced nightmares are referred to the article by Pagel in this issue.