Nightmares
Chronic nightmares are exhausting. For most, nightmares are a rare event. But for those with a history of trauma, nightmares can be a constant battle.
This makes sleep difficult, which in turn depletes the energy and concentration needed for the day ahead. Eventually the combination of nightmares and lack of restorative sleep can lead to anxiety and depression.1
Several ways to reduce nightmares have been studied and show promise. A recent publication looked at combining two of these interventions. The combined approach is termed Narrative Enhanced Imagery Rehearsal (N-IRT). The results are promising.2
Let's begin by looking at the main elements of this approach. This will help you better understand the rationale that underlies this therapy.
We will end with a look at how you can apply these same principles at home.
Narrative Enhanced Imagery Rehearsal (N-IRT)
Narrative Enhanced Imagery Rehearsal Therapy (N-IRT) is a novel approach to treating chronic nightmares, particularly in veterans with PTSD. Although the focus of this therapy has been with veterans, it applies equally well to anyone suffering from nightmares, especially those associated with PTSD.
N-IRT combines elements of two therapies: Imagery Rehearsal Therapy (IRT) and Narrative Therapy (NT). Patients meet with a therapist one or two times in order to clearly write down the thematic details of reoccurring nightmares.
The next step involves rewriting the “nightmare script” with the aim of injecting new themes. This includes externalizing certain aspects of the problem. For example, instead of discussing “my nightmare” the patient is encouraged to think of it as ‘the nightmare” (to not make it into a personal extension of him or herself).
Metaphors can also be useful to achieve this sort of distancing. Instead of referring to “my reoccurring nightmares” the patient is encouraged to think of it as “a frequent uninvited guest” or even to give the nightmare a name. Again, the idea being to put psychological distance between the nightmare and patient’s core identity.
To help patients gain a greater sense of personal agency, the therapist directs them to select what nightmare they would like to work on and then provides a schedule of mentally rehearsing the positively altered nightmare.
What’s more, patients are told to select each night what nightmare will appear during their sleep. Although this provides no guarantees, it shifts the patient’s frame of reference from being a passive victim haunted by a ruthless nightmare to being the hunter seeking out its tormentor.
This approach is effective because it directly rewires how the brain processes nightmares. Instead of just hoping the nightmares go away, you actively reshape them, while also building a sense of personal agency or control.
Step-by-Step Guide to Using N-IRT for Yourself
Now you know the general rationale for N-IRT. It’s time to move on to look at how you can apply this approach for yourself.
Step 1: Identify Your Recurring Nightmare
Think about the nightmare that bothers you the most. Write down the details, including what happens, who is involved, and how it makes you feel.
Step 2: Rewrite the Nightmare
Now, change the story. Rewrite it in a way that makes you feel strong, in control, and safe. This might include:
• Change the ending so that you overcome the threat.
• Add a protector—someone or something that helps you feel safe.
• If there is a specific tormentor, change them into a pathetic or comical character
• Make the setting brighter, calmer, or more peaceful.
• Give the nightmare a name, one that reinforces the idea that it is not a part of your identity, nor overpowering
Step 3: Rehearse Your New Dream Every Day
Practice visualizing your new, improved version of the dream. Spend 5-10 minutes a day imagining the rewritten dream in vivid detail. The more you do this, the more your brain will start accepting this new version as the dominant one.
Step 4: Write It Down and Read It Before Bed
Keep a notebook near your bed and read over your new dream before sleeping. This helps reinforce the changes and prepares your mind for a more positive dream experience.
Step 5: Check In with Yourself After a Few Weeks
As I’ve written many times before regarding positive psychological change, it seldom occurs all in a flash. Seeing results from your efforts is likely going to take a few weeks.
To make the most of your efforts you need to keep a simple record of the nights when you have had nightmares and rate their intensity (a 0 to 10 scale works well).
Then, set a date to review your progress.
Three or four weeks out from the start of your efforts should work well.
This review should focus on answering the following questions:
• Are my nightmares less frequent?
• Are they less intense?
• When nightmares do occur, do I feel more in control, and less panicked?
• Overall, has my sleep improved?
Summing Up
Nightmares occur for everyone. But when they become chronic (as often happens after trauma) they deserve attention. You need to fight back.
The approach described in this article is straightforward and requires little time to carry out. Yet, early research suggests it can be very effective.
Don’t be held captive by nightmares. Take the time and make the effort to push back in order to win peace of mind and a better night’s sleep.
Reference
1 Sleep Foundation. (2024, May 2). Why We Have Nightmares (And How to Prevent Them). https://www.sleepfoundation.org/nightmares
2 Wagner, A. M., Richards, A., Chiros, C., Thuras, P., Parsons, E. C., Oien, A. D., Schenck, C. H., & Irfan, M. (2023). A retrospective pilot study of imagery rehearsal therapy enhanced with narrative therapy principles for the treatment of nightmares in US military veterans. Sleep Science, 16(4), 439-445.
