A self-help method for nightmares

Nightmares are extremely frightening dreams from which a person wakes up
directly. Nightmares disturb the sleep and have a negative impact on daily
functioning, mental health, and physical health. Approximately 2-3% of the
Dutch population has a current problem with nightmares. However, treatment is
offered by a few institutions only, and most people do not even know that
nightmares can be treated.
There are two main methods to treat nightmares. Exposure (imagining of the
nightmare scenario) treatment reduces nightmare frequency to a certain degree.
A relative new cognitive-behaviour method, Imagery Rehearsal Therapy (IRT), is
the most effective treatment. (IRT consists of changing the ending of the
nightmare and imagining this during the day.) As IRT is a relatively new
treatment, exposure is still the most commonly used treatment for nightmares in
the mental health care (if any treatment is offered).
Moreover, in the mental health care protocols are used more often. Based on
these protocols self-help methods can be developed. Nightmares seem to be
effectively treated with self-help methods.
Recent evidence suggests that nightmares are treated more effectively by IRT,
and the self-help method needs to get adjusted to this new technique. The
effects of this self-help method (based on IRT) have to be examined and
compared with the most used and already existing self-help treatment, exposure.

The objective of this study is to validate a newly designed self-help treatment
for nightmares. This self-help treatment is based on Imagery Rehearsal Therapy.
This treatment will be validated in comparison to an exposure treatment a diary
condition and a waiting list condition.

This study has an experimental design; the intervention (exposure / IRT) is
manipulated. The effects on nightmare frequency, sleep quality, and mental
complaints are measured. Participants are randomly assigned to one of the four
conditions: two experimental conditions (IRT / exposure) and two control
conditions (diary / waiting list). After eleven weeks the two control groups
get IRT treatment.

In this study two interventions are used. The exposure intervention consists of
re-experiencing the nightmare in imagination. The IRT intervention consists of
altering the nightmare during the day and imagine the changed version of the
nightmare in imagination.

The current study has minimal risks and it is highly unlikely that there will
be lasting negative effects. Participants may experience anxiety during the
treatment, but that is part of the treatment and will eventually fade. We do
not expect any considerable harm. Moreover, the time investment for the
respondents is small (fifteen hours over twelve months). In our view conducting
this study is warranted because of the probable positive effects, the small
time investment, and the low risks.