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Treating your worst nightmare: a case-series of imagery rehearsal therapy for nightmares in individuals experiencing psychotic symptoms

Published online by Cambridge University Press:  05 November 2015

Bryony Sheaves ,
Juliana Onwumere ,
Nadine Keen  and
Elizabeth Kuipers
Bryony Sheaves*
Affiliation:
Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
Juliana Onwumere
Affiliation:
Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Nadine Keen
Affiliation:
Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK PICuP Clinic, South London and Maudsley NHS Foundation Trust, Clinical Treatment Centre, Maudsley Hospital, London, UK
Elizabeth Kuipers
Affiliation:
Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, Beckenham, UK
*
*Author for correspondence: Dr B. Sheaves, Department of Psychiatry, University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX (email: [email protected]).
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Abstract

Previous research has indicated that nightmares might be a common problem for people with psychotic symptoms. Furthermore, more distressing nightmares have been associated with higher levels of delusional severity, depression, anxiety, stress and working memory. However no known research has investigated the use of nightmare treatments in those with symptoms of psychosis. This study aimed to assess the acceptability and feasibility of using imagery rehearsal (IR) therapy as a treatment of nightmares for those presenting with co-morbid psychotic symptoms. Six participants presenting with frequent distressing nightmares and psychotic symptoms were recruited. Five participants attended 4–6 sessions of IR. Measures of nightmares, sleep quality, psychotic and affective symptoms were completed at baseline and immediately following the intervention. It was feasible to adapt IR for those experiencing psychotic symptoms. Descriptive improvements were noted on measures of nightmare-related distress, vividness and intensity. Positive post-session feedback endorsed the acceptability of IR. Nightmare frequency did not reduce following IR; however, participants described a change in emotional response. IR was an acceptable and feasible intervention for this small sample. A larger study powered to detect group changes, with an additional control is warranted to test the efficacy of the intervention for those with psychosis.

Keywords

CBTimagery rehearsalnightmarespsychosis
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 8 , 2015 , e27
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2015 

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References

Recommended follow-up reading

Casement, MD, Swanson, LM (2012). A meta-analysis of imagery rehearsal for post-trauma nightmares: effects on nightmare frequency, sleep quality, and posttraumatic stress. Clinical Psychology Review 32, 566–574.Google Scholar
Sheaves, B, Onwumere, J, Keen, N, Stahl, D, Kuipers, E (2015). Nightmares in patients with psychosis: the relation with sleep, psychotic, affective and cognitive symptoms. Canadian Journal of Psychiatry 60, 354–361.CrossRefGoogle ScholarPubMed

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