Researchers from the National Center for Posttraumatic Stress Disorder at the VA Boston Healthcare System and Boston University Medical Center performed a meta-analysis to evaluate the efficacy of imagery rehearsal therapy (IRT) as a treatment for nightmares, general sleep disturbance, and symptoms of post-traumatic stress.

Bibliographic databases and cited references were searched to identify clinical trials of imagery rehearsal in individuals with post-trauma nightmares.

Thirteen studies met inclusion criteria and reported sleep and post-traumatic stress outcomes in sufficient detail to calculate effect sizes.

The results indicate that imagery rehearsal had large effects on nightmare frequency, sleep quality, and PTSD symptoms from the initial to post-treatment assessments. Better yet, these effects were sustained through 6 to 12 months follow-up.

Additionally, interventions for insomnia that included both imagery rehearsal and cognitive behavioral therapy resulted in greater treatment-related improvement in sleep quality than imagery rehearsal alone.

However, the combined treatment (CBT + IRT) did not improve outcomes for PTSD or nightmares.
The investigators suggest that future research should identify necessary and sufficient components of interventions for trauma-related sleep disturbance and post-traumatic stress (e.g., exposure, cognitive reappraisal, sleep and circadian regulation).

Citation:  Casement MD, Swanson LM. A meta-analysis of imagery rehearsal for post-trauma nightmares: effects on nightmare frequency, sleep quality, and posttraumatic stress. Clinical Psychology Review. 2012 Aug;32(6):566-74. doi: 10.1016/j.cpr.2012.06.002. Epub 2012 Jun 30. [email protected]