The purpose of this study is to determine whether Imagery Rehearsal Therapy(IRT) is effective in the reduction of the number of nightmares and the nightmare distress in a population of patients with psychiatric disorders.
Within the normal population 4-8% of the people suffer regularly from nightmares. Clinical observations show that nightmares are a common problem for patients who suffer from all kinds of psychiatric disorders, and not just for the patients diagnosed with PTSD. Often nightmares can lead to sleep disorders, which have a negative impact on emotional well-being and cognitive functioning during the day. As well as this a strong relationship between severity of nightmares and severity of psychopathology has been found. This gives a strong argument for treatment of nightmares as a symptom, separate from the psychiatric disorder. A few controlled studies of the treatment of nightmares have been published, in which behavioral therapy, relaxation techniques, exposure and systematic desensitization have been studied, all of which have shown positive results. But these techniques do not seem to reduce the number of nightmares in patients who suffer from PTSD. These last few years more controlled studies of a cognitive behavioral technique called 'Imagery Rehearsal Therapy' (IRT) have been published. With IRT patients have to change the script of their nightmares into a different outcome, and rehearse this new script using cognitive imagery a few times a day. Comparisons: treatment of nightmares with IRT compared to a waitlist control group who do not get IRT until 6 months later.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
112
Imagery Rehearsal Therapy is given by psychologists, psychotherapists or psychiatrists. The IRT therapists are all trained by Annette van Schagen, principal investigator. IRT consists of six 1-hour sessions. The six sessions are given in a period of three months. Each session is described in the IRT Manual. The IRT Manual is devised by the principal investigator Annette van Schagen in colaboration with Victor Spoormaker PhD. There is a patient version of the IRT manual available for the patients, which includes descriptions of the IRT sessions and homework assignments.
GGZ Centraal, De Meregaard
Almere Stad, Netherlands
GGZ Centraal, Zon & Schild
Amersfoort, Netherlands
GGZ Centraal, De Rembrandthof
Hilversum, Netherlands
Frequency of nightmares scored in prospective daily nightmare logs
Time frame: Daily logs for 18 weeks, then periods of 4 weeks every 3 months
Frequency of nightmares scored on the Nightmare Frequency Questionnaire
Time frame: At beginning of trial, 4, 16, 30, 42 and 56 weeks
Intensity of nightmares scored in prospective daily nightmare logs
Time frame: Daily logs for 18 weeks, then periods of 4 weeks every 3 months
Effects of nightmares scored on the Nightmare Effects Survey
Time frame: 1, 4, 16, 30, 42 and 56 weeks
Nightmare distress scored on the Nightmare Distress Questionnaire
Time frame: 1, 4, 16, 30, 42 and 56 weeks
Sleep problems scored on the SLEEP-50
Time frame: 1, 4, 16, 30, 42 and 56 weeks
Psychiatric symptoms scored on the Symptom Check List (SCL-90)
Time frame: 1, 4, 16, 30, 42 and 56 weeks
Symptoms of post-traumatic stress disorder scored on the Zelf Inventarisatie Lijst PTSS ZIL (= PTSD Inventory)
Time frame: 1, 4, 16, 30, 42 and 56 weeks
Quality of life scored on the abbreviated World Health Organization Quality of Life scale (WHOQoL-Bref)
Time frame: 1, 4, 16, 30, 42 and 56 weeks
Nightmare efficacy and content measured by Nightmare Efficacy & Content Questionnaire
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Time frame: 1, 4, 16, 30, 42 and 56 weeks