Hostname: page-component-77f85d65b8-2tv5m Total loading time: 0 Render date: 2026-04-12T14:31:21.436Z Has data issue: false hasContentIssue false
  • English
  • Français

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: bryony.sheaves@psych.ox.ac.uk).
Get access Rights & Permissions [Opens in a new window]

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

Information

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

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

References

Afonso, P, Figueira, ML, Paiva, T (2014). Sleep-wake patterns in schizophrenia patients compared to healthy controls. World Journal of Biological Psychiatry 15, 517–524.Google Scholar
Aurora, RN, Zak, RS, Auerbach, SH, Casey, KR, Chowdhuri, S, Karippot, A, Maganti, RK, Ramar, K, Kristo, DA, Bista, SR, Lamm, CI, Morgenthaler, TI (2010). Best practice guide for the treatment of nightmare disorder in adults. Journal of Clinical Sleep Medicine 6, 389–401.Google Scholar
Barkham, M, Bewick, B, Mullin, T, Gilbody, S, Connell, J, Cahill, J, Mellor-Clark, J, Richards, D, Unsworth, G, Evans, C (2013). The CORE-10: a short measure of psychological distress for routine use in the psychological therapies. Counselling and Psychotherapy Research 13, 3–13.CrossRefGoogle Scholar
Barkham, M, Gilbert, N, Connell, J, Marshall, C, Twigg, E (2005). Suitability and utility of the CORE-OM and CORE-A for assessing severity of presenting problems in psychological therapy services based in primary and secondary care settings. British Journal of Psychiatry 186, 239–246.Google Scholar
Birchwood, M, Meaden, A, Trower, P, Gilbert, P, Plaistow, J (2000). The power and omnipotence of voices: subordination and entrapment by voices and significant others. Psychological Medicine 30, 337–334.Google Scholar
Buysse, DJ, Reynolds III, CF, Monk, TH, Berman, SR, Kupfer, DJ (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research 28, 193–213.Google Scholar
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
Cohrs, S (2008). Sleep disturbances in patients with schizophrenia: impact and effect of antipsychotics. CNS Drugs 22, 939–62.Google Scholar
Connell, J, Barkham, M (2007). CORE-10 User Manual, Version 1.1. CORE System Trust & CORE Information Management Systems Ltd.Google Scholar
Davis, JL, Rhudy, JL, Pruiksma, KE, Byrd, P, Williams, AE, McCabe, KM, Bartley, EJ (2011). Physiological predictors of response to exposure, relaxation, and rescripting therapy for chronic nightmares in a randomized clinical trial. Journal of Clinical Sleep Medicine 7, 622–631.CrossRefGoogle ScholarPubMed
Drake, R, Haddock, G, Tarrier, N, Bentall, R, Lewis, S (2007). The Psychotic Symptom Rating Scales (PSYRATS): their usefulness and properties in first episode psychosis. Schizophrenia Research 89, 119–122.CrossRefGoogle ScholarPubMed
Duggan, C, Parry, G, McMurran, M, Davidson, K, Dennis, J (2014). The recording of adverse events from psychological treatments in clinical trials: evidence from a review of NIHR-funded trials. Trials 15, 1–9.Google Scholar
Foa, EB, Cashman, L, Jaycox, L, Perry, K (1997). The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. Psychological Assessment 9, 445–451.Google Scholar
Fowler, D, Garety, P, Kuipers, E (1995). Cognitive Behaviour Therapy for Psychosis. Chichester: John Wiley & Sons.Google Scholar
Greenfield, SF, Strakowski, SM, Tohen, M, Batson, SC, Kolbrener, ML (1994). Childhood abuse in first-episode psychosis [published Erratum appears in British Journal of Psychiatry 1994, 165, 415]. British Journal of Psychiatry 164, 831–834.Google Scholar
Haddock, G, McCarron, J, Tarrier, N, Faragher, EB (1999). Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psychological Medicine 29, 879–889.CrossRefGoogle ScholarPubMed
Holowka, DW, King, S, Saheb, D, Pukall, M, Brunet, A (2003). Childhood abuse and dissociative symptoms in adult schizophrenia. Schizophrenia Research 60, 87–90.Google Scholar
Huppert, JD, Smith, TE, Apfeldorf, WJ (2002). Use of self-report measures of anxiety and depression in outpatients with schizophrenia: reliability and validity. Journal of Psychopathology and Behavioural Assesment 24, 275–283.Google Scholar
Ison, R, Medoro, L, Keen, N, Kuipers, E (2014). The use of rescripting imagery for people with psychosis who hear voices. Behavioural and Cognitive Psychotherapy 42, 129–142.CrossRefGoogle ScholarPubMed
Jacobson, NS, Truax, P (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology 59, 12–19.Google Scholar
Janson, C, Gislason, T, De Backer, W, Plaschke, P, Björnsson, E, Hetta, J, Kristbjarnason, H, Vermeire, P, Boman, G (1995). Prevalence of sleep disturbances among young adults in three european countries. Sleep 18, 589–597.Google Scholar
Leskin, GA, Woodward, SH, Young, HE, Sheikh, JI (2002). Effects of comorbid diagnoses on sleep disturbance in PTSD. Journal of Psychiatric Research 36, 449–452.CrossRefGoogle ScholarPubMed
Levin, R, Fireman, G (2002). Nightmare prevalence, nightmare distress, and self-reported psychological disturbance. Sleep 25, 205–212.Google Scholar
Li, SX, Zhang, B, Li, AM, Wing, YK (2010). Prevalence and correlates of frequent nightmares: a community-based 2-phase study. Sleep 33, 774–780.Google Scholar
Long, ME, Hammons, ME, Davis, JL, Frueh, BC, Khan, MM, Elhai, JD, Teng, EJ (2011). Imagery rescripting and exposure group treatment of posttraumatic nightmares in Veterans with PTSD. Journal of Anxiety Disorders 25, 531–535.CrossRefGoogle ScholarPubMed
Lovibond, SH, Lovibond, PF (1995). Manual for the Depression Anxiety Stress Scales. Sydney: Psychology Foundation.Google Scholar
Morrison, AP (2004). The use of imagery in cognitive therapy for psychosis: a case example. Memory 12, 517–524.Google Scholar
MRC (2000). A framework for development and evaluation of RCT's for complex interventions to improve health. London: Medical Research Council.Google Scholar
Nappi, CM, Drummond, SPA, Thorp, SR, McQuaid, JR (2010). Effectiveness of imagery rehearsal therapy for the treatment of combat-related nightmares in veterans. Behavior Therapy 41, 237–44.Google Scholar
Neylan, TC, Marmar, CR, Metzler, TJ, Weiss, DS, Zatzick, DF, Delucchi, KL, Wu, RM, Schoenfeld, FB (1998). Sleep disturbances in the Vietnam generation: findings from a nationally representative sample of male Vietnam veterans. American Journal of Psychiatry 155, 929–933.Google Scholar
Nielsen, T, Levin, R (2007). Nightmares: a new neurocognitive model. Sleep Medicine Reviews 11, 295–310.Google Scholar
Pigeon, WR, Pinquart, M, Conner, K (2012). Meta-analysis of sleep disturbance and suicidal thoughts and behaviors. Journal of Clinical Psychiatry 73, e1160–1167.Google Scholar
Schulze, K, Freeman, D, Green, C, Kuipers, E (2013). Intrusive mental imagery in patients with persecutory delusions. Behaviour Research and Therapy 51, 7–14.CrossRefGoogle ScholarPubMed
Semiz, UB, Basoglu, C, Ebrinc, S, Cetin, M (2008). Nightmare disorder, dream anxiety, and subjective sleep quality in patients with borderline personality disorder. Psychiatry and Clinical Neurosciences 62, 48–55.Google Scholar
Serruya, G, Grant, P (2009). Cognitive-behavioral therapy of delusions: mental imagery within a goal-directed framework. Journal of Clinical Psychology 65, 791–802.Google Scholar
Shaw, K, McFarlane, AC, Bookless, C, Air, T (2002). The aetiology of postpsychotic posttraumatic stress disorder following a psychotic episode. Journal of Traumatic Stress 15, 39–47.Google Scholar
Sheaves, B, Onwumere, J, Keen, N, Stahl, D, Kuipers, E (2015). Nightmares in patients with psychosis: the relationship with sleep, psychotic, affective and cognitive symptoms. Canadian Journal of Psychiatry 60, 354–361.Google Scholar
Ward, T (2010). Evaluation of the use of the ‘Clinical Outcomes in Routine Evaluation – Outcome Measure’ (CORE-OM) with clients with severe and enduring mental illness (unpublished report).Google Scholar
Wulff, K, Dijk, D-J, Middleton, B, Foster, RG, Joyce, EM (2012). Sleep and circadian rhythm disruption in schizophrenia. British Journal of Psychiatry 200, 308–316.Google Scholar
Submit a response

Comments

No Comments have been published for this article.