Confronting Your Nightmares with Imagery Rehearsal Therapy (IRT)

No one enjoys having nightmares. We all experience them at some point in our lives, but for some they can occur so frequently that it may feel like their dreams are consumed by fear, anxiety, or disturbing things. Unfortunately this can spill into our day, and can cause anxiety or irritability. Reclaim your dreams with imagery rehearsal therapy (IRT)!

What is Imagery Rehearsal Therapy?

So now you’re thinking, “Okay, I’ll bite. What is IRT?” IRT is an approach that’s supported by research that falls under the umbrella of cognitive behavioral therapy (CBT). This technique uses a form of cognitive restructuring to lessen the frequency of nightmares, lowers the distress experienced from nightmares, and can lead to better quality sleep. This is done by re-scripting, or rewriting the script to the ending of the nightmare to a more positive one. The point of this is not to pull meaning from the dream or to interpret it. Rather, the aim is to change the script, rehearse it, and ultimately overcome frequently occurring nightmares.

Sweet Dreams

How is it done? The application may vary in different settings, or depending on each individual’s situation or diagnosis. But what you can generally come to expect is to start by writing down the nightmare when you wake up. You then write a more substantial recall of this nightmare, identifying specifics about what is happening, which may include unpleasant sounds, injury, or other unpleasant images, and what lead up to the ending of the dream. The goal is to identify the fear/anxiety or otherwise aversive elements of the dream that are to be replaced along with the non-aversive elements of the nightmare that are to continue in the modified dream. Next the nightmare is modified. This is done by pulling out the identified anxiety/fear inducing or aversive elements and replacing them with neutral or pleasant things. The point is not to reimagine a completely new dream with none of the same elements or content, but to swap the intensely negative pieces that cause fear, anxiety, or other distress for a neutral or positive alternative. Now rewrite the dream, but swap out the negative pieces for positive or neutral ones, and change the ending to a positive one. It can be as outlandish or as realistic as you want. This is your dream! Now the new version of the dream is reimagined. Rehearse that new dream for about 20 minutes a day for a week. Once you are ready to try to change the nightmare, as you’re laying down for bed say to yourself, “If or when the same nightmare starts, I will instead be able to have this much better dream with a positive ending.” Now imagine the new, positively rewritten version in great detail from start to finish, and rehearse the phrase above to again.

Don’t get discouraged if it does not work right away; give it at least 10 nights and rewrite the dream again if you’d like. Keep your counselor/treatment team updated on how it’s going and what you’re trying. Once you successfully change the dream outcome, give yourself a pat on the back! You can continue to use this technique for nightmares you experience, or when you worry they are going to reoccur.

IRT can be a great treatment for recurring nightmares, and is closely ranked in effectiveness as medication intervention. Consult with your counselor and treatment team before going about your IRT journey, especially if your nightmares are rooted in trauma or cause extreme fear. If you experience recurring nightmares and you’re ready to fight back and confront them, talk to your mental health provider about IRT.

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-By Rachel Fox, Counseling Intern