Easing Nightmares Can Help Treat Depression and Other Maladies

Some psychology experts say that treating disturbing nightmares directly can help relieve symptoms of depression, post-traumatic stress disorder, insomnia, and other mental health problems.

Kim Painter of USA Today writes that when Yael Levy went to the Sleep-Wake Disorders Center at Montefiore Medical Center two years ago for help with her insomnia, she found that her nightmares were also treatable. Levy knew she had conquered her life-long nightmares the night she was able to turn a circle of sharks into a ring of dolphins. “I was able to change my nightmare while it was happening,” said the 29-year-old New York City graduate student. “I had control over my dreams.”

Shelby Freedman Harris, who helped treat Levy, said that addressing nightmares directly may help ease depression and other ills. “Traditionally, the idea was that you treat the main problem first and the nightmares will go away,” said Harris. “With depression, often the nightmares and sleep disturbances are the last symptoms to go.”

“In the past, the nightmares weren’t targeted specifically,” said Bret Moore, a former Army psychologist who now practices in Wilston, North Dakota. But when Moore treated soldiers for acute post-traumatic stress in Iraq, he found that many of them were plagued by disturbing nightmares. Using the same techniques Harris uses, he was often able to help.

The treatment is called imagery rehearsal therapy (IRT), and is a form of cognitive behavioral therapy, which focuses on changing harmful thought patterns. It’s not the only nightmare therapy, but it is gaining ground, said physician Barry Krakow, a sleep specialist who developed IRT and runs the Maimonides International Nightmare Treatment Center in Albuquerque.

In a 2001 study published in the Journal of the American Medical Association, Krakow found that sexual assault survivors had fewer nightmares, slept better, and saw improvements in other symptoms of PTSD after the treatment.

While undergoing IRT, patients meet with a therapist several times, and learn that persistent nightmares are like bad habits that can be unlearned. The patient then picks a nightmare and writes it down or tells the therapist about it. The patient is then instructed to rewrite the script for that nightmare and then practice the rewritten script repeatedly in his or her mind, fully engaging her waking imagination.

Harris said that when the treatment works, nightmares can quickly recede. The secret, she said, seems to be gaining a sense of control. She recalled one small boy: “He kept having nightmares that someone was chasing him, and just before they would catch him, he would wake up.” In his rewrite, the chase moved to “Hershey-land,” and the chaser “turned into a guy made out of chocolate.” In a twist, the boy had the chocolate man eaten by chocolate bunnies. “He just made it his own,” Harris said, and the nightmares stopped.

There is still hope.

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