{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T15:08:14Z","timestamp":1783696094249,"version":"3.55.0"},"reference-count":27,"publisher":"Georg Thieme Verlag KG","issue":"04","license":[{"start":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T00:00:00Z","timestamp":1700611200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sleep Sci"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Introduction\u2003Chronic nightmares are a common and disabling feature of posttraumatic stress disorder (PTSD) for which broadly effective treatments are still lacking. While imagery rehearsal therapy (IRT) demonstrates benefits for patients with idiopathic nightmares and some patients with PTSD-related nightmares, research indicates it may be less beneficial for veterans. Narrative therapy (NT) is a form of psychotherapy which is client-centered and value-focused and has demonstrated benefits for PTSD patients. The application of NT principles to IRT may provide a valuable therapeutic approach for treatment in veterans.<\/jats:p><jats:p>\n          Objective\u2003To perform a retrospective chart review of veteran clients participating in a novel, brief intervention developed by the first author consisting of IRT enhanced with NT principles (N-IRT) for the treatment of nightmares. The primary outcomes were nightmare frequency and intensity, and the secondary outcome was the impact of the intervention on nightmare distress and coping, subjective sleep quality, and overall PTSD symptoms.<\/jats:p><jats:p>\n          Materials and Methods\u2003We conducted retrospective chart reviews for eight veterans referred to the first author for the treatment of nightmares, who completed N-IRT, including baseline and end-of-treatment measures. The protocol involved a single 60-minute NT-enhanced rescripting session and assigned homework to rehearse the revised dream script, and a follow-up evaluation 4 weeks later. The subjects completed a sleep and nightmare interview developed by the first author and the PTSD Checklist at baseline and after the intervention at the follow-up evaluation. Paired t-tests were conducted to test for pre-to-post differences.<\/jats:p><jats:p>\n          Results\u2003In the statistical analysis, we observed a statistically significant and clinically meaningful reduction in the frequency (p\u2009=\u20090.04) and intensity of nightmares (p\u2009=\u20090.001) from pretreatment to the 1-month follow-up. Measures of nightmare-associated emotional distress, the ability to cope with nightmares, sleep duration and sleep efficiency, as well as overall PTSD symptoms also demonstrated significant improvements.<\/jats:p><jats:p>\n          Conclusion\u2003These pilot data provide compelling preliminary evidence that a single-session IRT intervention modified with NT (N-IRT) is effective in reducing nightmare frequency and intensity, reducing nightmare distress, improving the act of coping with nightmares, and improving sleep quality and overall PTSD symptoms in veterans. Further investigation of this method with gold-standard clinical trial designs and larger sample sizes is indicated to confirm effectiveness and to better understand the possible mechanisms of treatment effect.<\/jats:p>","DOI":"10.1055\/s-0043-1776796","type":"journal-article","created":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T23:32:03Z","timestamp":1700695923000},"page":"e439-e445","source":"Crossref","is-referenced-by-count":5,"title":["A Retrospective Pilot Study of Imagery Rehearsal Therapy Enhanced with Narrative Therapy Principles for the Treatment of Nightmares in US Military Veterans"],"prefix":"10.1055","volume":"16","author":[{"given":"Ann Marie","family":"Wagner","sequence":"additional","affiliation":[{"name":"Mental Health Services, Minneapolis Veteran's Affairs (VA) Health Care System, Minneapolis, MN, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Richards","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States of America"},{"name":"Mental Health Services, San Francisco Veteran's Affairs (VA) Health Care System, San Francisco, CA, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Chiros","sequence":"additional","affiliation":[{"name":"Mental Health Services, Minneapolis Veteran's Affairs (VA) Health Care System, Minneapolis, MN, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0888-3074","authenticated-orcid":false,"given":"Paul","family":"Thuras","sequence":"additional","affiliation":[{"name":"Mental Health Services, Minneapolis Veteran's Affairs (VA) Health Care System, Minneapolis, MN, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth C.","family":"Parsons","sequence":"additional","affiliation":[{"name":"Pulmonary and Critical Care, Puget Sound Veteran's Affairs (VA) Health Care System, Seattle, WA, United States of America"},{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, University of Washington, Seattle, Washington, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela D.","family":"Oien","sequence":"additional","affiliation":[{"name":"Pulmonary and Critical Care, Puget Sound Veteran's Affairs (VA) Health Care System, Seattle, WA, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos H.","family":"Schenck","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Minnesota Regional Sleep Disorders Center, Minneapolis, MN, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muna","family":"Irfan","sequence":"additional","affiliation":[{"name":"Pulmonary, Allergy, Critical Care and Sleep, Minneapolis Veteran's Affairs (VA) Health Care System, Minneapolis, MN, United States of America"},{"name":"Department of Neurology, Medical School, University of Minnesota, Minneapolis, MN, United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,11,22]]},"reference":[{"issue":"07","key":"ref1","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1176\/ajp.155.7.929","article-title":"Sleep disturbances in the Vietnam generation: findings from a nationally representative sample of male Vietnam veterans","volume":"155","author":"T C Neylan","year":"1998","journal-title":"Am J Psychiatry"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1016\/S0022-3956(02)00025-0","article-title":"Effects of comorbid diagnoses on sleep disturbance in PTSD","volume":"36","author":"G A Leskin","year":"2002","journal-title":"J Psychiatr Res"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1192\/bjp.147.1.67","article-title":"Therapeutic manipulation of nightmares and the management of neuroses","volume":"147","author":"N Bishay","year":"1985","journal-title":"Br J Psychiatry"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.5664\/jcsm.7178","article-title":"Position Paper for the Treatment of Nightmare Disorder in Adults: An American Academy of Sleep Medicine Position Paper","volume":"14","author":"T I Morgenthaler","year":"2018","journal-title":"J Clin Sleep Med"},{"issue":"04","key":"ref5","doi-asserted-by":"crossref","first-page":"e12820","DOI":"10.1111\/jsr.12820","article-title":"Aetiology and treatment of nightmare disorder: State of the art and future perspectives","volume":"28","author":"A Gieselmann","year":"2019","journal-title":"J Sleep Res"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.beth.2009.03.003","article-title":"Effectiveness of imagery rehearsal therapy for the treatment of combat-related nightmares in veterans","volume":"41","author":"C M Nappi","year":"2010","journal-title":"Behav Ther"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1207\/s15402010bsm0401_4","article-title":"Clinical management of chronic nightmares: imagery rehearsal therapy","volume":"4","author":"B Krakow","year":"2006","journal-title":"Behav Sleep Med"},{"issue":"10","key":"ref8","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1002\/jclp.21970","article-title":"Efficacy of a cognitive-behavioral treatment for insomnia and nightmares in Afghanistan and Iraq veterans with PTSD","volume":"69","author":"S O Margolies","year":"2013","journal-title":"J Clin Psychol"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1207\/S15402010BSM0103_2","article-title":"Impact of imagery rehearsal treatment on distressing dreams, psychological distress, and sleep parameters in nightmare patients","volume":"1","author":"A Germain","year":"2003","journal-title":"Behav Sleep Med"},{"issue":"05","key":"ref10","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1001\/jama.286.5.537","article-title":"Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: a randomized controlled trial","volume":"286","author":"B Krakow","year":"2001","journal-title":"JAMA"},{"issue":"04","key":"ref11","doi-asserted-by":"crossref","first-page":"389","DOI":"10.5664\/jcsm.27883","article-title":"Best practice guide for the treatment of nightmare disorder in adults","volume":"6","author":"R N Aurora","year":"2010","journal-title":"J Clin Sleep Med"},{"issue":"05","key":"ref12","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1002\/jts.20569","article-title":"Imagery rehearsal for posttraumatic nightmares: a randomized controlled trial","volume":"23","author":"J M Cook","year":"2010","journal-title":"J Trauma Stress"},{"issue":"02","key":"ref13","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1002\/jts.20199","article-title":"Randomized clinical trial for treatment of chronic nightmares in trauma-exposed adults","volume":"20","author":"J L Davis","year":"2007","journal-title":"J Trauma Stress"},{"key":"ref14","volume-title":"Narrative Means to Therapeutic Ends","author":"M White","year":"1990"},{"key":"ref15","volume-title":"What is Narrative Therapy? An Easy-to-Read Introduction","author":"A Morgan","year":"2000"},{"issue":"06","key":"ref16","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1002\/jts.21966","article-title":"A pilot examination of the use of narrative therapy with individuals diagnosed with PTSD","volume":"27","author":"C R Erbes","year":"2014","journal-title":"J Trauma Stress"},{"key":"ref17","volume-title":"Narrative Therapy Trauma Manual: A Principle-Based Approach","author":"J R Stillman","year":"2010"},{"issue":"08","key":"ref19","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/0005-7967(96)00033-2","article-title":"Psychometric properties of the PTSD Checklist (PCL)","volume":"34","author":"E B Blanchard","year":"1996","journal-title":"Behav Res Ther"},{"issue":"01","key":"ref20","doi-asserted-by":"crossref","first-page":"e2136921","DOI":"10.1001\/jamanetworkopen.2021.36921","article-title":"Comparison of Prolonged Exposure vs Cognitive Processing Therapy for Treatment of Posttraumatic Stress Disorder Among US Veterans: A Randomized Clinical Trial","volume":"5","author":"P P Schnurr","year":"2022","journal-title":"JAMA Netw Open"},{"key":"ref21","first-page":"3","volume-title":"Emotional Processing Theory: An Update.","author":"E B Foa","year":"2006"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.smrv.2017.08.004","article-title":"The mechanisms of action underlying the efficacy of psychological nightmare treatments: A systematic review and thematic analysis of discussed hypotheses","volume":"39","author":"A Rousseau","year":"2018","journal-title":"Sleep Med Rev"},{"issue":"01","key":"ref23","doi-asserted-by":"crossref","first-page":"2","DOI":"10.2307\/2136319","article-title":"The structure of coping","volume":"19","author":"L I Pearlin","year":"1978","journal-title":"J Health Soc Behav"},{"issue":"03","key":"ref24","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1097\/HRP.0000000000000185","article-title":"Functional Neuroanatomy of Emotion and Its Regulation in PTSD","volume":"26","author":"J M Fitzgerald","year":"2018","journal-title":"Harv Rev Psychiatry"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"221","DOI":"10.3389\/fpsyg.2014.00221","article-title":"The common and distinct neural bases of affect labeling and reappraisal in healthy adults","volume":"5","author":"L J Burklund","year":"2014","journal-title":"Front Psychol"},{"issue":"05","key":"ref26","doi-asserted-by":"crossref","first-page":"869","DOI":"10.3758\/s13415-022-01013-z","article-title":"The power of negative and positive episodic memories","volume":"22","author":"S E Williams","year":"2022","journal-title":"Cogn Affect Behav Neurosci"},{"issue":"01","key":"ref27","first-page":"1","article-title":"Narrative therapy and interpersonal neurobiology: Revisiting classic practices, developing new emphases","volume":"30","author":"M NZJ Beaudoin","year":"2011","journal-title":"J Syst Ther"},{"issue":"02","key":"ref28","first-page":"12","article-title":"Neuro-narrative therapy: brain science, narrative therapy, poststructuralism, and preferred identities","volume":"36","author":"J Zimmerman","year":"2017","journal-title":"J Syst Ther"}],"container-title":["Sleep Science"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0043-1776796.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T23:34:12Z","timestamp":1700696052000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0043-1776796"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,22]]},"references-count":27,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2023,11,22]]},"published-print":{"date-parts":[[2023,12]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0043-1776796","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1984-0659","1984-0063"],"issn-type":[{"value":"1984-0659","type":"print"},{"value":"1984-0063","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,22]]}}}