|
JAMA. 2001 Aug 1;286(5):537-45.
Comment in:
JAMA. 2001 Aug 1;286(5):584-8.
Imagery rehearsal therapy for chronic nightmares
in sexual assault survivors with posttraumatic stress disorder: a randomized controlled
trial.
Krakow B, Hollifield M, Johnston L, Koss M, Schrader R, Warner TD, Tandberg D,
Lauriello J, McBride L, Cutchen L, Cheng D, Emmons S, Germain A, Melendrez D,
Sandoval D, Prince H.
Sleep & Human Health Institute, 4775 Indian School Rd NE, Suite 305, Albuquerque,
NM 87110, USA. bkrakow@salud.unm.edu
CONTEXT: Chronic nightmares occur frequently in patients with posttraumatic
stress disorder (PTSD) but are not usually a primary target of treatment. OBJECTIVE:
To determine if treating chronic nightmares with imagery rehearsal therapy (IRT)
reduces the frequency of disturbing dreams, improves sleep quality, and decreases
PTSD symptom severity. DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled
trial conducted from 1995 to 1999 among 168 women in New Mexico; 95% had moderate-to-severe
PTSD, 97% had experienced rape or other sexual assault, 77% reported life-threatening
sexual assault, and 58% reported repeated exposure to sexual abuse in childhood
or adolescence. INTERVENTION: Participants were randomized to receive treatment
(n = 88) or to the wait-list control group (n = 80). The treatment group received
IRT in 3 sessions; controls received no additional intervention, but continued
any ongoing treatment.
MAIN OUTCOME MEASURES: Scores on the Nightmare Frequency Questionnaire (NFQ),
Pittsburgh Sleep Quality Index (PSQI), PTSD Symptom Scale (PSS), and Clinician-Administered
PTSD Scale (CAPS) at 3- and 6-month follow-up. RESULTS: A total of 114 participants
completed follow-up at 3 and/or 6 months. Comparing baseline to follow-up (n =
97-114), treatment significantly reduced nights per week with nightmares (Cohen
d = 1.24; P<.001) and number of nightmares per week (Cohen d = 0.85; P<.001)
on the NFQ and improved sleep (on the PSQI, Cohen d = 0.67; P<.001) and PTSD
symptoms (on the PSS, Cohen d = 1.00; P<.001 and on the CAPS, Cohen d = 1.53;
P<.001). Control participants showed small, nonsignificant improvements for
the same measures (mean Cohen d = 0.21). In a 3-point analysis (n = 66-77), improvements
occurred in the treatment group at 3-month follow-up (treatment vs control group,
Cohen d = 1.15 vs 0.07 for nights per week with nightmares; 0.95 vs -0.06 for
nightmares per week; 0.77 vs 0.31 on the PSQI, and 1.06 vs 0.31 on the PSS) and
were sustained without further intervention or contact between 3 and 6 months.
An intent-to-treat analysis (n = 168) confirmed significant differences between
treatment and control groups for nightmares, sleep, and PTSD (all P<.02) with
moderate effect sizes for treatment (mean Cohen d = 0.60) and small effect sizes
for controls (mean Cohen d = 0.14). Posttraumatic stress symptoms decreased by
at least 1 level of clinical severity in 65% of the treatment group compared with
symptoms worsening or not changing in 69% of controls (chi(2)(1) = 12.80; P<.001).
CONCLUSIONS: Imagery rehearsal therapy is a brief, well-tolerated treatment
that appears to decrease chronic nightmares, improve sleep quality, and decrease
PTSD symptom severity.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 11476655 [PubMed - indexed for MEDLINE]
CLOSE
|
