Therapeutic Management of Nightmares: Practice Guide for Imagery Rehearsal Therapy (IRT)

Purpose of Review Nightmares, vivid and distressing dreams leading to arousal, can significantly impact sleep and daytime functioning. Nightmare disorder can occur with or without psychiatric disorders and with or without a traumatic event. Effective management of nightmares is crucial not only for nightmare disorder but also to prevent the worsening of psychiatric disorders or complications, such as suicide. This review explores the range of available treatments, encompassing both pharmacological and non-pharmacological, for nightmare disorders and trauma-associated nightmares. Recent Findings Different interventions have shown their safety and effectiveness in the therapeutic management of nightmares, such as imagery rehearsal therapy; exposure, relaxation, and rescripting therapy; lucid dreaming therapy; desensitization and exposure therapy; self-exposure therapy; and Prazosin. Summary Imagery rehearsal therapy (IRT) stands out with robust evidence supporting its effectiveness in nightmare disorder as well as in trauma-associated nightmares and should be considered as a first-line choice for therapeutic management of nightmares. This psychotherapeutic intervention employs cognitive and behavioral techniques and involves practicing mental imagery during daytime to modify the content of nightmares. This review summarizes the core principles of IRT and presents comprehensive guidelines for clinical practice.