Our objective is to demonstrate that nightmares in rape victims with post- traumatic stress disorder (PTSD) can be reduced with direct behavioral methods, and that such reductions in nightmares will improve sleep quality and decrease daytime distress. Traditionally, nightmares have been viewed as a symptom of an underlying psychological conflict which might only be treated with psychotherapy. Alternatively, several case reports have demonstrated efficacy with behavioral approaches to nightmares. Overall, however, research on the treatment of nightmares has been largely neglected. In our previous controlled studies, using an imagery rehearsal method in the treatment of chronic nightmare sufferers, we have observed significant reductions in nightmares, and improvements in sleep quality and daytime distress. Sustained reductions in nightmares as well as improvements in sleep and distress have also been demonstrated in long term followup studies. This research supports the theory that nightmares may function as an independent sleep disorder which contributes to sleep disturbance and daytime distress. These findings also raise the possibility that nightmares may interact bidirectionally with post-traumatic stress disorder. The proposed study will focus treatment directly on nightmares, often the most predominant intrusive symptom in PTSD. We will employ imagery rehearsal to directly treat nightmares in rape victims with PTSD. Imagery rehearsal involves three steps: recalling a nightmare; changing the nightmare in some manner; then rehearsing the new set of images from the changed version. This is performed in the waking state for several minutes each day. The study will use a randomized, controlled, non-blinded, clinical intervention, repeated measures design. Statistical analysis will be conducted with MANOVA in evaluating the effects of the behavioral treatment of nightmares on nightmare frequency, sleep quality and daytime distress in treatment vs. wait-list control groups. Within and between subjects analysis will be conducted at followup of six months. The study population will include adult female rape victims with PTSD who are at least three months post-assault and who suffer from nightmares at a minimum of once per week. The high prevalence of disturbing dreams and post traumatic symptoms make this population well suited for studying the treatment of nightmares in PTSD. A short term therapy with a positive impact on PTSD (including long-term improvement in sleep quality and daytime distress) will be at a premium as health care services undergo major changes. With the followup difficulties observed in victims of sexual assault and abuse, a short term approach, such as imagery rehearsal, may have special appeal to rape victims who suffer nightmares. If similar results to our earlier research were achieved, imagery rehearsal (though not curative) could prove to be a cost- effective adjunctive treatment.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
1R01MH053239-01A1
Application #
2253265
Study Section
Violence and Traumatic Stress Review Committee (VTS)
Project Start
1995-08-01
Project End
1999-07-31
Budget Start
1995-08-01
Budget End
1996-07-31
Support Year
1
Fiscal Year
1995
Total Cost
Indirect Cost
Name
University of New Mexico
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
829868723
City
Albuquerque
State
NM
Country
United States
Zip Code
87131
Germain, Anne; Hall, Martica; Krakow, Barry et al. (2005) A brief sleep scale for Posttraumatic Stress Disorder: Pittsburgh Sleep Quality Index Addendum for PTSD. J Anxiety Disord 19:233-44
Krakow, Barry; Schrader, Ron; Tandberg, Dan et al. (2002) Nightmare frequency in sexual assault survivors with PTSD. J Anxiety Disord 16:175-90
Krakow, B; Sandoval, D; Schrader, R et al. (2001) Treatment of chronic nightmares in adjudicated adolescent girls in a residential facility. J Adolesc Health 29:94-100
Krakow, B; Hollifield, M; Johnston, L et al. (2001) Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: a randomized controlled trial. JAMA 286:537-45
Krakow, B; Germain, A; Warner, T D et al. (2001) The relationship of sleep quality and posttraumatic stress to potential sleep disorders in sexual assault survivors with nightmares, insomnia, and PTSD. J Trauma Stress 14:647-65
Krakow, B; Johnston, L; Melendrez, D et al. (2001) An open-label trial of evidence-based cognitive behavior therapy for nightmares and insomnia in crime victims with PTSD. Am J Psychiatry 158:2043-7
Krakow, B; Germain, A; Tandberg, D et al. (2000) Sleep breathing and sleep movement disorders masquerading as insomnia in sexual-assault survivors. Compr Psychiatry 41:49-56
Krakow, B; Artar, A; Warner, T D et al. (2000) Sleep disorder, depression, and suicidality in female sexual assault survivors. Crisis 21:163-170
Krakow, B; Hollifield, M; Schrader, R et al. (2000) A controlled study of imagery rehearsal for chronic nightmares in sexual assault survivors with PTSD: a preliminary report. J Trauma Stress 13:589-609
Krakow, B; Lowry, C; Germain, A et al. (2000) A retrospective study on improvements in nightmares and post-traumatic stress disorder following treatment for co-morbid sleep-disordered breathing. J Psychosom Res 49:291-8