A meta-analysis of imagery rehearsal for post-trauma nightmares: Effects on nightmare frequency, sleep quality, and posttraumatic stress
Open accessAbstract
This meta-analysis evaluates the efficacy of imagery rehearsal as a treatment for nightmares, general sleep disturbance, and symptoms of post-traumatic stress. Bibliographic databases and cited references were searched to identify clinical trials of imagery rehearsal in individuals with post-trauma nightmares. Thirteen studies met inclusion criteria and reported sleep and post-traumatic stress outcomes in sufficient detail to calculate effect sizes. Results indicate that imagery rehearsal had large effects on nightmare frequency, sleep quality, and PTSD symptoms from the initial to post-treatment assessments. These effects were sustained through 6 to 12 months follow-up. Furthermore, interventions that included both imagery rehearsal and cognitive behavioral therapy for insomnia resulted in greater treatment-related improvement in sleep quality than imagery rehearsal alone. Combined treatment did not improve outcomes for PTSD or nightmares. Notably, effect sizes were small in the single study that included an active-treatment control condition. Future research should identify necessary and sufficient components of interventions for trauma-related sleep disturbance and post-traumatic stress (e.g., exposure, cognitive reappraisal, sleep and circadian regulation).
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Most studies of IRT focus on adults with classic PTSD, with limited research in adolescents or CPTSD populations.
“However, most studies focus on adults with “classic” PTSD, with limited research in adolescents or in CPTSD populations [31, 33, 34].”
From Efficacy of imagery rehearsal therapy in the treatment of traumatic nightmares in youth with complex post-traumatic stress disorder (2026) · cites this paper as [31]
The Results > Sample Characteristics section (page not provided) says all included studies used adult samples, none with children met inclusion criteria, and 86% of participants in studies reporting diagnoses had PTSD. This supports the adult and PTSD portions of the claim, but the paper does not distinguish “classic” PTSD from CPTSD or assess how much research exists in CPTSD populations. (LLM, conf=0.86)
Experimental — accuracy not yet measuredImagery rehearsal therapy (IRT) is effective in adults, reducing nightmare frequency and distress and improving sleep.
“Its efficacy is well demonstrated in adults, reducing nightmare frequency and distress and improving sleep [31, 32].”
From Efficacy of imagery rehearsal therapy in the treatment of traumatic nightmares in youth with complex post-traumatic stress disorder (2026) · cites this paper as [31]
The Discussion reports that imagery rehearsal reduced nightmare frequency and improved sleep quality, and Results > Sample Characteristics confirms that all included studies used adult samples. The meta-analysis concerns post-trauma nightmares and does not report a reduction in nightmare distress as a separate outcome. It also evaluates imagery rehearsal protocols collectively, rather than IRT alone. (LLM, conf=0.88)
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“Its efficacy is well demonstrated in adults, reducing nightmare frequency and distress and improving sleep [31, 32].”
- Authors
- Casement, M. D., & Swanson, L. M.
- Affiliations
- Boston University (US)
- University of Michigan (US)
- Corresponding author
- Casement, Melynda D.
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2012-08
- Volume
- 32
- Issue
- 6
- Pages
- 566-574
- ISSN
- 0272-7358 (ISSN-L)
- PMC
- PMC4120639
- OpenAlex
- W1998601793
- Cited by
- 192
- References
- 56
- Citations by year
- 2026: 12 · 2025: 14 · 2024: 12 · 2023: 9 · 2022: 9 · 2021: 16 · 2020: 14 · 2019: 13 · 2018: 15 · 2017: 14 · 2016: 26 · 2015: 19 · 2014: 11 · 2013: 7
- FWCI
- 1.73
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (T32MH019836)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Keywords
- post-traumatic stress disorder, sleep disorders, sleep quality, cognitive behavioral therapy for insomnia, treatment efficacy, cognitive reappraisal, exposure therapy
- MeSH terms
- Dreams, Female, Humans, Implosive Therapy, Male, Sleep Wake Disorders, Stress Disorders, Post-Traumatic, Cognitive Behavioral Therapy, Imagery, Psychotherapy
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