PTSD and Nightmares: Re-living the Trauma

PTSD and nightmares frequently occur together because nightmares can be a symptom of PTSD. We’ve all experienced nightmares. You wake up suddenly; you can feel your heart beating in your chest and your breath coming fast. Feelings of fear and distress crowd your mind. Sometimes you remember your nightmares, and sometimes you don’t. Sometimes they are about real events, and sometimes they are completely imaginary. The estimates of nightmares in the general population vary, but evidence most strongly suggests that approximately 4-8% of the population are affected (Nielsen and Zadra, 2000).

For people with PTSD and nightmares, however, nightmares can become a long-lasting, devastating problem. Not only can they cause more upset to an already distressed individual, but they may also prolong the course of PTSD because the suffer is subjected to a repeated, vivid re-experiencing of the traumatic event which led to the development of PTSD.  This creates a vicious cycle of repeated victimization for the person living with PTSD and nightmares of the traumatic event.

PTSD is an anxiety disorder which occurs after the experience of a traumatic event. It involves experiencing vivid, distressing flash-backs of the traumatic event, avoidance of experiences which are similar to that which caused the trauma (e.g. avoiding getting in a car if one suffered the trauma of a car accident), and feelings of  ‘hyper-arousal’, characterised by being easily startled, feeling on edge and being prone to aggressive/angry outbursts. PTSD often occurs immediately or soon after a traumatic event, but in approximately 15% of the population, it can take months or even years for the first symptoms to occur (McNally, 2003). It is estimated that 3.6% of the American population experience PTSD each year (Kessler et al, 2005).

Nightmares are an extremely common symptom of PTSD and they are estimated to affect approximately 60% of suffers (Kilpatrick et al., 1998). Not only do nightmares in PTSD cause an extremely vivid re-experiencing of the traumatic event, making it very difficult to move on, they also clearly disturb sleep and may lead to an insomnia disorder or fear of sleeping, which further prolongs PTSD (Krakow et al, 2001).

Fortunately, PTSD and nightmares are now being brought to the forefront of treatment goals. Imagery rehearsal therapy (IRT) is a technique which has arisen from Cognitive Behavioural Therapy (CBT), and involves recalling the nightmare, writing it down, changing the theme, storyline or any part of the dream to make it more positive, and so allowing the patient to re-write or re-script the unwanted content of the dream when they recur. The technique is practised for 10-20 minutes per day during wakefulness (Best Practice Guide for the Treatment of Nightmare Disorders in Adults, Aurora et al, 2010). The effectiveness of IRT was tested by Krakow et al (2001) in patients with chronic nightmares who were victims of sexual assault and PTSD. Three sessions of IRT were given to the experimental group, and it was found that 65% of the participants had significantly reduced symptoms of PTSD, improved sleep quality and fewer nightmares. These effects were prolonged at a 6-month follow-up session. These results are supported by another study by Krakow et al (2001), where IRT was combined with CBT to treat both nightmares and insomnia in crime victims with PTSD. It was found that PTSD symptoms were improved, as well as symptoms of anxiety and depression and the frequency of nightmares was also reduced.

Other treatments which are focused at treating the entire range of PTSD symptoms are also effective at reducing nightmares. Exposure therapy focuses on helping patients to face and control their fear, and may involve visiting the site of the trauma, using mental imagery and writing about their trauma. In the 1980s, Dr Terence Keane showed how exposure therapy could be very effective at treating PTSD in Vietnam war veterans (Keane et al., 1989). In a randomised control trial (the ‘gold-standard’ of psychological research), it was found that exposure therapy reduced many PTSD symptoms, including flashbacks, memory and concentration difficulties, irritability and nightmares. Exposure therapy has also been shown to be successful for treating nightmares in rape victims with PTSD and the effects were maintained at a 3-month follow-up assessment (Foe and Meadows., 1991).

Despite the severe distress caused by PTSD and nightmares, help is available. Not only will treatment reduce nightmares, but it is also likely to reduce many other distressing symptoms of PTSD. If you, or somebody you know is suffering from PTSD, getting help is imperative to enable you to move on from your trauma and live a normal life again.

Because our treatment center relies on evidence based practices, our Intensive Outpatient Program shares many common methods with other successful treatment methods.  The foundation of our treatment program for relies on the principles of the stages of change, cognitive behavioral therapy, solution focused treatment, skills training and identifying repetitive dysfunctional behavioral relationship patterns to promote recovery from depression and other mental health disorders.  In fact, our Intensive Outpatient Program in Memphis, TN that has been proven to be effective in the treatment of these disorders in six peer reviewed treatment outcome studies.   Our treatment center provides services to those who need more treatment than one hour a week, but less than 24 hour care, by providing three hours of treatment per day, three to five days per week, in an intensive outpatient setting.  If you or a loved one is showing signs of depression or anxiety, they should be assessed by a trained mental health professional who can help design a treatment plan that can result in recovery.  Treatment for depression and anxiety can be highly successful.  Call us at 901-682-6136 to schedule an appointment.