Physiological predictors of response to exposure, relaxation, and rescripting therapy for chronic nightmares in a randomized clinical trial

J Clin Sleep Med. 2011 Dec 15;7(6):622-31. doi: 10.5664/jcsm.1466.


Study objectives: Evidence supports the use of cognitive behavioral therapies for nightmares in trauma-exposed individuals. This randomized clinical trial replicated a study of exposure, relaxation, and rescripting therapy(ERRT) and extended prior research by including broad measures of mental health difficulties, self-reported physical health problems, and quality of life. Additionally, physiological correlates of treatment-related change assessed from a script-driven imagery paradigm were examined.

Methods: Forty-seven individuals were randomized to treatment or waitlist control.

Results: The treatment group demonstrated improvements relative to the control group at the one-week post-treatment assessment. At the 6-month follow-up assessment, significant improvements were found for frequency and severity of nightmares, posttraumatic stress disorder symptoms, depression, sleep quality and quantity, physical health symptoms, anger, dissociation, and tension reduction behaviors. Participants also reported improved quality of life. Treatment-related decreases in heart rate to nightmare imagery were correlated with improvements in sleep quality and quantity; treatment-related decreases in skin conductance to nightmare imagery were correlated with improvements in nightmare severity, posttraumatic stress disorder symptom severity, sleep quality, and fear of sleep; and treatment-related decreases in corrugator activity to nightmare imagery were correlated with improved physical health.

Conclusions: Findings provide additional support for the use of ERRT in treating nightmares and related difficulties and improving sleep.

Keywords: Nightmares; physiological assessment; posttraumatic stress disorder; sleep quality; treatment.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Chronic Disease
  • Cognitive Behavioral Therapy / methods*
  • Dreams / psychology*
  • Electroencephalography
  • Female
  • Follow-Up Studies
  • Humans
  • Imagery, Psychotherapy*
  • Middle Aged
  • Neuropsychological Tests
  • Predictive Value of Tests
  • Reference Values
  • Relaxation / psychology*
  • Risk Assessment
  • Severity of Illness Index
  • Sleep Wake Disorders / etiology
  • Sleep Wake Disorders / therapy*
  • Stress Disorders, Post-Traumatic / complications*
  • Stress Disorders, Post-Traumatic / diagnosis
  • Stress Disorders, Post-Traumatic / therapy
  • Treatment Outcome
  • Young Adult