Nighmares don’t just affect your dream life. They cause depression and anxiety as well. Dr. Barry Krakow developed a simple therapy for nightmares, Imagery Rehearsal Therapy. In this therapy, people rehearse the kind of dream they want to have. Through daily practice, they gained more control over what plays out in their dream life. Here are the directions:
Begin by closing your eyes and fully picturing the nightmare that you want to reduce. Next, develop a new dream that you want to have instead. You can alter the plot of the old dream, or simply develop a new dream containing any imagery and events that you want. Imagine the new dream in its entirety. Imagine each sense - vision, smell, sound, etc - as you rehearse the dream in your mind. This repetition will help set down new tracks in your brain so that the old nightmare fades away.
How should you change the dream? Any way you want. Part of this exercise is recharging your imagination, and putting you back in control of your imagination. You can do this exercise any time of day – morning, night, or afternoon. You don’t have to imagine the same thing each day. The point of this is that you be in control of what you imagine, of what comes into your mind.
People made major gains by practicing this for as little as 5 minutes a day. The therapy has proven successful in over a dozen controlled studies. Just how powerful is it? One study compared imagery rehearsal therapy to our most effective medication for nightmares (prazosin), and concluded the therapy was as powerful as the medication (Yücel DE, Sleep Med Rev, 2020).
Nightmares have many causes, including trauma, stress, depression, and sleep disorders. Often, the relationship goes both ways, where dreams are darkened by an anxious or depressed mood, and the disturbing dreams then worsen the person’s mood the next day. This therapy works for all types of nightmares, but if your nightmares are due to sleep apnea you should look into medical treatments for that. They can be life-saving (see side bar)
Read more about imagery rehearsal therapy at Dr. Krakow’s website, which includes video, book and CD courses (barrykrakowmd.com).
Sleep apnea is a condition where breathing stops or the throat is constricted at night so the brain doesn’t get enough oxygen. It can cause nightmares, along with other signs like loud snoring, daytime headaches or fatigue, high blood pressure, and waking up gasping for air. Sleep apnea often comes on after age 40 in people who are overweight or have thick necks, but it is also is very common in people with post-traumatic stress disorder (PTSD), even when they are young and thin. People with PTSD develop sleep apnea because their anxiety rises while they are asleep, causing muscles in their throat to constrict. Sleep apnea requires a treatment of its own to open up the airways and allow oxygen to flow to the brain. When it is treated, people have better energy, less depression, clearer minds, and longer lives.
Imagery Rehearsal Therapy is a simple technique that can turn nightmares into dreams.