Abstract

Introduction

Imagery Rehearsal Therapy (IRT) is an efficacious treatment for Nightmare Disorder. In IRT, patients practice pleasant guided imagery techniques, then use these skills to re-script recurring nightmares, which lowers the frequency and intensity of overall nightmare activity. However, the most efficacious methods and dosage of guided imagery and nightmare re-scripting is undetermined.

Report of Case

The patient was a 70-year-old male with Nightmare Disorder. Patient denied any precipitating event or trauma associated with nightmare onset. He has a longstanding history of depression and OSA (uses CPAP). He was taking Seroquel, which reduced severity of nightmares but not frequency. Trials of other medications for nightmares had failed (including prazosin, Depakote, and trazodone).Patient presented as highly distressed, exhibited distrust towards medical providers, and was skeptical about the effectiveness of IRT. Despite his skepticism, patient self-initiated very detailed and media-enhanced methods for pleasant guided imagery and nightmare re-scripting, including written narratives, voice recordings, and created a movie of his re-scripted nightmare with pictures set to music. He listened to the recordings 2-3x/day. Themes of nightmares included lack of mastery over problems; patient’s re-scripted dreams put him back in control of frightening scenarios.Nightmare logs at baseline showed sleep quality=1.9/5; average=2.0 nightmares/night; average intensity= 6.2/10. At week 15 of treatment, sleep quality=3/5; nightmares/night average=0.25; average intensity=6/10. Sleep disturbance also improved (ISI=18-moderately severe clinical insomnia to 11-subthreshold insomnia); mood was stable (PHQ=5-mild depression).

Conclusion

Previous studies have suggested that IRT increases patients’ sense of mastery or perceived self-efficacy over nightmares (Rousseau et al., 2018). Additionally, higher verbal memory in persons with trauma-related nightmares has been shown to improve nightmare frequency and severity in IRT (Scott et al., 2017). In this case study, self-efficacy may have been activated by the highly detailed and media-enhanced imagery the patient created. Further empirical research on the mechanisms for enhancing IRT is warranted.

中文翻译：

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1222创意和“剂量”是否可以增强图像排练治疗的效果？成功的IRT案例

摘要

介绍

影像彩排疗法（IRT）是一种有效的梦Night症治疗方法。在IRT中，患者练习令人愉快的引导图像技术，然后使用这些技能来重写重复发生的噩梦，从而降低整体噩梦活动的频率和强度。但是，尚无法确定指导图像和噩梦改写的最有效方法和剂量。

案件报告

该患者是一名患有噩梦症的70岁男性。患者否认与噩梦发作有关的任何刺激事件或创伤。他有抑郁症和OSA（使用CPAP）的悠久历史。他正在服用Seroquel，可减轻噩梦的严重性，但不会减少恶梦的频率。其他用于噩梦的药物的试验失败了（包括哌唑嗪，地帕可特和曲唑酮）。患者表现出极大的痛苦，对医疗服务提供者表示不信任，并对IRT的有效性表示怀疑。尽管他持怀疑态度，但患者还是主动采用了非常详细的方法和媒体增强的方法来制作令人愉悦的引导性影像和噩梦改写，包括书面叙述，语音录音，并制作了一部他改写的噩梦的电影，其中的图片带有音乐。他每天听2-3次录音。噩梦的主题包括对问题的缺乏掌握；患者梦'以求的梦境使他重新控制了可怕的情况。基线时的噩梦记录显示睡眠质量= 1.9 / 5；平均= 2.0噩梦/晚；平均强度＝ 6.2 / 10。治疗第15周，睡眠质量= 3/5；噩梦/夜晚平均值= 0.25；平均强度＝ 6/10。睡眠障碍也得到改善（ISI = 18-中度严重的临床失眠至11亚阈失眠）；情绪稳定（PHQ = 5轻度抑郁）。睡眠障碍也得到改善（ISI = 18-中度严重的临床失眠至11亚阈失眠）；情绪稳定（PHQ = 5轻度抑郁）。睡眠障碍也得到改善（ISI = 18-中度严重的临床失眠至11亚阈失眠）；情绪稳定（PHQ = 5轻度抑郁）。

结论

先前的研究表明，IRT可以增强患者在噩梦中的精通意识或自我效能感（Rousseau等，2018）。此外，研究表明，与创伤相关的噩梦患者较高的言语记忆能力可改善IRT的噩梦发生频率和严重程度（Scott等，2017）。在本案例研究中，患者创建的高度详细和媒体增强的图像可能已激活了自我效能感。有必要对增强IRT的机制进行进一步的实证研究。