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Volume 15 No. 05
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Accepted Papers





Scientific Investigations

Randomized Controlled Trial of Imagery Rehearsal for Posttraumatic Nightmares in Combat Veterans

Gerlinde C. Harb, PhD1; Joan M. Cook, PhD2; Andrea J. Phelps, PhD3; Philip R. Gehrman, PhD1,4; David Forbes, PhD3; Russell Localio, PhD4; Ilan Harpaz-Rotem, PhD2; Ruben C. Gur, PhD4; Richard J. Ross, MD, PhD1,4
1Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; 2Yale University and National Center for PTSD, New Haven, Connecticut; 3Phoenix Australia Centre for Posttraumatic Mental Health, Melbourne, Australia; 4University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania

Study Objectives:

To examine the efficacy of imagery rehearsal (IR) combined with cognitive behavioral therapy for insomnia (CBT-I) compared to CBT-I alone for treating recurrent nightmares in military veterans with posttraumatic stress disorder (PTSD).

Methods:

In this randomized controlled study, 108 male and female United States veterans of the Iraq and Afghanistan conflicts with current, severe PTSD and recurrent, deployment-related nightmares were randomized to six sessions of IR + CBT-I (n = 55) or CBT-I (n = 53). Primary outcomes were measured with the Nightmare Frequency Questionnaire (NFQ) and Nightmare Distress Questionnaire (NDQ).

Results:

Improvement with treatment was significant (29% with reduction in nightmare frequency and 22% with remission). Overall, IR + CBT-I was not superior to CBT-I (NFQ: −0.12; 95% confidence interval = −0.87 to 0.63; likelihood ratio chi square = 4.7(3), P = .2); NDQ: 1.5, 95% confidence interval = −1.4 to 4.4; likelihood ratio chi square = 7.3, P = .06).

Conclusions:

Combining IR with CBT-I conferred no advantage overall. Further research is essential to examine the possibly greater benefit of adding IR to CBT-I for some subgroups of veterans with PTSD.

Clinical Trial Registration:

Registry: ClinicalTrials.gov; Title: Cognitive Behavioral Therapy (CBT) for Nightmares in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans; Identifier: NCT00691626; URL: https://clinicaltrials.gov/ct2/show/NCT00691626

Citation:

Harb GC, Cook JM, Phelps AJ, Gehrman PR, Forbes D, Localio R, Harpaz-Rotem I, Gur RC, Ross RJ. Randomized controlled trial of imagery rehearsal for posttraumatic nightmares in combat veterans. J Clin Sleep Med. 2019;15(5):757–767.




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