STUDY: IMAGERY THERAPY, SOUND REDUCED NIGHTMARES
Piano prompts patients to access ‘rewritten’ dream
Most people have occasional nightmares — those heart-pounding episodes that rouse you at their most terrifying moments and stay with you even when you are awake. But some others have nightmares frequent enough to seriously disrupt sleep and interfere with quality of life.
People who experience unrelenting nightmares “usually report significant distress or impairment in social, occupational or other important areas of functioning,” said Lampros Perogamvros, a psychiatrist at the Sleep Laboratory of the Geneva University Hospitals and the University of Geneva.
A treatment from Perogamvros and his team may help. The experimental method, which combined an established treatment —
imagery rehearsal therapy, or IRT — with a sound, led to fewer nightmares among participants for as long as three months afterward, their study showed.
“There is every indication that it is a particularly effective new treatment for the nightmare disorder,” Perogamvros said. “These
results also open up new perspectives for the treatment of other disorders, such as insomnia and posttraumatic stress disorder.”
An estimated 2 percent to 8 percent of people suffer from chronic, debilitating nightmares that wreck their sleep, according to the American Academy of Sleep
Medicine. While nightmares are common among children — most outgrow them by age 10 — an estimated 50 to 85 percent of adults also have them occasionally.
“Nightmare disorder is a serious problem for some people, especially affecting people with PTSD, but others as well,” said Timothy I. Morgenthaler, a sleep medicine specialist at the Mayo Clinic, who was not part of the study. “Occasional nightmares are unwelcome, but when they occur frequently — enough that the person becomes distressed with the prospect of experiencing another nightmare, anticipating stressful images during sleep, sometimes avoiding sleep to avoid yet another nightmare — it affects their sleep, daytime function and arguably their health.”
The scientists modeled their method after an approach known as targeted memory reactivation, or TMR, which uses a specific learning-associated trigger, typically an odor, to enhance memory consolidation when reapplied during sleep.
Their trigger was a sound, described as a “neutral” piano chord, which they added to imagery rehearsal therapy when patients are awake and to rapid eye movement (REM) sleep, the final stage of sleep when nightmares usually occur.
Imagery rehearsal therapy is an established cognitive behavioral technique where subjects try to change the negative storyline of their nightmares into a more positive ending, rehearsing the “rewritten” dream scenario for several minutes each day.
It is a very effective treatment, but it doesn’t work for everyone. Hoping to boost the success rate, the scientists theorized that adding the piano chord sound to the IRT would heighten the positive daytime experience and create a pleasant memory that subjects would associate with the sound. The goal was to increase the chances that patients, upon hearing the same sound during REM sleep, would experience a positive narrative.
All 36 subjects engaged in initial imagery rehearsal therapy in the lab. But only half heard the sound during the initial IRT lab session, meaning only one group formed a positive connection to the sound during therapy. Later, all received the sound while asleep at home via a wireless headband that automatically detected the onset of REM.
The results, published in the journal Current Biology, found that both groups experienced a decrease in nightmares, but the half that received the sound during the lab-based IRT session had even fewer nightmares and “more positive dream emotions” for two weeks after the experiment and a sustained decrease in nightmares up to three months later, the researchers said.