Table 2.
Controlled trials treating nightmares and assessing the impact on psychiatric symptoms.
| Citation |
Design |
N |
Sample |
Assessments |
Measure of nightmares |
Measure of psychiatric symptoms |
Key result for psychiatric symptoms |
Change in psychiatric symptom? |
|||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Depr. | Anx. | PTSD | Dissoc. | Suic. | Psychosis | ||||||||
| Ahmadpanah et al. (2014) | RCT testing: prazosin vs. hydroxyzine vs placebo. | 100 | Patients with PTSD and severe sleep disorders | Baseline and at 8 weeks (end of study) | PSQI item assessing bad dreams | PTSD (M.I.N·I) | Significant reductions in PTSD. | N/A | N/A | Yes | N/A | N/A | N/A |
| Burgess et al. (1998) | RCT testing: self-help exposure vs. self-help relaxation vs. waitlist control. | 170 | Nightmare sufferers | Baseline, 1-month and 6-month follow-up. | 4-week nightmare diary (frequency and intensity rated from 0 to 8). | Phobia (fear questionnaire), depression (BDI). | Significant reductions in phobia and depression. | Yes | Yes | N/A | N/A | N/A | N/A |
| Davis and Wright (2007) | RCT testing: ERRT vs. waitlist control. | 43 | Individuals experiencing a traumatic event and nightmares | Baseline, 3 and 6-month follow-up | Trauma Related Nightmare Survey | PTSD (Structured Clinical Interview for DSM-IV: PTSD & Modified PTSD Symptom Scale Self Report), Depression (BDI). | Greater improvements in PTSD symptoms (d = 0.53) and depression (d = 0.59) following treatment versus waitlist control. | Yes | N/A | Yes | N/A | N/A | N/A |
| Davis et al. (2011) | RCT testing ERRT vs. waitlist control. | 47 | Trauma-exposed individuals | Baseline, 1-week post-treatment and 3 and 6-months. | Trauma Related Nightmare Survey. | PTSD (CAPS), Trauma related depression, anger/irritability and dissociation (Trauma symptom inventory). | Significant improvements in depression (d = 0.37) and PTSD (d = 0.39). No significant reduction in dissociation (d = 0.11, p < .05). | Yes | N/A | Yes | No | N/A | N/A |
| Krakow et al. (2000) | RCT testing IRT vs. waitlist control. | 169 | Female sexual assault survivors with PTSD and chronic nightmares. | Baseline and 3-month follow-up. | Nightmare Frequency Questionnaire (NFQ), Nightmare Effects Survey (NES). | PTSD (PSS). | The IRT group had significantly lower PTSD severity than control at 3 months. Within subject effect sizes: IRT d = 1.20, waitlist d = 0.28). | N/A | N/A | Yes | N/A | N/A | N/A |
| Lancee et al. (2010) | RCT testing IRT vs. IE vs. recording (diary) vs. waitlist control | 399 | Those experiencing at least one nightmare or bad dream per week | Baseline and 11 weeks follow-up. | SLEEP-50 | Anxiety (STAI) Depression (CES—D), PTSD (IES). | Nightmares treated with IRT led to significant improvements in anxiety (d = 0.25) compared to waitlist control, but not depression (d = 0.26) or PTSD (d = 0.11). Nightmares treated with IE led to significant reductions in depression (d = 0.56) but not anxiety (d = 0.13) or PTSD (d = 0.09) compared with wait list. | Mixed | Mixed | No | N/A | N/A | N/A |
| Lancee, Effting, & Kunze, 2021 | RCT testing guided self-help imagery rehearsal therapy versus wait-list control. | 70 | Nightmare disorder according to DSM-5. | Baseline and post-treatment (5 weeks). IRT group followed up at 3 and 6 months. | Nightmare frequency questionnaire (NFQ), Nightmare distress and impact questionnaire (NDIQ). | Depression (PHQ-9), Anxiety (HADS-A). | No significant Treatment × Time interactions were found for depressive symptoms (PHQ; F = 1.68, p = .199, d = 0.30) or anxiety symptoms (HADS-A; F = 0.49, p = .488, d = 0.19). | Trend | No | N/A | N/A | N/A | N/A |
| Pruiksma et al. (2020) | Pilot RCT comparing ERRT with minimal contact control (MCC). | 40 | Active duty military personnel with nightmares | Baseline, end of treatment (5 weeks) and 1 month follow up | Trauma related nightmare survey | PTSD (PTSD checklist for DSM-5), depression (PHQ-9), suicide (depressive symptom index-suicide subscale) | ERRT led to medium effect size improvements in depression (d = −0.51) and marginal improvements in PTSD (d = −0.12) compared with MCC at post-treatment. MCC led to marginally greater changes in suicidal ideation than ERRT (d = 0.16). The study was not powered to detect statistically significant changes of this magnitude. | Yes | N/A | No | N/A | No | N/A |
| Raskind et al., 2013 | RCT testing 8 weeks of prazosin vs. placebo control medication. | 40 (34 analysed) | Veterans with chronic PTSD and severe trauma related nightmares. | Baseline, 4 and 8 week follow up. Only 8 week follow up yielded significant between group difference on nightmares. | Nightmare item of the CAPS PTSD scale. | PTSD (CAPS total), and depression (HAM—D) at baseline, 4 and 8 week follow up. | A trend towards reduction in depressive symptoms (p = .08). No significant reduction in PTSD at 8 weeks. | Trend | N/A | No | N/A | N/A | N/A |
| Raskind et al. (2013) | RCT testing 15 weeks of prazosin vs. placebo medication control. | 67 | Military personnel with PTSD and nightmares at least twice per week. | Baseline and 15 weeks. | Nightmare item of CAPS | PTSD (CAPS total) and depression (HAM-D and PHQ-9). | Significant between group effect on PTSD favouring the prazosin group. | Trend | N/A | Yes | N/A | N/A | N/A |
| Sheaves et al. (2019) | RCT comparing CBT for nightmares with treatment as usual (TAU). | 24 | Patients with weekly distressing nightmares and persecutory delusions and diagnosis of non-affective psychosis | Assessment at baseline and weeks 4 (end of treatment) and 8 (follow-up). | Nightmare severity (DDNSI, The Oxford Nightmare Severity Scale, daily nightmare logs). | Paranoia (GPTS), hallucinations (CAPS), negative affect (DASS-21), suicidal ideation (BSS), dissociation, (DES—B). | Medium effect size reduction in paranoia (d = −0.6), no effect on hallucinations (d = 0.1), reduction in dissociation (d = −0.8), mixed effects on negative affect. Suicidal ideation remained stable in CBT group but improved in TAU group (d = 0.3 at post-treatment, d = 0.7 at follow-up). | No | Mixed | N/A | Yes | No | Yes for paranoia, no for hallucinations |
| Taylor et al. (2008) | Within subjects crossover RCT testing Prazosin vs. placebo control | 13 | Outpatients with PTSD and nightmares. | Assessment and post 3 week treatment for each condition (separated by 1 week wash-out). | CAPS | PTSD Checklist-Civilian | Significant reduction in PTSD symptoms (d = 0.79). | N/A | N/A | Yes | N/A | N/A | N/A |
| van Schagen et al. (2015) | RCT comparing IRT plus TAU vs. TAU alone. | 90 | Patients with nightmares and a moderate to severe psychiatric disorder | Baseline, after IRT and 3-month follow-up. | Daily nightmare logs, the NFQ, Nightmare Distress Questionnaire and Nightmare Effects Survey. | General psychopathology (Symptom Checklist-90) and PTSD (Self-inventory list of PTSD symptoms) | Significant reduction in PTSD (d = 0.69) maintained at follow-up. Significant reduction in anxiety (d = 0.58), and depression (d = 0.55) at post-treatment, but fell short of significance at follow up. No significant reduction in agoraphobia. | Yes | Yes | Yes | N/A | N/A | N/A |
Anx. = anxiety. Depr = depression. Dissoc = Dissociation. Suic = Suicidal ideation / behaviour. ERRT = exposure, relaxation and rescripting therapy. IE = imaginal exposure. IRT = imagery rehearsal training. PTSD = post-traumatic stress disorder. TAU = treatment as usual. RCT = randomised controlled trial. WL = waitlist control.