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Imagery Rehearsal Therapy

Suffering from bad sleep? Learn about Imagery Rehearsal Therapy and how it can reduce nightmares and enhance sleep quality.

By Priya Singh on Jun 16, 2024.

Fact Checked by Ericka Pingol.

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Imagery Rehearsal Therapy

What is Imagery Rehearsal Therapy?

Most people have experienced the terror that comes with nightmares. Although experiences differ, many individuals are often left feeling anxious or unsettled following wake, which can flow onto daily activities post-sleep. Persistent experiences with nightmares can create fear of falling asleep or insomnia, creating a cycle of nightmare disorder.

Individuals experiencing conditions like post-traumatic stress disorder (PTSD) tend to have more frequent nightmares, as details of traumatic events can often be re-experienced when dreaming. This can be labeled as post-traumatic nightmares, which slow or limit recovery and make sleeping a stressful activity. To reduce the experiences of nightmares, Imagery Rehearsal Therapy was developed.

As a form of cognitive behavior therapy, Imagery Rehearsal Therapy (IRT) seeks to encourage patients to explore their nightmares when they are awake. This approach aims to help individuals address a specific issue within their nightmare and develop an alternative narrative for a more positive experience in their dreams. This involves repeatedly imagining the alternative dream during wake, hopefully substituting it for a nightmare.

Although IRT can differ depending on the individual's experiences, nightmare frequency, and PTSD symptoms, it usually involves daily rehearsal of the new dream sequence following therapy. For many individuals, it can usually take around 2 weeks before nightmare disorder experiences begin to subside. However, results can once again differ in response to the intensity of symptoms, experiences, and details related to the traumatic event.

Given that other issues often accompany a nightmare disorder or disturbing dreams relate to mental health, it may be beneficial for therapists to implement IRT as part of a broader treatment program. This may involve cognitive behavior therapy, trauma-focused art therapy, or group therapy approaches to alleviate chronic nightmares and support patients in their mental health journeys.

How does Imagery Rehearsal Therapy work?

Given that these conditions may manifest differently between individuals, the therapeutic process may vary slightly depending on various factors. These may include nightmare frequency, the level of PTSD symptoms experienced, current mental health status, and the therapies implemented in the treatment plan. However, the basis of Imagery Rehearsal Therapy is to treat nightmares rather than explore the trauma that caused them.

Imagery Rehearsal Therapy sessions seek to teach individuals that dreams can help process traumatic events or trauma-related nightmare memories. These sessions typically begin with the individual recounting the nightmare, which is followed by a discussion about the potential PTSD symptoms, triggers, or trauma that may be causing the nightmare disorder.

Following the discussion, therapists and patients typically work together to devise a different way for the dream to end. After the session, it is suggested that patients practice or rehearse this ending daily. Although the amount of rehearsal can differ depending on the type of dream or level of disturbance, it is usually recommended to rehearse for 10 to 20 minutes a day.

Individuals may begin noticing changes or a reduction in disturbing dreams. However, those experiencing more frequent nightmares related to trauma may have more sessions of Imagery Rehearsal Therapy. Additionally, individuals experiencing PTSD symptoms or other conditions impacting their mental health may be advised to integrate imagery rehearsal with other therapies.

When is Imagery Rehearsal Therapy used?

Imagery Rehearsal Therapy can be applied in various circumstances but is most typically used to support patients who are suffering from chronic nightmares and post-traumatic stress disorder. The following are some instances in which Imagery Rehearsal Therapy would be most useful:

Treating trauma-related nightmares

Imagery Rehearsal Therapy can help treat nightmares by exposing individuals to the nightmare in a more calming, supportive environment that enhances their power and sense of self. As individuals develop the power to solve the issue presented in the dream during the day, this technique can help them become desensitized to those details, allowing the brain to generate a more positive outcome when dreaming.

In accordance with other therapies

As a branch of cognitive behavior therapy, Imagery Rehearsal Therapy is often used by other therapies, such as art trauma-focused therapy treatment. Unlike Imagery Rehearsal Therapy, art therapy treatment is a non-verbal approach to visualizing a traumatic event that encourages PTSD patients to paint, collage, draw, or sculpt as a form of emotional expression.

What may cause nightmare disorder?

Although nightmare disorders can manifest in different ways, some common experiences enhance nightmare frequency and disturbing dreams. The following are some common causes of nightmare disorder:

Post-traumatic stress disorder

Following a traumatic event, such as a natural disaster or car accident, some individuals may be diagnosed with post-traumatic stress disorder. This results in an inability to move on from the event and reoccurring feelings of fear, stress, or anxiety, which can then be translated into disturbing dreams during the sleep state. Individuals experiencing PTSD symptoms often have recurring memories in their dreams and experience poor sleep quality and insomnia.


Individuals experiencing chronic stress or clinically significant distress are often more likely to experience nightmares. This is theorized as being the brain's way to practice responding to danger or stressful situations, but it often causes distress for the individual.


Individuals on certain medications such as beta blockers for blood pressure management, dopamine agonists, and some antidepressants may heighten their chances of having medications. This makes it essential to discuss any prescribed or non-prescribed medications a patient may be taking, as this could have a pivotal role in therapeutic trauma treatment and patient well-being.

Early life events

In some cases, early life events involving unpleasant memories or situations can cause nightmares in later adult life. Our early years are critical for brain development, meaning the brain tends to be under heavy processing and advancement throughout our toddler years. Therefore, if an individual experiences a traumatic event at around three years of age, the brain will develop a mechanism to accelerate the stress response. This is known as the stress acceleration hypothesis, which means that the brain may be less able to cope with stressful stimuli in adult years, even during sleep!

Risks and benefits of Imagery Rehearsal Therapy

Before beginning Imagery Rehearsal Therapy, it is incredibly important to understand both the risks and benefits of this therapy. The following are some of the benefits that individuals may experience:

  • Alleviated symptoms: Some individuals may experience less intense PTSD symptoms as they can separate the nightmare from their identity and reality.
  • Enhanced sleep quality: As nightmares begin to subside, individuals may find they can stay asleep longer and have a better quality sleep. Better sleep quality may also alleviate experiences of anxiety, as well as enhance mood and energy levels.
  • Reduced fear: Individuals experiencing nightmare disorder may often find it difficult to fall asleep or develop a fear of falling asleep. Because Imagery Rehearsal Therapy seeks to reduce the frequency and intensity of nightmares, individuals may experience a reduction in fear and break the cycle of nightmare disorder.

The following are some of the risks associated with Imagery Rehearsal Therapy:

  • Distress: Given that Imagery Rehearsal Therapy involves recounting disturbing dreams and potentially traumatic events. This can, at times, be distressing for the individual. Therefore, the therapist must continue providing ongoing support both during and after the session.
  • More distressing nightmares: For some individuals, although the frequency of nightmares becomes much less, the intensity of the nightmare may increase for more disturbing dreams. However, this is very rare and can be overcome by continuing imager rehearsal and incorporating other cognitive behavioral techniques such as art therapy nightmare treatment.

Why use Carepatron as your Imagery Rehearsal Therapy software?

At Carepatron, our vision is to provide ongoing practical solutions to support therapists in providing their patients with the best experience. Along with providing access to thousands of resources like this, Carepatron seamlessly integrates valuable tools and features for an all-in-one therapy practice management software.

To give you an idea of Carepatron's capabilities, here are a few reasons explaining how our software can support your practice:

Effective resources

One of our most notable features is our resource library. Filled with a diverse collection of information guides, therapy checklists, cognitive behavior therapy worksheets, and more, these resources are designed to streamline therapeutic practices.

Efficient documentation

As an online platform, Carepatron provides both patients and practitioners ongoing access to any patient notes, resources, and other documents they require. With our clinical notes software, these documents can all be stored in one place, making them easy to navigate. This saves the time and resources usually spent surfing through web pages, which can then be allocated to patient care.

Patient portal

With a user-friendly interface, our patient portal provides your clients ongoing access to the information, records, and activities they require. For individuals experiencing nightmare disorder, this feature will allow them to keep on top of their imagery rehearsal therapy. Furthermore, this portal allows patients to schedule appointments and reminders, enhancing the communication channels between practitioners and patients.

Embark on your journey to more effective therapeutic practice, and join Carepatron today!

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Commonly asked questions

What is Imagery Rehearsal Therapy?

Imagery Rehearsal Therapy is a technique of cognitive behavior therapy designed to help individuals experiencing recurring, traumatic nightmares. It focuses on recounting the nightmare and coming up with alternative endings that are more positive. These are then rehearsed during wake, to be translated into the individual's dream state.

How often do I have to rehearse?

Therapists typically recommend rehearsing for between 10 to 20 minutes a day for a few weeks or until the nightmare is no longer persistent. However, rehearsal times may differ depending on individual factors like nightmare frequency, the intensity of the nightmare, and the level of PTSD symptoms.

What can cause nightmare disorder?

Nightmare disorder can be caused by a range of factors that cause significant distress to the individual. This may include unpleasant childhood experiences, post-traumatic stress disorder, chronic or prolonged stress, and some medications.

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