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New Therapy Helps Sexual Assault Survivors

Changing bad dreams while awake eases nightmares, study finds

TUESDAY, July 31, 2001 (HealthDayNews) -- Women who have survived rape and sexual abuse struggle with more than terrifying memories. Many develop post-traumatic stress disorder (PTSD), and 60 percent of those with the disorder are haunted by nightmares.

Now, a new study from the University of New Mexico suggests a new therapy may ease the emotional fallout of sexual assault.

The new approach targets the nightmares rather than the symptoms of PTSD, say the study's authors who report their findings in tomorrow's issue of the Journal of the American Medical Association. The study was partly funded by the National Institutes of Mental Health.

"People who have chronic nightmares really do suffer from them," says study leader and psychologist Dr. Barry J. Krakow. "If you have nightmares, you're likely to become fearful of going to sleep, you're going to have awakenings at night, your sleep may be more restless, and the big one is that you're going to feel some daytime impairment, usually in terms of being tired or sleepy," he says.

And he says patients are likely to be preoccupied with images from their nightmares while awake.

Krakow says while the nightmares may have been caused by the same trauma that caused PTSD, the disorder alone isn't likely to fuel nightmares over a long time. Instead, he says, chronic nightmares are both trauma-induced and a learned behavior.

"[The new therapy] permits us and the patient to explore treating the nightmare directly," says Krakow.

Krakow and his colleagues worked with 168 women, 95 percent of whom had moderate to severe PTSD. Ninety-seven percent had experienced rape or sexual assault; 77 percent also reported a life-threatening sexual assault, and 58 percent also had experienced repeated sexual abuse in childhood or adolescence.

Krakow's team randomly divided the women into two groups of 80 and 88. The first group continued to receive whatever treatment they already were getting, while the second group received three sessions of so-called imagery rehearsal therapy.

During those sessions, which involved four to eight women at a time, therapists encouraged the women to recognize that their nightmares were trauma-induced and a learned behavior. In the first session, they were also coached in pleasant imagery exercises.

One week later, the women wrote about a single nightmare. The therapist told them to change anything they wanted about the nightmare, then to rehearse the new dream for 10 to 15 minutes. Once they left the session, the women had to rehearse the new dream for five to 20 minutes per day.

In the third session, the women discussed their progress with the group and asked questions about PTSD, nightmares and sleep.

Three months after they started the program, the women were asked about the quality of their sleep, frequency of nightmares and severity of PTSD symptoms. At the six-month mark, the women returned for a personal interview, where the researchers asked similar questions.

"Generally speaking, people [were] able to reduce their nightmares anywhere from 50 to 80 percent," says Krakow. In some cases, the nightmares disappeared entirely, although the technique didn't work at all for some survivors.

Krakow says most people who use the technique usually will report fewer nightmares, less intense nightmares or a different attitude towards their dreams. Eventually, he says they may experience all three.

Rosalind Cartwright, who heads the psychology department at Rush-Presbyterian-St. Luke's Medical Center in Chicago, says similar patterns of chronic nightmares also are found in Holocaust survivors and Vietnam veterans.

"Dreams of this kind tend to be repetitive and not self-resolving," says Cartwright. "They don't just fade the way bad experiences usually do. You have no way of coping with it unless you have some focused program during the day."

She says image rehearsal therapy lets patients guide their nightmares to a better end, one without trauma.

"In waking, he has them get a sense of control over that imagery. It is a very focused kind of treatment, and very quick," says Cartwright.

What To Do

You can visit Krakow's Center for Sleep Medicine and Nightmare Treatment or find out about nightmares from the Association for the Study of Dreams.

ABCNews.com also has this story on nightmare therapy.

SOURCES: Interviews with Barry J. Krakow, M.D., associate research professor, emergency medicine and psychiatry, University of New Mexico Health Sciences Center, and medical director, Sleep & Human Health Institute and Eastern New Mexico Sleep Disorders Center, Albuquerque, N.M.; Rosalind Cartwright, Ph.D., chairwoman, Department of Psychology, senior clinician, Sleep Disorders Service, Rush-Presbyterian-St. Luke's Medical Center, Chicago.; Aug. 1, 2001 Journal of the American Medical Association
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