![]() For this purpose, 104 patients with a primary DSM-5 diagnosis of nightmare disorder were randomly assigned to three weekly individual sessions of either IR or IE, or WL. With this randomized controlled trial, we compared IR and IE as individual treatments to a wait-list (WL) condition to determine whether these particular therapeutic elements reduced nightmare symptoms. Though it remains elusive which therapeutic elements are responsible for the beneficial effects on nightmare symptoms, imagery rescripting (IR) and imaginal exposure (IE) are commonly identified as active treatment components of nightmare therapies. Nightmares can be effectively treated with cognitive-behavioral therapies. Cognitive-behavioral therapy is currently the treatment of choice for recurrent nightmares (Lancee, Spoormaker, Krakow, & van den Bout, 2008 Spoormaker & van den Bout, 2005), with imagery rehearsal therapy (IRT) being the most empirically supported treatment format (Augedal, Hansen, Kronhaug, Harvey, & Pallesen, 2013 Hansen, H€ ofling, Kr€ oner-Borowik, Stangier, & Steil, 2013 Lancee et al., 2008) with moderate to large effect sizes (Krakow et al., 2001). Recurrent nightmares are often related to considerable suffering and distress (Lancee & Schrijnemaekers, 2013 Nielsen & Levin, 2007 Spoormaker, Schredl, & Bout, 2006), and they are further associated with various forms of psychopathology (Spoormaker & van den Bout, 2005) such as anxiety, depression, posttraumatic stress disorder (PTSD), suicidal ideation, substance abuse (Nielsen & Levin, 2007), and personality disorders (Schredl, 2016). In psychiatric populations, the prevalence is much higher, with up to 30% of patients suffering from frequent nightmares (Swart, van Schagen, Lancee, & van den Bout, 2013). In conclusion, this review highlights the importance for clinicians to investigate for the presence of chronic nightmares along with other sleep difficulties (most commonly, insomnia and sleep apnea), to consider the potential influence of nightmares on the course of the primary mental disorder, and to be prepared to grant access to treatments targeting nightmares. Moreover, the presence of nightmares in individuals with a mental disorder is often associated with poorer mental health, poorer sleep, and a greater risk for suicide. Empirical data generally support a positive relationship between nightmares and other mental disorders, with the autism spectrum disorder being an exception. Expectedly, the positive relationship between nightmares and PTSD is the most empirically supported. Differences in the experience of nightmares between mental disorders are also addressed. Therefore, this narrative review aims to summarize the most relevant literature on the experience of nightmares in posttraumatic stress disorder (PTSD), depressive disorders and bipolar disorders, anxiety disorders and obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, schizophrenia spectrum disorders, substance use disorders, autism spectrum disorder, eating disorders, and personality disorders. With a better understanding of nightmares in this population, clinicians will be more inclined to investigate for the presence of chronic nightmares, to consider nightmares for prognosis, and to treat this sleep difficulty independently from other mental disorders. No review has specifically focused on the experience of nightmares in individuals with a mental disorder. Higher annual nightmare frequency, higher scale scores of nightmare experience and personality disorder styles, and more associations between the two were found in nightmare disorder patients, implying the need for personality-adjustment therapy for nightmare disorder. Borderline, Schizotypal, and Passive-Aggressive styles in healthy volunteers and Dependent, Avoidant, Histrionic, and Paranoid in patients were significant predictors of some NEQ scales. Compared to healthy volunteers, nightmare disorder patients scored significantly higher on annual nightmare frequency and NEQ Physical Effect, Negative Emotion, Meaning Interpretation, and Horrible Stimulation, and higher on PERM Paranoid, Schizotypal, Borderline, Histrionic, Narcissistic, Avoidant, and Dependent styles. The authors invited 219 healthy volunteers and 118 nightmare disorder patients to undergo tests of the Nightmare Experience Questionnaire (NEQ), the Parker Personality Measure (PERM), and the Plutchik-van Praag Depression Inventory. Nightmares are prevalent in psychiatric disorders, and personality disorder features might be associated with nightmare experience, especially in nightmare disorder patients.
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