Review of: Spangler PT and Sim W, Psychotherapy (Chic) 2023;60(3):383-395

Study type: Literature review and meta-analysis

Image Rehearsal Therapy (IRT) and the Cognitive-Experiential Dream Model (CEDM) are two methods for working with dreams in psychotherapy that have evidence supporting their use. IRT and its related therapies address nightmares, sleep disturbance, and sleep-related traumatic stress symptoms. CEDM is a method to improve insight-oriented dream work in clinical settings where talking about dreams is indicated. This review helpfully describes each method in detail, and also several newer therapies based on these methods. It includes detailed clinical examples and offers a succinct overview of how these therapies are structured. It is well-suited for a busy clinician who wants to get up to speed in this area.

The authors review the evidence base for CEDM and for IRT and IRT-related therapies. Additionally, the authors conducted their own meta-analysis of specific CEDM outcomes that included 8 studies with 514 patients. For CEDM, all the evidence indicates that CEDM is an effective approach for helping clients gain insight into their dreams. For IRT and related therapies, the reviewed studies indicate moderate to large effects on reducing nightmare frequency, improving sleep quality, and reducing post-traumatic stress symptoms. The authors identified areas for future study in these highly effective approaches to nightmares, including whether they can be delivered in group formats, and to what degree exposure therapy is necessary for successful treatment of nightmares.

Carlat Take:

For patients struggling with nightmares and sleep disturbance, there are brief evidence-based therapies that clinicians can learn to use. The originator of IRT, Barry Krakow, MD, offers video training on his website. For clinicians and patients interested in using dream content in psychotherapy, CEDM offers an empirically supported approach to improve patient insight into the meaning and context of dreams. This article is a helpful resource for clinicians because it provides good summaries of different EBT approaches to dreams and nightmares and offers good clinical case examples. 

Reference

Spangler, P. T., & Sim, W. (2023). Working with dreams and nightmares: A review of the research evidence. Psychotherapy (Chicago, Ill.), 60(3), 383–395. https://doi.org/10.1037/pst0000484

Related content: Turning Nightmares Into Dreams