How to cope with nightmares?

How to cope with nightmares?


Don’t freak out!

Let`s cope with nightmares!


Mary Ntafouli, Panagiotis Bargiotas

Sleep-Wake-Epilepsy Center, University Hospital Bern


The essential feature of a nightmare disorder is the repeated occurrence of frightening dreams that lead to awakening, such that the individual becomes fully alert. Nightmares may be idiopathic (without clinical signs of psychopathology) or associated with other disorders.

3 successful treatments:

  • Image Rehearsal Therapy (IRT) is a modified CBT technique that utilizes recalling the nightmare, writing it down, changing the theme, story line, ending, or any part of the dream to a more positive one and rehearsing the rewritten dream scenario so that the patient can displace the unwanted content when the dream recurs[1].
  • Exposure, Relaxation and Rescripting Therapy (ERRT) is a specialized treatment modality targeting anxiety, which may manifest as physiological, behavioral, and cognitive dysfunction[2, 3]. The treatment involves psychoeducation, sleep hygiene, and progressive muscle relaxation training, exposure procedures such as writing out and rescripting the nightmares.
  • Self-exposure Therapy is a variant of CBT that utilizes a technique of “graded exposure.” The patient is instructed to make a hierarchical list of anxiety-provoking events/dreams [2]. The patient tries to expose in lowest anxiety situation until the fear/anxiety has decreased.


  1. Krakow, B., et al., Imagery rehearsal treatment of chronic nightmares: with a thirty month follow-up. J Behav Ther Exp Psychiatry, 1993. 24(4): p. 325-30.
  2. Aurora, R.N., et al., Best practice guide for the treatment of nightmare disorder in adults. J Clin Sleep Med, 2010. 6(4): p. 389-401.
  3. Kunze, A.E., et al., Efficacy of imagery rescripting and imaginal exposure for nightmares: A randomized wait-list controlled trial. Behav Res Ther, 2017. 97: p. 14-25.