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ABSTRACT

Treatment of Nightmares and Insomnia in Crime Victims

LISA G. JOHNSTON
SANTA FE, NM 
E-mail: lgjohnston@salud.unm.edu

Crime victims commonly manifest symptoms of posttraumatic stress disorder (PTSD). Two common PTSD symptoms are insomnia and nightmares, both of which can disrupt daytime functioning as well as thwart efforts towards overcoming other stress symptoms. Many traditional therapies (e.g., dream interpretation, psychodynamic modalities, etc.) have been developed to try and treat nightmares and to improve insomnia associated with nightmares. Although these therapies are helpful on many levels, recent studies have shown that a cognitive-behavioral treatment called "imagery rehearsal" has been shown to be very effective in treating nightmares among individuals suffering from PTSD.
This presentation will focus on the preliminary data from the first two years of a study on nightmares and insomnia among crime victims, which was funded by the New Mexico Crime Reparation Commission (Victim's of Crime Act) and the Oxnard Foundation. Participants were recruited through local rape crisis centers, advertisements, newspaper articles and through referrals from health care providers. Participants were screened by a research coordinator and invited to complete a packet of questionnaires related to nightmare frequency and chronicity, sleep quality, and PTSD. Participants were instructed on imagery rehearsal and sleep hygiene principles during three, three-hour treatment sessions and a three-hour follow up session. Ten weeks after the completion of the treatment session, participants completed the same packet of questionnaires.

Many participants, having suffered from nightmares for an average of 17 years, enter the program believing that their nightmares are uncontrollable. All participants entering the program come bearing some kind of belief system and history tied to having nightmares. Some participants have tried numerous therapies to rid themselves of nightmares and have almost given up on the possibility of a night of sound sleep, free from nightmares. Others have attempted medication with limited success. Many accept their nightmares as unconscious intrusions and have learned to survive with them as best they can, while others have the perception that their nightmares have become a part of their persona and, in turn, may be almost "unwilling" to let them go. No matter what their viewpoints, all participants enter the program looking for relief from nightmares, yet at the same time, they all share the common view they have little to no control over their disturbing dreams.
The basic thrust of imagery rehearsal as an effective treatment for nightmares is that participants learn that they can "control" or "change" their nightmares. While in a wakeful state, participants are instructed to recall a nightmare they have had and then to change it any way they wish, after which they rehearse the "New Dream", again, in the waking state. Many participants' rehearsal of dreams are affected by the belief system and history they had toward their nightmares when they entered the program. With practice, many nightmare sufferers will be able to reduce or eliminate their nightmares over a relatively short period of time, but usually this level of success is associated with a change in belief systems, particularly one that yields a greater sense of control over the bad dreams. In fact, the most successful patients will, within a few weeks, recognize this potential and report it in follow-up with fairly clear statements, such as, "It never occurred to me that I could control my dreams, but I think that is exactly what is happening and why they are going away."



LISA G. JOHNSTON
SANTA FE, NM 
E-mail: lgjohnston@salud.unm.edu