Targeting Nightmares: A Meta-Analysis Comparing Prazosin vs. Imagrey Rehearsal Therapy on Sleep Quality in the PTSD Population
Mentor:Christopher Warren, Assistant Professor, California State University Long Beach
The current meta-analysis hypothesized that two treatments designed to specifically target nightmares, Imagery Rehearsal Therapy and prazosin, would have an improvement on measures of sleep quality, nightmare intensity, and nightmare frequency in the PTSD population. Nightmares have historically been viewed as a mere symptom of other psychological disorders (Moore & Krakow, 2010); however, more recent studies have shown nightmares to be a strong predictor of the development of posttraumatic stress disorder (Creamer, O’Donnell, & Pattison, 2004; Picchioni et al., 2010) and have been hypothesized to be a factor in the maintenance of posttraumatic stress symptoms (Davis, Pruiksma, Rhudy, & Byrd, 2011; Moore & Krakow). Therefore, treating nightmares directly may lessen or prevent PTSD symptoms. Imagery Rehearsal Therapy is a cognitive-behavioral treatment in which participants write out reoccurring nightmares as a script, then “rescript” the nightmare into something less threatening. Using the RBNL meta-analytic procedures (repeated-measures), it was shown to have significantly improved sleep quality (k = 6, N = 195, Mρ^ = 2.8, 95% CI [0.17, 0.51]), nightmare frequency (k = 7, N = 211, Mρ^ = 0.28, 95% CI [0.22, 0.35]), and nightmare intensity (k = 4, N = 46, Mρ^ = 0.34, 95% CI [0.23, 0.45]). The psychopharmacological treatment, prazosin, is an α1-antagonist. By blocking the α1 receptors, prazosin prevents a chain reaction that releases cortisol into the body. It also showed a significant improvement in sleep quality (k = 5, N = 65, Mρ^ = 0.56, 95% CI [0.43, 0.68]), nightmare frequency (k = 5, N = 65, Mρ^ = 0.53, 95% CI [0.40, 0.66]), and nightmare intensity (k = 2, N = 17, Mρ^ = 0.47, 95% CI [0.14, 0.79]). Although more research is warranted for both treatments, they have a strong potential to become an important step in the treatment of PTSD.