Kunze Anna E, Lancee Jaap, Morina Nexhmedin, Kindt Merel, Arntz Arnoud
University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS, Amsterdam, Netherlands.
LMU Munich, Leopoldstraße 13, 80802, Munich, Germany.
Trials. 2016 Sep 26;17(1):469. doi: 10.1186/s13063-016-1570-3.
Recurrent nightmares can effectively be treated with cognitive-behavioral techniques such as imagery rehearsal therapy, which involves imagery rescripting (IR) of nightmares, and imaginal exposure (IE) therapy. However, the underlying mechanisms of these treatments remain largely unknown. To investigate this, we identified a number of variables that might mediate the therapeutic effect of rescripting-based and/or exposure-based therapies. Also, to control for the possible confounding influence of (other) treatment components, we designed two stripped-down treatment protocols, which primarily consist of either (1) rescripting of, or (2) exposure to, the nightmare content. In a randomized controlled trial, we aim to investigate the therapeutic efficacy of these stripped-down IR and IE treatments, and explore their working mechanisms.
Three weekly sessions of either IR or IE will be compared to a waiting-list control group. Ninety participants suffering from nightmare disorder will be included and randomly allocated to one of the three groups. The primary clinical outcome measures are nightmare frequency and distress caused by nightmares. Secondary clinical outcome measures include sleep complaints, dysfunctional beliefs about nightmares, and posttraumatic stress symptom severity. Outcomes will be assessed weekly from week 1 (pre-assessment) to week 5 (post-assessment). Online follow-up assessments will take place at 3 and 6 months after post-assessment. In order to investigate temporal relationships between mediators and outcome, we will measure the proposed mediators of the treatment effect 1 day after each outcome assessment (but not after the follow-ups). Mediators include nightmare distress and valence, mastery of the nightmare content, predictability, controllability, and tolerability of emotions elicited by nightmares, as well as sleep quality.
The proposed trial allows us to investigate the efficacy of IR and IE as intervention techniques for the treatment of nightmares, and to explore mediators of their respective therapeutic effects. The results may advance our understanding of nightmare therapies by identifying possible mechanisms of psychological treatments for chronic nightmares. Moreover, the results of the proposed study might provide useful knowledge about the working mechanism of rescripting-based and exposure-based treatments in general.
Netherlands Trial Register ( NTR4951 ), registered on 14 December 2014.
复发性噩梦可通过认知行为技术有效治疗，如意象演练疗法，该疗法包括对噩梦进行意象改写（IR）和意象暴露（IE）治疗。然而，这些治疗的潜在机制在很大程度上仍不为人知。为了对此进行研究，我们确定了一些可能介导基于改写和/或基于暴露的疗法治疗效果的变量。此外，为了控制（其他）治疗成分可能产生的混杂影响，我们设计了两种简化的治疗方案，主要包括（1）对噩梦内容进行改写，或（2）对噩梦内容进行暴露。在一项随机对照试验中，我们旨在研究这些简化的IR和IE治疗的疗效，并探索其作用机制。
将每周进行三次的IR或IE治疗与等待名单对照组进行比较。纳入90名患有噩梦障碍的参与者，并将他们随机分配到三组中的一组。主要临床结局指标是噩梦频率和噩梦引起的痛苦。次要临床结局指标包括睡眠主诉、对噩梦的功能失调信念以及创伤后应激症状严重程度。从第1周（预评估）到第5周（后评估）每周对结局进行评估。在评估后3个月和6个月进行在线随访评估。为了研究中介因素与结局之间的时间关系，我们将在每次结局评估后1天（但随访后不进行）测量所提出的治疗效果中介因素。中介因素包括噩梦痛苦和效价、对噩梦内容的掌握程度、可预测性、可控性以及噩梦引发的情绪的耐受性，以及睡眠质量。
拟议的试验使我们能够研究IR和IE作为治疗噩梦的干预技术的疗效，并探索其各自治疗效果的中介因素。通过确定慢性噩梦心理治疗的可能机制，研究结果可能会增进我们对噩梦疗法的理解。此外，拟议研究的结果可能会提供关于一般基于改写和基于暴露的治疗作用机制有用的知识。
荷兰试验注册库（NTR4951），于2014年12月14日注册。
