Schmid Carolin, Hansen Kathrin, Kröner-Borowik Tana, Steil Regina
Department of Clinical Psychology, Goethe University, Frankfurt am Main, Germany,
Department of Clinical Psychology, Goethe University, Frankfurt am Main, Germany.
Psychother Psychosom. 2021;90(5):328-340. doi: 10.1159/000512757. Epub 2021 Jan 21.
Both imagery rescripting and imaginal exposure have been proven to be effective in the treatment of chronic nightmares when compared to a waitlist condition. Little is known about their comparative efficacy and their efficacy compared to an active control.
The aims of this study were to compare the two treatments to one another and to positive imagery as an active control, and to explore covariates of the treatment effect.
In this single-blinded randomized controlled trial, 96 patients with nightmare disorder (idiopathic nightmares) from an outpatient clinic were randomly assigned to a single individual treatment session of rescripting, exposure, or positive imagery and 4 weeks of practice at home. The primary outcome was nightmare distress, and the secondary outcomes were nightmare frequency, nightmare effects, self-efficacy, and general psychopathology.
Nightmare distress was reduced in all groups (imagery rescripting: Cohen's d = -1.04, imaginal exposure: d = -0.68, positive imagery: d = -0.57), as were nightmare frequency, nightmare effects, and psychopathology. Self-efficacy was enhanced. No differential treatment effects were found on any primary or secondary measure. Treatment gains were not associated with demographic or disorder characteristics, baseline values, treatment credibility, or the number of practice sessions.
Even short nightmare treatments are effective regardless of personal characteristics, and different interventions produce similar results. Future research should aim to clarify the mechanisms of action. Health care should make more use of these powerful and easy-to-administer nightmare treatments.
与等待名单条件相比，意象改写和想象暴露已被证明在治疗慢性噩梦中有效。关于它们的相对疗效以及与积极对照相比的疗效，人们知之甚少。
本研究的目的是比较这两种治疗方法以及与积极意象（作为积极对照）的疗效，并探索治疗效果的协变量。
在这项单盲随机对照试验中，96名来自门诊诊所的噩梦障碍（特发性噩梦）患者被随机分配接受单次个体改写治疗、暴露治疗或积极意象治疗，并在家中进行4周的练习。主要结局是噩梦困扰，次要结局是噩梦频率、噩梦影响、自我效能感和一般精神病理学。
所有组的噩梦困扰均有所减轻（意象改写：科恩d值=-1.04，想象暴露：d=-0.68，积极意象：d=-0.57），噩梦频率、噩梦影响和精神病理学情况也有所改善。自我效能感得到增强。在任何主要或次要指标上均未发现差异治疗效果。治疗效果与人口统计学或疾病特征、基线值、治疗可信度或练习次数无关。
即使是短期的噩梦治疗也有效，与个人特征无关，不同的干预措施产生相似的结果。未来的研究应旨在阐明作用机制。医疗保健应更多地使用这些强大且易于实施的噩梦治疗方法。
