Nightmares Clinical Trial
Official title:
MARI - Treatment of Nightmares Via the Internet - a Randomized Controlled Trial
This study is a randomized controlled trial (RCT) to evaluate the effect of an internet-based, guided self-help treatment of reoccurring and distressing nightmares. Imagery Rehearsal Therapy (IRT) will be compared to an active control treatment (CONT) and a recording-only group (REG). It is hypothesized that both active treatments will be superior to REG, and that IRT will be superior to CONT.
Nightmares are distressing or frightening dreams, affecting 2.4 to 5% of the population.
Suffering consists of disturbed sleep, fear and distress during night and/or day, expectancy
anxiety and impaired functioning during the day.
Various forms of Cognitive Behavior Therapy (CBT) has been previously shown to be effective
against nightmares and among them Imagery Rehearsal Therapy (IRT) has been the most
promising. IRT consists of approaching the unpleasant dreams and to imagine a positive
ending to them. So far IRT has been compared to untreated controls or treatments that have
included methods to some extent similar to those in IRT, and it is therefore difficult to
determine the specific effect of IRT.
Since access to CBT therapists is low, different types of self-help treatments for
nightmares have been tested, but often these therapies have been provided without the
assistance of a therapist, a procedure known to usually lower the effect of self-help
treatments. So far, no nightmare treatment has been conducted over the Internet.
IRT will in this study be given as Internet CBT (ICBT) and will be compared to an active and
credible control treatment (CONT) consisting of relaxation and exercise to focus on positive
images or dreams, but without approaching or reinterpreting the nightmares. Relaxation
Training has previously shown preliminary positive effects on nightmares. Both active
treatments will be compared to a waiting list which only records how they manage their
nightmares (REG).
The main purpose of this study is to examine whether the positive effects of IRT that has
been seen in previous studies persists even when IRT is compared with a credible, active
control treatment that does not contain the presumed active parts of the IRT. In addition,
an untreated control group is used to ensure that the effects are not only due to
spontaneous improvement. The control group will afterwards be treated with IRT without
therapist support, in order to make a preliminary evaluation of the importance of therapist
support.
Some researchers argue that nightmares are not to be seen only as something that is often
caused or is a side effect of other conditions, but as a separate problem that should
receive special treatment. Our study will help to determine whether it is possible to treat
nightmares also in people with other problems such as posttraumatic stress disorder (PTSD).
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment
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