Presentation Title

Treatment for PTSD Nightmares


Most psychotherapeutic approaches to PTSD have seen the nightmare as one of many symptoms of the disorder, one that will dissipate with appropriate medication and/or psychotherapy. However, a contrary approach could be proposed, one that focuses directly on nightmare modification as the key to unraveling PTSD and restoring the traumatized individual to everyday functioning. As long as the PTSD nightmare recurs, the dreamer of the nightmare is blocked from resolving basic existential conflicts that prevent him or her from moving ahead. The mind is “frozen” in a particular time and space context, and the therapeutic challenge is to initiate a “thaw.”
After reviewing the literature on the use of medication for nightmares, Davis (2009c) concluded, "Practitioners have tested the efficacy of numerous medications for the amelioration of nightmares, with little success" (p. 100). Although one of the most encouraging medications is prazosin, an alpha-1-adreneric, its effect may be merely palliative. When it is discontinued, the nightmares often return (p. 101). Hartmann (1984) added, "While medication may reduce anxiety and reduce the immediate intensity of the nightmares, it may make the connecting process more difficult, perhaps by reducing REM sleep, thus making the traumatic nightmares more likely to become chronic" (p. 239).
Given the lack of positive results with medication, psychological interventions to work with nightmares can be a helpful part of a Whole Person treatment approach to working with PTSD.