Trauma-related nightmares can leave people feeling anxious at bedtime, fearful of falling asleep, or emotionally unsettled on waking. Nightmare re-scripting, also known as Imagery Rehearsal Therapy (IRT), is an evidence-based approach designed to reduce the frequency and intensity of PTSD-related nightmares. The approach to imagery rehearsal treatment of nightmares in PTSD here at St John of God is guided by the Phoenix Australia’s ‘Imagery rehearsal in the treatment of nightmares in PTSD’.
Nightmares are best understood as learned fear responses within the brain. Even when the trauma is no longer occurring, the nervous system may continue to signal danger during sleep. Nightmare re-scripting works by helping the brain learn something new - that night-time imagery does not have to be threatening. Rather than analysing the meaning of a dream, nightmare re-scripting focuses on changing the emotional experience of the nightmare. Participants are guided to select a recurring or particularly distressing nightmare and describe and write out the dream in detail. Participants then choose a change to the script or imagery of the dream and intentionally rewrite it while awake. The new version may involve greater safety, control, protection, or resolution, depending on what feels most supportive.
The revised version of the nightmare is then mentally rehearsed during the day, in short and manageable practice sessions. Because the brain responds to imagined experiences in similar ways to real ones, this rehearsal helps form new associations and reduces the fear response linked to the original nightmare.
Nightmare re-scripting is trauma-informed and collaborative. Participants remain in control of how much detail they engage with and move at a pace that feels safe. When combined with CBT-I or other sleep support, nightmare re-scripting can help restore a sense of safety around sleep and reduce the impact of trauma on night-time rest. The goal is not to erase memories, but to help the brain rest without repeatedly reliving threat.
This treatment is offered through a day program, one day per week for six weeks.
