A Systematic Review and Meta-Analysis of Psychotherapeutic Approaches for Recurring Nightmares

Recurring nightmares are a common symptom of various mental health conditions, including post-traumatic stress disorder (PTSD), anxiety disorders, and depression. Psychotherapeutic approaches have been used to treat recurring nightmares, but their relative effectiveness is unclear. This systematic review and meta-analysis aimed to compare the efficacy of three psychotherapeutic approaches in reducing the frequency and intensity of recurring nightmares: cognitive-behavioral therapy (CBT), imagery rehearsal therapy (IRT), and eye movement desensitization and reprocessing (EMDR). A comprehensive search of electronic databases from January 2000 to the present was conducted, along with a manual search of reference lists. Studies that met inclusion criteria (adult participants with a diagnosis of nightmare disorder or recurrent nightmares, and comparing the effectiveness of at least two of the three psychotherapeutic modalities) were selected for meta-analysis. Outcome measures included nightmare frequency, distress, or related symptoms (e.g., anxiety, depression). The risk of bias was assessed using the Cochrane Risk of Bias tool, and effect sizes were calculated using Hedges’ g. The meta-analysis included 15 studies with a total of 1209 participants. The results showed that all psychotherapeutic approaches were effective in reducing the frequency and intensity of recurring nightmares, with CBT and IRT being the most effective. Specifically, CBT was more effective than IRT in reducing the frequency of nightmares (g=0.73, 95% CI [0.58, 0.88], p < 0.001). The effect sizes for EMDR were smaller than those for CBT and IRT, but still significant. These findings suggest that CBT and IRT are effective psychotherapeutic approaches for treating recurring nightmares, and may be particularly useful for individuals with PTSD or other trauma-related disorders. However, the small number of studies on EMDR highlights the need for further research in this area. Overall, the results support the use of psychotherapeutic interventions as a first-line treatment for recurring nightmares.