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The phenomenology of nightmares in the context of psychosis, with a case series of imagery rescripting

Student thesis: Doctoral ThesisDoctor of Clinical Psychology

Introduction: Nightmares are a common problem recognised in Post-traumatic stress disorder (PTSD; Neylan et al., 1998) and Borderline personality disorder (Semiz, Basoglu, Ebrinc and Cetin (2008). In a healthy student sample, nightmare distress was positively correlated with paranoia and psychoticism (Levin & Fireman, 2002). However, nightmares have never been investigated in people with psychosis. Imagery Rehearsal (IR) has been effective in reducing the frequency of nightmares, improving sleep and symptoms of PTSD (Casement & Swanson, 2012), but again, has never been trialled in psychosis. Aims: Study A examined the prevalence of nightmares in those with psychosis, their link with sleep quality, psychotic, affective and cognitive symptoms. Study B investigated whether an IR protocol (IR; Nappi, Drummond, Thorp & McQuaid, 2010) might be suitably adapted for people with psychosis. Methods: Forty participants with psychotic symptoms completed a semi-structured interview to assess nightmares, sleep quality, severity of delusions, hallucinations, depression, anxiety, stress, global distress, PTSD, daily activities and working memory. Five participants completed 4-6 sessions of IR for nightmares (study B). Results: 55% of patients reported weekly distressing nightmares. Nightmare frequency was related to sleep quality, sleep efficiency and depression. More distressing nightmares were associated with worse delusions, depression, anxiety, stress and working memory. The case series demonstrated the feasibility of IR for the treatment of nightmares in those with psychosis; reductions in nightmare distress, vividness, intensity, affective and psychotic symptomatology were observed post-intervention. Conclusion: Nightmares are common in those with psychosis and impact on day and night time experiences. They may present a target for intervention. The cross sectional nature of study A and small, uncontrolled sample of study B present limitations to conclusions. Future research should aim to uncover the direction of causality between nightmares and daytime symptoms and further investigate IR as a nightmare specific intervention.
Original languageEnglish
Awarding Institution
Award date2013

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