Psychiatric Inpatient Nightmare Treatment

NCT04198142 | Unknown

• 1 other identifier: 2019-00773
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

Nightmares are repeated extremely dysphoric and well-remembered dreams, which typically occur during REM sleep in the second half of sleep, may awaken the dreamer, and upon awakening, individuals quickly become oriented and conscious of their surroundings. Nightmares are very common in psychiatric populations. In psychiatric populations, nightmares can occur as a freestanding disorder, persist in patients after undergoing treatment for a psychiatric disorder, and function as a risk and exacerbating factor regarding psychiatric symptoms. Imagery Rehearsal Therapy (IRT) is a cognitive-behavioral-oriented treatment for nightmares and asks patients to identify an especially distressing nightmare and then works together with the patient on changing the nightmare to a more positive theme, story line, or ending. The new contents are then rehearsed using imagery techniques. IRT is often recommended by guidelines. However, IRT has not been investigated in a randomized controlled trial in the population of psychiatric inpatients. In this study, sixty inpatients with nightmares will be recruited from the inpatient units of the Psychiatric University Hospital Zurich (PUK). Participants will be randomly assigned to an Imagery Rehearsal Therapy (IRT) group or a Treatment As Usual (TAU) control group. Questionnaires and dream diaries will measure changes in nightmare frequency, nightmare distress, nightmare effects, nightmare content, overall sleep quality, dream experiences and believes, symptom severity of primary psychiatric diagnoses, and psychotherapy motivation and hopefulness one week and two weeks after one IRT or TAU session. The TAU group will receive a session in which potential problems with the dream diary will be discussed. Patients in the IRT group will be instructed to use imagery exercises with the new dream narrative for 10 to 15 minutes a day for the duration of the study period.

Conditions

Nightmare; Psychiatric Disorder

Keywords

Psychiatric inpatient care

Outcome Measures

Primary Outcomes (3)

• Nightmare frequency (change from baseline to 1 and 2 weeks after intervention)

  The Nightmare Frequency Questionnaire and a dream diary will measure the number of nightmares for each night and for each week.

  Baseline, 2 weeks, 3 weeks

• Nightmare distress (change from baseline to 1 and 2 weeks after intervention)

  The Nightmare Distress Questionnaire and a dream diary will measure the amount of waking distress associated with nightmares for each night and for each week. Higher Nightmare Distress Questionnaire scores indicate higher nightmare distress (minimum value: 0, maximum value: 52).

  Baseline, 2 weeks, 3 weeks

• Nightmare Intensity (change from baseline to 1 and 2 weeks after intervention)

  An adapted version of the Mannheim Dream Questionnaire and a dream diary will measure the intensity of the nightmares of a person (waking up from the nightmare, emotional intensity during the nightmare, how clearly patients remember the nightmare after waking up) for each night and for each week.

  Baseline, 2 weeks, 3 weeks

Secondary Outcomes (11)

• Dream experiences and believes (change from baseline to 1 and 2 weeks after intervention)

  Baseline, 2 weeks, 3 weeks, 4 weeks

• Overall sleep quality (change from baseline to 1 and 2 weeks after intervention)

  Baseline, 2 weeks, 3 weeks, 4 weeks

• Nightmare effects (change from baseline to 1 and 2 weeks after intervention)

  Baseline, 2 weeks, 3 weeks, 4 weeks

• Nightmare content (change from baseline to 1 and 2 weeks after intervention)

  Baseline, 2 weeks, 3 weeks, 4 weeks

• Severity of depressive symptoms (change from baseline to 1 and 2 weeks after intervention)

  Baseline, 2 weeks, 3 weeks, 4 weeks

Other Outcomes (12)

• Demographic and personal information

  Baseline

• Primary psychiatric diagnosis

  Baseline

• Current medication

  Baseline, 2 weeks, 3 weeks, 4 weeks

Study Arms (2)

Imagery Rehearsal Therapy Intervention

EXPERIMENTAL

This group receives one to two sessions of Imagery Rehearsal Therapy.

Behavioral: Imagery Rehearsal Therapy

Treatment as Usual with dream diaries

ACTIVE COMPARATOR

This group receives the usual inpatient care without additional Imagery Rehearsal Therapy sessions, but also keeps dream diaries.

Behavioral: Treatment as Usual with dream diaries

Interventions

Imagery Rehearsal Therapy BEHAVIORAL

The Imagery Rehearsal Therapy (IRT) intervention used in this study is a short version of the treatment, consisting of 1-2 sessions. The protocol starts with a very brief explanation of the treatment. Then the patient will be guided through an imagery exercise. The next step is to choose a nightmare. This nightmare is then rescripted to a new narrative, which is in no way distressing to the patient anymore. Subsequently, the therapist will guide the patient through an imagery exercise with the new narrative. The new narrative is then either written down or recorded. Lastly, the therapist will explain to the patient, that he or she should rehearse the new narrative daily with imagery exercises.

Imagery Rehearsal Therapy Intervention

Treatment as Usual with dream diaries BEHAVIORAL

Treatment as Usual means that patients in this arm will receive usual inpatient care. Additionally, they will keep a dream diary. It has been shown in previous studies that keeping a dream diary has a positive effect on nightmares.

Treatment as Usual with dream diaries

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Male and female patients from the inpatient units at the Psychiatric University Hospital Zurich (PUK) between 18 and 65
• Self-reporting nightmares causing sleep disruption or significant emotional distress
• Currently receiving inpatient care at the PUK
• Fluent in German and able to understand the instructions

You may not qualify if:

• No self-reporting nightmares causing sleep disruption or significant emotional distress
• Psychotherapy for nightmare symptoms specifically, currently or in the preceding 12 months
• Not able or willing to engage in imagery exercises
• Patients with a one on one or 15- / 30-minute visual control by the nursing personnel because of risk of suicidal tendencies or the risk of harming others
• Head injury
• Cognitive impairment or other severe symptoms that would interfere with understanding instructions and questionnaires or participation in the study
• Neurological disease
• Shift work
• Trouble speaking and / or understanding the German language

Sponsors & Collaborators

• University of Zurich: lead
• Swiss National Science Foundation: collaborator
• Psychiatric University Hospital, Zurich: collaborator

Study Sites (1)

Psychiatric University Hospital Zurich

Zurich, 8032, Switzerland

RECRUITING

Related Publications (46)

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MeSH Terms

Conditions

Mental Disorders

Interventions

Therapeutics

Central Study Contacts

Birgit Kleim, PhD

CONTACT

+41443842351; b.kleim@psychologie.uzh.ch

Thomas Maeder, M.Sc.

CONTACT

+41798489793; thomas.maeder@uzh.ch

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: October 3, 2019
• First Posted: December 13, 2019
• Study Start: November 18, 2019
• Primary Completion: May 31, 2020
• Study Completion: May 31, 2020
• Last Updated: December 13, 2019

Record last verified: 2019-12

Locations

CH (1)